Carol Clements
30 May 2023 · Coroner Rebecca Ollivere · Birmingham and Solihull
The coroner's concerns
1. lack of mandatory training on enhanced supervision levels
“Enhanced Supervision Levels training is not included on mandatory training programmes”
2. inadequate induction training on falls risk assessment
“Falls risk assessment training is on the essential role training programme, however, I am concerned that this area is not covered suitably on induction of staff to the centre”
3. audits not checking correctness of falls risk assessments
“I was told that since this incident, falls risk assessments are being audited for compliance. I was also told that they are not being audited for correctness”