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recurance

Glenn Macmartin

7 May 2021 · Coroner Ian Arrow · Plymouth Torbay and South Devon

The coroner's concerns

  1. 1. inadequate accommodation selection

    “The selection of the accommodation was made without a physical inspection of its suitability for the deceased by the organisation with responsibility for providing the accommodation before the deceased took up residence”
  2. 2. care home closure due to poor service

    “The deceased was accommodated in a Care Home that was subsequently formally closed due to poor service”

Responses

2021-0142-Response-from-CQC.pdf ↗· Care Quality Commission

Stated action

“Review the selection and monitoring of care home provision and care given by private care home providers who are funded by Devon Partnership”

2021-0142-Response-from-Plymouth-Safeguarding-Adults-Partnership-Redacted.pdf ↗· Devon Partnership Trust and Plymouth Safeguarding Adult Partnership

2021-0142-Response-from-Wonford-House-Hospital-Redacted.pdf ↗· Care Quality Commission

Stated action

“Please review the selection and monitoring of care home provision and care given by private care home providers who are funded by Devon Partnership Trust.”
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Source: Prevention of Future Deaths reports and responses published by the Courts and Tribunals Judiciary at judiciary.uk. Crown copyright, used under the Open Government Licence v3.0. Data updated 26 Oct 2026.

A link shows that a similar concern was raised again, not why. It is not a finding about any organisation or person. Methodology and responsible use · Report an error