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recurance

Marc Davies

20 Oct 2025 · Coroner Caroline Saunders · Gwent

The coroner's concerns

  1. 1. inadequate welfare checks by guards

    “MCC contracted with MJ Events to provide safe guards; officers to ensure the security of the premises and the welfare of the residents. The officers were expected to undertake welfare checks if they had concerns about residents, including if they were under the influence of drugs or alcohol.”
  2. 2. lack of training on welfare checks and documentation

    “There was no evidence that the staff had received training on how to conduct welfare checks or what should be documented.”
  3. 3. failure to check staff welfare and pass information

    “A failure to check on the welfare of staff and to reliably pass that information on to others could again result in a resident not receiving medical care in a timely manner.”

Responses

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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.

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