Frederick Chisnall

Dear Dr Napier Re: Frederick Chisnall Deceased) Further to your response letter to Professor Sarah O'Brien, dated 07/02/17 , can provide the following update in relation to the safeguarding investigation and assurance actions taken to mitigate any future risks: Safequarding Investigation The safeguarding investigation was led by Warrington Local Authority as St Marys where Mr Chisnall resided was within the borough of Warrington this is in line with national guidance and procedures_ St Helens Local Authority Safeguarding Unit was apprised of the investigation and the outcomes_ The safeguarding case was closed on 23/01/17 . There we no actions identified for St Helens through the safeguarding investigation. The safeguarding investigation was partially substantiated was concluded that there was no evidence of neglect and that Mr Chisnall's death was not caused by a failure of those employed to deliver his care_ However concerns did exist in relation to staff record keeping in respect of the agency staff and responsiveness to the changes in clinical condition of Mr Chisnall in respect of a nurse employed by St Mary's. Working in partnership with and Si Helens StHelens Council Chamber Way

Action Taken as part of the Safeguarding investigation: Challenge Recruitment- no action taken as no findings Reflex Agency- further training provided to the staff by the agency St Nursing home- disciplinary action was taken in respect of the nurse by St Mary's_ St Mary's Nursing Home gave assurance that they would no longer use Reflex Agency for non-registered staff: The Team Manager for St Helens Contracts and Quality Monitoring service also liaised directly with the agencies involved for assurance of actions taken following the conclusion of the safeguarding investigation Since the incident; St Mary's CQC inspection determined that were good overall: had quality audits in place and Warrington Borough Council's care quality monitoring team had found no issues with the service. AlI nurses complete audits of records on monthly basis which is further quality assured by the home manager: Assurance Further to the above would like to offer assurance that robust contractual and quality monitoring processes are in place in respect of all placements funded by St Helens CCG and St Helens Local Authority All service users will be assessed to determine the level of need and the type of placement required and wherever possible this will be provided within borough Before admission a placement vetting process is undertaken which for out of borough placements will include Iiaison with the host authority. The service user will receive an annual review and there is a contractual expectation that the residentiall nursing home will review care needs on an on-going basis and advise if there is any significant change in the needs of an individual. In addition for out of borough placements the Local Authority Quality Monitoring Team will undertake regular desk top reviews where will speak directly with the host authority, the carelnursing home, the service user or representative and check any CQC reports. In respect of the use of agency staff the agency contract is with the carelnursing home. There is clear expectation that agency staff will be provided with the relevant training, and supervision from the agency and that work to the carelnursing homes policies and procedures as part of its CQC registration_ hope this answers your additional queries,