Source · Prevention of Future Deaths
Walter Willows
Ref: 2015-0218
Date: 10 Jun 2015
Coroner: John Pollard
Area: Manchester (South)
Responses identified: 0 / 1
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Care plans, especially feeding regimes, were reviewed insufficiently frequently for clients with changing needs, specifically regarding swallowing ability, leading to inadequate dietary adjustments.
Date
10 Jun 2015
56-day deadline
5 Aug 2015
Responses identified
0 of 1
Coroner's concerns
Care plans, especially feeding regimes, were reviewed insufficiently frequently for clients with changing needs, specifically regarding swallowing ability, leading to inadequate dietary adjustments.
View full coroner's concerns
During the course of the inquest hearing was told, inter alia, that the Care Plans for such clients were reviewed on a three monthly basis. This included their specific feeding regimes. In the case of Mr Willows it was apparent that this should have been looked at far more frequently so as to adjust his diet to suit his swallowing ability. took the view that these Plans (and especially that part relating to feeding) should be examined more frequently and it was within the power of yourselves to arrange for this to happen.
Report sections
Investigation and inquest
On 10th October 2014 commenced an investigation into the death of Walter Willows dob 19"h December 1937 The investigation concluded on the 24th February 2015 and the conclusion was one of Accidental death: The medical cause of death was Ia asphyxia 1b Choking on food 11. Coronary Artery Atheroma
Circumstances of the death
On the 3rd October 2014 he was at his home address_ He ate a crumpet and choked: This led him to asphyxiate.
Action should be taken
In my opinion action should be taken to prevent future deaths and | believe you have the power to take such action.
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Report details
- Reference
- 2015-0218
- Date of report
- 10 June 2015
- Coroner
- John Pollard
- Coroner area
- Manchester (South)
Responses identified
Responses identified
0 of 1
1 response not yet linked
Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 5 Aug 2015.
Sent to
- Westwood Homecare Limited