Philip Quelch

On 9th July 2025 and investigation was commenced into the death of Philip Andrew Quelch aged 56 years. The investigation concluded at the end of the inquest on 8th May 2026, the conclusion of the inquest was accidental death. Philip Quelch was subject to a Deprivation of Liberty Safeguarding Order and was a resident at Crouched Friars Residential Home on Colchester. He had an in-life diagnosis of vascular dementia dn neurofibromatosis which were degenerative conditions. He needed hep with personal care and nutrition. Mr Quelch died after choking on a large piece of ham which was part of his lunch of ham salad at the home. Post mortem examination revealed a large piece of ham obstructing his epiglottis.

His medical cause of death was recorded as: 1a. Airway obstruction 1b. Food stuck in epiglottis.
2. Vascular dementia and neurofibromatosis

Mr Quelch died at Crouched Friars Residential Home in Colchester on 5th July 2025. He lived in the home as there had been safeguarding concerns when he lived in the community. He died as a result of a choking episode whilst eating a meal at the home. Mr Quelch was subject to a Deprivation of Liberty Safeguarding Order. He was to be assisted with meals and as a minimum needed his food cutting up.

Family reported he needed help with eating and drinking, and his care notes documented that he was unable to meet his nutritional and hydration needs independently. He preferred to stay in his room and did not particularly enjoy socialising with the other residents as he had said he felt, essentially, he didn’t have anything in common with them. Mr Quelch had had a previous episode of choking at the home and had been referred to the SALT team. He did not ever attend an appointment however as there was a waiting list and as he had not had any more choking episodes it was decided that the referral could be closed. On the day he died he had chosen a ham salad for his lunch. It appears he was left with his meal and although staff had checked in on him he was subsequently found not to have eaten much but to be unconscious and unresponsive at 15.15 hours, his meal having been delivered between 12.30 and 12.45 and a further check made at 1336 and around 2pm. CPR was commenced both by staff and by paramedics who attended but sadly Mr Quelch could not be revived.

In my opinion unless action is taken to address the above concerns then there is a significant risk of future deaths and I believe each of you have the power to take such action.