Individual at Braley House

Circumstances surrounding the death of a man at an
Approved Premises in July 2004
Report by the Prisons and Probation Ombudsman for England and
Wales
January 2005
CONTENTS
Summary
Approved Premises
Pre-release planning
The man’s time at the Approved Premises
The week leading up to the man’s death
The crisis management
Considerations and Conclusions:
- Potential recall
- Communication
- Mouth guards and emergency response
- Injecting heroin
- Psychiatric services
- Support for staff and residents
- Funeral expenses
Recommendations
2
This is a report of an investigation into the death of a man in an Approved
Probation Premises, in July 2004.
The purposes of my investigation were to discover whether the level of care
provided for the man by the Approved Premises was sufficient, and whether
there are any lessons that can be learned to help prevent a similar death in
the future.
The death of a loved one is a devastating experience, and I would like to offer
my sincere condolences to the man’s family and friends. Since this
investigation, the man’s father has also sadly died.
An investigator from the Prisons and Probation Ombudsman’s Office carried
out the investigation with the assistance of the Assistant Chief Officer of the
local Probation Area. I am grateful to him for facilitating the investigation, for
providing policy advice and for helping interview members of staff and
residents. I am also grateful for the co-operation that the Investigators
received from the local Probation Area, the local police, HMP Featherstone
and, in particular, from the manager and staff of the Approved Premises.
The Investigators conducted formal interviews with the hostel manager,
deputy manager, hostel staff and hostel residents. The Investigators also
examined other documents provided by the local Probation Area, the Parole
Board and Featherstone prison.
This report presents a generally favourable view of the Approved Premises
and the care and support that staff offer to residents. The local Probation
Service decided a final warning was warranted and Lifer Management Unit
accepted this. However, like the Investigator, I am surprised that the man's
clear and repeated breaches of his licence conditions did not result in him
being referred back to the Parole Board for possible recall to prison.
STEPHEN SHAW CBE
PRISONS AND PROBATION OMBUDSMAN JANUARY 2005
3
Summary
The man was released on life licence from Featherstone prison for the second
time in March 2004. He went to live at the Approved Premises in accordance
with his licence conditions.
The deceased was a man with complex needs. Licence conditions were
tailored to help him address his previous offending behaviour and help reduce
the considerable risk he could pose.
Although he made some effort to complete the Domestic Violence Intervention
Program (DVIP), he found it difficult to control his drinking habits. At times, he
seemed to show a lack of regard to his licence conditions, and his behaviour
began to give cause for concern.
The man died in July at the Approved Premises. He had been drinking
heavily and then took heroin with another resident who raised the alarm and
staff attempted resuscitation until the paramedics arrived. The paramedics
took the man to hospital but, by the time they arrived at the hospital, he had
died.
The deceased was an intelligent man, with a great deal to offer. It would
appear that his inability to control his risk taking behaviour eventually led to
his own death.
The death of this man has raised several issues for Approved Premises and
the wider Probation Service. There is a question mark over whether the man
should have been referred to the Parole Board for recall. It is surprising to the
investigation team that referral for recall had not been given further
consideration. It is also of concern that the man felt able to take drugs on
hostel premises.
Staff involved in attempting to resuscitate the man acted appropriately and
with care. It was clear that many staff and residents had been very affected
by the death.
As in other Approved Premises, staff at the hostel are increasingly dealing
with residents who present a high risk of serious reoffending. A great deal is
expected of these staff, a fact that is insufficiently appreciated by the rest of
the criminal justice system and by the public at large.
The report makes eight recommendations. However, it is important to stress
that this hostel appeared to be a supportive environment for both staff and
residents.
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The Approved Premises
5. Approved Premises, formerly known as Probation and Bail Hostels, are
approved by the Secretary of State within Section 9 of the Criminal Justice
and Court Services Act 2000. Their purpose is to provide accommodation for
persons granted bail in criminal proceedings, and in connection with the
supervision and rehabilitation of persons convicted of offences. Approved
Premises can provide a supportive, structured environment in the community
for high risk and difficult to manage offenders. The management of offenders
accommodated in Approved Premises is governed by the National Standards
for the Supervision of Offenders and the guidance contained in the National
Approved Premises Handbook.
6. This hostel can hold 18 residents, 15 men and three women. Residents
share kitchen and bathroom facilities.
7. The hostel accepts offenders on bail and subject to community penalties or
prison licences. Residents must be over the age of 18 but the hostel will
consider any type of offender depending upon the level of assessed risk and
the dynamics of the resident group at any particular point in time.
8. Over the last ten years or so, the profile of the Approved Premises
population has gradually shifted toward a preponderance of offenders
assessed as posing a high risk of harm to the public. Premises no longer
simply offer accommodation for those who have nowhere else to go, and the
purpose of this hostel is to provide an enhanced level of supervision for some
of the most difficult and high-risk offenders in the community. Accordingly,
there is a curfew from 11pm to 7am (for those not working) but earlier curfew
hours can be enforced.
9. The staffing complement is:
Manager (Part time)
Deputy Manager
Six Assistant wardens (four full time, two part time)
Two night staff (there is one sleeping and one waking staff member each
night)
Administrative Services Officer.
10. There is a frequent need for relief cover, but there tends to be a pool of
relief staff who are called upon. They carry out all duties except key work.
Assistant wardens perform key working duties where they meet with residents
weekly.
5
Pre release planning
11. In the period leading up to the man's release from prison a number of
meetings were held under the auspices of the Multi Agency Public Protection
Arrangements. The purpose of the meetings was to share relevant
information, assess the risks posed and give careful consideration to how he
could best be supported and supervised post-release so as to manage the
risks most effectively. The last of these meetings before his release from
prison and was held on 22 January 2004. It was attended by nine members
of staff from the police, probation, probation victims unit, the approved
premises and Featherstone prison.
12. A member of staff from the lifer unit in Featherstone prison presented
concerns he had regarding the man's contact with his former girlfriend. The
man had continued to deny any contact, but evidence from the prison pin
phone system demonstrated that he had in fact been in regular contact with
her.
13. Referrals had already been made to appropriate services such as the
Advisory Service on Alcohol and the Domestic Violence Intervention
Programme.
14. The man was an intelligent man studying for a master’s degree and had
made good progress in prison. By far the two key concerns with him were a)
his drinking and b) his potential for violence in relationships. Alcohol
preceded the violence in his index offence, previous offences and his previous
licence recall. The level of concern is reflected in the fact that three of the 11
licence conditions directly relate to these issues.
He shall abide by the rules and curfew requirements of any hostel in
which he is currently residing and any contact with his probation officer
as he might reasonably require. He shall also work with and comply
with any reasonable direction of his Probation Hostel Manager,
particularly relating to matters of supervision, on-going education,
alcohol and his other risk factors.
He shall comply with any requirements reasonably imposed on him by
his probation officer for the purpose of ensuring that he addresses his
risk areas including alcohol, anger, relationship and domestic violence
issues.
He shall attend upon such counsellors or other professionals including
any domestic violence programme, the Advisory Service on Alcohol
and any appropriate psychological assessment.
15. Furthermore, due to the above risk factors there was concern that the man
may get involved in a complex relationship as he was with the victim of his
index offence, and when he was recalled. There were two further licence
conditions instructing the man to inform his probation officer of the developing
6
nature of any personal relationship, and to have no contact with his former
girlfriend.
The man's time at the Approved Premises
16. The man arrived at the hostel in March 2004. He was inducted and
apprised of the rules and regulations. It was noted by staff that he was very
upfront and quite intimidating. He had a huge physical presence. As time
went on, he proved himself to be popular with a good sense of humour.
17. The man was allocated a key worker in the hostel. It was agreed with the
man's probation officer, that he would remain the supervising officer, with the
key worker holding responsibility for the day to day contact with the man.
18. In many respects, the man settled well into the hostel. He attended all
meetings with his key worker, made slow but steady progress on the
Domestic Violence Intervention Programme, and after some reluctance
attended meetings with the Advisory Service on Alcohol. However, there was
cause for concern in other aspects of his behaviour, in particular his excessive
drinking. This was reported in a supervision report by his probation officer on
20 April and the man subsequently received his first formal warning. It was
agreed this would be the last report written by his probation officer and that his
key worker would carry out all future reports. Between the man's release and
the date of the first supervision report, the man had returned to the hostel
drunk on at least four occasions. There had also been a police intelligence
report alleging that he had contact with his former girlfriend.
19. Each key worker holds an individual file on each of the residents they
supervise, however, there are some more general records for the hostel as a
whole. The hostel records events in a variety of different ways. There is a
hostel log book, a handover book and an individual record which has two
parts; the week by week notes, and the more in depth extended record sheet.
The hostel log book consists of anything significant that happens in the day. It
is not a detailed record of an individual. Some staff will comment if a resident
is drunk or under the influence of drugs, but others feel it is not necessary
unless the resident is causing problems as a result of their intoxication. The
handover book contains basic information on routines, notices or warnings
about residents, record sheets that have been raised, outstanding jobs that
need to be completed, and alert staff to things they need to know or need to
do. Anyone can make entries into the log book and handover book. There is
also a staff meeting every Monday afternoon where every case is briefly
reviewed. There is no formal recording of these meetings. Part time staff and
agency staff will not normally attend these meetings, and therefore rely on the
log book and handover book for information on residents.
20. As time went on, some of the man's behaviour still gave cause for
concern. There was another intelligence report from the police that he had
been seen with a woman matching his former girlfriend’s description, but
generally he seemed to be adjusting to life outside of prison. It should be
noted however, that during this time of relative stability, interviews with staff
7
show that he was drinking regularly. Although this was not always noted in
the log book, some staff said they thought that he drank most days.
21. Unfortunately, the man continued to show an apparent lack of regard to
his licence conditions. He continued drinking, and his key worker received
reports from another resident that he had started injecting heroin. He denied
this. His key worker decided to complete a drug test with him. The results
were negative. There was other information from other residents about him
carrying a knife, that he had been drinking on hostel premises at 7am and had
been bragging about seeing his former girlfriend. He was late back to the
hostel on three occasions and, although he phoned, he missed his curfew
time. Then on 17 July, he stayed out all night.
22. The key worker was concerned that the man was escalating out of control,
and continued to inform his probation officer and risk manager of the issues.
The key worker also tried to work closely with the man and warn him of the
impact of his actions. The risk manager discussed the situation with the area
manager and decided that the man should be issued a final warning for his
continued drinking and overnight stay - generally stretching the boundaries.
The key worker wrote a report to the lifer management unit on 21 July and
they issued him with the final warning on 29 July.
8
The week leading up to the man's death
23. On 23 July, the man arrived back at the hostel in time for his curfew
having been drinking. On 26 July, he was unwell, suffering from sickness and
diarrhoea. He then developed chest pains so a doctor was called. The doctor
attended and gave him some tablets to stop the sickness and some
painkillers.
24. On 28 July, the man was suffering with back pain. Staff were concerned
about him and called the doctor again. However the man had left to sign on
when the doctor arrived. The man did attend the Domestic Violence
Intervention Programme that evening and took part. The following day a staff
member from the DVIP emailed the key worker, probation officer and risk
manager to update them on the man's progress at the group. His progress
was acceptable. She also noted that when the man had rolled up his trouser
leg it had revealed "lacerations of his lower left leg…which looked quite
nasty". In interview, the key worker said he had not asked the man about this,
as he had not seen it as an issue. When the man returned to the hostel that
evening, staff noted that he seemed "really under the influence" and did not
want to take his medication. The key worker said that the man might have
been thinking he would be recalled to prison after his recent behaviour and
staying out all night.
25. On 30 July, the man spent the day with a close friend. They went walking
in the hills. His friend said that the man was still in some pain with his back
but generally in good spirits. Amongst other things, they discussed the man's
future and the possibility of him moving closer to the coast where he felt he
could get more support.
26. When the man returned to the hostel he had a meeting with his key
worker. He mentioned the future possibilities of moving closer to the coast,
and they also completed a drinking diary. The man reported not having had a
drink all week except on the Thursday. The key worker and the man
completed a worksheet about situations where he found it easy and difficult to
avoid drinking. It is worth noting that he reported finding it difficult to avoid
alcohol when "I'm on a really big high and I want to celebrate…When I've got
money in my pocket…When I'm with the wrong people". On his list of "wrong
people" the man included his former girlfriend. The key worker used this
meeting to inform him that he was being given a final warning for his
continued drinking and overnight absence, rather than being breached and
referred back to the Parole Board for possible licence recall. In the extended
record sheet, the key worker reported that he still did not feel the man fully
accepted the implications of his drinking habits.
27. On 31 July, the man again complained of backache and went to the
doctor’s surgery. He returned at 10am having been prescribed co-dydramol
tablets. The man's close friend, whom he had seen the day before said that
he had phoned both her, and his father and again seemed in good spirits.
9
28. Having spent the afternoon drinking, the man returned to the hostel at
about 8.30pm. He spoke to a relief warden in the front office, asking why his
flatmate had been moved to another flat. The relief warden reported in the log
book that the man felt he was being singled out and felt “someone is trying to
push him all the time". In interview, the key worker explained that the reason
for the move was purely to accommodate a new resident with differing needs,
and was nothing to do with the man or his conduct. The key worker also said
there was no reason why the reasons for any such move could not be
explained. However, relief staff might not know the reasons as they are
normally discussed at meetings.
29. In interview, the relief warden said that the man went out again that night,
but was back before curfew. Another resident living at the hostel, was
interviewed. He reported that they had gone together to buy some heroin,
and taken it back to the hostel, but reported that they had not done this
together before. However, a female resident, who was friends with the man
who subsequently died, said he did take heroin by injection. The man who
died, and the other resident had gone to his room where they had both taken
it. The second resident reported “We arranged to get some and we came
back to the hostel and took the drugs, was talking for about half hour and then
I ended up douching which is like being under the influence of the drug.” He
went on to say that he awoke again at about ten to eleven. The man was
sitting in the chair and he tried to wake him but could not. The second
resident left the room and ran down the stairs to see if the man's flat mate was
there, but he was not. As he came out of the man's flat, he saw two members
of staff coming up the stairs: the relief warden and a night warden. He told
staff that the man was not moving and they all ran back up the stairs.
30. There is no evidence to suggest that the man intended to take his own life.
10
The Crisis Management
31. The night warden stated that when they all arrived at the scene, they
knew from the man's appearance that something was seriously wrong. The
relief warden left the room, ran back down the stairs to the ground floor and
asked another relief warden based in the front office, to call an ambulance. In
the meantime, the night warden had checked to see if the man was breathing.
She could not feel a breath and could not detect a pulse. The night warden
asked the second resident to help her, and together they moved the man onto
the floor and placed him on his back. The night warden then commenced
CPR. Soon after, the relief warden returned to the room and helped with the
CPR, taking it in turns to perform chest compressions and breathe for the
man. Mouth guards had been issued to staff should mouth to mouth
resuscitation become necessary, but at the time neither member of staff was
carrying a guard. The ambulance arrived after about five minutes. The relief
warden based in the office showed the paramedics to the scene, and they
took over the CPR. Staff were aware at this time that the man appeared to
have taken a drugs overdose.
32. The second resident waited in the doorway, but once the ambulance
arrived he moved into the kitchen. The ambulance crew requested another
ambulance, which was better equipped to help carry the man down the stairs.
From the time that the man was found by staff, until he left in the ambulance,
the night warden did not leave him. The two relief wardens organised the
paramedics and helped carry the paramedics’ equipment.
33. Once the paramedics had left with the man, the staff made sure all the
appropriate people were contacted. Staff attempted to make sure no-one
went into the room and the second resident was given another room for the
night. However, there was an opportunity for the second resident, and others,
to go into the room before staff had a chance to double lock the door.
34. A little later, the hospital phoned to say that the man had been
pronounced dead before they reached the hospital.
35. The following morning all residents in the Approved Premises were told
individually about the death. However, the female resident that had been
friends with the deceased, had been on weekend leave. She returned to the
hostel on the Monday, and the news was broken to her then. She had been
close to him, and she was angry and upset. One of the assistant wardens,
noted in the log book that the female resident blamed the second resident
because “he should not have injected him”, and because two of her friends
had been arrested. (This refers to the people who the local Police
subsequently arrested and charged for allegedly supplying the heroin).
36. The Assistant Chief Officer, attended the hostel on 2 August to see how
staff were and to outline the support that was available to them should they
need it.
11
Consideration and Conclusions
37. There are several issues that warrant further exploration. The issues my
investigation looked at are: whether the man should have been referred for
recall to prison; communication issues within the hostel; the issue of mouth
guards and mobile telephones; allegations surrounding the actual
consumption of heroin; psychiatric services provision in the hostel, funeral
expenses assistance, and support for staff and residents after the man's
death.
Potential recall
38. The Parole Board were primarily concerned with a) The man's drinking
habits and how alcohol had been an element in his offending, and b)
Domestic violence. This concern is evident from the fact that three of the
eleven licence conditions relate to the man addressing his alcohol and
domestic violence problems. From the time that he was released until he
died, it was reported in the log book by staff that he had returned to the hostel
drunk on six occasions. However, on interview, all staff that knew him
reported him being a regular drinker - some staff thought daily. On one
occasion, cans of lager were found in the man's room and another resident
reported seeing him drinking alcohol early in the morning in the hostel. It is
important to note that hostel rules expressly ban the drinking of alcohol and
taking of drugs on the hostel grounds.
39. Another licence condition was to abide by the rules and curfew
requirements of the hostel. The curfew at the hostel was 11pm. In the man's
time at the hostel he returned late on three occasions, and stayed out
overnight on one occasion.
40. Yet another licence condition was that the man should not seek to
approach or communicate with his former girlfriend. It should be noted that
the former girlfriend herself did communicate with various members of the
Probation Service in an attempt to have this condition lifted. However, the
decision was taken that this condition could not be lifted until the man had
completed the Domestic Violence Intervention Programme, and, at the very
least, had showed that he could comply with his licence conditions. There
were three police intelligence reports concerning the man and his former
girlfriend. One referred to the man being seen with a female matching his
former girlfriend’s description. One was a report from the man's close friend,
who became concerned after having a telephone conversation with the man in
which he admitted seeing his former girlfriend, and was concerned about the
former girlfriend’s safety and the man's future. The third report was from a
witness who had seen the man and his former girlfriend in a public house,
under the influence of alcohol. They had been asked to leave the pub. This
witness gave an oral account initially, but later provided a written statement
shortly before the man's death. The man also cited his former girlfriend as a
bad influence on his drinking behaviour.
12
41. The key worker demonstrated that he was very aware and concerned
about the man's behaviour. In the main, there is evidence of the key worker
reporting the man's behaviour to the man's probation officer, and risk
manager. The key worker was largely responsible for the day to day running
of the hostel, management of staff, and overseeing the casework within the
hostel. The key worker felt supported by the hostel manager. However, it
was not clear to the investigation team, who held ultimate responsibility for the
man's case and the roles of key worker, probation officer and risk manager
seemed blurred.
42. Had the man been recalled to prison, it is likely he would have been
facing a considerable period of time in custody. I understand how this may
have contributed to the staff's reluctance to take action. On a day to day
basis, staff must consider the fine balance of trying to help someone
reintegrate into the community whilst protecting the public. The man did
receive a formal and a final warning, and a MAPPP meeting had been
arranged for the week following the man's death. However, questions remain
as to why enforcement procedures were not enacted at an earlier stage.
43. I recommend that the National Probation Service conduct a review
into whether the man should have been referred to the Parole Board for
breaching his licence conditions.
The report was shown to the National Probation Directorate and the local
Probation Service at draft stage. A review was conducted by the manager of
the hostel and concluded that the measures taken were appropriate.
44. I recommend that where management and supervision roles are
shared, it is made clear in writing in the case record, who is responsible
for different areas of the case management.
13
Communication
45. In general, conversations and incidents with residents at the hostel were
thoroughly recorded by staff. It became clear during the investigation, that
staff were very aware that the man was a heavy drinker, although reports of
him drinking were only logged six times. Some staff said they made a note if
they knew a resident was under the influence of alcohol or drugs; others said
they only made a note if residents were disruptive due to their intoxication. It
would have made sense in a case such as this, where the licence conditions
were strongly linked to his alcohol usage, for staff to have been asked to
record any incident relating to alcohol.
46. Staff felt confident they knew who to speak to if they came across a
problem with a resident, and said they found the weekly team meetings
useful. At these meetings they have an opportunity to discuss their cases and
any concerns with the rest of the team and the core team were well aware of
risk factors relating to the residents. However, the two part time staff only
attend half of these meetings due to their shift pattern, relief staff do not attend
these meetings, neither do the regular night staff. These people form a
substantial number of staff, and relate to all three members of staff on duty on
the evening that the man died. Although this did not contribute to the man's
death, the staff on duty had a limited knowledge of the man compared to other
staff.
No note is taken of the meetings. Whilst I understand these meetings are
informal, minutes would be of great value to the agency and night staff on
whom the hostel rely quite heavily.
47. I recommend that a note is taken of the full content of weekly
meetings and this recorded in the Meeting minutes book as a reference
for all staff.
14
Mouth guards and emergency response
48. Staff carry pouches that hold items that may be of use in their work
around the hostel such as keys. Staff had also been issued with mouth
guards to protect themselves and others should mouth to mouth resuscitation
be necessary. However, on the evening of the man's death, neither the night
warden nor the relief wardens were carrying these mouth guards. This was
brought to the management’s attention by the night warden.
49. I recommend that staff be reminded to carry the mouth guards on
their person at all times.
50. I understand from the manager of the hostel that he verbally reminded the
staff to carry mouth guards during a team meeting following the man's death.
51. The man was found in a room on the third floor. When staff arrived, one
immediately had to leave the crisis situation to raise the alarm and summon
help, leaving the other person alone. A mechanism to raise the alarm quicker,
allowing the two staff members to stay together would have been preferable.
52. I recommend that all staff working within the hostel are given mobile
telephones or alarms for use when they are on duty.
53. This issue was raised with the manager during the investigation and he
reported that he had decided to order mobile telephones.
15
Injecting heroin
54. Two days after the man died, the female resident who had been friends
with the deceased, returned to the hostel from weekend leave. She had felt
close to the man, and was upset and angry when she heard of his death. She
was heard to say "he shouldn't have injected him". This was discussed with
the female resident in interview. She reported that the man did use heroin
recreationally and she had previously taken it with him. She stated that he
never injected himself, sometimes because he was drunk and sometimes he
simply could not do it even when he tried. She said he only used very small
amounts and she believed the second resident, with whom he had taken
drugs with had injected him.
55. During an interview with the second resident, he was clearly upset, and
felt in part, responsible for the man's death. This was because he was not
sure whether the man would have known where to buy the heroin without his
help. The second resident denied injecting the heroin, and said that the man
injected himself.
56. Transcripts of both interviews were passed to the police for their
consideration. It is also worth noting that the police have arrested and
charged two people on suspicion of supplying the heroin to the residents.
16
Psychiatric services provision
57. It was clear from talking with staff at the hostel that they are eager to
support residents. The manager and key worker have evidently worked hard
to build and maintain links with drug and alcohol agencies, and with
employment and training services. However, concern has been raised about
the provision of psychiatric services. The investigation was told it was very
difficult to find a Community Psychiatric Nurse (CPN) willing to be involved
with residents. After the man's death, there was a raised level of tension at
the hostel. There were particular worries about the safety of one resident who
had expressed suicidal thoughts to staff. The Psychiatric Emergency Service
team had advised them the resident should be taken to A&E if necessary and
were felt not to be very helpful. The resident subsequently seriously harmed
himself. Although, this issue does not directly concern the death, it is worthy
of comment for the benefit of all residents.
58. The hostel management team said they had tried to improve this situation
but to no avail. Strategic intervention is needed at both an Area level, and a
National level.
59. I recommend that the National Probation Directorate consider with
the Department of Health how best to ensure that appropriate and
effective psychiatric support is provided to residents of Approved
Premises.
60. I recommend that the local Probation Service consider with the local
Primary Care Trust how best to ensure that appropriate and effective
psychiatric support is provided to residents of Approved Premises.
17
Support for staff and residents
61. Every member of staff who was interviewed felt they had been supported.
Staff, including agency staff, seemed clear on the different avenues of help
they had available to them.
62. It is also worth mentioning that two of the residents who were interviewed
were very distressed. This caused the investigation team concern and they
identified the key workers for those residents and shared their worries with
them. The key workers then spent a considerable length of time talking with
the residents.
63. It was clear that the hostel provided an extremely supportive environment
in which staff felt able to discuss issues with one another and with the
management team.
18
Funeral Expenses
64. The deceased man's father had some difficulty paying for the funeral.
When a person dies in Prison Service custody, the Prison Service (under
Prison Service Order 2700) will pay reasonable funeral expenses. The
National Probation Service has no such provision and expects families to rely
on the complex means testing process of the Department of Work and
Pensions. Whilst the payment of funeral expenses might not be appropriate in
all cases when a resident dies in Approved Premises, this is a matter that
merits further consideration.
65. I recommend that the National Probation Directorate considers the
introduction of a scheme whereby the reasonable funeral expenses of
those who die whilst residing in Approved Premises are met by the
relevant Probation Area.
19
Recommendations
National Probation Directorate
66. I recommend that at the National Probation Service conduct a review
into whether the man should have been referred to the parole board for
breaching his licence conditions. (Implemented)
67. I recommend that staff be reminded to carry the mouth guards on
their person at all times.
68. I recommend that the National Probation Directorate work with the
Department of Health to ensure that appropriate and effective
psychiatric support is provided to residents of Approved Premises.
69. I recommend that the National Probation Directorate considers the
introduction of a scheme whereby the reasonable funeral expenses of
those who die whilst residing in Approved Premises are met by the
relevant Probation Area.
Local
70. I recommend that where supervision roles are shared, it is made
clear in writing, who is responsible for different areas of the case
management.
71. I recommend that a note is taken of the full content of weekly
meetings and this is recorded in the Meeting minutes book as a
reference for all staff.
72. I recommend that all staff working within the hostel are given mobile
telephones for use when they are on duty.
73. I recommend that the local Probation Service consider with the local
Primary Care Trust how best to ensure that appropriate and effective
psychiatric support is provided to residents of Approved Premises.
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