Source · PSOW (Public Services Ombudsman for Wales)

Cardiff and Vale University Health Board

PSOW (Public Services Ombudsman for Wales) Not Upheld Reference PSOW-202306657 Sector Health Category Clinical treatment in hospital Decided 12 March 2024

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Full decision

Ms C complained about the care provided to her father, Mr A, by Cardiff and Vale University Health Board (“the Health Board”) when he suffered an unwitnessed fall in the early hours of 10 August 2023. We investigated whether there were appropriate falls risk assessments and prevention measures in place for Mr A, and whether he was being monitored appropriately.

The Ombudsman found that all appropriate risk assessments were in place to consider Mr A’s personal risk of falling, including whether bedrails should be used. It was appropriate for him to have bedrails in place at the top of the bed (“half top bedrails”). The bed was at its lowest setting and a urine bottle and call bell were within Mr A’s reach. Mr A was not confused or disorientated, and he got out of bed independently. There was nothing further that should have been done to prevent Mr A’s fall. The complaint was not upheld.

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Other decisions involving Cardiff and Vale University Health Board

Reference Date Summary Outcome
PSOW-202410002 30 Apr 2026 Ms C complained about the care and treatment provided to her late mother-in-law, Ms D, when she was investigated and … Partly Upheld
PSOW-202502189 23 Apr 2026 The investigation focused on whether Ms A’s waiting time for gallbladder surgery was appropriately managed in line with the Welsh … Partly Upheld
PSOW-202510196 23 Apr 2026 Mr A complained that the Health Board inappropriately submitted three Multi Agency Referral Forms (“MARFs”) to the Council in relation … Resolved / Early Resolution
PSOW-202501454 16 Apr 2026 Mr C complained that Cardiff and Vale University Health Board had not provided him with the mental health care and … Resolved / Early Resolution
PSOW-202509648 15 Apr 2026 Mrs A complained that the Health Board had not responded to all her concerns in its complaint response, and that … Resolved / Early Resolution
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