Gloria Mekins

28 May 2019 · Coroner Clare Bailey · Teesside and Hartlepool

The coroner's concerns

1. lack of first aid response to choking
“The Health Care Assistant who initially discovered Ms [name redacted] choking carried out no first aid, nor did she take any action to try to clear Ms [name redacted]' mouth or help improve her breathing, eg back slaps or Heimlich manoeuvre.”
2. confusion over DNA CPR status
“There was confusion as to the existence of a DNA CPR and this led to a delay in the Provision of first aid.”
3. lack of internal investigation and remediation
“The Care Home had not undertaken an internal investigation into events surrounding Ms [name redacted]' death and have not identified the above issues, nor have they attempted to remedy them. The Senior Coroner is concerned that the above issues place residents at the Care Home at risk of serious injury or death.”