Janet Tripp
9 Feb 2026 · Coroner Guy Davies · Cornwall & the Isles of Scilly
This report repeats 1 earlier warning. See the linked reports.
The coroner's concerns
1. lack of care rounds
“There was insufficient evidence before the court to indicate that the above failings found at Inquest had been addressed by the hospital”
2. lack of training regarding basic patient care
“There was insufficient evidence before the court to indicate that the above failings found at Inquest had been addressed by the hospital”
3. no risk assessment conducted
“There was insufficient evidence before the court to indicate that the above failings found at Inquest had been addressed by the hospital”
4. no documentation of required dressings
“There was insufficient evidence before the court to indicate that the above failings found at Inquest had been addressed by the hospital”
5. no handover
“There was insufficient evidence before the court to indicate that the above failings found at Inquest had been addressed by the hospital”
Linked reports
Closely relatedConfidence 0.85 · high
Earlier report
“There were no applicable standard operating procedures for worsening patients in the renal unit at the date of [the deceased]'s death and none had been implemented by the date of Inquest.”
This report
“There was insufficient evidence before the court to indicate that the above failings found at Inquest had been addressed by the hospital.”