John MacGregor
6 Mar 2024 · Coroner Hugh Bricknell · Herefordshire
The coroner's concerns
1. future deaths
“risk that future deaths will occur unless act i on is taken”
2. quality of residents care documentation
“quality of residents care documentation and its completion”
3. escalation or non-escalation procedures
“Procedures regarding escalation or non-escalation following a fall and subsequent medical intervention”