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70-year-old died alone in filthy flat in Cornwall

70-year-old died alone in filthy flat in Cornwall

Published by Emma Carton at 7:00am 15th September 2019.

A review has revealed how a pensioner from Cornwall was living in squalid conditions before his death.

Paul (not his real name), had complex physical and mental health needs and showed signs of self-neglect and neglect.

The 70-year-old died alone in his flat on May 27th 2016, in conditions described as filthy.

These included rancid food in his fridge and a bowl of faeces under his chair.

Despite concerns raised by his support worker, officials said that it appeared his care and support plan was not reviewed.

The care agency, commissioned by Cornwall Council to support Paul, has not been identified in the safeguarding review.

However, Cornwall's Safeguarding Adults Board has now put together an action plan for care organisations working with people who show signs of neglect.

"All of the Board and the agencies involved in this review have expressed their sadness about the circumstances surrounding Paul's death and acknowledge that more needs to be done in challenging cases like these where the individual does not appear to want the support that is offered. 

"The purpose of a review is not to lay blame at any particular organisation or individual but to look in detail and question what went wrong and why and, most importantly, learn from it so we can put it right for the future".

Safeguarding Adults Board, Fiona Field

What are the circumstances surrounding Paul's death?

Paul was found at home by a care worker who attempted Cardiopulmonary Resuscitation (CPR) and sought assistance from Paul's neighbour, who reported her shock at the state of his home.

Safeguarding concerns were raised by AUKCIOS through the multi-agency safeguarding adults procedure. 

These concerns included identification of risks relating to the conditions in Paul's property, highlighting the presence of rancid food in the fridge and public health risks around the living room, which was the one room in the flat in which he lived. 

AUKCIOS noted that a bowl of faeces was found on the floor under his chair and that he was sleeping on the sofa. 

The AUKCIOS worker also questioned the fact that Paul stated he was paying for services for which he was not liable. 

Further concerns were raised about the general state of the living area, Paul not taking his medication and appearing grubby and unkempt. 

No personal care appeared to have been provided as part of his care and support plan.

Paul died twelve weeks after his care and support plan was put in place. 

There appeared to be no reviews of his care and support plan, no escalation of concerns, despite the significance of risks highlighted by the AUKCIOS worker and no apparent concern that Paul was showing some signs of self-neglect/neglect.

For these reasons, the Cornwall and Isles of Scilly Safeguarding Adults Board decided to conduct a statutory Safeguarding Adults Review.

What did the review find?

Paul was clearly, from the information provided to this Review, a man who had well-defined views and who could be, in the words of his Housing Officer, 'feisty and up to a challenge'.

He was embroiled in a dispute with his neighbour that escalated, he had mental health problems, experiencing anxiety and depression and his physical health deteriorated significantly over the last year of his life. 

His physical ill health, the symptoms of which were largely related to his respiratory problems had an increasingly detrimental effect on his day-to-day wellbeing and Paul grew more depressed as his physical health deteriorated. 

There is no evidence that there was any consideration of the inter-play between his anxiety and physical wellbeing and this indicates a lack of professional curiosity. 

With the exception of the worker from AUKCIOS, the review has not seen any evidence of agencies considering why he was angry, why he shouted and further how this might be ameliorated to enable a conversation about risk and services that could address them.

The other concern for this Review in respect of Paul's capacity to make relevant decisions (assuming this was considered, but not recorded) is his decline in health, particularly his health in respect of his intake of oxygen and his increasing frailty.

The review has seen a lack of consideration of Paul's dignity; this was exemplified by the care agency's use of simply his family name throughout the IMR and only serves to suggest a lack of respect for Paul.

The review has identified a significant lack of partnership working throughout Paul's contact with agencies. 

There does not seem to have been a concern about sharing information, simply a lack of impetus for doing so. 

This can only lead to a conclusion that his 'feistiness' and refusal services influenced that impetus.

The Review reports an absence of joined up working in supporting Paul. Even though a safeguarding adults concern was raised the day prior to his death, the local authority did not seek to involve those agencies that knew Paul in consideration of risk and instead chose to focus solely on consideration of the agency's development and practice concerns; the entire focus was on the provider's failures, not on Paul's experiences.

There has been reference throughout this Review about self-neglect, but really it appears that Paul was not provided with optimal care by the care agency commissioned to support him and also by statutory agencies, in particular, the local authority. 

In hindsight, it is clear that Paul would accept help if it was offered in a way that suited him; the challenge for services was to work out what that was. 

The AUKCIOS worker and Community Matron did so, as did some frontline care workers.

Good practice in working with people focuses on understanding people's personalities, their histories, their likes and dislikes; this is what was incumbent on those services that worked with Paul.

The above information is taken directly from the review - you can read the full review here.

What action has/is being taken?

Following Paul's SAR an action plan was created that all relevant organisations involved in his life have begun to implement.

The recommendations were:

  1. People who show reluctance to co-operate with care, display challenging behaviour and signs of self-neglect should be offered multi-disciplinary case conferences on a regular basis.
  2. An audit of people who meet these criteria should be conducted to establish how much more support they need so they receive the optimal care.
  3. The SAB may wish to develop a task and finish group to establish if there are effective care pathways for individuals who self-neglect and this group should also consider how this links in with mental capacity.
  4. The SAB should seek assurance that all agencies commissioning care provider services should check whether there are adequate quality assurance mechanisms in place to enable speedy withdrawal of contract should quality markers fail.
  5. The Local Authority should ensure there is a consistent referral system to the Fire and Rescue service for all individuals considered to self-neglect.

The Board has instructed a 'Task and Finish Group' who are responsible for making sure these actions are implemented across all of the organisations involved.

The Board has also commissioned self-neglect expert Michael Preston Shoot to work with organisations and support them to make the changes. 

If you are concerned about an adult who may be experiencing abuse or neglect or if you're an adult experiencing abuse or neglect you can call 0300 1234 131 or email accessteam.referral@cornwall.gov.uk

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