Neglect Contributed to Death of Woman Found in Ward Toilet After 25-Minute Delay
By Emma Walker,World-Today-News.com – November 8, 2023
A coroner has ruled that neglect contributed to the death of Cerys, a vulnerable patient who was found unresponsive in a ward toilet after a 25-minute delay in discovering she was missing. The findings, delivered following a detailed inquest, reveal a disturbing pattern of falsified records and systemic failures within the care facility.
the inquest heard harrowing details,corroborated by CCTV footage,outlining the timeline of events leading up to Cerys’s discovery on May 18th,after she tragically passed away five days later.
At 2:42 PM, Cerys entered the ward garden. Observation records falsely stated she was in her bedspace by 2:45 PM – a claim the coroner dismissed as “not accurate.” She was then seen entering a toilet on the ward at 2:54 PM and closing the door.
Crucially, a support worker, Mr.Rafiq, claimed to have seen Cerys at 2:57 PM, and afterward recorded in observation notes that he saw her ”along the corridor, looking flat-faced” at 3:00 PM. However, CCTV evidence proved Cerys remained inside the toilet during this period.
Confronted with the discrepancy, Mr. Rafiq admitted to the coroner that his records were “falsified.” He testified that he was shown by other staff how to routinely record observations every 15 minutes, even if those observations hadn’t actually taken place. “That’s how they did it and that’s how I did it,” he stated.
The lack of diligence continued with the shift change at 3:00 PM. A new support worker took over observations with no verbal handover,and relying on Mr. Rafiq’s inaccurate notes which indicated Cerys had recently been seen.
It wasn’t untill 3:15 PM that the new support worker began searching for Cerys, with CCTV footage capturing her increasingly frantic efforts to locate the patient in communal areas and along the corridor. At 3:19 PM, she used a master key to open the toilet door and discovered Cerys inside, promptly raising the alarm.
The coroner heavily criticized the care provided, stating there was a “gross
