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SL71-Death of a Service User Policy

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Death of a Service User Policy

1. Purpose

The purpose of this policy is to provide clear, lawful and compassionate guidance for staff on the actions to take following the death of a service user receiving care or support from {{org_field_name}}. This policy applies to deaths that occur while a regulated activity is being provided, deaths that may have resulted from the regulated activity or the way it was provided, and deaths identified after support has ended where there may be a connection with the care or support provided.

This policy supports compliance with the Health and Social Care Act 2008, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the Care Quality Commission (Registration) Regulations 2009, the Care Act 2014, the Mental Capacity Act 2005, the Data Protection Act 2018, UK GDPR, the Notification of Deaths Regulations 2019, the Medical Certificate of Cause of Death Regulations 2024, and CQC guidance on statutory notifications and the fundamental standards.

The policy aims to ensure that the deceased person is treated with dignity and respect, that families and representatives are supported sensitively, that staff know when to contact emergency services, the GP, medical examiner, coroner, police, local authority safeguarding team, Integrated Care Board and CQC, and that all records, notifications and learning actions are completed without delay.

2. Scope

This policy applies to all staff, managers, healthcare professionals, and external agencies involved in the management of the death of a service user in {{org_field_name}}’s care. For supported living services, this policy applies where the person dies in their own home, shared supported living accommodation, hospital, community setting, during an activity, or at any other location where {{org_field_name}} is providing, has recently provided, or may have contributed to regulated care or support. Staff must remember that the person’s home must be treated as their private home and not as a care home environment. Any action taken after death must respect the person’s tenancy, privacy, possessions, cultural wishes, religious beliefs and the rights of family members, attorneys, deputies, executors or other lawful representatives.

It covers:

3. Related Policies

4. Policy Statement

{{org_field_name}} is committed to ensuring that the death of any service user is managed with compassion, dignity, respect, openness and professionalism. Staff must respond promptly to preserve life where appropriate, respect valid advance decisions and DNACPR recommendations, protect the dignity and privacy of the deceased person, support those affected, and ensure that all legal, safeguarding, regulatory and contractual reporting requirements are met.

Where a death is unexpected, unexplained, suspicious, potentially linked to abuse, neglect, acts or omissions, unsafe care, medicines, equipment, infection, restraint, self-harm, accident or any failure in care delivery, staff must escalate immediately to the Registered Manager or on-call manager. The Registered Manager must consider whether notifications are required to CQC, the local authority safeguarding team, police, coroner, Integrated Care Board, commissioner and any other relevant body.

{{org_field_name}} will act in accordance with the statutory Duty of Candour where a death amounts to, or may amount to, a notifiable safety incident. This includes being open and transparent with the relevant person, offering an apology, providing reasonable support, explaining what is known, and sharing the outcome of any investigation where appropriate.

5. Immediate Actions Following a Death

5.1 Recognising an Emergency, Verification of Death and DNACPR

If a staff member finds a service user unresponsive, they must immediately check for danger, attempt to gain a response, call for help, and follow emergency procedures. Staff must not assume that a person has died unless death has been verified by an appropriately qualified professional.

Unless there is a valid, accessible and applicable DNACPR recommendation or advance decision refusing CPR, staff trained and competent in basic life support must start CPR and call 999 immediately. Where staff are not trained in CPR, they must call 999 immediately and follow the instructions of the ambulance call handler.

A DNACPR recommendation relates only to cardiopulmonary resuscitation. It does not mean that the person should be denied comfort, dignity, personal care, pain relief, emotional support, medical review, oxygen, treatment for reversible conditions, or emergency assistance where this is clinically appropriate.

If a valid and applicable DNACPR recommendation, ReSPECT form, advance decision to refuse treatment, or advance care plan is available, staff must follow the recorded instructions and immediately inform the Registered Manager or senior on-call person. If there is any uncertainty about validity, applicability, identity, mental capacity, deterioration, injury, choking, accident, overdose, abuse, neglect or suspicious circumstances, staff must call 999.

Verification of death must be completed by an appropriately qualified professional, such as a doctor, paramedic, nurse or other professional acting within their role and local arrangements. Staff must record the name, role, organisation, contact details and time of attendance of the professional who verifies the death. Staff must not complete a Medical Certificate of Cause of Death.

5.2 Preserving the Scene Where Death Is Unexpected, Unexplained or Suspicious

Where the death is unexpected, unexplained, suspicious, violent, accidental, possibly self-inflicted, linked to a fall, choking, medication error, injury, neglect, abuse, omission, equipment failure, fire, infection outbreak, restraint, or any concern about the care provided, staff must preserve the scene as far as possible.

Staff must not move the body, remove medicines, dispose of dressings, bedding, waste, food, fluids, equipment, care records, MAR charts, communication logs or other potential evidence unless instructed to do so by emergency services, police, coroner, medical examiner or a senior clinician.

Staff must make the area safe, maintain privacy and dignity, prevent unnecessary access, record who enters or leaves the room, and immediately contact the Registered Manager or senior on-call person.

5.3 Notifying the Appropriate Authorities

The Registered Manager, senior on-call person or nominated senior staff member must oversee all notifications following the death of a service user. Staff must record the date, time, person contacted, advice received, reference numbers and actions agreed.

Expected death

An expected death is a death that was anticipated due to the person’s known illness, frailty or palliative/end of life care plan, and where there are no concerns about abuse, neglect, accident, omission, unsafe care, medication, equipment, injury or suspicious circumstances.

In an expected death, staff must:

Unexpected, unexplained or suspicious death

In an unexpected, unexplained or suspicious death, staff must call 999 immediately and follow the instructions of emergency services. The body and immediate environment must not be moved or altered unless required to preserve life, prevent harm, or because emergency services, police or another authorised professional instructs staff to do so.

The Registered Manager must consider immediate notification to the police, local authority safeguarding team, commissioner, Integrated Care Board where relevant, CQC and any other relevant professional or agency. The Registered Manager must also ensure that records, medicines, MAR charts, care notes, risk assessments, rotas, visit logs, electronic call monitoring records and communications are preserved.

Medical examiner and death certification
From 9 September 2024, all deaths in England and Wales are subject to independent scrutiny by either a coroner or a medical examiner. Where the death is not referred to the coroner, the medical examiner will scrutinise the proposed medical cause of death and may contact the bereaved person or relevant professionals. Staff must cooperate with reasonable requests for factual information and must immediately escalate any concern raised by the medical examiner to the Registered Manager.

Staff must not advise families that the death can be registered until the appropriate medical certification and medical examiner or coroner process has been completed.

5.4 Medicines, Equipment, Records and Assistive Technology After Death

Following a death, staff must secure but not destroy, remove or alter any medicines, medication administration records, topical medicine charts, controlled drugs records, care records, risk assessments, moving and handling equipment, pressure care equipment, oxygen equipment, falls equipment, alarms, sensors, call bells, keys, financial records or electronic care records until the Registered Manager confirms what action is lawful and appropriate.

Where medicines are present in the person’s home, staff must follow the Medication Management Policy and local arrangements. Medicines must not be returned to a pharmacy, disposed of, or handed to family members until any police, coroner, safeguarding, medical examiner, commissioner, internal investigation or CQC requirements have been considered.

Where equipment is owned by the NHS, local authority, landlord, the person, family or {{org_field_name}}, staff must record what is present and seek instructions before removal. Equipment must not be removed where it may be relevant to an investigation.

6. Reporting the Death

6.1 Internal Reporting

Staff must immediately inform the Registered Manager or senior on-call person of any death of a service user, whether expected or unexpected. The staff member must complete an incident report before the end of the shift wherever possible and must ensure that the care record is factual, timed, dated and signed.

The incident report must include:

The Registered Manager must review the incident report, care notes, visit logs, risk assessments, care plans, MAR charts, rotas, communication records and any relevant electronic monitoring records to decide whether further investigation, safeguarding referral, CQC notification, commissioner notification, Duty of Candour action or staff debrief is required.

6.2 External Reporting

The Registered Manager is responsible for ensuring that all statutory and contractual notifications are completed accurately, honestly and without delay. Where the Registered Manager is unavailable, the senior on-call person must ensure notifications are made and must inform the Registered Manager as soon as possible.

CQC notification — death of a person using the service

CQC must be notified without delay where:

In supported living, this includes deaths that occur during or shortly after a care or support visit where there may be a link with personal care, medication support, nutrition, hydration, moving and handling, pressure care, infection prevention, observation, missed or late calls, staff action, staff omission, risk management or any other aspect of the regulated service.

CQC notifications must be submitted through the CQC provider portal or other CQC-approved route as soon as possible and without delay. A copy of the notification and confirmation/reference number must be retained in the service user’s records and the provider’s incident/notification log.

Safeguarding notification

The local authority safeguarding adults team must be contacted immediately where there is any concern or allegation that abuse, neglect, organisational abuse, self-neglect, omission, acts by staff, acts by others, medication error, unsafe discharge, missed care, poor risk management or failure to follow the care plan may have contributed to the death.

Police and coroner

Police must be contacted immediately via 999 where the death is suspicious, violent, unexplained, accidental, potentially self-inflicted, linked to injury, possible neglect, abuse, medication error, fire, equipment failure or any other circumstance requiring emergency or criminal investigation. Staff must cooperate with police, coroner and medical examiner requests and must not interfere with evidence.

Medical examiner

Where a medical examiner requests factual information about the care provided before death, the Registered Manager or delegated senior person must respond promptly and accurately, within confidentiality and data protection requirements. Any concern raised by the medical examiner must be treated as a governance concern and reviewed under this policy and the Incident Reporting and Management Policy.

Integrated Care Board, commissioner or local authority contracts team

The relevant Integrated Care Board, local authority commissioner, NHS commissioner, case manager or funding body must be informed where required by contract, where the person received NHS-funded care, jointly funded care or commissioned local authority support, or where there are safeguarding, quality, risk or continuity concerns.

Duty of Candour

Where the death is, or may be, a notifiable safety incident, {{org_field_name}} must follow the Duty of Candour Policy. This includes informing the relevant person as soon as reasonably practicable, providing a truthful account of known facts, offering an apology, giving reasonable support, recording the discussion, providing written follow-up and sharing the outcome of any investigation where appropriate.

6.3 Duty of Candour Following a Death

The Registered Manager must consider Duty of Candour following every unexpected, unexplained or potentially care-related death. Duty of Candour applies where a notifiable safety incident has occurred. In adult social care, this may include a death that may have resulted from the care or treatment provided, or from acts, omissions, delays or failures in the regulated activity.

Where Duty of Candour is triggered, {{org_field_name}} must:

An apology under Duty of Candour is an expression of sorrow or regret and does not, by itself, amount to an admission of liability.

Where there is uncertainty about whether Duty of Candour applies, the Registered Manager must seek advice from the nominated individual, provider governance lead, insurer, legal adviser or safeguarding/commissioning lead as appropriate, but must not delay taking urgent steps to keep people safe, preserve evidence or notify CQC where required.

7. Supporting Families, Staff, and Other Service Users

7.1 Informing and Supporting Families and Representatives

A senior member of staff must contact the person identified in the care record as the emergency contact, family contact, next of kin, attorney, deputy, executor, advocate or other relevant representative, unless police, coroner, medical examiner or safeguarding professionals advise otherwise.

Staff must communicate with sensitivity, compassion and professionalism. Staff must avoid speculation about the cause of death and must only share factual information that is known and appropriate to disclose. Where the cause of death is unknown, staff must explain that this will be considered through the appropriate medical certification, medical examiner or coroner process.

Staff must check the person’s care plan, advance care plan, cultural plan, religious/spiritual preferences and any recorded wishes about who should be contacted, who should not be contacted, funeral preferences, handling of the body, personal possessions, pets, tenancy matters and information sharing.

Staff must offer reasonable emotional and practical support, including signposting to bereavement services, the GP, local authority, funeral director, medical examiner office, coroner’s office or advocacy services where appropriate. Staff must not make funeral arrangements, dispose of property, hand over medicines, close accounts, surrender keys or make tenancy decisions unless this has been authorised by the appropriate lawful person and agreed by the Registered Manager.

7.2 Supporting Other Service Users

The Registered Manager must assess whether other service users may be affected by the death, particularly where they lived with the person, witnessed the incident, were close to the person, or may be distressed, confused or at risk.

Information shared with other service users must be respectful, factual, proportionate and confidential. Staff must not share personal, medical, safeguarding or investigation details. Communication must be adapted to the person’s needs, including easy-read, pictorial, communication aids, interpreter support, advocate involvement or family involvement where appropriate and lawful.

Where appropriate, staff may support remembrance activities in line with the deceased person’s known wishes, the wishes of those affected, cultural and religious considerations, and the privacy of the family or representative.

7.3 Staff Support, Debrief and Professional Accountability

Staff involved in or affected by a death must be offered a timely debrief and appropriate emotional support. This may include supervision, reflective discussion, access to the Employee Assistance Programme, occupational health support or signposting to external bereavement support.

Where a death is unexpected, traumatic, suspicious, safeguarding-related or subject to investigation, the debrief must not compromise evidence, influence witness accounts or replace formal investigation processes. Staff may be asked to provide factual statements. Managers must ensure staff understand the difference between emotional support, reflective learning and formal investigation.

Where staff practice concerns are identified, these must be addressed through supervision, training, competency review, disciplinary procedure, safeguarding procedure or referral to the Disclosure and Barring Service or professional regulator where required.

8. Handling Personal Belongings, Property, Money and Keys

Staff must treat the deceased person’s belongings, money, documents, keys, medicines, aids, equipment and home with respect and must remember that supported living accommodation is the person’s home.

A full inventory must be completed by two staff members wherever possible. The inventory must include valuables, cash, bank cards, documents, keys, medicines, equipment, mobility aids, communication aids and items of sentimental value. The inventory must be dated, signed and stored securely. Photographs may be taken where appropriate and lawful.

Personal property must only be released to a person with appropriate authority, such as an executor, administrator, attorney acting within lawful authority, deputy, family member authorised by the estate, or another person confirmed by the Registered Manager as appropriate. Staff must record the name, relationship, identification where appropriate, date, time and signature of the person receiving items.

Staff must not dispose of, donate, sell, remove or hand over property where there is any dispute, uncertainty, safeguarding concern, police investigation, coroner involvement, tenancy issue or estate issue. In such cases, the Registered Manager must seek advice from the landlord, commissioner, local authority, police, coroner, legal representative or other relevant body as appropriate.

Unclaimed property must be managed in accordance with {{org_field_name}}’s property procedure, tenancy arrangements, estate law considerations and any legal or contractual requirements. Disposal must only occur following documented management authorisation and after reasonable steps have been taken to identify and contact the lawful representative.

9. Record-Keeping, Confidentiality and Information Sharing

All records relating to the death must be accurate, factual, complete, contemporaneous, dated, timed, signed and stored securely. Records must include care notes, incident reports, body maps where relevant, risk assessments, care plans, MAR charts, communication logs, visit logs, electronic call monitoring data, professional contacts, family contacts, notifications, safeguarding referrals, Duty of Candour records, investigation records, debrief notes and learning actions.

Records must not be altered, deleted, backdated or amended in a way that obscures the original entry. If a correction is needed, it must be clearly marked as a correction, dated, timed, signed and explained.

Confidentiality continues after death. Information about the deceased person must only be shared where there is a lawful basis, legitimate need, consent from an appropriate lawful representative where required, safeguarding reason, statutory requirement, contractual requirement, police/coroner/medical examiner request, CQC requirement or other lawful justification.

Requests for access to records after death must be referred to the Registered Manager and handled in accordance with the Access to Health Records Act 1990, Data Protection Act 2018, UK GDPR and {{org_field_name}}’s Record Keeping and Access to Records Policy.

The Registered Manager must ensure that all notifications, reference numbers, emails, letters and professional advice are retained in the person’s record and in the provider’s central incident and notification system.

9.1 Investigation, Learning and Governance Following a Death

The Registered Manager must review every death of a service user to determine whether the death was expected, unexpected, unexplained, potentially care-related, safeguarding-related, subject to Duty of Candour, subject to CQC notification, or requiring further internal investigation.

The review must consider:

Learning from deaths must be reviewed through management meetings, quality assurance processes and provider governance systems. Actions must be recorded, allocated to a responsible person, given a completion date and checked for effectiveness.

10. CQC Compliance and Legal Framework

This policy supports compliance with the Health and Social Care Act 2008 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including:

This policy also supports compliance with the Care Quality Commission (Registration) Regulations 2009, including:

{{org_field_name}} will also comply with relevant requirements under the Care Act 2014, Mental Capacity Act 2005, Equality Act 2010, Data Protection Act 2018, UK GDPR, Access to Health Records Act 1990, Notification of Deaths Regulations 2019 and Medical Certificate of Cause of Death Regulations 2024.

10.1 Supported Living Specific Considerations

In supported living, staff must recognise that the service user’s accommodation is their own home. Staff must not treat the property as provider-controlled premises unless {{org_field_name}} has a specific housing management role.

Following a death, staff must consider:

Staff must not enter the person’s home after death unless there is a lawful reason, management authorisation and a clear record of the purpose of entry. Where access is needed for safeguarding, police, coroner, medical examiner, property security, medicines, equipment or welfare reasons, staff must record who entered, when, why and what action was taken.

10.2 Training and Competency Requirements

Staff must receive training appropriate to their role in:

The Registered Manager must ensure staff competency is reviewed through induction, supervision, spot checks, incident reviews, team meetings and learning from deaths.

11. Policy Review

This policy will be reviewed annually, or sooner where there are changes to legislation, CQC guidance, death certification requirements, safeguarding procedures, commissioner requirements, operational practice or organisational learning.

The policy must also be reviewed following any death that identifies a gap in procedure, record keeping, communication, staff training, safeguarding, Duty of Candour, CQC notification, emergency response or supported living practice.

The Registered Manager is responsible for ensuring that staff are informed of changes to this policy and that training, templates and local procedures are updated accordingly.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.

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