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Registration Number: {{org_field_registration_no}}

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Death of a Service User Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} responds to the death of a service user in a dignified, compassionate, person-centred and legally compliant manner. This policy sets out the actions staff must take when a service user dies, including recognising an apparent death, obtaining appropriate medical assistance, verification of death, preserving evidence where a death is unexpected, suspicious or unexplained, notifying relatives and representatives, notifying Care Inspectorate Wales (CIW), supporting the Medical Examiner and coroner processes, safeguarding personal belongings, maintaining accurate records, and supporting staff and other service users following the death.

This policy supports compliance with the Regulation and Inspection of Social Care (Wales) Act 2016, the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, the Social Services and Well-being (Wales) Act 2014, the Mental Capacity Act 2005, data protection legislation, the statutory Medical Examiner system for England and Wales, and relevant CIW notification requirements.

2. Scope

This policy applies to all staff, including care workers, nurses, managers, and administrative personnel, as well as any external professionals involved in end-of-life care and post-death procedures. It covers:

• Recognition and verification of death.
• Immediate actions following a service user’s passing.
• Notifying appropriate authorities and next of kin.
• Handling personal belongings and documentation.
• Providing bereavement support to staff and service users.
• Compliance with legal and regulatory reporting requirements.

• Advance care planning, end-of-life wishes, DNACPR documentation, advance statements, advance decisions and Lasting Power of Attorney for health and welfare, where applicable.
• Medical Examiner scrutiny and death certification processes.
• CIW notification of the death of an individual and the circumstances.
• Coroner, police and safeguarding escalation where a death is unexpected, unexplained, suspicious, related to an incident, or raises concerns about abuse, neglect or improper treatment.
• Duty of candour and open communication with relatives, representatives and relevant professionals.
• Record retention and secure storage of records following the death.

3. End-of-Life Planning Before Death

Where a service user is approaching the end of life, {{org_field_name}} will ensure that their personal plan reflects their wishes, preferences, needs and personal outcomes. This will include, where applicable:

• the service user’s preferred place of care and preferred place of death;
• cultural, religious, spiritual and personal wishes;
• the people the service user wishes to be contacted or present;
• advance statements and advance decisions;
• DNACPR documentation, where in place;
• details of any Lasting Power of Attorney for health and welfare, court-appointed deputy, appointee, advocate, representative or next of kin;
• arrangements for palliative care, anticipatory medicines and pain or symptom management;
• communication needs, including Welsh language needs and accessible information requirements;
• any relevant safeguarding, deprivation of liberty, mental capacity or best-interest considerations.

Staff must ensure that end-of-life information is reviewed when the service user’s needs change and that the service user, their representative, GP, community nursing team, palliative care team, local Health Board professionals and commissioners are involved as appropriate.

The service user must be supported to remain in the care home at the end of life where this is their wish and where this can be safely achieved, unless there is a clinical reason why this should not occur.

4. Recognition of Apparent Death and Verification of Death

If a service user is found unresponsive, staff must act immediately and in accordance with their training, the service user’s care plan, end-of-life plan, DNACPR documentation where applicable, and local clinical procedures.

Staff must:

• call for urgent medical assistance unless the death is expected and there is an agreed local end-of-life procedure in place;
• call 999 immediately where there is any doubt, trauma, accident, choking, fall, attempted resuscitation, suspicious circumstance, unexpected deterioration, or concern that the death may be unnatural;
• commence first aid or cardiopulmonary resuscitation where appropriate and where there is no valid DNACPR or other lawful instruction indicating otherwise;
• inform the nurse in charge, senior staff member and Registered Manager immediately;
• preserve the scene and avoid moving the body where the death is unexpected, unexplained, suspicious, related to an accident or incident, or where police or coroner involvement may be required;
• record the time the service user was found, the staff present, the circumstances, observations made, action taken, and the names and times of professionals contacted.

Verification of death must only be completed by an appropriately authorised healthcare professional in line with local Health Board, GP, community nursing, ambulance service or organisational arrangements. Care staff must not state that death has been verified unless this has been completed by an authorised professional.

Verification of death is separate from certification of the cause of death. Certification and registration must follow the statutory death certification and Medical Examiner process or coroner process, as applicable.

5. Immediate Actions Following Verification of Death

Once death has been verified, staff must continue to treat the deceased person with dignity, privacy and respect. Staff must:

• notify the Registered Manager or delegated senior person immediately;
• confirm whether the death was expected or unexpected;
• check the personal plan, end-of-life plan and any recorded wishes regarding cultural, religious, spiritual or personal care after death;
• ensure the deceased person is cared for respectfully and prepared in accordance with their wishes, unless the death is unexpected, unexplained, suspicious or subject to police or coroner direction;
• ensure the body is not moved where police or coroner involvement is required, unless instructed by emergency services or required to preserve life or safety;
• contact the next of kin, representative, advocate, attorney or other nominated person in a compassionate and sensitive manner, unless police, coroner or safeguarding instructions require a different approach;
• offer relatives or representatives the opportunity to attend, view the deceased and spend time with them where appropriate;
• support staff, other service users and visitors who may be affected by the death;
• secure medicines, records, valuables and personal belongings;
• begin the death record and notification log.

Where the death is expected, staff must follow the agreed end-of-life plan and local clinical arrangements. Where the death is unexpected, unexplained, suspicious, related to an accident or incident, or where there are concerns about abuse, neglect or improper treatment, staff must escalate immediately to the Registered Manager, emergency services, GP or relevant healthcare professional, police, local authority safeguarding team and coroner route as appropriate.

6. Notifications and Reporting Requirements

All deaths of service users living in the care home must be reported in accordance with CIW, safeguarding, medical, coroner and organisational requirements.

The Registered Manager, or delegated senior person, must ensure that the following are notified as applicable:

• GP or relevant medical practitioner: to support verification, certification and referral through the Medical Examiner or coroner process.
• Medical Examiner Office: for scrutiny of all non-coronial deaths in line with the statutory Medical Examiner system.
• Coroner: where the death is unexpected, unexplained, suspicious, violent, unnatural, related to an accident, related to an incident, may be due to neglect, may be due to an industrial disease, occurred during or following a deprivation of liberty concern, or where a medical practitioner cannot certify the cause of death.
• Police: where the death is suspicious, unexplained, traumatic, potentially criminal, linked to abuse or neglect, or where emergency services advise police attendance.
• Next of kin, representative, attorney, advocate or nominated person: in line with the service user’s wishes, best interests and any police or coroner instructions.
• Care Inspectorate Wales: the death of an individual in a care home where accommodation is provided, and the circumstances, must be notified without delay and in writing using the method required by CIW, normally through CIW Online.
• Commissioner or placing authority: where the service user is funded, placed or commissioned by a local authority or Health Board, or where the contract requires notification.
• Local authority safeguarding team: where there is any concern that abuse, neglect, improper treatment, omission, poor care, unexplained injury or organisational failure may have caused or contributed to the death.
• Health Board, community nursing team, palliative care team or other professionals: where involved in the service user’s care.
• Funeral director: only when authorised by the next of kin, representative, executor, attorney or appropriate legal person, and after any police, coroner or Medical Examiner requirements have been followed.

All notifications must be recorded, including:

• date and time of notification;
• name, role and organisation of the person contacted;
• method of contact;
• information shared;
• advice or instructions received;
• name of the staff member completing the notification;
• follow-up actions required.

7. Medical Examiner and Death Certification Process

From 9 September 2024, all deaths in England and Wales that are not referred to a coroner must receive independent scrutiny by a Medical Examiner before the death can be registered.

{{org_field_name}} will co-operate fully with the Medical Examiner Office, GP, attending practitioner, coroner, registrar and other relevant professionals. Staff must provide accurate factual information when requested, including care records, medication records, incident records, end-of-life documentation, body maps, falls records, safeguarding records, DNACPR documentation, communication logs and details of any concerns raised by staff, relatives or professionals.

Staff must not advise relatives that a death can be registered until the required Medical Examiner or coroner process has been completed and the appropriate certification has been issued.

Relatives and representatives must be supported sensitively and given clear information about who will contact them, including the GP, Medical Examiner Office, coroner’s office, registrar or funeral director, as applicable.

8. Unexpected, Suspicious or Safeguarding-Related Deaths

A death must be treated as requiring urgent escalation where it is unexpected, unexplained, suspicious, violent, unnatural, related to an accident or incident, follows a fall, choking episode, medication error, pressure damage, infection outbreak, restraint, possible neglect, possible abuse, self-harm, absconding, or any other event that may have caused or contributed to the death.

In these circumstances staff must:

• call 999 where emergency assistance is required or where the death is suspicious, traumatic or unexplained;
• preserve the scene and avoid moving the body or disturbing the room unless required for safety or instructed by emergency services;
• retain all relevant records, including daily notes, medication records, charts, food and fluid records, turning charts, falls records, incident forms, body maps, wound care records, hospital discharge information, communication logs and staff rota information;
• inform the Registered Manager and Responsible Individual without delay;
• notify CIW without delay;
• make a safeguarding referral where abuse, neglect, omission, improper treatment or organisational failure may have caused or contributed to the death;
• follow police, coroner, safeguarding and CIW instructions;
• ensure staff involved provide factual statements where requested;
• ensure the duty of candour is followed with relatives and representatives, unless this would compromise a police, coroner or safeguarding investigation.

No member of staff must speculate about the cause of death or make statements of blame. Staff must record and report facts accurately, honestly and promptly.

9. Duty of Candour and Communication with Relatives

{{org_field_name}} will act in an open, honest and transparent way with service users, relatives, representatives, commissioners, CIW and other relevant agencies.

Where a death follows an incident, concern, complaint, safeguarding matter, error, omission or unexpected event, the Registered Manager or Responsible Individual must ensure that relatives or representatives are given:

• a sincere expression of condolence;
• clear factual information about what is known at the time;
• information about any immediate actions taken;
• information about any investigation, safeguarding referral, coroner referral, CIW notification or Medical Examiner process;
• an apology where appropriate;
• the name and contact details of a person they can speak to;
• information about how to raise concerns or make a complaint.

Communication must be recorded accurately. Staff must not withhold relevant information, falsify records, discourage concerns, or obstruct another person from raising concerns.

10. Personal Belongings, Valuables and Property

The deceased person’s belongings must be handled respectfully, securely and in accordance with the service user’s wishes, legal requirements and organisational procedures.

Staff must:

• complete a full inventory of belongings and valuables as soon as practicable;
• ensure the inventory is checked and signed by two staff members;
• record jewellery, cash, bank cards, keys, documents, mobility aids, dentures, glasses, hearing aids, electronic devices, clothing, furniture and any other items of value or significance;
• store valuables securely until they are collected by the legally authorised person;
• ensure medicines are managed in accordance with the medication policy and not handed over unless legally appropriate;
• obtain signed confirmation when property is collected;
• record the name, relationship, contact details and proof of identity of the person collecting belongings;
• seek advice where there is a dispute about who is entitled to collect property.

Belongings must only be released to the next of kin, executor, legal representative, attorney, administrator of the estate or other authorised person. Where there is uncertainty, the Registered Manager must seek advice before releasing items.

11. Bereavement Support for Staff and Service Users

The death of a service user can impact staff and fellow residents. {{org_field_name}} provides:

• Support and debriefing for staff who may require emotional support following a service user’s passing.
• Counselling referrals for staff struggling with grief.
• Compassionate communication and emotional support for other service users affected by the death.
• Memorial arrangements if appropriate, including remembrance services or gatherings.

Bereavement support must be proportionate to the circumstances of the death and the needs of those affected. The Registered Manager must consider:

• whether other service users need information, reassurance or emotional support;
• whether any service user requires advocacy, family contact, faith support, counselling or GP involvement;
• whether staff require debriefing, supervision, counselling, occupational health support or time away from duties;
• whether the death has affected staffing levels, morale or the safety of the service;
• whether any learning should be shared through team meetings, supervision, audit or quality assurance processes.

Any memorial, remembrance activity or communication with other service users must respect confidentiality, the wishes of the deceased person, the wishes of relatives or representatives, and the emotional needs of others living in the home.

12. Records Following the Death of a Service User

A full and accurate record must be completed following every death. Records must include:

• the date, time and place the service user was found;
• the name of the staff member who found the service user;
• the circumstances in which the service user was found;
• whether the death was expected or unexpected;
• details of end-of-life plans, DNACPR documentation, advance decisions, advance statements or Lasting Power of Attorney, where applicable;
• observations and action taken by staff;
• whether emergency services were contacted;
• the name, role and organisation of the person who verified death;
• the time death was verified;
• details of GP, Medical Examiner, coroner, police, safeguarding, CIW, commissioner and family notifications;
• CIW notification reference number or confirmation;
• details of any incident, accident, safeguarding concern, complaint or investigation linked to the death;
• personal care provided after death;
• cultural, religious or spiritual arrangements followed;
• belongings and valuables inventory;
• property handover receipt;
• funeral director details, where known;
• staff involved;
• management review and learning actions.

Records relating to adults must be retained securely for at least three years from the date of the last entry. Records relating to children must be retained securely for at least fifteen years from the date of the last entry, unless returned to the placing authority where required. Records must be stored securely and processed in accordance with UK GDPR, the Data Protection Act 2018 and organisational confidentiality procedures.

13. Management Oversight, Audit and Learning

The Registered Manager is responsible for ensuring that this policy is implemented following every death. The Responsible Individual must maintain oversight of deaths, notifications, safeguarding concerns, complaints, duty of candour issues and learning arising from deaths.

Following each death, the Registered Manager must review:

• whether the service user’s personal plan and end-of-life wishes were followed;
• whether medical, family, CIW, commissioner, safeguarding, police, coroner and Medical Examiner notifications were completed correctly;
• whether records were accurate, timely and complete;
• whether belongings and valuables were managed safely;
• whether staff and other service users received appropriate support;
• whether the death followed any incident, concern, complaint, fall, pressure damage, infection, medication issue, choking episode, restraint, safeguarding matter or change in need;
• whether any policy, training, staffing, care planning, communication or record-keeping improvements are required.

Deaths, themes, learning and improvement actions must be included within the service’s quality assurance and governance arrangements, including audits, supervision, staff meetings and quality-of-care review processes where relevant.

14. Related Policies

This policy should be read alongside:

• CHW07 – Person-Centred Care Policy
• CHW11 – Safe Care and Treatment Policy
• CHW16 – Health and Safety at Work Policy
• CHW34 – Confidentiality and Data Protection Policy
• CHW42 – Communication and Engagement with Service Users and Families Policy

• Safeguarding Adults and Children Policy
• Duty of Candour Policy
• End-of-Life Care Policy
• Mental Capacity and Deprivation of Liberty Safeguards Policy
• DNACPR and Advance Care Planning Procedure
• Medication Management Policy
• Incident Reporting and Investigation Policy
• Notification to CIW Policy
• Record Keeping and Records Retention Policy
• Complaints Policy
• Whistleblowing Policy
• Personal Property, Money and Valuables Policy
• Infection Prevention and Control Policy
• Falls Prevention and Management Policy
• Pressure Damage Prevention and Management Policy

15. Policy Review

This policy will be reviewed at least annually, or sooner where there are changes to legislation, Welsh Government guidance, CIW requirements, Medical Examiner arrangements, coroner requirements, safeguarding procedures, local Health Board procedures, organisational structure, or learning from an incident, complaint, safeguarding referral, inspection, audit or death.

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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}}
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