Sally Lewis Inquest: Julie McGirr

The last witness to give evidence on Day 2 of Sally’s inquest was Julie McGirr, a previous employee of Dimensions. She told the coroner that at the time of Sally’s death she was employed by Dimensions UK as a Locality Manager and in that role she was responsible for overseeing a number of Supported Living services. She no longer works for Dimensions.

The sound remained difficult, although not as bad as some previous witnesses but this will remain very much a partial account. The coroner asked what overseeing those services meant and she said that she was responsible for overseeing the management of the staff team, for making sure that they had sufficient staffing, that staff were up to date with their training, recruiting new staff, adding “there’s quite a lot in the role, a number of things I was responsible for”.

C: Do you recall, if you need to refer to your statement please do. Do you recall how many different services you were managing at the time?

JMcG: According to my statement I was managing 6 services, possibly some registered care services as well

C: At The Dock, there were 3 residents. Were other services of a similar size?

JMcG: I believe 3 services were individual services with just one person living in those services, from memory, possibly trying to think which services were, they changed often. Possibly another service with 5 people and another with 3 people. All spread over Redditch, Bromsgrove and Kidderminster

C: In terms of staff, how many staff do you think you were managing, roughly over those six?

JMcG: It’s quite difficult to track…[can’t hear] maybe 40 staff

C: Certainly in your statement you talk about managing around 40 to 50 people and 11 people supported by Dimensions. Does that sound about right?

JMcG: Yes

Asked if she was responsible for training, she said she was. Asked if she was responsible for arranging the training, she said that a lot of it was electronic, it was e-modules to complete and she listed some training staff had to undertake “it was a lot of areas, was training around epilepsy, hygiene, health and safety”. Asked by the coroner if it was her responsibility to ensure that staff had completed the requisite amount of training required for their roles, she told the court that staff were made aware of the requirements in induction. Asked if she’d have checked they’d done it she said that it’s going back a few years now but she believed she got an electronic account of staff training records and she’d have been alerted by her managers if there was a concern.

C: That’s what I was going to ask you next, you say when you first recruit people you would check what training they had and what they need to do? Some falls out of date and has to be renewed, was that your responsibility?

JMcG: It was personal responsibility of staff that they kept training up to date. Was part of my supervision of those staff, the question would be asked and I’d check that with them when I met with them.

C: So yes, it was your ultimate responsibility to make sure they were up to date with their training, is that fair?

JMcG: As I say, it was part of my role to make sure staff were up to date, but sometimes if staff were on maternity or off sick it may go out of date

C: You’ve described a couple of areas training would cover, was their training in place dealing with bowel issues and constipation?

JMcG: There was no training as far as I’m aware

C: Can I ask why not?

JMcG: You maybe need to ask the provider organisation, it was something that wasn’t asked of, it wasn’t something Dimensions were asking staff to complete

C: As a locality manager, as we’ve heard, one of your residents at one of your places had significant bowel issues didn’t she?

JMcG: I’m aware of that now

C: You weren’t aware of that at all at the time?

JMcG: No

C: Not at all?

JMcG: No, I wasn’t aware

C: If you had been aware that Sally was someone with bowel issues, regular constipation, on medication, do you think that your staff should have had training to be aware of that and know how to deal with it?

JMcG: Yes [fuller answer – can’t hear]. Yes I think that is something that is now in place, for similar staff teams

Ms McGirr couldn’t recall when she first came across Sally but she told the court she’d known Sally when she lived at Stourbridge Road.

C: How often once Sally was at The Dock, how often would you see her?

JMcG: Again without looking at my calendars from that time, I’d find it really difficult to pinpoint

C: How often would you visit The Dock yourself?

JMcG: Possibly once a week, might not be as frequently as that. When Sally moved to the dock, it had been de-registered so it became a Supported Living service, so the focus was, there wasn’t an office. Much of my role was office based and being in front of a computer, so I’d often go there to see staff and complete supervision or have team meetings.

C: Am I right in thinking that none of the staff who worked regularly at The Dock were trained nursing staff?

JMcG: No

C: Now in Sally’s case we know she had learning difficulties, we know she had mental health issues, she was on an anti-psychotic medication among other things, and we know she was on regular medication for constipation. How did you satisfy yourself that the staff you were employing, supervising at The Dock were able to deal with those issues and the medication?

JMcG: Medication training there would be patients, staff, administering medication carried out either by myself or the Assistant Locality Manager and we’d observe their practice [fuller answer – can’t hear]

Sorry could you repeat the first part of your question.

C: Yes. How would you ensure given what we know about Sally and the challenges she presented, your staff could deal with Sally and the medication?

JMcG: They were a very experienced staff team. Some of the staff had known Sally longer than I had, were more expert in her needs than I was. They were the people watching her every day, supporting with her personal care. I met with her staff regularly and relied upon them feeding back to me if they had any concerns.

The coroner asked Ms McGirr to turn to a document in the bundle and asked her if she recognised the document, she did. Asked to explain what the purpose of the document was she gave an answer I couldn’t hear. Asked by the coroner who was responsible for drawing up the document she said that initially she didn’t know “it would have been the whole team I suppose, with the focus being on key workers to take the lead in collating the information within it”.

The coroner took her to the end of the document which had her name on it. She agreed it was her name and asked why she flicked through the document before saying it had been a number of years and then giving an answer which I couldn’t hear. She said that there had been a previous version of the document, a plan put in place by someone called Jenny who was a behaviour analyst employed by Dimensions, and she thought “I along with the key worker felt that we maybe needed to change the format of that document in order to make it more user friendly”. Asked again by the coroner she accepted that she’d taken some responsibility for revising the document.

JMcG: For revising it

C: Yes, for that current version?

JMcG: Yes

C: One of the sections, page 148 concerns toileting doesn’t it? So, can I take it you were aware there were some issues sometimes Sally had with toileting?

JMcG: The issues I was aware of was incontinence. Sally was supported to wear incontinence pads, had gone incontinent of urine… [fuller answer – can’t hear]

C: So when we read this but hear about toileting, that wasn’t drawn up with her constipation issues in mind?

JMcG: I don’t think so, no

C: Alright. Can you now turn back to tab number 1 please, health action plan, a document you’re familiar with?

JMcG: I am familiar with the template

C: What about Sally’s own health action plan? Would you have read that at some point?

JMcG: It’s hard to say, is a few years ago

C: As Locality Manager did you make a habit of reading your resident’s Health Action Plans? Did you think it was important that you should?

JMcG: [Can’t hear]

C: If you turn please to page 24 can see what’s written at bottom of that page is ‘I need help with my bowel function, I take Laxido daily’.

That sets out, if date is as on the front June 2015, as early as June 2015 is a document spelling out Sally has issues with her bowel function, that’s what it shows isn’t it?

JMcG: Yes

C: Can I take it then as Locality Manager you were aware Sally had issues with her bowel function?

JMcG: [Can’t hear]

C: Do you think it’s likely, given your usual practice of reading the documents, you would have been aware of it?

JMcG: There are so many documents we were involved with every day, I can’t recall

C: I’m not asking you to recall specifically whether you read this document, you’ve said “I’d like to think as Locality Manager I would have read my service user’s support plans and Health Action Plans”. If that’s right, do you think it’s likely at some point you would have read this document and would have been aware Sally had issues with her bowels?

JMcG: It is likely

C: If you’d read this document, I need help with my bowel function, what measures would you have put in place, should you have put in place, to assist with that?

JMcG: There’s been a lot of work done since this incident… making sure bowel charts are in place, that protocol around PRN medication

C: We’ll come to what’s changed since. At the time?

JMCG: Would have been regularly monitoring of Sally’s bowels and would have been recorded in her support plan

C: So you’d have expected, at the time, a service user with these sorts of problems to have had regular monitoring of their bowel movements?

JMcG: Yes

C: How would that be achieved and how would it be recorded?

JMcG: I believe there was a standard template that was used, but there were bowel charts, it wasn’t the Bristol Stool Chart but was a chart ticked if there had been a bowel movement

C: So you’d have expected Sally’s bowel movements to be recorded?

JMcG: Yes

In response to a question from the coroner she said that it would have been obvious on the bowel charts whether a bowel movement had happened so she didn’t believe at that point there was recording if someone hadn’t had a bowel movement.

C: Alright this is, these are actions you would have expected at the time someone to take, for someone with Sally’s bowel issues? Regular monitoring of her bowel movements and recording of her bowel movements?

JMcG: Yes

C: In terms of recording, not only when they happened but what stool was like, how large, what consistency, that sort of thing?

JMcG: Yes

C: You say this is what you would have expected to happen, whose responsibility would it have been to ensure something was in place so staff could monitor and record Sally’s bowel movements?

JMcG: Key Workers were generally people who’d support people to appointments, looking over those records, I would have offered support if I’d been made aware but generally as I say Key Workers would ensure that was taking place

C: So the Key Workers would know, would they? That someone like Sally had issues with bowel movements? They’d know they should have in place charts and a system so they could monitor and record Sally’s bowel movements?

JMcG: I would have hoped so

C: You say would have hoped so, how would Key Workers have known that was part of their responsibility?

JMcG: It was part of their induction.

Ms McGirr told the coroner that Sally’s staff were experienced “this was a team of staff with previous knowledge before me, this wasn’t a team of staff who haven’t got experience”.

C: Do you yourself, did you at the time, understand the potentially serious consequences of severe constipation? Did you understand severe constipation could be a serious health condition?

JMcG: [Can’t hear]

C: You did know that?

JMcG: I think there has been a huge change in not just within our organisation but within others, in learning disabilities team. There’s much more, it’s been talked about a lot more, colleagues are out there trying to alert people to these risks, I think prior to this I’m not sure it was, nobody anticipated, I didn’t anticipate that this would happen to Sally.

C: From what you’re saying, you appreciated at the time, you understood severe constipation could lead to serious health issues?

JMcG: Yes

C: You understood the process, you realised how that could happen?

JMcG: Yes

C: Do I take it that you accept was no clear system in place at The Dock at the time, to deal with this situation and manage it properly?

JMcG: I don’t think there was a clear system across the whole organisation. Following this incident, the changes that Dimensions asked myself and every Locality Manager within our region to implement, showed that there wasn’t a clear system in place.

The coroner then took Ms McGirr to another document in the bundle. She said that she recognised the document as medication administration records, MAR charts. She described their purpose as to say what medication, and what times, people required medication administering to them.

C: As the Locality Manager did you make it your job to ensure you were familiar with these documents for your service users?

JMcG: Being clear of medication administration records wasn’t something I, like I said previously, I was present within that service maybe once a week, I wasn’t administering medication when I was there, the staff team were responsible for ordering prescriptions from the GP and liaising with the pharmacy and checking those in and administering them.

C: Alright, I’m looking at paragraph 12 of your statement, you say this:

“If I had been aware that there had been issues surrounding Sally’s bowels I would have considered whether further guidance could have been incorporated within her support plan”.

If you’d read these documents you’d have been aware she was on regular medication for her bowel movements wouldn’t you?

JMcG: Yes, but as I say, it wasn’t, I was managing a number of services, I relied on those staff teams who, to feed back… as I say I wasn’t in that service, I wasn’t administering medication myself. A number of people we supported, I couldn’t tell you what medications each of those people were taking.

The coroner then took Ms McGirr to a record of the medications given to Sally.

C: One medication played a prominent part in medication so far, Laxido, described as PRN medication, to be taken as required. Purpose written there to take one sachet daily when required to try to get one soft daily motion, ok?

JMcG: Yes

C: How would staff have been able to ensure that medication was given appropriately? How would they have known when it should be given, how long should be given for, or the state of Sally’s stools?

JMcG: Following this, now been implemented…

C interjected: I know what’s been implemented now. I’m trying to understand how on earth would staff have been able to implement all of that?

JMcG: If they weren’t monitoring Sally’s bowels they wouldn’t have been able to.

C: We heard evidence from Sally’s Key Worker this morning that no-one checked bowel movements, that Sally’s behaviour was quite challenging and it wasn’t done, no-one checked bowel movements. Are you surprised to hear that?

JMcG: [Can’t hear] For me, as said previously, I wasn’t aware of the significant issue for Sally, as I say, knowing the staff team were aware, it shocks me that they weren’t monitoring her bowels.

C: The evidence we’ve heard from the staff team seems to be they didn’t realise what to do or how to do it. Suggests they’d not been given enough guidance about this issue, would you agree with that?

JMcG: [Can’t hear]

C: I mean, if in fact you had given them guidance and you feel they should have known what to do, this is your opportunity to say that. Did your staff have that kind of guidance?

JMcG: The support plan was in place prior to me being there as the Manager, I would have expected my predecessors when putting that support plan together would have identified that need and that would have been put into the support plan. As far as I was aware the support plan met Sally’s needs and the onus was on staff members to implement that support plan.

C: You say your predecessors …. how would you know that support plan was sufficient unless you’d read it yourself?

JMcG: Unless someone alerted me to that need, it wouldn’t have occurred to me that part was missing.

C: So reading this support plan where it says very clearly Sally has bowel issues, she takes Laxido medication for her bowels, and doctor’s instruction we were just looking at now?

JMcG: [Can’t hear]

C: Ok, but that’s still an important document. Do you think your staff are being fair, or honest, when they say we didn’t know we had to do anything else?

JMcG: I’d have expected an experienced staff team, who’d known Sally for the time they’d known her and supported her at GP appointments, to be aware of what they needed to implement

The coroner then took Ms McGirr to the daily notes booklet in the bundle and Ms McGirr confirmed that they’d be in bundles for each month. The coroner asked about the table at the back of the monthly records where staff could refer to additional records, including a bowel chart, Ms McGirr said she was familiar with it.

C: You were familiar with it. Did you ever say to your staff you need to ensure if you’re monitoring bowels you need to tick this to show you’ve been assessing bowel movements?

JMcG: [Can’t hear]

C: Besides this document here, were there bowel charts for staff to use to record bowel movements?

JMcG: There was a template within the organisation, I don’t recall a particular one for that service. It wasn’t the Bristol Stool Chart, but there was a template. Was developed by my predecessor.

C: So a physical chart as opposed to an electronic one?

JMcG: Yes

C: You say available within the organisation, did you at any stage ever draw attention of the staff working at The Dock to that template so they knew they could use it if they needed to?

JMcG: It’s going back a few years but I believe another person within that service was having their bowels monitored.

C: What at The Dock?

JMcG: I believe a template would have been available

C: So that template you’ve referred to being available in the organisation at large, Dimensions, was being used for another service user at The Dock?

JMcG: I believe so

C: How did you know about that?

JMcG: The Key Worker of that individual shared that with me at supervision. It was documented as part of the support plan.

C: This was someone living in the dock at the same time as Sally?

JMcG: I believe so [fuller answer – can’t hear]

C: Do you know who the Key Worker was who drew your attention to the template?

JMcG: I think it was Anne Venn.

The coroner asked if there were bowel charts on the electronic system and Ms McGirr said that it was a few years on and she couldn’t tell him. He then asked when she finished working at Dimensions and she responded in May 2019. The coroner then took Ms McGirr to another document in the bundle, the print out of the electronic bowel charts.

C: It’s a print off, particularly of a bowel chart isn’t it, it’s a bowel chart that on occasions has been completed by people hasn’t it? 21 entries in all between 1 January and the date of Sally’s death in October 2017, and some of those entries are negative entries, no bowel movement aren’t they. Is that right?

JMcG: Yes

C: Can I take it you were still the Locality Manager when the system was introduced

JMcG: I believe so, yes

C: How is it we start to have some entries on bowel charts electronically when previously don’t seem to have any records on bowel charts before it was introduced? Did you give extra training to staff?

JMcG: I believe iplanit was introduced to different services at different points and I believe The Dock was one of the first services… and I don’t believe that staff had formal training within the system and I believe there was some issues initially with it [can’t hear]

C: So, the reason they wouldn’t have been doing it previously was because there wasn’t anywhere for them to record it?

JMcG: [Can’t hear]

C: Ms McGirr you were the Locality Manager. You were in charge of these systems, responsible to make sure staff knew how to record these things weren’t you?

JMcG: I was overseeing a number of services, only so much you can achieve within the contracted hours. My role at the time was very much a managerial role, a lot of that time was spent on recruitment, facilitating team meetings, and I was hugely reliant on those members of staff coming to me and highlighting their concerns in order for me to support them.

C: Would you agree with me 21 entries over 10 months or so is totally inadequate for Sally’s needs?

JMcG: Yes.

The coroner then took Ms McGirr to another section of the bundle saying that it was an auditing sheet and it said that it was the first line manager’s responsibility to make sure daily records were checked at least once a week. The coroner asked who the first line manager was and Ms McGirr gave an answer that I couldn’t hear fully but it ended “or myself”.

C: Is it going to surprise you to hear for the records we have, daily records between June 2016 and June 2017, for a whole 12 month period, none of these auditing sheets have been completed?

JMcG: It doesn’t surprise me

C: It doesn’t surprise you. Why not?

JMcG: Didn’t allow [can’t hear]

C: How would you or anyone else be able to check these daily records were completed correctly?

JMcG: Staff at supervision, at team meetings, in general audits from Dimensions

C: How often would you have an internal audit? Once a year?

JMcG: Every 3 months [fuller answer – can’t hear]

C: But the purpose of this is to ensure once a month that people look like they’re completing, it doesn’t require you to go through with a fine toothcomb but to satisfy yourself people are completing in the way they should?

JMCG: [Can’t hear] I was basically working above my contract hours, had a number of services, I don’t believe when I first …. Went through two restructures and ended up with six services…

C: Next question. This is obviously quite an important task would you agree? To check records are being completed correctly?

JMcG: Yes

C: If you didn’t have enough hours in the day did you raise it with your manager and say I’m really worried, haven’t had time to audit these at all?

JMcG: My managers were aware of the stresses I was under, I raised it [fuller answer – can’t hear]

The coroner then moved onto the events on the day Sally died.

C: Alright, I’d like to ask you please briefly about events on 26 and 27 October 2017. Am I right in thinking on the morning of 27 October you received a phone call from Susan Casey?

JMcG: That’s right

C: What was that call about?

JMcG: She phoned to inform me two staff members due to take over from her had both phoned in sick

C: She’d been on her own, overnight duty?

JMcG: Yes

Ms McGirr said she believed she’d received that phone call at about 06:45 and that she’d called Sonia Parchment and asked her to work at The Dock that day.

C: In the case of that call did she tell you anything else about Sally?

JMcG: I believe she told me that Sally was unwell, that Sally was unwell and Sue had made the decision to sleep downstairs, because Sally was wobbly, not to support her up to her bed and to remain downstairs with Sally overnight

C: Ok. Did she say how she was at the time she called you?

JMcG: She told me she was settled

C: When Sue told you that, what did you think, what did you do?

JMcG: [Can’t hear] That Sally had had an unsettled night, I think I made some reference to Sally, see how she is this morning and if we need to book up the doctor

C: I think you a little later had another phone call, when was that?

JMcG: 8am. I received a phone call from Sonia, who sounded very distressed. She informed me that Sally had passed away and that an ambulance was at The Dock.

Ms McGirr told the coroner that when she received that phone call she drove to The Dock. He asked her when she got there if she spoke to Sue Casey, I couldn’t hear her answer, and if she spoke to Sonia Parchment.

JMcG: Staff were extremely distressed and needed some reassurance [can’t hear]. I don’t recall any specific conversations I had with Sonia other than the ambulance crew was still there at the time.

C: Last question, as an experienced carer yourself and as a Locality Manager, you’ve already accepted I think that the monitoring of someone’s bowel movements, someone like Sally with her particular issues, the recording of those movements and the provision of medication for bowel care as per the GPs instructions, those are all things that staff ought to have been able to carry out?

JMcG: I believe so

C: You believe so. Would you agree, all those things, monitoring, recording, giving medication, were what might be described as basic medical attention?

JMcG: Yes

Next Mr Clarke, for Sally’s family had the opportunity to ask Ms McGirr questions.

SC: You said you raised issues about your capacity with your line manager, was that Ms Campbell?

JMcG: Yes Julie Campbell was my Line Manager at the time

SC: What was the response of Julie Campbell and Dimensions when you raised it?

JMcG: Generally I was supported by Dimensions to look at how I could change ways of working in order to accommodate, we talked through those issues, I don’t feel that Dimensions dismissed my concerns, but [can’t hear] things that were difficult to, really challenging things, such as recruitment where there wasn’t any easy answers to those things.

SC: In response to the concerns was there any review of services you were dealing with, as to whether the checks were actually being carried out? Once you’ve raised your concern about capacity, was there any checks done by Ms Campbell or Dimensions of what was happening on the ground while you were struggling with this capacity issue?

JMcG: I believe Dimensions had a quality audit team who were often present within services who would go through records and make checks.

Ms McGirr told Mr Clarke that Sonia Parchment was a Lead Support Worker in her locality and that she was very flexible and would move to where there was a need. Asked if there was anyone specifically allocated to supervise Support Workers employed at The Dock, Ms McGirr said there wasn’t.

SC: So in relation to The Dock, in terms of that day to day supervision of Support Workers, was there anyone specifically allocated to do that?

JMcG: There wasn’t anyone specifically allocated but as I said previously the team at The Dock, I’d say were the most experienced team in my locality. They’d worked with the individuals, some very experienced Support Workers, I had huge confidence in their ability at the time.

Mr Clarke asked about the process to audit entries made on the electronic system.

JMcG: I don’t recall, it was a relatively new system that managers had got access to, but I don’t recall the auditing process of the electronic system

SC: I’ll come back to the internal quality team, I’ve not been able to find… there’s reference to an internal investigation in September 2017, do you recall whether any concerns about auditing, quality of entries, support plans were raised with you in September 2017?

JMcG: As I say I would have seen that document but I cannot tell you what was in that document or whether there were any concerns.

SC: You don’t recall anything about The Dock in 2017 audit?

JMcG: I don’t recall anything.

Mr Clarke took Ms McGirr to a document in the bundle which she said she didn’t believe was in place at the time of Sally’s death, he then took her to a further document and she responded similarly.

SC: Turning away then from training, Support Plans and Health Action Plans, in relation to your statement, signed and dated 9 January 2020, is it safe to say your memory was better then than it is today?

JMcG: Possibly

SC: Am I right?

JMcG: I believe my statement was prepared by Dimensions’s solicitors, I believe that was in December 2018.

SC: Even though you signed it in 2020?

JMcG: I don’t believe it was forwarded to me until that date, I could be incorrect, I’d left the organisation at that point.

SC: Before signing it you had chance to check the accuracy?

JMcG: I believe this was sent to me by the CQC and I was asked to sign it.

SC: Looking at paragraph 15 in particular. “Each supported person’s Support Plans were reviewed on an annual basis and I do recall that in approximately April 2017 I organised for a team day with those working at The Dock and we went through and discussed the support plans for all three of the residents at The Dock”. Now do you recall that meeting?

JMcG: I believe we, it was tagged onto a team event, as I say I don’t entirely recall. It could have been to do with the [can’t hear] I’m not entirely sure, I said to the team can we bring Support Plans, will have every team member there, ask each team member to look at each individual Support Plan and highlight any concerns or gaps they felt were there.

SC: Can you recall any issues around Sally’s constipation?

JMcG: No [fuller answer]

SC: Were there any concerns about Sally’s Support Plan you recall raised at all?

JMcG: I don’t recall any concerns.

SC: What about in relation to supervising Sally and her bowel movements, was that discussed?

JMcG: No, I don’t believe it was.

SC: We’ve heard in evidence about a decision not to supervise Sally due to her challenging behaviour, and to give her privacy, was that a decision you were aware of?

JMcG: I wasn’t aware of that decision.

SC: Do you recall being asked to give an opinion?

JMcG: I don’t recall.

SC: If the decision not to supervise was because of concerns for her privacy, is that something you should have been consulted on?

JMcG: If there were concerns about that, if staff were aware of bowel issues, then should have warranted a wider discussion with professionals, and maybe a Best Interests Decision. It was deemed that Sally had capacity to make that decision.

Mr Clarke then asked about communication with the GP but I couldn’t hear Ms McGirr’s answer. Then in response to a question she told the court that she thought the staff team would be more inclined to read Sally’s Support Plan, and that detail around what they needed to do should have been included in the Support Plan. Asked if she’d expect a record to be kept about Sally’s visit to Dr Willamson, Ms McGirr said she would expect there to be a photocopy kept in Sally’s room.

SC: Would it surprise you to know there’s no record of Sally visiting Dr Williamson for a learning disability review?

Ms McGirr said it would.

SC: Was it ever raised with you, any missing records?

JMcGL No that was never raised.

SC: Would it be fair to say it’s critical that is accurately documented?

JMcG: I’d say [can’t hear] would have been acted upon, led into Sally’s support.

SC: This is basic care Dimensions were providing to Sally?

JMcG: I’d assume they would have made those records.

SC: In terms of making those records, stored them safely and securely so they can look at them in the future?

JMcG: Yes [fuller answer – can’t hear]

No further questions from Mr Clarke. Mr Kay KC said he had two short areas to address with Ms McGirr. He started by checking that she had over 30 years experience in the nursing and care sector, she said that was correct.

DK: You’re an NVQ Level 4 Registered Manager?

JMcG: That’s correct

DK: That’s an award for managers already in the care sector who have achieved a Level 4 qualification, for example NVQ in care [fuller question – can’t hear]

JMcG: I don’t think you would undertake Level 4 without significant experience.

When Mr Kay asked a further question about the qualification Ms McGirr said that it was a number of years since she’d undertook that qualification.

Mr Kay then took her to a document in the bundle and asked if she’d accept they were some of her responsibilities.

DK: The 4th and 5th ensure services are operating in line with Dimension’s standards?

JMcG: Yes

DK: And maintain live training records for all staff?

JMcG: Yes

DK: Last two bullet points, just before that, third one down, ensure staff using iplanit to keep daily records, yes? Would you accept those were some of the responsibilities you had at the time?

JMcG: I’d say that was the list, whether was capacity in the hours I worked for me to carry out all of those tasks, um, I don’t. Medication and finance audits, that was something that I’d been able to delegate some of those tasks, following this incident it was implemented that all Locality Managers needed to be completing these tasks themselves

DK: You’ve mentioned Assistant Locality Manager, come back to capacity in a moment, you’ve mentioned tiers of Dimensions staff go from service user, someone like Sally, closest contact is the Support Worker is that right?

JMcG: Yes

DK: Then if there is one, Lead Support Worker for that service?

JMcG: Yes

DK: Then there may be an Assistant Locality Manager? And you had one of those correct?

JMcG: I had Sam who was 15 hours

DK: And then you? You’re the 4th tier effectively from the service user?

JMcG: That’s correct

DK: Then Julie Campbell was an OD, Operations Director, so she’s 5th tier?

JMcG: That’s right

DK: You said in your evidence you raised the issue of capacity with Julie Campbell, as your line manager. I’ll suggest to you any concerns you raised with her about capacity were raised after Sally’s death, and not before.

JMcG: I’d say not. I had supervision with Julie the week that Sally died and I’d raised some concerns regarding capacity on 23 October. I also would say that it was common, not myself but other Locality Managers, to have discussions at Managers Meetings around capacity, and in particular about struggles with recruitment and retention of staff.

DK: Julie Campbell is giving evidence next and she’ll give her evidence about what she recalls about that. It’s right isn’t it you didn’t raise any concerns with Julie Campbell about Sally Lewis at any time?

JMcG: I didn’t raise any concerns in particular around Sally.

DK: Or the health needs of anyone at The Dock?

JMcG: I don’t recall, but as I say this is 6 years ago.

DK: OK, as I say she’ll give her evidence next, that’s all I had, thank you.

No questions from Mr Cox for Worcestershire County Council, none from Mr Mumford for Dr Williamson and none from Ms Wilks for CQC.

Mr Hassall KC for Dimensions had questions for Ms McGirr.

CH: You said right at the start of your evidence you were responsible for 6 Supported Living Services, you said possibly some registered care services as well. Do you know whether 299 Stourbridge Road was a registered care service?

JMcG: I believe it was registered, yes.

CH: What’s the difference?

JMcG: My understanding was that I was the named Registered Manager for the registered service, as opposed to services coming under the domiciliary care umbrella. I would hope, I think there were differences in how services were funded through the local authority and I believe when services went over to Supported Living Services that following needs assessments that people were having individual allocated hours, as opposed to services being block funded.

CH: So within all of that would be an assessment of how much care or how much support an individual needed?

JMcG: Yes, as I say that was completed by xxx colleagues.

CH: Thank you, you said you were responsible for 6 separate services, 3 of the 6 you said were single occupant services. The Dock we know had 3 occupants including Sally. In your statement you said you were responsible overall for support provided to 11 individuals?

JMcG: I believe that figure was correct at that time, however as I say that figure had fluctuated as I believe I’m correct in saying this, up until August 2017 I was managing 7 services, another registered care service in Redditch which closed in that August. So it varied.

CH: Alright. It varied, but you’re confident, it’s in your statement, at the time of Sally’s death was 11 individuals including Sally as one of them, whose services you were the line manager for?

JMcG: I believe so yes.

CH: One of responsibilities was for you to ensure annual reviews?

JMcG: I wasn’t the best person to complete that review, I wasn’t supporting individuals.

CH: You were the best person, were you not, to supervise that review, make sure had taken place, had happened as Line Manager?

JMcG: Is part of what I might discuss with staff during their supervision, if due for review, allocating their time for them to achieve that task.

CH: That’s what you were doing in April 2017 at The Dock, you talk about that in your statement?

JMcG: I’m not sure that’s what we were doing but was part of a team day where I thought was helpful when got all the team together to read through Support Plans and highlight any gaps they thought were there.

CH: You qualified as a disability nurse when you were 18?

JMcG: A Learning Disability Nurse.

CH: You were aware of the risks of severe constipation?

JMcG: Yes, but can I also stress I wasn’t employed as a nurse. It wasn’t part of my job role, didn’t require me to be a nurse to carry out the role of Locality Manager.

CH: You knew about the risks of severe constipation?

JMcG: Yes

CH: And the link between severe constipation and sepsis?

JMcG: Yes

CH: You knew what a Bristol Stool Chart was?

JMcG: Yes

CH: And you know the difference between a Bristol Stool Chart, which is a chart with pictures on, descriptions of, and a bowel movement recording chart?

JMcG: As I say I was working for Dimensions at the time, not in a nursing role, and those things were not part of my role, as I say.

CH: You knew what they were?

JMcG: Yes

CH: You said none of the staff regularly working providing support at The Dock were trained nurses?

JMcG: That’s correct yes.

CH: You said they were a hugely experienced team and were individuals in the team in whom you had huge confidence?

JMcG: At the time I did, yes.

CH: Did you have huge confidence in Susan Casey?

JMcG: I didn’t have any concerns around Sue Casey at that time.

Mr Hassall then asked Ms McGirr about the staff’s monitoring of bowel movements.

CH: You said Support Workers at The Dock ought to be able to carry out Dimension’s monitoring… is it not the case they demonstrably were able to carry out bowel movement monitoring, because you told us they did carry it out for someone else who lived at The Dock?

JMcG: Yes, so they were capable of doing that.

CH: So why was that person’s bowel movement’s recorded?

JMcG: Because that had been highlighted as a risk by the Key Worker at the time.

CH: In the support plan?

JMcG: Without that lady’s plan in front of me, but to the best of my knowledge I believe the lady who lived there was having her bowel movement’s monitored.

CH: So you were supervising support being delivered to that other person as well weren’t you?

JMcG: I was yes.

CH: So how was it you were aware of that person’s difficulties, medical conditions in relation to their bowels but not Sally’s?

JMcG: Because theirs had been raised with me, Sally’s issues hadn’t been raised with me.

Mr Hassall then asked about some questions about the guidelines for managing Sally’s challenging behaviour relating to toileting. Ms McGirr told the court that the information relayed to her from the staff team was that the challenge related to Sally passing urine, not opening her bowels.

CH: Part of your role, you identify in your statement, was to monitor completion of daily notes, is your evidence you didn’t do that because you simply didn’t have time?

JMcG: May I say this statement was prepared for me, I didn’t write this statement. Following a 2 hour meeting with a member of Dimension’s legal team, it didn’t come to me until a much later date.

CH: You signed this document?

JMcG: I have signed this document.

CH: When did you sign it?

JMcG: According to this in January 2020.

CH: You’re not saying this wasn’t the date you signed it?

JMcG: I met with the person who prepared this in December 2018 and it doesn’t appear to have been sent to me for me to review and sign for 13 months.

CH: At the start of that statement is a declaration on it.

JMcG: I don’t think this was sent to me.

CH: The declaration says this: This statement, consisting of 3 pages, signed by me, is true to the best of my knowledge and belief and I make it knowing that, if tendered in evidence, I shall be liable to prosecution if I have wilfully stated in it anything which I know or believe to be false or do not believe to be true.

JMcG: I was surprised when I read this statement, how much information I did give, and how limited that information was transferred onto this statement.

CH: What else do you want to say?

JMcG: I say it’s been a number of years, I would have expected, at the time the statement was prepared actually would have been more detail. I did give more information I believe.

CH: So what I asked you about, a few moments ago, was you set out there part of your role was to monitor the completion of daily notes?

JMcG: That was, think I already answered question regarding that, that wasn’t something that I found easy to complete within my capacity, so we’d have daily notes for individual’s support …

CH: There was you Locality Manager, and you also have certain number of hours a week an Assistant Locality Manager as well, did you delegate at the time the monitoring of daily notes to the assistant?

JMcG: I’m not aware

CH: Why not?

JMcG: I can’t describe to you how full on the role of Locality Manager was. As I say I already said I was regularly working above my contracted hours, I was often having to backfill services where we weren’t able to recruit or had sickness.

My role asked me to be involved in recruitment, whole process of recruitment from writing job adverts to monitoring, onboarding, to interviewing staff, to inducting staff, carrying out investigations. … supervising, could be 40 staff, attending team meetings and as I say the role became unmanageable, which is why [can’t hear]

Mr Hassall then took Ms McGirr to a page in the bundle and said contrary to what we might have heard this morning, this document wasn’t a bowel chart but where staff would record if there had been a bowel chart. Ms McGirr agreed. Ms McGirr also agreed that a record she was taken to was a form where checking of daily records should have been recorded. Mr Hassall then asked a question that I couldn’t hear.

JMcG: If weekly medication audit you’re referring to, then Dimensions did provide training to particular Support Workers to enable them to carry out that task.

CH: One of the concerns here was that the Laxido was piling up at The Dock because it wasn’t being administered to Sally?

JMcG: I wasn’t aware of that.

CH: And you didn’t discover that for yourself?

JMcG: No.

CH: Those are my questions.

C: Thank you. Yes Ms McGirr thank you very much, those are all the questions we have for you, you’re welcome to stay or leave as you wish.

Ms McGirr was released at 16:10. A short timetabling conversation followed and that was the end of Day 2.

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