Beechdale Health Centre
Notification of Other Incidents –
Outcome 20 Composite Statements and Forms
Document Control
A.
Confidentiality Notice
This document and the information contained therein is the property of Beechdale Health
Centre.
This document contains information that is privileged, confidential or otherwise protected from
disclosure. It must not be used by, or its contents reproduced or otherwise copied or disclosed
without the prior consent in writing from Beechdale Health Centre.
B.
Document Details
Classification:
Author and Role:
Organisation:
Document Reference:
Internal
Sally Bills- receptionist
Beechdale Health Centre
Notification of Other Incidents –
Outcome 20 Composite Statements and Forms
Current Version Number:
Current Document Approved By:
Date Approved:
1
Sally Bills
11.12.2012
C.
Document Revision and Approval History
Version
1
Date
11.12.12
Version Created By:
Version Approved By:
Sally Bills
Sally Bills
Comments
Created from default document
Doc. Ref – Version – Filename: Notification of Other Incidents - Outcome 20 Composite Statements and Forms
Page 1 of 13
CONTENTS
Pages 3 > 5
-
Notification of Serious Injury to a person who uses the service
Page 6
-
Applications to Supervisory Bodies or the Court of Protection to deprive a
person of their liberty
Pages 7 > 8
-
Notification of events that stop or may stop the registered person from
running the service safely and properly
Pages 9 > 10
-
Notification of allegations of abuse
Pages 11 > 12 -
Notification of incidents reported to or investigated by the Police
Page 13
Practice Record for Notification of “Other” Incidents
-
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Page 2 of 13
Practice Statement – Notifying the CQC of Serious Injury to a Person who uses
the Service
The Practice Manager at the Practice is responsible for notifying the CQC without delay about
events that lead to:
 Serious injury to any person who uses the service.
 An injury requiring treatment by a healthcare professional to avoid death or serious injury.
These serious injuries include:

Injuries that lead to or are likely to lead to permanent damage – or damage that lasts or is
likely to last more than 28 days – to:
 A person’s sight, hearing, touch, smell or taste
 Any major organ of the body (including the brain and skin)
 Bones
 Muscles, tendons, joints or vessels
 Intellectual functions, such as
 Intelligence
 Speech
 Thinking
 Remembering
 Making judgments
 Solving problems.

Injuries or events leading to psychological harm, including:
 Post-traumatic stress disorder
 Other stress that requires clinical treatment or support
 Psychosis
 Clinical depression
 Clinical anxiety
 The development after admission of a pressure sore of grade 3 or above that develops
after the person has started to use the service (European Pressure Ulcer Advisory Panel
Grading)
 Any injury or other event that causes a person pain lasting or likely to last for more than
28 days
 Any injury that requires treatment by a healthcare professional in order to prevent:
 Death
 Permanent injury
 Any of the outcomes, harms or pain described above.
Where the Registered Person is unavailable, for any reason, the practice secretary will be
responsible for reporting the serious injury to the CQC.
When making serious injury notifications on the dedicated CQC form, Unique Identifiers will be
used in place of:
 The name of the injured person;
 Relevant dates and circumstances.
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Page 3 of 13
CQC – Notification of Serious Injury Form
This embedded form has been created and provided by the CQC for the Practice to report
occurrences of Serious Injury under the circumstances illustrated in the Practice Statement,
above.
Serious Injury
Notification.doc
The completed form must be e-mailed to: HSCA_notifications@cqc.org.uk
Reminders within iQ Created CQC Documents to Notify CQC of Serious Injury to a
Person who uses the Service
The below list of iQ created documents include appropriate reminders for the Practice that they
may need to notify CQC in the event of Serious Injury to a person who uses the service whilst
they are under an episode of care from the Practice:
Document Title
Clinical Waste Protocol
Contagious Illness Policy
Control of Substances Hazardous to Health (COSHH) Policy
& Risk Assessments
Decontamination of Re-usable Instruments Policy
Estate Management Policies & Protocols
Fire Safety Policy
HIV / AIDS Policies for Patients and Staff
Infection Control Biological Substances Incident Protocol
Legionella - Management, Testing & Investigation Policy
Needlestick Injuries Policy
Patient Emergency Handling - Patient in Distress Desk Aid
Return to Work Interview Guidance and Template
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Page 4 of 13
Document Title
Safety Alert Protocol and Procedure
Use of Medical Equipment Protocols – Staff and Patients
Working Alone / Home Working Policy
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Page 5 of 13
Practice Statement – Notifying the CQC of Applications to Supervisory Bodies or
the Court of Protection to Deprive a Person of their Liberty
The Practice Manager at the Practice is responsible for notifying the CQC without delay of any
application to deprive a person of their liberty.
Where the Registered Person is unavailable, for any reason, the practice secretary will be
responsible for reporting the application to the CQC.
When making notifications about applications to deprive a person of their liberty on the
dedicated CQC form, Unique Identifiers will be used in place of:
 The name of the person;
 Relevant dates and circumstances.
CQC – Notification of Applications to Supervisory Bodies or the Court of
Protection to Deprive a Person of their Liberty Form
This embedded form has been created and provided by the CQC for the Practice to report
occurrences of applications to deprive a person of their liberty under the circumstances
illustrated in the Practice Statement, above.
Deprive Liberty
Notification.doc
The completed form must be e-mailed to: HSCA_notifications@cqc.org.uk
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Page 6 of 13
Practice Statement – Notifying the CQC of events that stop or may stop the
registered person from running the service safely and properly
The Practice manager at the Practice is responsible for notifying the CQC without delay about
events that stop or may stop the registered person from running the service safely and properly,
including:

A level of staff absence or vacancy, or damage to the service’s premises that mean that
people’s assessed needs cannot be met.

The failure of a utility for more than 24 hours.

The failure of fire alarms, call systems or other safety-related equipment for more than 24
hours.

Any other circumstances or events that mean the service cannot – or may not be able to –
meet people’s assessed needs safely.
Where the Registered Person is unavailable, for any reason, the practice secretary will be
responsible for reporting the application to the CQC.
When making notifications about events that stop or may stop the registered person from
running the service safely and properly on the dedicated CQC form, Unique Identifiers will be
used in place of:
 The name of any affected person;
 Relevant dates and circumstances.
CQC – Notification of events that stop or may stop the registered person from
running the service safely and properly
This embedded form has been created and provided by the CQC for the Practice to report
occurrences of events that stop or may stop the registered person from running the service
safely and properly under the circumstances illustrated in the Practice Statement, above.
Events that Stop
Service Notification.doc
The completed form must be e-mailed to: HSCA_notifications@cqc.org.uk
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Page 7 of 13
Reminders within iQ Created CQC Documents to Notify CQC of events that stop
or may stop the registered person from running the service safely and properly
The below list of iQ created documents include appropriate reminders for the Practice that they
may need to notify CQC in the occurrence of events that stop or may stop the registered person
from running the service safely and properly:
Document Title
Control of Substances Hazardous to Health (COSHH) Policy
& Risk Assessments
Estate Management Policies & Protocols
Fire Safety Policy
Legionella - Management, Testing & Investigation Policy
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Page 8 of 13
Practice Statement – Notifying the CQC of Allegations of Abuse
The practice manager at the Practice is responsible for notifying the CQC without delay about
allegations of abuse including:

Any suspicion, concern or allegation from any source that a person using the service has
been or is being abused, or is abusing another person (of any age), including:
a) Details of the possible victim(s), where this is known, including:
b) A unique identifier or code for the person.
c) The date they were or will be admitted to the service.
d) Their date of birth.
e) Their gender.
f) Their ethnicity.
g) Any disability.
h) Any religion or belief.
i) Their sexual orientation.
j) All relevant dates and circumstances, using unique identifiers and codes where relevant.
k) Anything you have already done about the incident.
 A unique identifier or code for the actual or possible abusers, together with, where it is
known:
 The personal information listed in a) > k) above
 Their relationship to the abused person
 A unique identifier or code for any person who has or may have been abused by a person
using the service, together with (where known):
 The same personal information listed in a) > k) above
 Their relationship to the abused person
 The person who originally expressed the suspicion, concern or allegation (using a unique
identifier or code).

In relation to where the alleged or possible victim of abuse is an adult the notification must
include details of the allegation, including:
 Any relevant dates, witnesses (using unique identifiers or codes) and circumstances.
 Whether the allegation has been reported to local multi-agency safeguarding
arrangements and/or the police.
 The type of abuse (using the categories in the Department of Health document No
Secrets).
 Anything the registered person has done as a result of the allegation.

In relation to where the alleged or possible victim of abuse is a child or young person under
18 years, the notification must include details of the allegation, including:
 Any relevant dates, witnesses (using unique identifiers or codes) and circumstances.
 The date the allegation was notified to the police, local safeguarding children board and
the strategic health authority (where appropriate).
 The type of abuse (using the categories in the Department for Children, Families and
Schools document Working Together).
 Anything the registered person has done as a result of the allegation.
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Page 9 of 13
Where the Registered Person is unavailable, for any reason, the practice secretary will be
responsible for reporting the application to the CQC.
When making notifications about events that stop or may stop the registered person from
running the service safely and properly on the dedicated CQC form, Unique Identifiers will be
used as detailed on Page 7:
CQC – Notification of Allegations of Abuse
This embedded form has been created and provided by the CQC for the Practice to report
allegations of abuse under the circumstances illustrated in the Practice Statement, above.
Abuse
Notification.doc
The completed form must be e-mailed to: HSCA_notifications@cqc.org.uk
Reminders within iQ Created CQC Documents to Notify CQC of Allegations of
Abuse
The below list of iQ created documents include appropriate reminders for the Practice that they
may need to notify CQC in the event of Allegations of Abuse from, or in relation to a service user:
Document Title
Confidentiality Code of Practice
Health and Wellbeing Policy for
‘Looked After’ Children and Young Persons
Patient Dignity and Respect Policy
Referral Protocol & Additional Guidance
Safeguarding Children
Safeguarding Children – Practice Self-Evaluation Workbook
Welfare Forums - Safeguarding Children and Vulnerable Adults
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Page 10 of
Practice Statement – Notifying the CQC of Incidents Reported to or Investigated
by the Police
The practice manager at the Practice is responsible for notifying the CQC without delay about
incidents reported to or investigated by the Police including:

Any incident reported to or investigated by the police that is associated with the delivery of
the service and affects or may affect the health, safety and welfare of a person using the
service, its staff, or anyone who visits the service. These events include:
 People who use services going missing
 Assault or malicious damage
 Theft of property or money belonging to people who use the service.
Where the Registered Person is unavailable, for any reason, the practice secretary will be
responsible for reporting the application to the CQC.
When making notifications about applications to deprive a person of their liberty on the
dedicated CQC form, Unique Identifiers will be used in place of:
 The name of the person;
 Relevant dates and circumstances.
CQC – Notification of Incidents Reported to or Investigated by the Police
This embedded form has been created and provided by the CQC for the Practice to report
incidents reported to or investigated by the Police, under the circumstances illustrated in the
Practice Statement, above.
Police Incidents
Notification.doc
The completed form must be e-mailed to: HSCA_notifications@cqc.org.uk
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Page 11 of
Reminders within iQ Created CQC Documents to Notify CQC of Incidents
Reported to or Investigated by the Police
The below list of iQ created documents include appropriate reminders for the Practice that they
may need to notify CQC of incidents reported to, or investigated by the Police which affect either
a service user whilst they are under an episode of care from the Practice, Practice staff, the
Practice itself or other members of the public / visitors:
Document Title
Emergency Incident Procedure
Estate Management Policies & Protocols
Panic Alarm Protocol
Professional Qualifications & Registration Policy for New & Existing Staff
Working Alone / Home Working Policy
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Page 12 of
Practice Record for Notification of “Other Incidents”
Notifications often need to refer to confidential information. It would be against the Data
Protection Act 1998 to submit a notification that included confidential personal information
about the data subject(s), such as the person(s) name, or any other information that could
identify them.
You must therefore use a Unique Identifier or code, rather than a name, when giving information
about the data subject in a notification.
This embedded Excel Workbook is for the Practice to keep its own records of Unique Identifiers
or codes for the types of Incidents listed below and in case the CQC require further details about
individual cases:





Notification of Serious Injury to a person who uses the service
Applications to Supervisory Bodies or the Court of Protection to deprive a person of their
liberty
Notification of events that stop or may stop the registered person from running the service
safely and properly
Notification of allegations of abuse
Notification of incidents reported to or investigated by the Police
CQC - Incidents
Notification Records
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