custody_injury · 2024-Q3
Bureau du coroner (Québec) · Bureau du coroner
Finding
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Disposition
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Cohort size
177
Redacted summary
A person died from medical complications after a fall in a care facility. The coroner's investigation found that the risk of falls had not been assessed and the sensitive mat was defective. The coroner made recommendations to improve clinical documentation and risk screening.
Officer
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Source
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