In your letter of complaint, you advised that you did not believe that pressure ulcers can form to the severity that your Mother has experienced in a 48 hour period. The safeguarding officer who was investigating liaised with the District Nursing team and they confirmed that this tissue damage was not evident when they last assessed your Mother two days before she became acutely unwell. Your Mother developed pressure damage to her heels when her health deteriorated rapidly which compromised her skin integrity, this was exacerbated when she became bed-bound and was unable to manage her own positional changes. You advised us that you do not believe that staff undertook positional changes. I do not substantiate that your Mother did not have any positional changes carried out over a 48 hour period as the pressure damage would have been extensively worse to all bony prominence on her body if the staff had not managed her positional changes.<br>As part of learning lessons from any concerns raised, we strive to make improvements, as part of my investigation, I discovered that the staff did not record positional changes on a supplementary document, despite undertaking these care interventions. These findings will be shared with the team in team meetings so that care provided can be evidenced moving forward.<br>I hope this provides further clarity but of course, should you wish to gain an alternative opinion, you may choose to seek advice from the tissue viability nurses if you need to further ascertain the mechanism of injury of pressure damage.