BACKGROUND
Figures released by London Fire Brigade reveal that an average of around 500 fires have occurred each year since 2008 in the capital’s care homes and sheltered accommodation, resulting in an average of 3 fire fatalities and 40 fire-related injuries annually. We are also reminded of the tragic fire which occurred in January 2004 at the Rosepark care home in Scotland, which claimed the lives of 14 residents. Primary causes of fires in care homes, in no particular order, are faulty electrical wiring and equipment, cooking, smoking, misuse of equipment and arson.
Of further serious concern is a report published by the London Fire Brigade (early 2019), which found that 57% of the 177 care homes in a series of one-off inspections received a formal notification to address fire safety issues. In 45% of the care homes inspected, the fire risk assessment was found to be not suitable or not sufficiently comprehensive. One in three premises had inadequate or poorly maintained fire doors and the report concluded there was “widespread confusion” about fire evacuation strategies. The report also warns that fire risk assessments are being carried out by people without the proper skills and experience.
These statics are coupled with the fact employees in care, leisure and other personal service occupations have according to the HSE statistically significantly higher rates of both injury and ill health compared to all occupations, with the health and social care sector having the highest number of reported handling injuries in 2012/13.
Against this background, this Guidance Note aims to provide information on some of the main risk assessment and control features applicable in the care home environment.
FIRE RISK ASSESSMENT
Fundamental to fire safety is the requirement that a suitable and sufficient fire risk assessment is carried out and periodically reviewed in accordance with the Regulatory Reform (Fire Safety) Order (FSO) 2005 and similar regulations applying to Scotland and Northern Ireland and that the significant findings and actions arising from the assessment are implemented. Key provisions regarding the risk assessment include:
Except in circumstances where in-house fire safety competency and experience can be suitably demonstrated, the appointment of a third party registered/certificated Fire Risk Assessor must be a firm requirement for all care homes (this is a legal requirement in Northern Ireland).
In cases where there are less than five employees, the fire risk assessment should be recorded in writing, notwithstanding that there is no legal requirement to do so.
A written fire emergency plan should be prepared based on the outcome of the risk assessment and in line with the planned evacuation strategy for the premises.
Implementation of the findings and actions arising from the risk assessment should be constantly monitored as part of the ongoing management of risk, and should be formally reviewed following any changes in working practices, changes in premises layout, etc. In the absence of any alterations, formal review of the risk assessment annually is strongly recommended.
Some homes have Personal Emergency Evacuation Plans (PEEPS) for each resident.
Aspects relating to general health and safety are detailed later in this Guidance Note.
FIRE RISK CONTROL
It is important that fire risk management within the care home environment is recognised as an ongoing process which includes attention being given to the following hazards and preventative/protection measures:
1. Electrical Installation
Electrical wiring to be installed in accordance with BS7671: Requirements for Electrical Installations by an Approved Contractor or a Registered Member appropriate for the type of installation, of a UKAS accredited electrical contractor certification or inspection body scheme, or by a company which is a UKAS accredited Full Member of the Safety Assessment Federation (SAFed).
All temporary wiring and use of multiple adaptors and extension leads are to be avoided.
Electrical installation to be periodically inspected and tested at least every five years and an Electrical Installation Condition Report issued, and routine checks carried out at least annually. Any actions arising from the inspection must be completed.
Portable appliances to be inspected and tested as appropriate (RiskSTOP Technical Bulletin 27 refers). Personal electrical items should also be subject to periodic inspection and testing.
All plugs, sockets and connectors used in the open to be suitable for outdoor use and the electrical supply to any hand-held electrical equipment used outside must have suitable RCD protection.
2. Gas Safety
All gas appliances, together with pipe work and flues to be checked for safety at least once a year by a Gas Safe registered engineer in compliance with the Gas Safety (Installation and Use) Regulations.
3. Heating
Central heating boilers should be inspected and maintained in accordance with the manufacturers’ instructions or in cases where no such instructions are available at least annually; gas appliances by a Gas Safe registered engineer and oil-fired appliances by an OFTEC registered technician.
Biomass boilers are to be operated and maintained by suitably trained and competent persons in strict accordance with the manufacturer’s instructions. Installation and maintenance should be entrusted to a HETAS registered/MCS certified installer.
All forms of portable heating should be avoided and under no circumstances are portable LPG appliances to be employed. In circumstances where supplementary heating is required in severely cold weather or for emergency purposes, this should take the form of modern electric fan or convector heaters used under strict control and subject to portable appliance inspection and testing.
(Safety hazards of water temperatures and hot surfaces are dealt with under Health and Safety).
4. Kitchens
Fire safety measures in kitchens will vary depending on the size and extent of usage with particular reference to the amount of deep fat frying. They may include:
Routine inspection and cleaning of extract systems.
Provision of emergency isolation valves to the extract system, gas and electrical supplies.
Provision of high temperature limit controls operating at 230 oC on deep fat fryers.
Installation of a fire suppression system where significant deep fat frying is conducted.
5. Laundry Rooms
Whilst in some cases laundry is contracted out, a laundry room is a common feature in many care homes to which the following risk control measures apply:
All plant and machinery should be inspected and maintained in accordance with the manufacturers’ instructions. Tumble dryers should be given special attention, ensuring that thermostats are functioning correctly. Tumble dryers may be electric or gas powered.
Filters to tumble dryers are to be cleaned daily or at intervals as instructed by the manufacturers. In addition, dryer extract ducts are to be cleaned internally as a matter of routine and areas around and to the rear of dryers checked for the build-up of fluff and fly.
Under no circumstances is laundry to be left in tumble dryers overnight. Ideally, all laundry should be removed from tumble dryers and fully processed prior to the closure of the laundry each day. Alternatively, it must be separated out onto workbenches, allowing any heat to dissipate.
Electric irons to be provided with pilot light protection at the socket, together with suitable non-combustible stands.
Laundry chutes in multi-storey premises should incorporate automatic fire dampers.
6. Contractors Operations
Close controls are to be exercised in respect of all contractors’ operations for which risk assessments shall be conducted and method statements prepared. Particular care must be excised in respect of hot work for which a hot work permit system should apply.
7. Fire Protection
Sprinklers: From 1 May 2005 all new build and newly converted care homes and extensions to existing homes in Scotland have been required to be fully sprinkler protected. In Wales, the Domestic Fire Safety (Wales) Regulations 2013 have required that an automatic fire suppression system (currently sprinklers in accordance with BS 9251: Sprinkler systems for domestic and residential occupancies – Code of practice) is installed in all new build and newly converted care homes.
Where sprinklers are encountered, arrangements should be made for conventional testing to be carried out at weekly intervals and the installation to be serviced and maintained annually by contractors approved by the LPCB to Loss Prevention Standard 1048 or 1301.
Fire Alarms: All care homes should have an automatic fire detection and alarm system. In small homes, e.g. with no more than one floor above ground, accommodating up to four residents who do not need assistance to escape, a basic system based on mains powered interlinked smoke alarms with battery back-up is likely to provide suitable protection, for which guidance should be taken from BS 5839-6:2013 Fire detection and fire alarm systems for buildings - Code of practice for design, installation, commissioning and maintenance of systems in domestic premises.
In larger premises, where all the residents are capable of evacuating themselves without staff assistance, the system should include detectors in all the escape routes, in any room opening onto any escape route and in any other areas of high risk. This is to be achieved by a category L2 system in accordance with BS 5839-1: 2017 Fire detection and fire alarm systems for buildings - Code of practice for design, installation, commissioning and maintenance of systems in non-domestic premises.
In other larger premises, particularly those accommodating more than ten residents above the ground floor, or where a significant proportion of the residents are dependent upon staff assistance to escape in the event of a fire, a more comprehensive system of detection covering all areas of the building will be appropriate, achieved by a category L1 system in accordance with BS 5839-1.
Special considerations apply to the placement and sound levels of audible warning devices in the care home environment. In some cases, voice alarms may be employed.
The latest version of BS 5839 includes the following provisions concerning care homes:
Ø Where occupants of a building are going to need assistance from staff to evacuate the building, the fire detection and fire alarm system should be addressable if the building has facilities for more than ten people to sleep.
Ø In residential care homes, facilities should be considered for automatic transmission of alarm signals to an alarm receiving centre, although often local sounders may be considered adequate.
Ø In residential care homes, a staff alarm should not incorporate any delay in summoning of the fire and rescue service when the fire alarm system operates, but there may be a delay in the general alarm signal, provided all staff is made aware of the fire alarm.
Ø Filtering measures should not be applied to signals from fire alarm systems in residential care homes; instead the fire and rescue service are to be summoned immediately the fire detection and alarm system operates.
Whilst the enhancements to BS 5839 apply to newly designed systems and are not intended to be applied retrospectively, there is no reason why the measures relating to remote signalling and alarm management should not be applied to existing care home systems as part of the overall fire safety programme.
Importantly, the fire alarm system is to be tested from a different break-glass call-point weekly and the system inspected and serviced periodically in accordance with the recommendations of BS: BS 5839-1: 2017, by a company which is approved by suitable third-party certification scheme.
Fire Extinguishers: The provision of fire extinguishers to BS 5306-8: 2012 – Fire extinguishing installations and equipment on premises – Code of practice for the selection and installation of portable fire extinguishers is an essential requirement in all care homes, serviced annually under contract. Nominated staff should receive instruction and training in the use of fire extinguishers.
Signs and Notices: Escape signs and fire safety notices must be provided appropriate to the premises. The requirements for the characteristics of fire safety signs and notices are encompassed within the Health and Safety (Safety Signs and Signals) Regulations 1996 and the guidance in relevant British Standards, including BS ISO 3864-1 and BS EN ISO 7010.
Emergency Lighting: Where installed, the emergency escape lighting system must be tested at monthly and annual intervals as prescribed in BS EN 50172:2004/BS 5266-8:2004: Emergency escape lighting systems and all such tests recorded. In addition, it is recommended that the system be inspected and maintained annually by a competent engineer.
Ventilation/Air Conditioning Systems: Ducts should be fitted with fire dampers where penetrating compartment walls and floors. These are to be inspected and tested at regular intervals, not exceeding two years. Spring operated fire dampers should be tested annually.
Smoke Control Systems: Natural or powered, smoke and heat exhaust ventilation systems, which may be encountered in large multi-storey care homes, should be serviced regularly and maintained in good working condition by a specialist contractor.
8. Means of Escape
The provisions surrounding means of escape in care homes can be complex involving one or more strategies of simultaneous evacuation, progressive horizontal evacuation and delayed evacuation. Consequently, this is not a subject on which Consultants should be involved beyond checking free access and other management issues. In cases where there may be serious doubts concerning the adequacy of escape arrangements, the Policyholder must be advised to consult the local Fire Authority, or employ the services of a third party registered/certificated fire risk assessor.
9. Fire Authority Inspections
Routine fire safety inspections of care homes are carried out by Fire Authorities throughout the UK, the frequency of which (normally between 1-5 years) will be determined by their risk rating. Following the inspection, a letter will be issued to the care home management, either confirming compliance with fire safety requirements or detailing the corrective actions and additional measures required which, depending on the circumstances, may prompt further actions.
10. Transient Overvoltage Protection
In addition to potentially critical IT and telecoms facilities, many care homes will contain vulnerable and highly critical electronic nurse call systems for which transient overvoltage protection may require to be considered in larger establishments (RiskSTOP Technical Bulletin 7 refers).
11. Smoking
Under smoke-free legislation, care homes are exempt for being smoke free. Care home providers may, should they wish, provide designated smoking rooms (which may include bedrooms) used for smoking which should meet the following legal requirements:
The responsible person in charge keeps a written record of the rooms designated to be used for smoking and a copy of this record is kept permanently.
The rooms are clearly marked as rooms in which smoking is permitted.
The rooms have a ceiling and, except for doors and windows, are completely enclosed on all sides by solid floor-to-ceiling walls.
The rooms do not ventilate into any other part of the building (except other designated smoking rooms) or into any other smoke-free premises. It must be possible to fully open the windows in a designated room. However, a risk assessment should be undertaken where there is a risk that vulnerable people may fall or jump from a window in a smoking room above ground floor level. This may apply particularly to people with dementia, learning disabilities, mental health or substance misuse issues. Where there is considered to be a risk, HSE guidance should be followed and windows in smoking rooms above ground floor level that are large enough to allow people to fall out should be restrained to prevent falls. The window opening should be restricted to 100mm or less based on the vulnerability of the people using the service.
The rooms have mechanically closing doors, which should meet other relevant legal requirements, including fire regulations.
Designated rooms where smoking is permitted are intended for the use of residents only, not for staff or visitors. Staff should not normally be required to work in designated smoking rooms. If they have to enter them, their time of exposure to second-hand smoke must be kept to a minimum. Staff with pre-existing conditions exacerbated by second-hand smoke e.g. asthma, should not be asked to enter a designated smoking room.
In addition to the dangers from passive smoking, the fire hazards associated with smoking must be considered as part of the fire risk assessment and suitable arrangements made for the disposal of discarded smoking materials.
With regards to residents (service users) who wish to smoke, individual risk assessments must be conducted. Such assessments must:
Be carried out by someone with sufficient understanding of the service user’s needs and of the wider impact on fire and health and safety.
Be carried out in partnership with the service user and any other relevant persons, including families, relatives and visiting friends. Their involvement and cooperation is key in the effective management of safe smoking practices.
Consider the service user’s physical ability and mental capacity to undertake smoking activities safely.
Give particular consideration to service users with specific needs, including those with dementia or a learning disability, who smoke, as they may be at increased risk.
Consider the interaction between service users who smoke, and the potential for the sharing of smoking materials.
Consider the risks to other service users and other occupants of the building, including staff.
Identify the physical precautions as well as the management arrangements such as appropriate level of supervision necessary to ensure that the service user can smoke without presenting danger to themselves or others.
Be reviewed regularly i.e. when there is a change in needs, and at least annually.
12. General Housekeeping
All fire escape routes to be maintained clear at all times and all fire doors routinely checked weekly for condition and correct function, where applicable via the operation of panic bars or similar approved fire exit door hardware.
Waste materials to be removed from the buildings daily, or alternatively retained in a designated compartment of fire resisting construction.
Waste bins located at least 10m from buildings and secured as required, wherever possible, although circumstances often limit the clearance distance possible.
DSEAR risk assessment conducted in respect of any flammable liquids, gases or oxidising agents held and appropriate storage and safe handling arrangements provided. Oxygen and other medical gases should be handled and stored in accordance with the manufacturers’ safety data sheet.
Plant rooms, switch rooms, service risers and switch cupboards maintained clear of all storage and combustibles, and kept locked secure.
Storage areas kept in an orderly fashion ensuring 500mm clearance below sprinkler heads, smoke detectors and light fittings.
Voids (including roof voids) maintained free of combustible storage.
Implementation of end of day fire safety checks.
13. Fire Safety Records and Auditing
In addition to recording the fire risk assessment, larger and more complex homes should keep a dedicated record of all maintenance of fire protection equipment and training. This can take the form of a fire safety log book, many examples of which are available on free download from the internet.
It is also desirable that formal routine self-inspections are undertaken and recorded, ensuring that housekeeping and fire safety disciplines are maintained and that fire protection measures and procedures are fully functional.
14. Fire Emergency Plans
Comprehensive fire emergency plans and instructions, appropriate to the premises, should be prepared and communicated to all employees. These may include contingency plans for situations when life safety systems, such as evacuation lifts or fire detection and alarm systems are out of order.
15. Fire Safety Training
All staff should receive basic fire safety induction training taking account of the fire risk assessment, followed by refresher training at pre-determined intervals. More comprehensive training for staff undertaking the role of fire marshals should be provided such as in use of fire extinguishers and for staff indicated in the emergency plan as having a supervisory managing role. Written records of all training are to be kept.
Directly linked with the emergency plan and fire safety training is the need to carry out fire drills to evaluate their effectiveness. Recommended practice is for fire drills to be carried out at least annually or as determined by the risk assessment. Fire drills should be followed by a short debriefing session in which any shortcomings are identified and remedial measures implemented.
SPECIAL PERILS
It is common for many care homes to incorporate large conservatories and extensive flat, felt on timber roofed extensions which may present an increased storm risk. This may also apply to lightly constructed outbuildings.
Overflowing of hand basins in residents’ rooms is a further hazard, although a normal feature of the occupancy.
Caution may need to be observed regarding trees in close proximity to the buildings and potential subsidence.
THEFT
Apart from prestigious care homes which may contain high value contents such as paintings, silverware, etc, the 24/7 occupancy is such that security protections do not normally require special consideration. Outbuildings must not be overlooked, however.
Drugs and medicines should be kept secure in a proprietary drugs cabinet or store cupboard, preferably to BS 2881: Specification for cupboards for the storage of medicines in health care premises, the keys to which should be strictly controlled. Particular care should be exercised over the security of controlled drugs where held on the premises.
Residents personal belongings may need to be considered where part of the care home policy, although invariably such cover will normally be restricted to a nominal amount. Some homes will routinely take photographs of resident’s personal belongings and retain these with their care plans.
HEALTH AND SAFETY/LIABILITY
Care homes differ from other workplaces because they are not only a place of work, but they are also a home for their residents. They therefore need to be pleasant places in which to live whilst ensuring the health and safety of residents, staff, contractors and visitors is effectively managed.
Residents in care homes have varying degrees of independence and therefore different needs. A person living in a rehabilitation hostel will have different requirements from an elderly person in a care home. These differences need to be reflected in the design of the home, facilities and safeguards provided.
Homes are owned or run by a wide range of organisations including local authorities, the NHS and those from the private and voluntary sectors.
Social care employers are subject to a range of legislation, enforced by a number of different authorities. These include:
The Health and Safety Executive (HSE), responsible for enforcing health and safety legislation in all Homes with nursing, and Residential Homes owned or run by local authorities;
Local authority environmental health departments, responsible for:
Ø enforcing health and safety legislation in Homes (without nursing); and
Ø food safety and hygiene enforcement in all Residential Homes, with or without nursing;
The devolved care regulators in England, Scotland, Wales and Northern Ireland who enforce national minimum standards or essential quality and safety standards.
MANAGING HEALTH AND SAFETY
Social care is a people-orientated industry with a large diverse workforce looking after a predominantly vulnerable population. Employees have the right to work in a healthy and safe workplace and residents have the right to care that is safe, and takes the needs, freedom and dignity into account.
Key questions:
Does everyone in your organisation understand their roles and responsibilities towards health and safety?
Do you have access to competent advice?
Do you understand the risks in your workplace?
Are all risk assessments suitable and sufficient, both generic and resident specific?
Are the control measures identified through risk assessments implemented?
Are there arrangements for consulting with employees and union representatives?
Are staff suitably trained?
Do you monitor health and safety performance, actively and reactively?
Is a review of health and safety performance undertaken?
REPORTING OF INCIDENTS
Incidents at work can provide an indication of how health and safety is being managed.
Key questions:
Do staff report incidents, including near misses?
Are all reportable incidents reported through RIDDOR?
Do you have an accident book and do you keep a record of any reportable injury, disease or dangerous occurrence for three years?
Do you investigate incidents and take action, e.g. review risk assessments?
MOVING AND HANDLING
Manual handling is a key part of the working day for most members of staff; from moving equipment, laundry, catering, supplies or waste, to assisting residents. A significant number of injuries to staff in social care arise from the moving and handling of people.
The types and amount of equipment needed in a Home will vary according to the dependency and specific needs of residents.
Equipment typically can include: a selection of hoists, slings, slide sheets / transfer boards, turntables, electric profiling beds, wheelchairs, handling belts (not for lifting), lifting cushions, support rails/poles, emergency evacuation equipment, suitable walking aids.
Equipment should only be introduced following an assessment and should be used in conjunction with the care plan and the manufacturer’s instructions.
Key questions:
Do you assess all hazardous moving and handling tasks carried out in the home?
Do you have person centred moving and handling plans in place?
Are plans specific about handling tasks and the equipment to be used?
Are plans reviewed periodically and when the person’s needs change?
Are staff competent to carry out moving and handling techniques safely?
Does the home have suitable and sufficient moving and handling equipment available?
Do your monitoring arrangements ensure safe techniques and equipment are used?
EQUIPMENT SAFETY
Every year, there are numerous accidents to employees, carers, and residents from using work equipment in care homes. Having well trained staff use the right, well-maintained equipment can prevent accidents and reduce the personal and financial costs.
Key questions:
Is work equipment adequately maintained in accordance with PUWER?
Is lifting equipment (including accessories) examined in accordance with LOLER?
Is electrical equipment properly maintained?
Have staff been trained in safe use of equipment?
Are there procedures in place to monitor safe use?
BED RAILS
Bed rails, also known as side rails or cot sides, are commonly used in Homes, to reduce the risk of falls from beds. They can be a very effective means of preventing falls when used with the right bed, in the right way, for the right resident.
Poorly fitted bed rails have caused asphyxiation where a resident’s neck, chest or limbs have become trapped in gaps between the bed rails. Other risks are, rolling over the top of the rail, climbing over the rail, climbing over the footboard, violently shaking and dislodging rails and violent contact with bedrail parts.
Key questions:
Are bedrails only provided where they are the most appropriate solution to prevent falls?
Are staff trained in the risks and safe use of bed rails?
Do risk assessments take account of the bed occupant, the bed, mattresses, bed rails and all associated equipment?
Are rails and any accessories compatible with the bed and mattress?
Does the mattress fit snugly between the rails?
Are rails correctly fitted, secure, regularly inspected and maintained?
Are checks completed to ensure that gaps that could cause entrapment of neck, head, and chest are eliminated?
SLIPS, TRIPS AND FALLS
The majority of workplace injuries are as a result of slips, trips, and falls. In Homes, falls on the same level account for a significant number of reportable injuries to residents.
Key questions:
Have risk assessments been completed identifying the risks from slips, trips and falls?
Is the flooring throughout the premises suitable for the activities carried out e.g. non-slip flooring in wet areas?
Do you clean floor surfaces in a safe manner, which does not expose people to slip risks?
Are arrangements in place to ensure floor surfaces are adequately maintained and free from trip hazards?
Where residents are assessed at being at high risk of falls, are individual contributory factors and environmental factors considered as part of the care plan?
FALLS FROM WINDOWS AND BALCONIES
Accident data continues to highlight the serious issue of residents falling from windows or balconies in social care premises. There have been many prosecutions by the HSE following accidents to vulnerable people.
There are three broad categories of falls:
Accidental falls, falls arising out of confused mental state, and deliberate self-harm.
Key questions:
Do you have residents who are at risk, or likely to be at risk, of falls from windows, balconies or other areas?
If so, have you assessed accessible windows, balconies or other areas where there is a risk of falls, and are the controls adequate?
Where control measures are identified are these suitably robust and maintained to prevent determined adults defeating them?
HAZARDOUS SUBSTANCES, INFECTIONS AND DISEASES
Hazardous substances used in Homes include cleaning materials, disinfectants and other products containing chemicals e.g. pesticides or drugs. Other hazards include infections and diseases caused by micro-organisms (for example, associated with clinical waste, soiled laundry or exposure to bodily fluids).
Skin problems can be caused by frequent exposure to soaps and cleaners, and ‘wet work’. Other hazardous agents include rubber chemicals, which may be present in natural rubber latex and synthetic rubber materials, bleach and sterilisers, preservatives, and fragrances.
Control of infection is an important consideration throughout the Home environment.
There may be the potential for exposure to a range of human pathogens with the consequent risk of harm or disease. All Homes should have an infection control policy.
Employees, particularly nurses, are sometimes at risk from infections carried in blood and body fluids, including hepatitis B and C, and human immunodeficiency virus (HIV).
Employees may have to deal with clinical waste that is potentially hazardous. In general, the majority of waste in Homes falls under the category of ‘offensive/hygiene’ waste. This is waste which is non-infectious and which does not require specialist treatment or disposal, but which may cause offence to those coming into contact with it.
Medicines affect different people in different ways. Certain medicines are 'hazardous' and may cause significant risk if there is direct occupational exposure. Hazardous drugs include cytotoxic drugs used for chemotherapy, some hormones, antiviral drugs and other miscellaneous drugs.
When a Home looks after a person’s medication, the registered manager is responsible for the safe and appropriate handling of those medicines.
Medicines should be kept secure, locked away and free from heat, moisture and light.
Key questions:
Have you assessed the risk to staff and others from exposure to hazardous substances?
Have you introduced appropriate precautions to prevent or control the risk?
Do you inform, instruct and train staff about the risks and precautions to be taken?
Are staff given appropriate protective equipment/clothing?
Do you ensure that the precautions are used, and procedures followed?
Are hazardous substances safely stored, e.g. locked in a cupboard and out of reach of vulnerable adults?
LEGIONELLA
Legionnaires’ disease is a potentially fatal type of pneumonia. It is contracted by inhaling tiny airborne droplets containing viable legionella bacteria. Although healthy individuals may develop Legionnaires’ disease, there are some people who are more at risk such as older people, smokers, alcoholics and those with cancer, diabetes or chronic respiratory or kidney disease. Residents in a Home are likely to be particularly vulnerable.
Legionella bacteria can be found in both natural and artificial water sources. The bacteria multiply where temperatures are between 20-45°C and nutrients are available. The bacteria are dormant below 20°C and do not survive above 60°C. Airborne water droplets are created by water systems such as hot and cold water services, atomisers, wet air conditioning plant, whirlpool baths and hydrotherapy baths.
Key questions:
Do you have a competent person who can manage the risk from legionella?
Have you assessed the risks and put suitable and sufficient controls in place?
Do you ensure that the system remains clean, at the correct temperatures and there is no stagnation of water?
HOT WATER AND SURFACES
Homes often provide care for residents who may be vulnerable to risks from hot water or hot surfaces. Those at risk include older people, people with reduced mental capacity, mobility or temperature sensitivity, or people who cannot react appropriately, or quickly enough to prevent injury. Incidents often occur in areas where there are low levels of supervision, for example, in bedrooms, bathrooms, and some communal areas.
Key questions:
Are water temperatures, hot surfaces and the vulnerability of individuals adequately assessed?
Are suitable engineering controls provided, and are they effective?
Are controls adequately maintained?
VIOLENCE AND AGGRESSION (‘CHALLENGING BEHAVIOUR’)
The HSE defines work-related violence as: ‘any incident, in which a person is abused, threatened or assaulted in circumstances relating to their work.’
Examples of aggressive behaviour include:
A carer is bitten by a person with learning disabilities during normal care activities.
An irate visitor who considers that his relative has not been properly treated verbally abuses a manager.
A carer is threatened by a resident who is unwilling to take prescribed medication.
A confused resident punches a contractor repairing an item of equipment.
Training in the prevention and management of violence and aggression can provide staff with appropriate skills to reduce / diffuse potential incidents. Training should be available to all staff who come into contact with residents, including temporary or agency staff.
Key questions:
Has the risk of violence and aggression towards employees, or between residents, been assessed?
Where necessary, are resident specific assessments completed?
Do staff receive training in dealing with violent or aggressive residents, for example dealing with dementia?
Does the Home have a procedure for handling a violent incident?
Are incidents of violence reported and not treated as ‘part of the job’?
WORK-RELATED STRESS
Stress is people’s reaction to excessive pressure; it is not a disease in itself but it can lead to mental and physical ill health, e.g. depression, nervous breakdown, or heart disease. Being under pressure often improves performance and can be a good thing for some people. However, when demands and pressures become excessive, and exceed the person’s capacity and capability to cope, this may lead to stress.
The cost of stress may show up as high staff turnover, an increase in sickness absence, reduced work performance, poor timekeeping and complaints.
Key questions:
Have you assessed and managed potential causes of work related stress?
Have you worked with your employees and their representatives to tackle the issues?
Do you take action if employees are showing signs of stress?
GENERAL WORKING ENVIRONMENT
Homes aim to provide a homely and welcoming environment for their residents, but they are also a workplace so, whilst making the home environment comfortable for residents, providers must also comply with the law.
Key questions:
Have you carried out an assessment of the premises, and do you regularly check they are in good repair?
Have DSE workstations been assessed and, where risks have been identified, have actions been taken to reduce them?
Are utilities, such as gas, properly maintained?
Do you know whether or not there are asbestos containing materials in your premises, and if there is do you have a system for managing the risks?
How do you check that any contractors you use are competent and do not put your staff and residents at risk?
GENERAL WELFARE
As mentioned previously the aim is to ensure that Homes provide a homely environment, whilst ensuring that the welfare of employees is safeguarded.
Key questions:
Do you provide adequate welfare facilities?
Do you have a policy on smoking in the Home?
Have you made adequate arrangements for first aid provision in the Home?
If you use migrant workers, have you considered the need for additional instruction and training?
Do you have arrangements in place to consider the risks to new and expectant mothers?
If you employee young persons have you carried out a specific risk assessment for them?
SURVEY EXPECTATIONS
The latest report from the London Fire Brigade (early 2019) serves as a stark reminder to all Consultants of the need to remain extremely vigilant when conducting surveys in the care home environment, with particular regard to fire safety management and evidence that a suitable and sufficient risk assessment has been conducted and periodically reviewed, which in the majority of cases is likely to require the services of a third party certificated or registered Fire Risk Assessor.
Prior to conducting surveys of care homes, Consultants should refer to the Care Quality Commission www.cqc.org.uk for the latest quality rating and report. ( http://www.careinspectorate.com/ for Scotland, www.cssiw.org.uk for Wales and www.rqia.org.uk for Northern Ireland).
During the survey it is important that Consultants obtain written evidence of the date and outcome of the most recent Fire Authority inspection and whether there are any outstanding issues.
An aide memoire covering specific issues relating to care homes is attached which some Consultants might find useful.
ADDITIONAL INFORMATION
Comprehensive information concerning safety in care homes is contained in the following publications:
