A Registered Care Home Manager’s guide to health and safety in residential care

This guide, created by our social care leadership expert, Liam Palmer, is packed with vital information about health and safety in residential care, and contains a checklist to help Registered Care Home Managers audit their own service.

Liam Palmer, passionate about quality leadership in care home management

Health and Safety for residential care

This is a very broad area which is now regulated by the CQC. It was previously overseen by the HSE – the Health and Safety Executive.

It is important that registered managers have adequate knowledge of the subject.

Often, registered managers will do an IOSH “Managing Safely” – management level 3 day course and a CIEH Occupational Health and Safety Course (L3) to better understand their specific responsibilities. IOSH stands for Institution of Occupational Safety and Health. (CIEH stands for Chartered Institute of Environmental Health.)

The HSE publish an extremely useful guide to health and safety in care homes, this is HSG220, this can be downloaded free of charge from the HSE website. 

Is your care home properly maintained?

Plant infrastructure

Firstly, it is important to be able to evidence the building is professionally maintained with suitable checks for all plant infrastructure – e.g. gas, electric, water, cookers, lifts, heating, fire doors checked. Fire alarms tested and current service contracts are in place and that the building is in a reasonable state of repair.

Maintenance of the care home

Secondly, that the specific equipment in the building is being suitably maintained e.g. hoists, wheelchairs, slings, bed rails? See the LOLER. PUWER regulations etc.

These relate to lifting equipment and any other equipment used in a workplace. Remember, that anything used in the course of the work is regarded as equipment and this must be safe and fit for purpose.

We have all used a chair instead of a step ladder to change lightbulb, in a workplace it is a legal requirement that the correct equipment is used for the task. In this case even the step ladder needs to meet certain criteria.

Another example of poor practice is to use a wheelchair to transport bags of waste out to the bins, this is hazardous practice from a safety and infection control perspective.

Furniture 

Thirdly that the furniture – sofa’s, beds, all equipment being used in the home are fit for purpose and safe with appropriate quality / design.

That all materials are fire retardant (as per Regulatory Reform of Fire Safety Order 2005).

The safety of the electrical system needed to be tested and all portable electronic equipment require PAT testing, this includes portable appliances which belong to service users and staff.

Infection avoidance

Fourthly, that flooring, sinks and walls are suitably maintained to avoid risk of harm / infection control issues as bacteria can accumulate in broken tiles or fittings. The Department of Health published a Code of Practice on infection control in social care in 2015, this provides guidance on how social care providers can comply with their legal responsibilities.

Some requirements include; a designated infection control lead, writing an annual infection control compliance statement and the correct use of cleaning schedules.

An evidence file is needed to demonstrate controls are in place including, daily, weekly, monthly audits according to the service and its respective needs. Other points are having an up-to-date list of keys and spare keys for every bedroom (crucial for safety / fire).

Fire Safety

This is a crucial area that needs continual attention.

Fire safety needs to be taken seriously by the whole team, and the registered care home manager needs to provide leadership here.

Naturally, there needs to be suitable alarms in place, they need to checked and signed off.

There needs to be evidence of fire drills done regularly.

Door closers need testing and checking. Resident doors need to be fire retardant to protect the hallway and to provide a period of safe protection from potential fires surrounding their room.

The roofing and layout of the building needs to be fit for purpose in regards to fire safety.

Good practice with managing fire safety is to do frequent full fire drills at different times of the day / night / weekend.

This ensures all staff understand their responsibilities and are used to knowing what to do in the event of an actual fire and to document this clearly.

Good practice would likely show where there are gaps in training or knowledge and what is being done to address them.

This process provides evidence that the service is being managed appropriately, complying with the relevant health and safety legislation.

PEEPS and Business Continuity Plan

A Personal Emergency Evacuation Plans (PEEPS) will confirm who is in the building and how they need to be moved from the building in an event of a fire. Nighttime staffing levels need to reflect these needs.

This must be updated whenever there is an admission / discharge. There also needs to be a business continuity plan. This is contingency planning for major events – e.g. catastrophic fire, flood etc.

These possible events requires some consideration – e.g. if the building was on fire, where would residents go? This needs documenting in advance.

Whilst this may seem like a lot of paperwork (it is!) but once it is done properly, it simply needs reviewing yearly.

You never know when you may need this. When dealing with the lives of vulnerable people in your care, don’t take unnecessary risks.

Contingency planning and clear up to date documentation are how we manage those risks.

Food hygiene and the safe storing of certain medications

Temperatures for fridges and freezers are both significant areas within health and safety because if the temperature is not optimal / consistent it can impact the characteristics of food, beverage and medication held there.

Fridge temperatures should be in the range 1°C - 8°C and a temperature of 3°C is ideal.

Chilled food must be kept below 8°C and if food is delivered then the delivery temperature should be below this. Frozen food deliveries must be below -18°C and freezers should operate below -18°C.

Temperature control of hot food is important, often care home prepare food too far in advance and then there are issues of keeping it warm, you can hot hold food for a maximum of 2hrs and it must be kept above 63°C.

For food - poor temperature control can make the food unsafe to eat / possible food poisoning

Stock rotation and rules around the keeping of food with clear dates and which shelf to use in the fridge, different chopping boards all need to be adhered to. There is often confusing around “use by”, “best before”, “display until” dates.

Best before means exactly that, it is at it’s best before that date and is safe to eat after that date although the longer the food is kept then the quality will be affected.

It is illegal to sell or serve food past midnight on the date specified on the use by date label.

Meat needs to kept separate from veg etc, there are protocols to reduce the risk of contamination and therefore food poisoning, this includes not reheating cooked food more than once.

Remember that cook chill products such as ready meals or pre-prepared foods as used in some care homes have been cooked once already in the factory. So, when you cook this food you are actually reheating it.

The principles are stricter than in someones home but when dealing with elderly or physically vulnerable residents, safety through reducing risk is an important consideration.

For meds – poor temperature control can mean the medicines that are kept in the fridge lose their effectiveness and are no longer safe to be used.

This could be through temperatures being too low or too high. Stock control is also important – whatever is out of date needs to be disposed of appropriately.

Importance of good housekeeping practices

Cleaning routines to be followed and evidenced, using the correct products. The correct products need to be safely stored away from residents.

These practices need to be audited as evidence that the registered manager is fulfilling their health and safety obligations.

See COSHH (Control of Substances Hazardous to Health) and risk assessments.

Dangers of the kitchen for vulnerable people

Security around access to sharp knives, detergent, cookers, hot water or foods (e.g. a person with severe diabetes consuming excess sugary snacks could be dangerous).

Whilst this level of control over the environment may seem excessive if you consider a person with a severe learning difficulty or mid to later stage dementia may have no sense of place or risk regarding these things.

The home manager has a legal obligation to take measures to keep everyone safe using various controls under the Health and Safety at Work Act 1974. The risk assessment processes and documentation is the way these risks are managed. These need to be adhered to and documented clearly and reviewed periodically.

Related articles and stories

• The Complete Care Home Manager Career Guide

• Other articles by Liam and his Podcast series 'Care Home Quality'

• Patient numbers at Muckamore Abbey Hospital ‘significantly reduced’ following abuse

• Study shows music has a calming influence on elderly dementia patients

• What does a Care Home Manager need to know about CQC inspections?

• Like this? Subscribe to the Nurses Weekly

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