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Meeting Food Hygiene Regulation for Care homes
There are approximately 17,600 care homes in the UK. 70% of these are residential homes and 30% are nursing homes (carehome.co.uk). Care homes care for and support vulnerable individuals, such as the elderly, people with physical and mental disabilities, individuals struggling to live alone and those with complex medical conditions. A fundamental part of a person’s care is food (and drink) that meets their needs, is nutritious, of good quality and safe to eat.
All care homes must comply with food safety laws and adopt good hygiene practices. If they do not, it increases the risk of contamination and can make food unsafe. Contaminated food in a health and social care setting can have serious consequences. It can make residents ill, cause injuries and may even be life-threatening in some cases. Unsafe food is a greater risk for those more vulnerable, e.g. the elderly, allergy sufferers and those with existing illnesses and weakened immune systems.
Poor hygiene and unsafe practices, such as not cooking or chilling high-risk food sufficiently, and cross-contamination can cause food poisoning. Allergen products coming into contact with allergen-free ones can result in severe allergic reactions in some people. Physical contaminants can injure the mouth and may even result in choking. Preparing and cooking food for vulnerable people introduces additional risks that care home providers need to account for in their HACCP systems.
All care homes will be inspected as part of the Food Hygiene Rating Scheme (FHRS). If a care home provider has poor food safety and hygiene standards, their food hygiene rating score is likely to be lower. A previous Guardian report highlighted that more than 500 care providers in the UK, including 19 hospitals and other NHS facilities, have failed hygiene and food safety inspections.
According to an NFU Mutual Food Hygiene Report, 69% of people check food hygiene ratings, and people would turn away from a 3-star rated business, but not one that was 5-star rated. Individuals and their families will be reluctant to use a care provider with a poor food hygiene rating. Non-compliance with food safety standards can also result in enforcement action and loss of registration.
This guide will provide care home operators with general advice on achieving good food safety and hygiene standards. It will also highlight why food safety and hygiene is essential when running a care home business.
Food hygiene legislation for care homes
All care home providers need to comply with food safety and hygiene legislation.
The main laws are:
- The Food Safety Act (FSA) 1990 – Provides a framework for food safety legislation in Great Britain (England, Wales and Scotland). Northern Ireland has different legislation; the Food Safety (Northern Ireland) Order 1991. The FSA 1990 covers food safety, consumer protection, food information etc.
- The Food Safety and Hygiene (England) Regulations 2013 – Created under the FSA 1990. The regulations cover the enforcement of food hygiene and the HACCP principles from Regulation (EC) 852/2004 (retained EU law). There are different regulations for each UK country, e.g.:
– The Food Hygiene (Scotland) Regulations 2006.
– The Food Hygiene (Wales) Regulations 2006.
– The Food Hygiene Regulations (Northern Ireland) 2006.
- The Food Information Regulations 2014 – Places duties on food businesses to provide information to consumers on allergens. These regulations were amended by the Food Information (Amendment) (England) Regulations 2019 to include Natasha’s Law, which came into force on 1st October 2021.
Further information on the key regulations is on the Food Standards Agency webpage. There may be other food safety laws, depending on the type of care home. The operator must ensure they know and comply with all relevant laws. Ignorance of legislation is not a defence.
All care homes will need to register with the Care Quality Commission (England) or equivalent regulator for Wales, Scotland and Northern Ireland. The CQC requires that where food is provided to service users, it is handled, stored, prepared and delivered in a way that meets the requirements of the Food Safety Act 1990. Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 will also apply. Care providers must legally meet the nutritional and hydration needs of service users.
During an inspection or a registration visit, if the CQC finds that a care provider is not complying with food safety legislation, it can notify local authorities (LAs). It could result in the refusal or removal of registration or affect the care provider’s rating (under the Care Act 2014). It may even result in the CQC and Environmental Health Officers (EHOs) taking enforcement action against the care provider.
EHOs are responsible for enforcing food safety and hygiene. They have certain powers under the FSA 1990 and various food hygiene regulations. If care home providers do not comply with legislation, EHOs can issue enforcement notices. For more serious offences and non-compliance of notices, officers may decide to prosecute, which may mean fines, imprisonment and even closure of the business. If residents are made ill by unsafe food, they (or their families) may also claim compensation, which can be very costly.
Care home prosecution cases
- Care home operators received a fine of £20,000 after 15 people, aged between 73 and 100, were struck down with Clostridium perfringens food poisoning. The outbreak was caused by reheating and cooling minced beef several times (Teesside Live).
- A care home operator received a fine of £14,415.17 after six elderly residents fell ill with Clostridium perfringens food poisoning. Investigators thought a beef meal was responsible and found evidence of poor temperature control and recording (Evening Standard).
Staff training on food hygiene for care homes
Legally, all food operators must ensure that any staff who prepare, handle or sell food are supervised, instructed and trained in food hygiene matters. It does not mean that staff have to have a food hygiene certificate. However, having evidence of this type of training is the best way to demonstrate to EHOs and residents/families that the care home is committed to food safety. It also provides evidence for due diligence purposes if there is an investigation or legal action.
Staff should receive training in line with their responsibilities, the area where they work and their tasks.
There are different levels of food hygiene training, e.g.:
- Level 1 – Introduction to food hygiene, typically for those handling low-risk food. This course may be useful for staff with limited food contact, e.g. serving hot drinks and pre-packed foods, such as biscuits.
- Level 2 – Basic food hygiene certificate for staff preparing, cooking, handling and serving food, e.g. kitchen staff, cooks, chefs and servers.
- Level 3 – Intermediate food hygiene certificate for those with more responsibilities, e.g. care home owners, supervisors, managers and those involved in food safety management systems and HACCP.
Refresher training is also a requirement. The frequency will depend on the nature of the care home, its risks, the vulnerability of residents, and the competence of workers.
Staff should also take the Care Certificate, which covers food safety in fluids and nutrition.
Food hazards in care homes
Food hazards are contaminants that can enter food and potentially cause harm to consumers. The Food Standards Agency (FSA) defines a food hazard as “something that could make food unsafe or unfit to eat”.
There are four different types of food hazards: biological, chemical, physical and allergenic.
Biological hazards happen when microorganisms contaminate food, and poor practices provide optimal conditions for harmful pathogens to grow. In care homes, contamination may occur due to poor food storage, cooking, reheating and chilling. It can also result from cross-contamination (e.g. raw foods coming into contact with ready-to-eat foods), poor personal hygiene and using food past its use-by date.
Examples of biological hazards include:
- Bacteria, e.g. salmonella, E. coli, listeria, clostridium and campylobacter.
- Fungi, e.g. yeasts and moulds.
- Viruses, e.g. norovirus.
These microorganisms can cause foodborne illnesses, including food poisoning and intoxication.
Chemical hazards occur when naturally occurring or human-made substances contaminate food. In a care home, chemical hazards may occur due to cross-contamination, i.e. storing or spraying cleaning products near food, preparing food on surfaces where chemicals have been and medicines coming into contact with foods.
Examples of chemical hazards include:
- Toxins produced by animals, plants and microorganisms, e.g. by bacteria and moulds.
- Unintentionally added chemicals, e.g. cleaning chemicals and medicines.
- Intentionally added chemicals to food but could be hazardous if used in excess quantities, e.g. flavourings and colourings.
Eating food contaminated with chemicals can result in immediate harm to people. It can also cause long-term health effects if exposed to the hazard over time.
Physical hazards are foreign materials, objects and extraneous matter that can enter food during preparation, cooking and serving but may also be in raw ingredients. In care homes, these may occur due to poor personal hygiene but can also come from packaging, poorly maintained premises/equipment, medicines and pests.
Examples of physical hazards include:
- Natural hazards – Occur naturally in food, e.g. dirt on potatoes, fruit pips and stones, bones in meat and fish and shells from nuts.
- Unnatural hazards – Should not be present in food, e.g. stones, human hair, fingernails (including false fingernails), jewellery, plastic, glass, animal droppings, metal and wood.
These hazards can cause injuries to the mouth, teeth, dentures and gums. In some cases, physical contaminants can even result in choking, especially in the elderly and infirm. Some can be generally unpleasant to find in food, i.e. a hair.
Allergens are proteins that occur naturally in some foods but can contaminate other foods by cross-contact. These types of hazards can cause allergic reactions in food allergy sufferers. There is a risk of anaphylaxis in those with severe allergies.
There are 14 recognised allergens, which include:
- Peanuts (groundnuts).
- Celery (all of the plant, including the root celeriac).
- Mustard (liquid, powder and seeds).
- Tree nuts (almonds, hazelnuts, walnuts etc.).
- Sesame (seeds).
- Lupin (flower and seeds).
- Cereals (gluten) (oats, rye and barley).
- Molluscs (oysters, snails and mussels).
- Sulphur dioxide and sulphites.
- Crustaceans (crab, prawns and lobster).
In care homes, allergenic hazards may result from using and storing allergen products where non-allergen products are. Staff can also inadvertently contaminate products with allergens through poor personal hygiene and practices.
There is potential for all types of food hazards in care homes. The risk will depend on the care home, the residents being cared for, and the food/drink served. Care home providers must have a suitable food safety management system to prevent and control food safety risks.
Care homes should follow the 4Cs of food hygiene to prevent food hazards. These are cleaning, cooking, cross-contamination and chilling. These four simple rules cover essential food hygiene and safety practices.
According to the Food Standards Agency (FSA), a lack of thorough cleaning is one of the most common reasons for prosecution. Cleaning is essential as it stops harmful pathogens and allergens from spreading, discourages pests, and is a legal requirement. It is also part of infection control.
Care homes should have effective cleaning procedures and schedules to ensure that food storage, preparation, cooking, serving and eating areas are kept clean and safe, including mini-kitchens. Adopting a ‘clean as you go’ approach will help keep areas constantly clean and tidy. It is also important to keep equipment clean.
Food must be cooked thoroughly before serving. If food is undercooked, it can cause food poisoning, particularly with high-risk foods such as meat, poultry, fish and rice. Cooking at the correct temperature for the appropriate time will help kill any harmful bacteria. It is also important to hot hold food properly (see the safely storing food section).
The cooking method, time and temperature will depend on the type of food. However, care homes should always follow the cooking instructions on food packaging (where present), and food must always be piping hot before being served. When cooking, food should reach at least 70°C and stay at that temperature for 2 minutes (or at an equivalent temperature and time, i.e. 80°C for 6 seconds). It is advisable to test the food temperature with a clean, calibrated probe to ensure it is properly cooked.
If reheating any food, it should be at least 75°C for 30 seconds. In Scotland, the regulations require reheated food to be at least 82°C. Only reheat food once.
Foodborne illnesses usually occur due to the transferring of harmful bacteria between people, food, surfaces and equipment. This is known as cross-contamination, and it is one of the most common causes of food poisoning (FSA). It can also occur with chemicals, e.g. spraying chemicals in the air that can land on food, surfaces and equipment. Where allergens are concerned, it is known as cross-contact. This is where products containing allergens are often unintentionally transferred to allergen-free ones.
Care homes must ensure they prevent cross-contamination and cross-contact as much as possible, which can be achieved by:
- Good personal hygiene, e.g. washing and sanitising hands thoroughly.
- Thoroughly washing salad, fruits and vegetables.
- Not washing raw poultry, as bacteria can splash onto surfaces, equipment and other foods.
- Using separate areas, equipment and utensils for different types of foods, e.g. raw and cooked.
- Cleaning and disinfecting equipment, cleaning materials and utensils (before use, between uses and after).
- Storing food correctly, e.g. keeping raw foods away from cooked and ready-to-eat foods and keeping away from chemicals and medicines.
- Storing allergenic foods and non-allergenic foods separately, including ingredients and prepared food.
- Covering open food.
- Adopting a high standard of cleanliness at all times.
- Preventing and controlling pests.
- Training staff on avoiding cross-contamination.
Certain foods, e.g. those with use-by dates, cooked and ready-to-eat foods, must be stored chilled to be safe. Chilling does not kill harmful bacteria, but it does help to stop them from growing. If food is improperly chilled, it can enter the danger zone and encourage pathogens to grow, increasing the risk of food poisoning.
Care homes must ensure that food is properly chilled and stored correctly, for example:
- Ensuring chilled and frozen food is stored at the correct temperature on receipt/delivery.
- Ensuring chilled food is kept out of the refrigerator for the shortest time possible during preparation.
- Refrigerator temperatures are at 5°C or below, and freezer temperatures are at least -18°C or below.
- Ensuring food is stored correctly within refrigerators, e.g. raw food at the bottom or in separate fridges to ready-to-eat and cooked foods.
- Defrosting frozen foods as per the instructions on the packaging or safely in the refrigerator overnight.
- Following the storage instructions on food packaging and monitoring use-by dates.
Personal hygiene in care homes
Personal hygiene is vital when working with food. It includes many different aspects of the body, clothing and habits, such as handwashing, protective clothing, hair, jewellery, smoking, illnesses etc. If staff do not follow good personal hygiene practices, they can contaminate food with hazards through direct contact and cross-contamination.
Care homes should instruct and train their staff on the expected standards of personal hygiene when working with food.
It can include (this list is not exhaustive):
- Keeping hair, body and hands clean.
- Washing hands regularly and thoroughly (e.g. after visiting the toilet, after handling raw meat and before touching ready-to-eat/cooked food, after cleaning up accidents and after helping residents use the toilet).
- Tying hair back and covering it with a hairnet and/or hat.
- Short fingernails, no false fingernails and no nail varnish.
- No jewellery or watches, except a plain wedding band.
- No strong perfumes or other toiletries, which could taint food.
- Wearing clean clothes and suitable protective clothing (such as hairnets, gloves, overalls and aprons) and changing it regularly.
- No coughing or sneezing over food and preparation/serving areas.
- No smoking, eating or drinking when handling food.
- Discouraging behaviours, e.g. touching the face/hair, spitting, chewing gum and picking teeth/nose.
Under Regulation 852/2004, food handlers must maintain high standards of personal hygiene and cleanliness at all times.
If workers are ill, it can compromise food safety. Care homes have a legal responsibility to ensure that staff do not handle food if they have an infection. It also applies if they show any symptoms of food poisoning, e.g. vomiting and diarrhoea, and have any infected wounds, skin infections or sores. Any cuts and sores should be covered with brightly coloured waterproof plasters or dressings, even if they are not infected.
Care homes should have reporting procedures for when food handlers have gastrointestinal symptoms, Hepatitis A, and wounds, sores and skin conditions. If a worker has diarrhoea or vomiting, they should report to their manager/supervisor immediately. If they are at home, they should stay there or go home straight away if they are at work. They must not return to work until 48 hours after their symptoms have stopped.
Food allergens in care homes
Legally, care homes must inform residents and visitors in writing if any of the 14 allergens are in the ingredients of the food/drink they provide and sell. It will apply to pre-packed, pre-packed for direct sale (PPDS) and non-pre-packed (loose) food.
These are foods that are already in packaging before being sold. It has to be opened to be altered and is ready for sale. Most care homes will likely buy and provide pre-packed food, such as bottled and canned drinks, chocolate, biscuits and other snacks.
There has to be an ingredients list with all allergens emphasised on the packaging. Care homes should check the labels to ensure the allergens are clear before serving pre-packed foods to residents and visitors.
Pre-packed for direct sale (PPDS)
PPDS foods are prepared and packed on the same premises where sold and before they are ordered or selected by customers (or residents). This will apply if care homes make food on-site and put it in packaging ready for selection/sale.
The regulations have recently changed regarding PPDS food. Natasha’s Law came into force on 1st October 2021. Businesses must now label PPDS foods with a full ingredients list with all of the allergens emphasised on the packaging.
The Food Standards Agency (FSA) has further information on the allergen labelling changes for PPDS foods.
In a care home, non-pre-packed foods will include meals served to residents and visitors and any loose foods selected from display units.
Care homes must ensure they provide allergen information for all loose foods containing any of the 14 allergens. They can do this by adding full allergen information to menus or putting it on a chalkboard. They can also provide written information packs or a notice informing people how to obtain allergen information.
When preparing food, care homes must ensure that food allergens are handled and managed effectively to prevent cross-contact, which can be achieved by:
- Including allergenic hazards in HACCP systems and putting controls in place.
- Including any food allergies and other dietary requirements in residents’ care plans and ensuring all staff who prepare, cook, handle and serve food are aware.
- Providing allergen training for staff, including what to do in an emergency if a resident has an allergic reaction.
- Looking for hidden allergenic ingredients, e.g. Worcestershire sauce contains anchovies (fish).
- Preparing and storing allergen-containing products separately from non-allergen products, e.g. using separate equipment, such as colour-coded boards.
- Cleaning and disinfecting surfaces and equipment thoroughly where separation is not possible.
- Carefully checking pre-packed food labels for allergenic ingredients.
- Labelling any ingredient containers clearly with the allergens they contain.
- Recording allergen information accurately, including product specification sheets, ingredients labels and recipes of the dishes.
- Checking that any gift food brought by family and friends does not contain allergenic ingredients.
Unlike bacteria, allergens are not affected by cooking. Care homes will also need to consider various dietary requirements and food intolerances. Avoid cross-contact as much as possible when preparing and handling food.
Safely storing food in care homes
Care homes will store a variety of foods on the premises, such as:
- Ambient, e.g. foods kept at room temperature, such as sauces, herbs, spices, bread, cereals, flour, rice, pasta, vegetables, tea and coffee.
- Chilled, e.g. refrigerated foods, such as meat, fish, salads, butter, cheese, desserts and milk.
- Frozen, e.g. foods kept in the freezer such as ice cream, ice, fish, chips, meat and vegetables.
Store foods correctly to prevent contamination from food hazards and keep them fresh, so good quality, safe food is served.
Here are some top tips:
- Check all food deliveries before putting them into storage and reject anything that could compromise food safety and quality.
- Keep dry goods in sealed, labelled containers.
- Keep storage areas clean and tidy.
- Do not store any food, equipment or utensils on the ground.
- Have an effective stock rotation system, e.g. First In First Out (FIFO).
- Regularly check the temperatures of fridges and freezers.
- Store chilled medicines away from food in refrigerators.
- For pre-packed foods, always follow the storage instructions on the packaging.
- Where possible, store raw and ready-to-eat foods separately. If it is not possible, keep higher risk foods, e.g. raw meat and poultry, below ready-to-eat and cooked foods.
- Allergen-containing foods must be kept separate from other foods.
- Store chemicals and cleaning equipment away from food storage areas.
- Keep an eye on use-by dates and best before dates, and dispose of any food that has expired. Using food beyond its use-by date is unlawful.
- Label any non-pre-packed foods with the name and any allergens.
- Label any chilled and frozen food with dates put into storage.
- Use any open food within two days unless the instructions state differently.
Most care homes will hot hold food, e.g. in heated display units and bain-maries, which provides a perfect opportunity for harmful bacteria to grow if it is not at the correct temperature.
When hot holding food, it must be at a temperature of 63°C or above. The food can be kept below this temperature for up to two hours.
However, if not used after this time, it should be:
- Reheated until steaming hot and put back into hot holding (only reheat once).
- Cooled as quickly as possible to a temperature of 8°C or below.
- Disposed of if it has been out for more than two hours.
It is always best to throw out any leftovers to minimise the risk of food poisoning. Remember, reheating food more than once was why 15 residents were made ill.
Some care homes may display chilled food. Before putting any food into chilled units, they must be at the correct temperature before use, i.e. set at 5°C or below. The temperature should be checked at least once a day (using a clean probe between chilled food packs). Display all chilled food for the shortest possible time.
Hold cold foods below 8°C, but ideally between 0-5°C. It can be held above 8°C for up to four hours, but only once. After this time, the food should be disposed of properly.
Preparing food safely in care homes
Residents are likely to have various dietary requirements. Some may eat particular foods for religious reasons, other beliefs, needs and preferences, e.g. vegan, vegetarian, kosher and halal. Some may have food intolerances, e.g. to gluten or lactose. It is important to ensure that different types of food are kept separate during preparation to avoid cross-contamination.
This can be achieved by:
- Ensuring dietary needs, preferences and intolerances are included in residents’ care plans and making staff aware.
- Training staff on different diets and the precautions to take.
- Purchasing foods from approved suppliers and ensuring the correct type of foods are selected and delivered.
- Having separate preparation areas, equipment, boards and utensils for different foods. If this is not possible, thoroughly cleaning and disinfecting them.
- Following the 4Cs, especially for cross-contamination.
Safely serving food in care homes
Food contamination can also occur during food service. All areas and equipment should be kept in good repair and clean. All staff handling and serving food must maintain a high standard of personal hygiene at all times.
When serving food:
- Have separate serving areas for different foods.
- Take extra care when handling and serving ready-to-eat foods, as bacteria and allergens will not be killed by cooking or reheating.
- Provide and use utensils to serve wherever possible to avoid directly touching food.
- Use gloves when serving and change them regularly.
- Do not use dirty tea towels or clothing when carrying hot plates.
- Do not blow on or touch hot food to cool it before feeding an individual. Test the temperature if required to minimise the risk of burns.
- Follow hot holding guidance where food has to be kept hot before serving, and similar for chilled.
- Encourage residents to wash their hands thoroughly before eating.
- Always follow the 4Cs.
Waste management in care homes
Care homes are likely to produce many different types of waste, e.g. food, packaging and clinical. If waste management is inadequate, it can encourage pests and may even result in infestations. It can also increase the risk of food becoming contaminated with harmful pathogens. Food can start to smell as it deteriorates, which can be unpleasant.
All care homes should have appropriate provisions for the segregation, storage and removal of waste, for example:
- Having an approved and licensed waste carrier to remove waste.
- Not allowing waste to accumulate by removing it regularly from food areas.
- Having appropriate bins inside and outside, e.g.:
– Sufficient in number.
– Different types of bins for different wastes.
– Bins with foot pedals, so no hand touching.
– Bins with tight-fitting lids to prevent pests.
- Cleaning and disinfecting bins regularly.
- Lining bins with appropriate liners.
- Regularly emptying bins.
- Ensuring bins are placed and kept in areas designated for waste disposal.
- Keeping outside bins closed when not in use.
Pest control in care homes businesses
A pest is any insect or animal which can contaminate food with harmful pathogens and become an infestation if uncontrolled. They can also introduce physical hazards, e.g. contaminating food with droppings, feathers, fur or the pest itself.
Pests in food businesses are relatively common, and EHOs close down food businesses due to pest infestations more than any other problem.
Many different types of pests can contaminate food. The ones that may be in and around care homes may include:
- Rodents – Mice and rats.
- Insects – Flies, ants and cockroaches.
- Stored product insects – Beetles, particularly weevils, can be found in flours, grains and cereals.
- Birds – Pigeons.
Some examples of pest prevention and control methods include:
- Checking the premises regularly and trying to spot gaps or holes that could allow pests into buildings.
- Training staff to spot the signs of pests and how to report.
- Ensuring that external areas around the premises are kept clear of vegetation and anything that could encourage or harbour pests.
- Looking for evidence of pests or pest damage when checking deliveries, e.g. insects or gnawed packaging. Do not accept deliveries if there are any signs.
- Keeping the premises clean and tidy, especially where food is stored, prepared and served.
- Removing internal and external waste regularly.
- Using fly screens on any open windows and other pest control methods.
- Not having open bins and keeping lids closed when not in use.
- Storing food correctly, e.g. not on the floor, and keep it covered or well-sealed.
- Having an approved contractor to manage and monitor pest control within and around the premises and contacting them if there are any signs of an infestation.
- Taking extreme care to ensure any pest control chemicals used do not contaminate food.
- Disposing of any food touched by pests.
The Food Standards Agency (FSA) has a food safety management pack called Safer Food, Better Business. It can help care homes meet the requirements of food safety and hygiene legislation. There is also a supplement pack for residential care homes.
We also offer various food hygiene and HACCP courses, including a specific food hygiene course for care homes which can help providers and staff understand their legal obligations and assist them in achieving a five-star food hygiene rating.