Food Safety Guide for Care Homes

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

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.

It is unlikely people will catch the COVID-19 virus from food (Food Standards Agency). However, care homes must follow current Government Guidance to reduce the risk to staff, residents and visitors.

Chemical

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

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.

Allergenic

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:

• Eggs.
• Fish.
• Milk.
• 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).
• Soybeans.
• 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.

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.

Pre-packed

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.

Non-pre-packed (loose)

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.

Precautions

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.

Hot holding

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.

Chilled display

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.