Health and Safety Guide for Care Homes

What are the Main Health and Safety Risks Care Home Workers Can Encounter?

There are many potential health and safety hazards and risks present in a care home environment which could lead to severe injury or even death. Manual handling is the most common cause of injury at work. Employees in care homes are at a higher risk of back injuries because assisting residents with movement is a large part of a carer’s job. Some people may need assistance to move around safely, whilst others may be dependent on staff for bathing, dressing and other tasks which involve moving and handling. Manual handling injuries have a major impact on all workplaces and sectors, costing the economy hundreds of millions every year. Manual handling encompasses a wide range of actions including lifting, lowering, pulling, pushing, and carrying awkward and heavy objects; the risks are endless for anyone working in care homes, who may experience manual handling injuries such as:

• Back injuries
• Hernias
• Musculoskeletal disorders (MSDs) such as shoulder strain
• Repetitive strain injury (RSI) such as wrist strain
• Soft-tissue injuries to the wrists, arms, shoulders, legs or neck
• Long-term pain in the arms, legs or joints

All staff should receive manual handling training and training in the use of specific equipment such as slings. In addition, load handling assessments must be recorded for all manual handling work activities. All completed risk assessments must be communicated to staff.

Slips, trips and falls are common risks in any workplace. In fact, they remain one of the biggest causes of non-fatal injuries, and care homes are no different. The main causes of slip and trip accidents for carers include slippery or wet floors, as floors are being cleaned on a regular basis often leaving them wet and slippery; obstructions, for example medical or mobility equipment; and trailing wires. Where possible, slip-resistant materials should be used in kitchens and bathrooms. In addition, staff should be encouraged to wear footwear with good amounts of grip. Good housekeeping and a ‘clean and clear as you go’ policy should also help to minimise this risk in a care home environment.

Equipment and medical device safety is an important consideration for health and safety. Hoists, lifts, motorised ramps, bed rails etc can all pose a risk if not correctly maintained. Regular maintenance checks should be carried out to ensure everything is working correctly according to legal requirements and in line with manufacturers’ recommendations, as this will reduce the risk of an incident occurring when using the equipment in a care home. Consideration should be given to the location and storage of any equipment when not in use and anyone required to use the equipment should be trained to do so correctly. Lifting equipment will need to have statutory inspections and service maintenance records completed.

Electrical equipment, including residents’ own electrical equipment, will require portable electrical testing (PAT) and other specific inspections. All equipment that uses a flexible wire or cable to connect to a power supply qualifies as a portable appliance and needs to be checked. Portable appliance testing (PAT) is the term used to describe the examination of electrical appliances and equipment to ensure that they are safe to use.

Most electrical equipment safety defects can be found by visual examination but some types of defects can only be found by testing. A PAT test involves a visual inspection to check the appliance casing and flex for wear or damage. Plugs are also checked for damage, correct wiring and ensuring that the correct fuse rating is used.

After the equipment has passed a visual inspection it will normally undergo a series of electrical tests using a fully calibrated electrical PAT tester. A label will be attached to each appliance indicating the test results; any item failing the tests will be easily identifiable and should be removed from service until repaired. You should record and retain the results of all PAT testing in an appliance register for future reference.

When a fire starts in a building, it can happen very quickly. Fire safety is even more important in establishments like care homes, where there may be lots of people in the building who are hard of hearing, have impaired vision or are unable to walk. The situation is even more dangerous at night-time, when the majority of residents are likely to be in their bedrooms, relaxing or sleeping. The Regulatory Reform (Fire Safety) Order 2005 and the Care Homes Regulations regulate fire safety in care homes and state that the registered person – in most cases this will be the owner or manager – should:

• Consult with a fire authority for advice.
• Take adequate precautions against fire risk.
• Make arrangements for the detection, containment and extinguishment of fires through provision of recommended fire safety equipment.
• Ensure the regular maintenance of fire safety equipment.
• Be responsible for the training of care home staff, and the appointment of competent fire wardens for the premises.
• Organise regular fire drills to practise evacuation procedures; all drills must be recorded, as should any equipment testing.

Hot water and hot surfaces are hazards that pose risks to both staff and residents in care homes. Residents in a care home may have conditions that make them vulnerable to injury from hot water or hot surfaces. A resident could fall onto a hot surface and be unable to move away, for example. Protective guards and warning notices will help here, as will a reduction in the core temperature of the water that comes from a hot tap.

Medication in care homes presents many risks. Care home providers/management should assess each person’s needs for storing their medicines and ensure that medicines are stored safely and securely.

They should provide storage that meets the person’s needs, choices and risk assessment and should consider medicines storage such as:

• Temperature requirements of the medicines
• Who needs to access the medicines
• How access will be restricted to authorised people
• The legal requirements relating to medicines storage
• The people that the medicines are for

Food handling and preparation. Outbreaks of food poisoning or other infectious diseases often occur from meals prepared in the kitchen in a care home or from food service, through unhygienic practices when handling, storing and cooking food. Anyone working with food should be trained in best hygiene practices, to avoid contamination. There are regulations that you need to adhere to including The Food Safety Act 1990. Food hygiene is particularly important in a care home as residents are often elderly, frail, have weaker immune systems, have ongoing health problems and are more vulnerable to diseases.

Some of the main elements of good food management and hygiene practices are:

• Good personal hygiene, including washing hands, wearing protective clothing such as aprons and hairnets and general cleanliness.
• Cleaning procedures, including washing and disinfecting the kitchen, equipment, plates and cutlery.
• Food storage, such as using proper containers, labelling and temperature control, especially with sensitive foods like meat and fish.
• Preventing cross-contamination of harmful bacteria through the use of separate chopping boards and storage, also with regards to allergens.
• Cooking food at the appropriate temperature, again particularly with meat, fish and also rice.

Any systems that use/control water or water extraction can be a breeding ground for bacteria if not properly maintained and may lead to water-based hazards such as legionnaires’ disease. This could include air conditioning units, spas, pools or water supplies. Regular maintenance of any systems should be put in place to mitigate this risk. Staff should be aware of any control procedures that would need to be implemented quickly if an outbreak of legionnaires’ disease occurs in the care home. Legionnaires’ disease is reportable under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) which places duties on employers, the self-employed and people in control of work premises (the responsible person) to report certain serious workplace accidents, occupational diseases and specified dangerous occurrences (near misses). There are other infections and diseases that may be reportable by care homes under RIDDOR, for example Covid-19 is a good example of how an infectious disease can be a hazard to a care home.

Dealing with challenging behaviour, predominantly from residents with a mental illness, can put those working in care homes at an increased risk of being subjected to violence and aggression at work. Any incident in which a member of staff is verbally abused, threatened or assaulted by a resident or member of the public during the course of their work should be reported. Staff should be effectively trained to work with potentially violent and aggressive residents; for example, being able to recognise triggers and have appropriate strategies to use to de-escalate situations.

The care sector is one of the most affected by higher stress levels. Work-related stress must be properly managed to maintain good mental and physical health. Stressors such as time and budget constraints, awkward residents or their families, inadequate staffing levels, and long hours can all have an impact. Staff who suffer from burnout tend to find themselves unable to continue performing their role effectively. For many, this can lead to anxiety or emotional distress. In severe cases, the affected individual may choose to end their employment. From a care perspective, care home residents may also end up experiencing a lower quality of service because staff duties may not be fulfilled as quickly or efficiently as before.

Safe staffing and safe recruitment are a fundamental part of getting care and support right for individuals and operating a healthy and safe environment. Safe staffing is about having enough staff, who have the right values and skills, to deliver high-quality care and support. Safe recruitment is about ensuring that only individuals who are suitable for working with vulnerable people, whilst keeping them safe from harm and risks, are appointed. These make sure that people receive safe and effective care and support that is responsive to their needs. If a care home does not implement safe staffing and safe recruitment it could put staff and the people they support at risk. For example, staff shortages or unsuitable appointments put services under extreme pressure and can mean staff have to choose what care can or can’t be delivered that day. This could lead to neglect and/or a safeguarding incident.

Carrying out a full risk assessment in the care home will help to manage health and safety standards.