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In the UK there are two main types of care homes – residential homes and nursing homes – with some care homes offering both residential and nursing care places. Several different types of care are provided in residential care homes, for example emergency care, convalescent care, respite care, short-term/long-term care, palliative care and end-of-life care. There are also specialised care homes for people with mental health, dementia, severe physical disabilities or learning disabilities.
The health, safety and welfare of care home employees, and the health, safety and welfare of other persons who may be affected by its activities, including residents and visitors, should be of primary concern to a care home at all times. Both the staff and management of the home should work in partnership to ensure that its statutory duties with regard to safety are met at all times. As there are countless safety hazards for those working and residing in care homes that need to be overcome on a daily basis, care workers will need to maintain their own safety, as well as the safety of the area and the people around them.
What is the role of a care home?
The term care home is fairly broad. Care homes provide accommodation, personal care and, in some cases, nursing care for people who need extra support in their daily lives. The personal care that these homes can provide to their residents includes assistance with eating, washing, dressing, going to the toilet and administering medication. In a nursing home, residents with specific conditions such as dementia, severe physical disabilities or learning disabilities or patients with cancer or terminal illnesses usually have access to round-the-clock medical care and nursing care.
Residential care homes and nursing homes employ a variety of people to ensure residents receive the care and support they need to live comfortable, happy lives, and to make sure that the home is run safely and in line with national standards, guidelines and regulations. Job roles in a care home can include, but are not limited to, care workers, managers, registered nurses, therapists, catering staff, maintenance staff, cleaners, administrators, and drivers. Job function and responsibilities will vary according to the establishment; however, the Care Quality Commission (CQC), which is the regulator body for care homes in England, states in their regulation that:
Depending on where and the type of work that they are doing, the role of workers and management in care homes may involve, but is not limited to:
Care workers / senior care workers, also called care assistants or support workers:
- Supporting people with social and physical activities as well as the basics such as eating and drinking
- Assisting with personal care, for example washing, dressing etc.
- Providing company to residents such as chatting and sharing news, accompanying people on appointments
- Encouraging residents to get involved with recreational activities and hobbies
- Involvement with writing residents’ care plans and providing information to family members regarding the care plan
- Administering medication under supervision and recording medication administration
- Working with other health and social care professionals to provide holistic care
- Giving feedback to health and social care professionals
- Record keeping
- Health and safety, and safeguarding
Management, includes owner/manager, managers, deputy managers:
- Responsible for the day-to-day running of the care home
- Conducting care assessments
- Care planning and risk management
- Monitoring quality of care to ensure care standards are high across the service
- Providing and maintaining safe equipment at all times
- Leading and managing the care team in their day-to-day duties
- Developing policies and practices
- Managing budgets
- Safe recruitment
- Managing contracts
- Managing records
- Training and supervising staff
- Promoting residents’ rights and being available to provide advice, support and information to residents, families and staff
- Dealing with any complaints directed at the home or staff
- Health and safety, and safeguarding management
- Working to strict legal requirements
- Assessment of new residents
- Care planning and risk management
- Providing medical care to residents as and when needed
- Supervising the care and support delivered by other members of staff
- Managing conditions associated with ageing and/or frailty
- Providing care for residents with complex care needs
- Monitoring vital signs and progress
- Fluid and medication administration
- Often the first point of contact for residents and visitors
- Processing pre-admission, admission and discharge documents
- Booking medical appointments
- Record keeping
- Creating and maintaining staff and resident files
- Financial tasks needed to support the home and its residents
- Assisting with basic IT issues
- All admin responsibilities that are crucial for the safety and care of the residents
- Menu planning
- Ensuring resident’s nutritional and/or dietary needs are being met
- Meal preparation and all food service
- Carrying out the cleaning rota and ensuring appropriate food waste disposal
- Ensuring that all kitchen equipment, crockery and cutlery is clean, free of stains/debris after washing
- Food ordering and stock control
- Providing excellent standards of hygiene and infection control
Maintenance / Drivers / Cleaners:
- Maintaining the building(s) to ensure residents have a safe and comfortable environment
- Electrical PAT testing
- Testing fire systems
- Grounds work
- Monitoring vehicle safety and maintenance
- Deep cleaning in all areas of the building
- Following the cleaning schedule
- Maintaining a high cleaning standard, free from infection
- Understand the cleaning requirements of different surfaces and coverings and the properties of cleaning materials to ensure safety
- Removal and safe disposal of rubbish including clinical waste
Therapists – a variety of therapists can work with residents in care homes. These are either directly employed or contracted for specified activities.
Therapists who work in care homes might include, but are not limited to:
- Occupational therapists
- Art/music therapists
- Speech and language therapists
- Activities coordinators
Generic to all roles is ensuring compliance with all relevant policies and procedures, and legal and regulatory requirements including health and safety. The above lists are not exhaustive and there is often a crossover of duties between roles. Whatever the environment they work in, care home workers will be responsible for ensuring the safety of their work and any equipment to protect the safety of themselves and other people.
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
- 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.
Under the Management of Health and Safety at Work Regulations (1999), the minimum a business must do is:
- Identify what could cause injury or illness in your business (hazards)
- Decide how likely it is that someone could be harmed and how seriously (the risk)
- Take action to eliminate the hazard or, if this isn’t possible, control the risk
Risk assessment requires making a judgement on Risk Severity. Risk Severity = probability of risk materialising x impact of risk on, for example, a person or people, a business, a property etc.
Probability may be understood as:
- Low (Level 1) – a reasonably informed person would think it very unlikely this risk would materialise in the foreseeable future.
- Medium (Level 2) – a reasonably informed person would think there is a significant possibility this risk would materialise in the foreseeable future.
- High (Level 3) – a reasonably informed person would think there is a very significant or even likely possibility the risk would materialise in the foreseeable future.
Impact may be understood as:
- Low (Level 1) – any impact that is minimal, having regard to the importance of interests affected, impairment of function and duration. Typically, the impact is isolated and short-lived.
- Medium (Level 2) – any impact that is significant, having regard to the importance of interests affected, impairment of function and duration. Typically, the impact is limited to one function or group, but there is a material operational impact and the effects may continue.
- High (Level 3) – any impact that is severe, having regard to the importance of interests affected, impairment of function and duration. Typically, the impact impairs a critical function and/or has a systemic impact and the effects may be long-lasting or permanent.
Care homes must ensure an assessment has been made of any hazards, which covers:
- What the potential hazard is – the risk assessment should take into consideration, for example, the type of equipment used, the way in which it is used and the environment it is used in
- Who or what could be harmed by the hazard
- How the level of risk has been established
- The precautions taken to eliminate or control that risk
Managing risk is an ongoing process that is triggered when changes affect the care home’s work activities; changes such as, but not limited to:
- Changing work practices, procedures or the work environment
- Purchasing new or used equipment or using new substances
- Workforce changes
- Planning to improve efficiency or reduce costs
- New information about the workplace risks becomes available
Risk assessments should be recorded and records regularly reviewed and updated whenever necessary. Should an accident occur, the Health and Safety Executive (HSE) will request copies of the risk assessments.
There are a number of laws and regulations that apply to the management of health and safety risks in care homes including, but not limited to:
- The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
- HSG220 Health and Safety in Care Homes, published by the Health and Safety Executive (HSE)
- Safe handling of hazardous substances (COSHH)
Why is PPE important
Personal protective equipment (PPE) protects workers from hazards such as trips, burns, electrocution, infections and falls. While there is some PPE that is universal to many occupations, care home staff have certain PPE which is specific to their job.
This includes, but is not limited to:
- Disposable gloves (vinyl or nitrile) should be worn when there may be exposure to blood, bodily fluids, secretions or excretions and when handling contaminated equipment.
- Disposable plastic aprons are designed to protect uniforms/clothing from moisture/soiling during direct resident care. In the majority of cases, plastic aprons will be appropriate for standard precautions. In some cases, where extensive contamination of blood/body fluids is anticipated a long-sleeved fluid-repellent gown may be more appropriate.
- Fluid-repellent surgical masks (type IIR) – these provide barrier protection to the wearer from splashes and droplets to the area of the wearer’s nose, mouth and respiratory tract. They do not provide protection against aerosolised particles and are not classified as Respiratory Protective Equipment.
- Respirator masks – the purpose of respiratory protection is to protect the wearer from pathogens spread by the airborne route, for example measles, chickenpox, tuberculosis, and when performing aerosol generating procedures on residents with suspected or known influenza or other respiratory tract infections.
- Eye protection (where there is a risk of contact with body fluids) – eye and face protection must be worn when there is a risk of splashing body fluids onto mucous membranes, for example the eyes or nose.
Some main pieces of PPE that can help limit risks and boost safety for kitchen staff include:
- Apron – hot liquids and spills can be kept at bay while using an apron.
- Oven gloves – these protect the hands of the employees who need to move hot plates and pots and pans around the kitchen.
- Footwear – non-slip shoes should be worn at all times, no matter the environment, to prevent slips and falls.
- Disposable vinyl gloves – these protect hands from hot foods, such as chillies and peppers during preparation that can irritate the skin and eyes.
- Hair ties or nets for those with moulting or long hair – this will mainly keep their hair from falling down and getting in the way of visibility and help prevent any hair and dirt from touching and affecting food preparation.
Maintenance and cleaning staff roles can come with a different set of hazards and risks.
PPE requirements may include:
- Eye protection to protect their eyes from hazards their job role might present to them, such as dust particles, debris and chemicals splashing up.
- Safety gloves / disposable gloves protect against different hazards such as corrosive chemicals and prevent germs and bacteria from people’s hands from being directly transferred onto items being cleaned and used.
- Overalls and/or outerwear provide protection from spillages or marks, and protect maintenance staff from the elements.
Staff should comply fully with all policies and procedures, including those relating to PPE wearing and hand sanitisation. In addition, PPE may sometimes be used by the resident’s family/visitors, particularly if they are providing direct care, for example assisting a resident with toileting. In these circumstances, family/visitor carers must be fully inducted in the use of PPE and hand hygiene.
What training should care home workers take?
Depending upon their role, staff and management working within a care home will have completed training and qualifications specific to that role. In addition to their occupational training, care home staff will need to participate in adequate health and safety training to ensure that they are competent to do their work. When care home workers are trained to work safely, they should be able to anticipate and avoid injury from job-related hazards. Safety training is essential for all care home employees appropriate to their role, and training should be directly applicable to the responsibilities and daily practices of the person being trained.
This training for care home employees might include, but is not limited to:
- Health and Safety for Employees
- Health and Safety for Managers
- Manual Handling
- Workplace First Aid
- Personal Protective Equipment (PPE)
- Assessing Risk
- Fire Safety Awareness
- Workplace Stress Awareness
- Violence at Work
- Electrical Safety Awareness
- PAT Testing Awareness
- COSHH Awareness
- Food Safety and Hygiene for Catering Level 2
- Food Safety and Hygiene in Care
- Safer Recruitment
- Administering Medication
- Care Certificate
Care home workers should at a minimum refresh their safety training at least every 2 years and participate in continuing professional development (CPD).
Get started on a course suitable for care homes
Workplace First Aid£20 + VAT View course
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Health and Safety for Managers£49 + VAT View course
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