Food Safety and Hygiene in Care Homes

There are more than 17,000 care homes in the UK with nearly half a million residents. As well as the residents, care homes in the UK have an estimated workforce of almost 700,000.

The Food Standards Agency (FSA) found that care homes in the UK fail hygiene and food safety inspections more than any other type of care provider, with some care homes being awarded a 0 – the lowest possible score.

As care home residents are usually extremely vulnerable, unsafe food practices can be detrimental to their health and safety.

What is food safety and hygiene?

Many people are unaware of the differences between food safety and food hygiene and use the two terms interchangeably. Food safety refers to all of the important practices that must be followed to ensure that food is fit to eat. It is the whole system of managing, eliminating and reducing the risks related to food.

On the other hand, food hygiene is a subcategory of food safety and refers to the processes directly related to food and its ingredients.

Let’s take a look at food safety and food hygiene in more detail.

Food safety

Food safety concerns the management systems that must be in place within the food industry. This includes businesses and establishments that sell, cook or serve food. Food safety ensures that all food is safe to eat and is as advertised.

Any business or establishment that deals with food must ensure:

• All food is safe to eat.
• Nothing is added or removed from the food, nor is it treated in any way that could make it harmful to the consumer.
• The food is the same quality as is stated or advertised.
• They do not mislead people through labelling, advertising or marketing.
• They keep accurate records recording traceability (where the food came from) and that this information is available on demand.
• Any unsafe food is withdrawn or recalled, and an incident report is completed.
• They provide information about why food has been withdrawn or recalled.
• The food hygiene rating is clearly displayed (if applicable).
• Any additives that are used are approved for use in food.
• All personnel follow good hygiene practices.
• Appropriate food management systems are implemented.
• The premises are well-maintained.

Food hygiene

Food hygiene guarantees that food has not become contaminated and is safe to eat. Food hygiene is essential in every stage of the food process, including food handling, storage, preparation, transport, cooking and serving.

Food hygiene practices aim to minimise or remove food hazards through safe food processes. All hazards should be controlled to acceptable levels and should be regularly monitored.

This can help to prevent the food from becoming contaminated, spoiled or being made unsafe to eat as a result of bacteria or foodborne diseases. Contaminated food can cause serious illnesses, and in extreme circumstances, for example when eaten by people who are vulnerable, can result in hospitalisation or even death.

Food hygiene includes multiple components, processes and procedures that all work together to ensure that food is safe to consume.

• Preventing Cross-Contamination
  Contamination can be bacterial, physical, chemical or allergenic. Food establishments can avoid cross-contamination by following safe hygiene practices such as using different equipment and utensils for raw and cooked food, washing utensils, equipment and surfaces thoroughly, and storing foods correctly.
• Implementing Cleaning Procedures
  Cleaning procedures should include a schedule for cleaning. The management of cleaning materials and equipment and the cleaning processes all staff will follow must also be included in the procedures. Cleaning procedures should apply to food preparation areas, equipment, kitchenware, appliances, the working area, surfaces and floors.
• Personal Hygiene
  All employees who come into contact with food and food preparation and storage areas must ensure a high level of personal hygiene. This includes wearing protective clothing, keeping hair tied back or wearing a head covering, and not wearing jewellery. Food handlers should also ensure they do not eat or chew gum near food and avoid smoking or touching their face or hair.
• Following Handwashing Procedures
  Frequent and effective handwashing can help to prevent harmful bacteria from spreading and food from becoming contaminated. Some examples of when you should wash your hands include before preparing food, after touching raw food, after handling food waste or touching bins, after cleaning, after coughing, sneezing or blowing your nose, and after touching light switches, door handles, mobile phones, cash registers and other surfaces.
• Following Temperature Guidelines
  You must follow the temperature guidelines for cooking food, cooling food and for food that is refrigerated or frozen. This can help to prevent spoilage and the growth of harmful bacteria.
• Safe Food Storage
  You should consider where food is stored, the type of storage containers that are used, the labelling process, the temperature of all storage areas and whether there is any risk of contamination. You should also consider following the FIFO – First-In/First-Out – method of putting new stock behind the older stock.
• Allergen Control
  All food establishments must be aware of the 14 major allergens – celery, cereals containing gluten, crustaceans, eggs, fish, lupin, milk, molluscs, mustard, peanuts, sesame, soybeans, sulphur dioxide and sulphites – and ensure consumers are made aware if any of the allergens are present. You should also prevent allergens from cross-contaminating other foods.

Why is food safety and hygiene in care homes important?

Although it is important that all food establishments adhere to food safety and hygiene guidelines, this is particularly vital in care homes. Residents of care homes are usually more vulnerable.

This could be because:

• They are elderly.
• They have weaker immune systems.
• They have other health problems.
• They are more vulnerable to illness and disease.

Many care homes prepare and cook food on-site for their residents. It is essential that care homes monitor their food safety procedures and ensure good hygiene practices to protect the health and safety of their residents.

Eating unsafe food can result in food poisoning or a food-related infection. People who are not considered as vulnerable may experience mild symptoms, such as vomiting, diarrhoea, stomach cramps and nausea.

However, people who are vulnerable such as those who are residents of care homes may be more likely to experience complications or other health problems as a result of food poisonings, such as gastroenteritis, dehydration, reactive arthritis and kidney failure.

If toxins released by the bacteria in unsafe food enter your bloodstream, this can cause high blood pressure, kidney failure, kidney disease and neurological damage. In serious circumstances, this can result in death. For more information about food poisoning in care, consult our knowledge base.

Personal hygiene in care homes

One of the most effective ways of protecting care home residents is to ensure all staff maintain a high level of personal hygiene.

There are several ways you can ensure good personal hygiene when preparing, cooking or serving food.

According to the World Health Organisation (WHO), the main transmission of germs and bacteria in healthcare settings is hands. Following proper hand hygiene practices is essential in avoiding the transmission of germs and bacteria. All care home employees, not just those who work in the kitchen, should be aware of the importance of hand hygiene. Staff should be aware of proper handwashing techniques and when they should wash their hands.

Some other ways that care home employees can ensure good personal hygiene are:

• Wear suitable and protective clothing.
• Keep long hair tied back or wear a hair net or other head covering.
• Wear gloves where necessary.
• Do not wear jewellery, especially on the hands and wrists.
• Wear a blue coloured, water-resistant plaster over any open wound, cut or scratch.
• Do not eat or chew gum near food.
• Do not smoke before handling food.
• Do not touch your face or hair when handling food.
• Do not cough or sneeze near food. If you do cough or sneeze, follow techniques to prevent contamination.
• Keep your nails clean and short if possible.

Maintaining a high level of personal hygiene can significantly reduce the risk of cross-contamination. As well as preventing contamination from bacteria, good personal hygiene can also prevent physical contamination from foreign objects such as hair, fingernails, skin, jewellery and plasters.

Reducing the risk of contamination and ensuring good personal hygiene can help to protect the health and safety of care home residents and staff.

Protective clothing in care homes

Any staff who cook or handle food must ensure they are wearing appropriate protective clothing. Appropriate clothing can help to protect both the residents and staff.

Clothing that could be worn to ensure food safety and hygiene in care homes includes:

• Hats or hair nets – This helps prevent physical contamination from hair or dandruff.
• Food safe gloves – Gloves can help you to hygienically prepare food and prevent contamination from germs, fingernails, nail varnish, jewellery and skin. Food safe gloves are made from materials that are considered safe to use with food and food packaging and are powder-free.
• Aprons and other clothing coverings – Wearing an apron or another form of clothing covering can act as a barrier between the kitchen or food preparation area and the outside world. This can prevent contamination.
• Enclosed, non-slip and clean shoes – Not only does this type of shoe help to protect the employee from hazards in the kitchen, such as hot spills, falling utensils and equipment, and slips, but ensuring your shoes are clean also helps to reduce the likelihood of hazards entering food areas on your shoes.

You should also ensure that all clothing is cleaned before the start of your shift. Clothing such as kitchen uniforms and aprons should be cleaned in a washing machine using detergent on a hot wash. Your clothing should also have minimal contact with the outside environment to reduce the risk of hidden bacteria, chemicals or other contaminants from coming into contact with your clothing.

Wearing the correct protective clothing can help to ensure food safety and food hygiene standards are high in care homes.

Food handling and preparation in care homes

Food handling is any duty related to the preparation, storage or serving of food. Any member of staff who handles open food or touches a surface that comes into direct contact with food is considered a food handler. This can include equipment, utensils and food packaging.

In a care home, it is not merely the chef who handles food. Many members of staff will be considered food handlers and food may even be handled by the residents themselves, for example, if they are involved in growing and picking fruits and vegetables, collecting eggs from chickens, or baking or cooking activities.

It is important that anyone involved in food handling, including care home residents, properly clean their hands and wear protective clothing.

When preparing food in a care home, you must ensure you avoid cross-contamination. Some ways you can do this include:

• Wash hands and surfaces frequently.
• Wash any utensils, crockery and chopping boards that are used for raw and cooked food thoroughly between each task.
• Wipe or clean any spillages as soon as possible.
• Don’t wash raw meat.
• Use different utensils, crockery and chopping boards for raw meat, seafood, poultry and cooked food.
• Replace chopping boards if they become difficult to clean or worn down.
• Rinse fruits and vegetables thoroughly under running water to remove any mud, dirt or grime.
• Ensure all food is within its best before or use-by date.
• Ensure all individuals who are handling and preparing food are wearing the correct protective clothing.
• Ensure any food that is opened is used within the correct timeframe.

Although many people may think that the chef is responsible for food safety and hygiene in a care home, it is actually the care home manager who has the overall responsibility.

The manager must take an active role in ensuring the highest standard of food hygiene within the care home. They must also regularly monitor the hygiene practices of staff and ensure the high hygiene standards of the kitchen environment.

This includes ensuring that the kitchen and other food storage and preparation areas comply with regulations and standards.

As part of their role, the care home manager will also need to carry out written audits to show that standards are consistently maintained. They are responsible for safeguarding the health and safety of all care home residents and staff.

Food storage and temperature control in care homes

Food safety and hygiene guidelines are specific regarding the safe temperatures that must be maintained during the different stages of the food process, including when food is being stored in the care home.

The danger zone for food temperatures is between 8°C and 60°C. Temperatures below 8°C result in the growth of bacteria stopping or significantly slowing. Temperatures above 60°C will result in bacteria starting to die.

By following the temperature guidelines set out by the Food Standards Agency (FSA), care homes can minimise the risk of the food being contaminated by harmful bacteria and ensure that the food is safe to eat. This helps to protect the health and safety of care home residents and reduces the risk of them contracting food poisoning or another foodborne illness.

As well as following guidelines and regulations on safe food temperatures, care homes must also ensure they correctly store all food.

Some ways to ensure food is correctly stored include:

• Always follow the storage instructions on the label or packaging.
• Store raw meat, poultry and seafood in sealed containers at the bottom of the fridge to prevent liquids from leaking or dripping onto other foods.
• Observe all use-by and best before dates.
• Store eggs in their original container in the fridge.
• Ensure all food and ingredients are dated and rotate the stock correctly.
• All shelf-stable foods should be kept in a temperature-controlled area and should be covered to prevent contamination from dust, insects and pests.

The importance of cleaning and disinfection in care homes

A key way to ensure the health and safety of all care home residents is by ensuring proper sanitation, disinfecting and cleaning. This helps to ensure a controlled environment for residents that is both clean and safe.

All care homes should have recorded procedures and protocols that are implemented across the care home and are followed by all staff. Frequent cleaning and disinfection can help to prevent the spread of germs and bacteria that could cause illness.

Cleaning helps to physically remove organic matter, dirt, dust and germs. However, cleaning alone doesn’t destroy all the harmful bacteria and germs that can contaminate food.

Care home staff should ensure that after surfaces have been thoroughly cleaned, they are then disinfected. Disinfection can destroy any harmful germs and bacteria that remain on surfaces.

Included in these procedures will be protocols related to cleaning and disinfecting in the kitchen and other food areas.

Cleaning procedures should include:

• A cleaning schedule for food preparation and storage areas, including refrigerators, freezers, ovens and other kitchen appliances.
• How frequently routine cleaning should take place.
• How frequently deep cleaning should take place.
• The cleaning procedure staff should follow if surfaces or equipment become contaminated.
• Cleaning procedures that must be followed during food preparation and cooking.
• Which equipment and food areas should be disinfected.
• The protocol for checking and replenishing cleaning products and equipment.
• COSHH (Control of Substances Hazardous to Health) regulations and what must be done to ensure these are adhered to.
• The personal protective equipment (PPE) that is required when handling food in the care home.
• The PPE that is required when cleaning in the care home.
• How frequently PPE should be washed and replaced.
• The cleaning procedures that should be followed in the event of an outbreak or incidences of infection in the care home, such as enhanced routine cleaning and disinfection.
• The types of cleaning products and equipment that are used for specific areas of the kitchen and certain cleaning tasks.
• The colour coding scheme that applies to cleaning materials.
• Circumstances that may require terminal cleaning, such as an infection outbreak.

Food safety and hygiene training in care homes

The level of food safety and hygiene training that is required will depend on the role the staff members have in handling, preparing and cooking food. All food handlers must be suitably trained and complete a Level 1, Level 2 or Level 3 Food Hygiene Certificate within three months of beginning their work in the care home. It is also recommended that care home staff update their training at least every three years.

Level 1 food hygiene certificate

The Level 1 Certificate covers the basic principles of food hygiene and food hazards. Training will include information on temperature control, personal hygiene, avoiding cross-contamination, food poisoning and other foodborne illnesses, correct waste disposal, cleanliness in preparation areas, food storage and other food safety issues. The Level 1 Certificate is recommended for care home staff who do not directly prepare, cook or handle food in any way.

Level 2 food hygiene certificate

The Level 2 Certificate is designed for those who handle, prepare or serve food. It covers all of the topics taught as part of the Level 1 Certificate in more detail. It also covers how to control food safety hazards, implementing cleaning procedures, how to protect food from contamination, the principles of HACCP, and all legal responsibilities related to food hygiene.

The majority of care home staff will be expected to hold a Level 2 Food Hygiene Certificate. If any care home residents are involved in food handling, preparation or another aspect of the food process, staff members will need a minimum of a Level 2 Food Hygiene Certificate. This allows staff to properly supervise and ensure good food safety and hygiene practices throughout.

Level 3 food hygiene certificate

This is the most advanced certification and is recommended for kitchen managers, chefs, cooks and care home managers who handle food as part of their role or who are responsible for food safety management. As well as the topics taught in Levels 1 and 2, the Level 3 course teaches care home staff how to take responsibility for food safety and monitoring procedures and how to achieve a 5-star hygiene rating. It will also cover how to comply with laws and regulations and how to train or supervise others in following the correct food hygiene and safety procedures.

Not only is food hygiene training a legal requirement in care homes, but it also gives care home staff the necessary knowledge and skills to effectively monitor food safety and achieve the highest possible level of food safety and hygiene. This can help to safeguard the care home residents from any foodborne illnesses or harmful bacteria.

Food safety management in care homes

A Food Safety Management System (FSMS) is a systematic approach that helps care home staff to control food safety hazards. It can help to ensure that all staff are following food safety and hygiene practices at all times. It is a written document that records exactly how a care home manages food safety and hygiene.

An FSMS should be implemented in all care homes and should be recorded and documented in line with the HACCP. All care home staff should be able to access the FSMS at any time. An FSMS is a legal requirement that ensures care homes are complying with food safety and hygiene regulations.

The FSMS should include the procedures that will be followed to effectively manage food safety and to ensure complete compliance from all care home staff. It should also identify the specific hazards and risks related to the care home and the controls.

An FSMS ensures that all food that is served in the care home is safe to consume. As part of the FSMS, a care home must have distinct standards and procedures for every part of the food process. The FSMS must identify any food safety hazards and the controls that are needed to minimise or eliminate hazards.

The FSMS should follow the principles of the Hazard Analysis and Critical Control Point (HACCP).

1. Identify any potential hazards.

2. Determine the critical control points for each hazard (the controls that can be introduced to prevent or eliminate hazards).

3. Establish the critical limits.

4. Implement procedures for monitoring the critical control points.

5. Establish any actions that can be implemented to prevent critical control points from failing.

6. Establish procedures to verify that all steps are working correctly.

7. Implement a record-keeping system for all hazards, actions and critical control points.

An FSMS is an effective way a care home can demonstrate its compliance with food safety legislation and guidelines.

Failure to implement an effective FSMS can not only result in a care home breaching regulations and receiving a low hygiene rating, but it can also result in a potential closure. The FSMS also helps to protect residents from food safety risks and being exposed to any hazards.

Meeting CQC guidelines

The Care Quality Commission (CQC) is the independent regulator of care homes across the UK. The CQC was established by the Health and Social Care Act 2008. It ensures that care homes are providing high-quality care that is safe and effective. All care homes and other care providers must be registered with the CQC.

The CQC is responsible for inspecting care homes and ensuring they are complying with regulations. As part of their inspection, CQC inspectors will assess the cleanliness of a care home’s kitchen. They will assess whether there are any risks to residents’ health and safety and whether potential hazards have been identified and addressed.

The CQC inspector will check whether food preparation and storage areas are safe and sanitary and that the care home has an effective Food Safety Management System (FSMS). They will also check whether the care home is following Hazard Analysis Critical Control Point (HACCP) guidelines, has conducted regular risk assessments, and has implemented effective cleaning procedures and policies.

The inspector will also assess whether the care home is:

1. Safe – Are the residents protected from harm and abuse?

2. Effective – Does the care, treatment and support help residents to maintain quality of life and achieve good outcomes?

3. Caring – Do staff treat residents with compassion, kindness, dignity and respect?

4. Responsive – Are services organised so that they meet the needs of residents?

5. Well-led – Do the leadership and management of the care home make sure high-quality care is provided?

The CQC inspector will assess the care home and assign them a grade of ‘Outstanding’, ‘Good’, ‘Requires Improvement’ or ‘Inadequate’.  The report is published online and is accessible to the general public. If a care home is rated as inadequate, it may be required to create an action plan that shows how it is going to improve, with the CQC also having the power to suspend or cancel a care home’s registration, resulting in the potential closure of the care home.

Food safety and hygiene laws and regulations in care homes

There are several laws and regulations that cover food safety and hygiene in care homes. The Food Standards Agency (FSA) is the government department responsible for protecting public health in relation to food in England, Wales and Northern Ireland. The FSA ensures that the food consumed in care homes is safe and that food regulations and laws are met.

To comply with the FSA’s good safety regulations, care homes must:

• Ensure hygienic food handling.
• Ensure the physical condition of the care home.
• Ensure Food Safety Management Systems are implemented.

Care homes must also ensure they comply with the Food Safety Act 1990, focusing on the preparation, storage and serving of food and drink in care homes. Care homes must ensure high hygiene standards when they handle, store, prepare, cook and serve food. The Food Safety Act 1990 is the main framework for food safety laws in the UK.

Under the Food Safety Act 1990, care homes must:

• Ensure all staff follow good hygiene practices.
  This includes ensuring good personal hygiene, the safe handling of food, effective cleaning procedures, allergen control, safely storing food, following cooking temperature guidelines, and preventing cross-contamination.
• Implement appropriate food management systems.
  This includes implementing an FSMS and following HACCP processes. Care homes must also ensure they keep accurate records, correctly label all foods and ingredients, and ensure they train their staff properly.
• Maintain hygienic premises.
  As well as ensuring clean practices, care home staff must also ensure the maintenance and upkeep of the building, suitable lighting, correct ventilation, pest control and effective waste management.

The Food Safety (General Food Hygiene) Regulations 1995 set out the food hygiene requirements for businesses and establishments, including care homes, in the UK.

Under these regulations, care homes must:

• Ensure the food premises are kept clean and in good repair and condition.
• Ensure there is suitable and sufficient ventilation, lighting and drainage.
• Ensure there are adequate handwashing facilities.
• Ensure floors, walls, ceilings, windows, doors and surfaces are in good condition and are easy to clean.
• Ensure there are adequate facilities for cleaning utensils and equipment and washing food.
• Ensure there is both hot and cold running water.
• Ensure there is adequate facilities for maintaining and monitoring food temperatures.
• Avoid the risk of contamination, where possible.
• Keep waste bins closed and not gather waste in food rooms.
• Maintain a high level of personal hygiene.
• Ensure that any individuals carrying any type of infection that can be transmitted through food are not allowed in food areas.
• Ensure food is stored correctly and protected from contamination.
• Ensure all food handlers receive food hygiene training at a level appropriate to their role.

What is the penalty for non-compliance?

As the CQC is the governing body inspecting the food safety and hygiene of care homes, they will be responsible for any penalties related to non-compliance. If a care home is found to be not complying with food safety and hygiene laws and regulations, the CQC has the power to place the care home into special measures.

If a care home is placed into special measures, the CQC will conduct another inspection within six months. As part of the special measures, the care home must significantly improve the quality of the care it provides. The CQC can provide a framework to ensure improvements are made.

The responsibility of food safety and hygiene in the care home is usually placed on the chef, kitchen staff and care home manager and they will work closely together to ensure compliance. They will need to ensure the food that is being provided to residents is high-quality and is prepared in a clean, hygienic environment.

If the non-compliance is particularly serious, the CQC also has the power to shut a care home down. They are more likely to do this if they deem the health and wellbeing of residents to be at risk. The CQC can also initiate prosecution in serious cases where a resident has been injured or harmed.