Both the Care Quality Commission and Local Authorities carry responsibilities for health and safety in care homes in terms of inspection, regulation and prosecution.
In terms of Domiciliary care the picture is slightly less clear but the Health and Safety Executive provides guidance
here as to when the Health and Safety at Work Act does and does not apply, in most cases where domiciliary care is provide the HSAW will apply.
In both cases care homes and domiciliary care there is a duty of care that needs to be met to keep everyone as safe as possible the two are interdependent.
Once a risk is identified it must be managed by a risk assessment.
Risk assessments
A risk assessment is an organised and methodical look at an identified risk in terms of your premises, service users and the activities carried out to identify effective methods to reduce the risk of harm.
The aims of the risk assessment are:
- To identify the hazards, and the probability of the hazard causing harm, for example falling, the hazard is falling and the risk is that of injury. A risk assessment seeks to prevent the Hazard i.e. reduce the likelihood of falling and if the risk should materialise the person does fall then reduce the likelihood of injury (Harm
- A good risk assessment will reduce the risk of harm by developing a management strategy that reduces the probability of the risk happening, and also if it does happen the degree of harm is minimised.
There are a lot of factors that make falling more or less likely such as medication, the time of day or the use of walking aids.
There are also factors that can reduce the risk of harm, such as the removal of sharp edges, using soft furnishings or crash mats.
When considered together these factors can be used to mitigate the risk. For example, allow Mr M to sit on the side of his bed for 10 minutes prior to getting up and then ensure a staff member stays with Mr M for at least 10 minutes and that he has his walking aid with him. All of these would reduce the likelihood of Mr M falling.
Additionally you may move the sharp edged coffee table to reduce the possibility of Mr M causing injury on the table corners should he fall.
Registered Manager's responsibility
The registered manager is responsible for ensuring a safe environment and safe working practices. If a risk assessment is in place and staff are aware of it the registered manager is responsible if staff decide not to follow it, you should have known and addressed the issue impacting on both safe risk assessment not being followed and well led manager was unaware or even worse was aware but did nothing. If a risk is known about and there is no risk assessment in place then it is the registered manager's responsibility to complete a risk assessment.
The largest prosecutions are where a risk was known about but nothing was done and an individual suffered harm. For example, an unlocked door at the top of a set of concrete stairs in a care home was identified by the CQC. Several days later a resident fell down the stairs and died. Fines totalled almost half a million pounds because the death was preventable.
If the mitigation is dependent on the provider organisation (the overarching organisation that the registered manager is managed by) and the registered manager has informed them and followed up then it is the responsible individual who is accountable. .
The key document for health and safety in care homes and to a large extent domiciliary care is Health and safety in care homes
External link (PDF, 767KB) produced by the Health and Safety Executive.
A good overview for domiciliary care can be found
here.
Undertaking a risk assessment
Step 1 what is the hazard you are assessing e.g. choking, falling etc.
What is the initial probability of a specific individual suffering harm from that hazard if you do nothing different? If the risk is acceptably low then no need for a risk assessment (If Mrs Miggins is at no greater risk of choking than anyone else and she has never had a choking episode then why do a risk assessment?
Next consider what are the factors that make harm more likely for this individual:
E.g. The type of food they are eating – the consistency – their body positions, the impact of any Dementia- medical history etc. Identify why this person is at a higher than normal risk of choking.
WE then go on to look at how we can best manage these factors.
Undertake an assessment for best food type – provide support and encouragement - ensure correct body position, - check for changes in any medical issues, hopefully this will prevent any choking.
If the risk comes to pass and the person chokes what then can be put in place to reduce the impact.
- Degree of supervision - staff training to deal with choking incidents -
In terms of organisation the process is the same
What’s the Hazard – Fire (obviously there are a lot more factors than just these a guide to all of them can be found
here
External link but the process is the same
Identify what factors make it more likely to occur - rubbish piled up outside – too many things plugged into a socket
Identify what you can do to manage the risk - remove the rubbish away from the building – check for overloaded plugs - etc.
If the risk should occur how we can limit the impact – ensure fire alarms work – good evacuation procedure - call fire brigade and if safe to do so use fire extinguisher.
