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This is the third in my series looking at the common mistakes made by care providers and how to avoid these. This series is based upon many observations that I have made whilst undertaking mock inspections and service audits of care services over the last decade or so. Previous issues have looked at:-
1. Policies and procedures
2. Medication timings
This issue looks at the complex issue of safe premises. This applies equally to all types of premises where care and support is provided, this includes both care home and home care. The risks are potentially greater in care homes but home care providers have to consider the safety of both their offices (which may be visited by service users) and the service users home. There is a great deal of guidance on safety in care homes but less guidance on safety in the service users own home. I will cover some of the key aspects of safety in both types of service in this issue. It is important to recognise that every premises and every service is unique and my observations relate to generic services and providers should seek appropriate advice and support in matters such as health and safety.
Some of the common risks that I have observed include:-
• Unrestricted access to the building – on many occasions I have been able to access a care home, this has been via an unlocked front door, by pressing a buzzer and the door just opening, being let in by a visitor of staff member (I must look trustworthy) or by using another door as nobody answered the door bell. Once inside the building I am rarely challenged by staff. This effectively means that there is a risk to the people supported as the building can be accessed by anybody whatever their motives.
• Not being asked to sign the visitors book – this is a legal requirement. Not only are I and others not asked to sign the visitors book but I notice that other entries are illegible, this means that the care home does not have a record of visitors, nor does it know how many people are in the building and who they are. If there were an incident then any investigation would be hampered by this lack of vital information.
• Obstructions – these are usually boxes or equipment which has been left in location where is obstructed access and egress to and from the building. Not only does this impact on emergency evacuation procedures but it presents a risk to those in the building from trip hazards. There are two common occurrences of this, firstly; deliveries which are offloaded to the reception or entrance area and then left there for many hours until staff are available to relocate them to the appropriate storage area. Secondly, equipment and supplies which are left by staff in a location which is unsafe but convenient for staff e.g a hoist left in a corridor, cleaning chemicals left “hidden” behind a chair etc.
• Substances left in accessible places – this may be cleaning chemicals left where they can be accessed by people to whom the substances pose a risk. It may also include the contents of staff bags which are left in places (such as an unlocked staff room) where they can be accessed by people to whom the contents i.e. medication, perfume, foodstuffs etc pose a risk.
• Damaged fixtures and fittings – this includes damage to the fabric of the building such as wonky grabrails, protruding nails etc. It also includes damages equipment such as chairs with lose arms and bed tables where the bungs from the tubular legs have gone missing. All of these pose a risk that the premises are not safe for those who work and live in them.
To the above we can also add the risks posed by issues such as; electrical equipment, legionella, asbestos, working practices and violence and aggression. However, these risks are usually identified and managed in most care homes as they are more obvious than some of the risks that I have discussed above.
Some of the common risks I have observed include:-
• Obstructions in hallways, on stairs and in offices – it appears to me that some providers have no system for filing records and the records along with boxes of supplies are left wherever there is a flat surface. We must remember that the office is accessible to service users and other visitors and that if the office is not safe for a regulatory inspector then it will not be safe for anyone else.
• Unmanaged risks in service users homes – of course we know that the service users home is their home, but it’s also a workplace. Provider must assess and manage all risks to service users and workers. Some obvious risks include; trip hazards (rugs especially), cluttered spaces, electrical safety, pets, family members and so on.
• Risks associated with cars – OK, not strictly “premises” but risky all the same. I have lost count of the number of times I have observed home care workers driving a breakneck speed between calls whilst picking up voicemail messages, ringing the office and checking their rota. OK, I exaggerate a little but all of the above happens and the provider must do as much as possible to prevent (not cause) this.
Prevention is better than prosecution
There is a really simple solution to managing risks such as those above, that is do risk assessments. These should be undertaken by someone who is competent to do so and a robust methodology should be used. Risks are often assessed on the basis of severity and likelihood and scores assigned to these. If these scores are added or multiplied (depending on the method used) then this determines the risk rating. If the risk is unacceptable i.e. not low then further control measures (remedial action) is needed to further reduce the risk. Control measures normally work by reducing the likelihood of the risk occurring.
Risk assessments must be made available to all those affected by them, control measures implemented into practice and it is vitally important to monitor compliance with the control measures. Risk assessments should be reviewed whenever there is a change in circumstances, an incident or at least annually.
The HSE has some useful documents which care providers can use, these include:-
http://www.hse.gov.uk/pubns/books/hsg220.htm Health and safety in care home – some of this applies to home care as well
http://www.hse.gov.uk/risk/ – risk management