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The Control of Legionella in Care Homes


Philip on The Control of Legionella in Care Homes

The term ‘care home’ may be used to describe a wide range of properties of varying size and complexity catering for people with a wide range of needs. Whilst care providers tend to specialise in a particular group or type of residents, the common factor is that these establishments provide residential accommodation in an environment that caters specifically for those who are less able to live independently and care for themselves. These include homes for the elderly, physically disabled, children with special needs and those with mental health needs. Nursing homes are a special type of care home with the ability to provide more advanced levels of medical care.

Care homes may be run independently or as part of a group. There are many commercially run homes but there are also homes run by charities and local authorities. Often care home managers are very specialised in the type of care provided, alternatively they may also have a more generalist managerial skill set. In both cases they are unlikely to possess a specialist knowledge in water systems safety.

Like other businesses and service providers care home operators have a duty of care to protect residents, staff, visitors and anybody else who may be affected by their undertaking from foreseeable risks to their health, safety and wellbeing.

Vulnerable Residents

Due to the nature of care homes residents are often vulnerable to a wide range of risks. This includes the risk posed by waterborne pathogens and scalding by hot water. Legionnaires’ disease and other waterborne pathogens are more of a threat to older people and those with underlying health concerns. With respect to scalding, guidance from the HSE tells us that “those at risk include children, older people, people with reduced mental capacity, reduced mobility, a sensory impairment, or people who cannot react appropriately, or quickly enough, to prevent injury.”

Complex Water Systems

Care homes often require bigger and more complex water systems than typical households due to the number of residents and the components and services needed e.g. size and complexity of the building, multiple en-suite facilities, assisted bathrooms, commercial grade catering facilities, high rate of hot water consumption during periods of peak demand. Larger and more complex water systems can be more difficult to keep under control and represent a greater potential for problems.

Legionella virus


The HSE’s Approved Code of Practice [ACOP] “Legionnaires’ disease, the control of Legionella bacteria in water systems”, L8 [4thEdition], applies to all duty holders that own or operate equipment or systems where there is a reasonably foreseeable risk of expose to Legionella bacteria. Due to the vulnerable populations and more complex water systems the standards and the control measures applied to care homes may need to be more involved than those applied to other establishments such as schools and offices, for example. Of course, any organisation that undertakes medical services or procedures should look to the specific healthcare guidance contained in the Department of Health’s Health Technical Memorandum [HTM] 04-01. It could be argued, however, that most care homes occupy a middle-ground between general-needs accommodation and healthcare.

What needs to be in place?

Regardless of the level of care or the standards to be applied, the key to managing the risk is the implementation of five key steps, as advocated under the HSE’s Approved Code of Practice [ACOP] L8:

  1. Appoint a manager to be responsible for others;
  2. Identify and assess sources of risk (i.e. carry out risk assessments);
  3. Prepare a scheme to prevent or control risk (aka a water safety plan);
  4. Implement, manage and monitor the scheme of precautions;
  5. Keep records of the precautions.

We have looked at these requirements in previous blogs, please follow the links provided for more information.

It is the risk assessment that identifies the level of risk and therefore informs the written scheme and the control measures defined within it. The assembly of a competent risk assessment team is therefore of paramount importance. The team should comprise both care professionals and water hygiene specialists to understands not only water system installation but also the operational requirements and user profile.

What can go wrong?

Legionella training

A quick round up of related news articles reveals that water hygiene problems are not uncommon in care home environments. The summary below links to some interesting articles and highlights the deficiencies reported in each case:

Failure to appoint a ‘Responsible Person’: Reports stated that the management at St Christopher’s Hospicein Sydenham had failed to appoint a competent person to manage the risk from Legionellosis. A patient died from Legionnaires’ disease and a worker at the hospice who also contracted the disease spent 18 days in a coma. This is a poignant reminder that Legionnaires’ disease does not only affect the most vulnerable individuals.

Inadequate Risk Assessments: A water treatment company were prosecuted for providing inadequate risk assessments to care homes in Wales.  Nursing homes were rated as low risk, and there was no evidence that regular temperature readings were taken.  DEBA UK were fined £24,000 and ordered to pay full costs of over £17,000

In another unrelated example a care home failed to comply with an improvement notice that required a risk assessment to be carried out.  Mother Redcaps Care Home Ltd were ordered to pay over £40,000.

Devise, implement and manage a scheme of control measures: Following the death of a resident in an elderly persons’ care home run by Reading Borough Council, an HSE spokesperson indicated that the council’s failings were “systemic” and that “the control and management arrangements were not robust, and the legionella training of key personnel fell significantly below the required standard”.

Similarly, in this report BUPA were fined £3m after failing to implement measures to monitor and control hot and cold water systems during refurbishment works.

Selecting and monitoring contractors: In this final example, Four Seasons Healthcare had engaged a specialist contractor to maintain the hot and cold water systems, however, they admitted to not having undertaken any checks on the contractors “level of technical expertise” and were fined £600,000 for safety breaches. Click here to read another article that provides further details.

August LTD
Grahame Gardner
Mr Trax Curtain & Blind Solutions
Care Show London
Inspired Inspirations
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