Protecting the vulnerable

Healthcare in all forms is growing. The rise in the age of the population is meaning more people are requiring care and for much longer. The NHS is struggling to cope and more and more people are getting care in different arenas. Most people will automatically think of old people’s homes but even these are rapidly changing to meet demand and changes.

When you mention residential care homes people automatically think of old people’s homes and they think that these are homes where old people get some support and company in their later years. However in reality residential care is a much wider spectrum than this.

There are care facilities for all ages and these can be split into several categories: care homes with nursing care; care homes without nursing care; retirement homes; sheltered housing; assisted living (normally care in retirement properties); and home care.

These house some of our most vulnerable people and Fire & Rescue Authorities (FRA)  quite rightly invest considerable resources in protecting these though regulatory fire safety inspections, Home Fire Safety Visits (HFSVs) and advice in seminars and literature.

There are many recent reports on how the population is aging; we already have nearly one million people aged over 85 and reports suggest by 2025, one in ten people will live to be 100.

These figures will only increase the numbers of people who require care in the future. Added to this the pressures posed on the NHS and we are already seeing those who would normally be in hospital going into care homes with nursing. This is pushing people down the care chain. Those who get home care would have most likely been in sheltered housing ten years ago.

History of Fire Safety in care homes

Residential care homes came under the auspices of the 1971 Fire Precautions Act but were never a designated use so were subject to minimum fire legislation. Prior to the introduction of the Fire Precautions (Workplace) Regulations 1997 (FPWR) FRA inspected care homes as agents for local authorities. I remember as an inspecting officer in the early nineties inspecting local authority homes on an annual basis and seeing the same problems each year but powerless to do anything. However as soon as we found issues at private homes the local authority would demand the improvements made.

FPWR gave FRAs legislative powers in care homes and introduced to fire the concept of risk assessment and emergency plan. The onus was on the employer to comply and dealt mainly with the safety of employees. This has been built upon by the Regulatory Reform (Fire Safety) Order 2005 (RRO).

The RRO places a number of duties on the ‘responsible person.’ In a workplace the responsible person is the employer, if it is not a workplace then it could be the person who has control of the premises in connection with carrying out a trade or business or the owner of the premises.

The duties placed on the responsible person are also placed on any other person, who has control of the premises, to any extent. This would include care home mangers, duty managers and so on.
The duties include:
•    Reducing risk from fire
•    Suitable and sufficient risk assessment
•    Emergency plan including evacuation
•    Appropriate fire safety arrangements
•    Mitigating effects of fire
•    Suitable training
•    Nominate competent persons
•    Provide information to employees and others

Why are Care Homes an issue?

As previously stated they house some of the most vulnerable people in society. Latest figures show that most fire deaths occur in a domestic environment and the over 80s are the most affected. A large majority of these are receiving some form of care. There have also been tragedies such as Rose Park where 14 residents tragically lost their lives. 

There have been a number of fires and prosecutions which have attracted media interest and fines have been in excess of £100,000 in some cases. Therefore FRS and care operators want to avoid this.
Care is one of the most regulated industries there is a huge amount of legislation and regulations that operators have to abide by. They therefore see the fire inspector as just another hoop they have to go through.
However fire is probably the only occurance that can lead to multiple deaths and injuries.

The key to good fire safety and compliance with fire safety law is a robust fire risk assessment process and a comprehensive, workable, evacuation plan.

Robust fire risk assessment process

The fire risk assessment process is fundamental to compliance. It is not just a piece of paper but a living working document that adapts with the care home.

There are a number of risk assessment methodologies that can be used to undertake the risk assessment but although the RRO does not require it, best practice would be to appoint a competent person to undertake the risk assessment.

The fire risk assessment competency council has issued a draft document which states: In general, other than in the case of simple, low risk buildings, fire risk assessors, particularly those offering their services on a commercial basis, need an appropriate knowledge of:
•    The assessment of risk from fire
•    Applicable legislation 
•    Appropriate guidance 
•    Behaviour of fire in buildings
•    Behaviour of people in fire situations
•    Means of escape
•    Fire prevention  
•    Fire Protection ( includes passive & active)
•    Management of Fire Safety
Due to the type and nature of care homes, fire risk assessors need to demonstrate they are knowledgeable and experienced in the above.

Robust evacuation strategy

Once the suitable and sufficient fire risk assessment has taken place this will influence the evacuation plan. Other than very small homes the normal evacuation strategy is Phased Horizontal Evacuation (PHE). However, this can only be used where a number of fire safety measures are in place that are maintained and in effective working order.

This includes fire compartmentation. Any doors, walls, or ceilings that make up the fire compartment have the required fire resistance. There are no breaches by services, pipes or damaged parts. Fire doors fit in their frames, self close and are fit for purpose. Best practice involves using third party accredited products installed by third party accredited installers.

Another measure is automatic fire detection giving adequate system and coverage for risk to provide early warning so staff can commence PHE.

Staff training is also vital. Staff should be trained in the following where necessary:
what to do if they discover a fire; how to raise the alarm; how to interpret a fire alarm panel and any zone plans; and knowledge of how home is compartmentalised.

Staff should also be trained in first aid and fire fighting; what information to give on-coming fire crews; how to report fire safety issues; and knowledge of the requirements of patients.

The list above is not an exhaustive one, please see the guidance documents mentioned later in this article to gain further information.

The RRO states that the responsible person must nominate competent persons to assist them in their emergency plan. A competent person is someone who has sufficient training and experience or knowledge and other qualities.

The evacuation plan must be able to work 24/7 regardless of the number of staff or any key member of staff. It also needs to take into account the changing condition of residents. It must not rely on the fire and rescue service to provide evacuation assistance.

When an inspector calls
When you get a visit from the FRA it can be for a number of reasons. These include a post fire audit, looking at unwanted fire signals (UwFS), a programmed audit or operation familiarisation visit.

The fire safety audit consists of three parts and is carried out by a fire safety inspecting officer (FSIO). The FSIO will be looking to check that you can demonstrate compliance with the RRO. To check this compliance they will ask to see evidence of the following: fire risk assessment; robust fire safety policy; emergency plan; maintenance of fire safety measures; staff training records; knowledge of personal emergency evacuation; and plans (PEEP) for individual residents.

This is known as the management audit.
The information that is received by the FSIO will determine how much of a physical inspection is carried out. There will be a minimum of some risk critical areas to verify the management audit findings. This is known as the physical audit.

The third part of the audit is the outcome of the audit which is a derived from a combination of both physical and management audit.
The outcome can be one of the following:
•    Educate and inform through verbal advice
•    Informal written advice
•    Formal notice
•    Prohibition or restriction of premises
•    Prosecution under the RRO

At the end of the audit it should be clear to the responsible person what action the FRA is to take. If it is necessary this will be backed up in writing.

Guidance available to responsible persons

The Department of Communities and Local Government (DCLG) have produced a suite of guides for responsible persons. There are specific guides for residential care and health care premises. These can be found on the DCLG website.

Recently the Chief Fire offices Association (CFOA) and the National Association for Safety and Health in Care Services (NASHiCS) issued additional guidance to support the existing  DCLG residential care guide.

Due to the life risk in these premises FRAs see care homes as a integral part of the fire safety inspection programme. Therefore they want to work with care home providers to protect the vulnerable as part of the aims of each FRA. Please contact your local FRA if you have any concerns or require general advice.

Further reading:

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