Fire Safety: Are Care Homes Doing Enough To Protect Lives?
By Gavin Scarr Hall, Health & Safety Director at Peninsula (www.peninsulagrouplimited.com)
Care homes occupy a unique space when it comes to fire safety. In most work environments, people can hear fire alarms, recognise what they are, evacuate the premises quickly and, for the most part, unassisted. Any exceptions are identified, with personal plans being drawn up to help them.
There are no such assurances in care homes. Vulnerable residents may have a range of specific needs, including a lack of mobility, partial hearing or deafness, and even mental health conditions. When the occupants of your premises can’t hear or respond to an emergency, leaving them to make their own escape simply isn’t an option.
Every single care home manager should be keenly aware of the high fire risk to their residents, yet, consistently, Fire & Rescue Services are responding to incidents caused, or made worse by, a lack of planning and preparation.
When fire broke out at Newgrange Care Home in Cheshunt, Hertfordshire, their lack of planning had terrible consequences. There were no sprinklers in the building, inadequate compartmentation allowed the fire to spread, confusion over where the fire was located meant valuable time was wasted checking the wrong floor and, to top it off, a bizarre evacuation policy directed staff to leave residents inside and wait for firefighters to rescue them.
Most were eventually rescued, but crews were unable to reach two residents trapped by falling debris. Both died in their rooms.
Coroner Geoffrey Sullivan’s report into the fire was published in February, five years after the fire, after criminal proceedings had concluded. The coroner acknowledged many failings by managers of the care home but chose to address his report to the Secretary of State, underlining two key issues threatening safety in the sector.
Firstly a concern that sprinkler systems are not mandatory for care homes, despite the clear risk to those with impaired mobility. Had a sprinkler system been in place at Newgrange, the coroner found it very likely that the two victims would have survived.
The second concern raised is that care homes are not categorised as ‘higher risk buildings’, except those over 18m, or 7 storeys high. As it stands, care homes technically fall into a lower category of risk, simply based on their size. This does not take into consideration the fact that care home residents with limited mobility cannot self-evacuate and can lead to complacency, as well as a false sense that managers have ‘done enough’ towards assessing fire risk on their premises.
Why details matter
Any measures stemming from a fire risk assessment must be proportionate. Care homes present a higher, more complex risk therefore plans need to be detailed, or crucial points can easily be missed.
Private healthcare provider BUPA learned this lesson recently when they were fined a record £1.04m following a fire at a South London care home. A 69-year-old resident died after a cigarette set light to his clothes.
Emollient creams used to treat the man’s skin condition had soaked into his clothing, rendering them highly flammable. When he lit up his usual cigarette, his clothes went up in flames and he died from his injuries.
The record fine in this case stemmed from BUPA’s failure to protect a vulnerable resident in their care and came down to two key factors.
Lack of supervision when smoking meant care home staff had no idea the man had previously been burned, despite knowing that he regularly smoked.
Although a smoking risk assessment had been carried out, it did not assess or put controls in place to mitigate the risks of using emollient cream.
It’s well-known that emollient creams can be flammable if allowed to build up on skin, clothing, or bedding. The Medicines and Healthcare Regulatory Agency (MHRA) have issued safety alerts about the risk in 2008, 2016 and in 2018.
Details matter.
How can care homes stay compliant?
The Regulatory Reform (Fire Safety) Order 2005 (RRO) gives fire and rescue services the authority to inspect and audit premises. They have the knowledge and the experience to spot potential fire hazards. The RRO gives them the power to make inspections and issue Improvement Notices if they determine a building is unsafe for use.
Rather than prescriptive codes, the RRO is based around risk assessment. Named Responsible Persons take on the duty of carrying out or arranging for a fire risk assessment of their premises. This ensures that any control measures are proportionate to the risks present, rather than relying on a ‘one size fits all’ arrangement.
Some key areas to carefully consider for any care home fire risk assessment include:
Evacuation – Evacuating vulnerable or mobility challenged residents in the event of fire, especially at night, is one of the most challenging areas for care homes.
Smoking – Residents who smoke present several challenges. Most providers are conscious of risks associated with indoor smoking and have in place suitable policies around preventing bed and furniture fires from lighters, matches or dropped cigarettes but there are other hidden risks, such as smoking around medical equipment, as discussed above.
Safe escape routes – Some areas of fire safety can be difficult to reconcile with the wider needs of residents. Creating a homely, stimulating environment whilst ensuring safe escape routes is one.
Mobility scooters – Mobility scooters should be stored in areas separated from escape routes by suitable fire doors, etc. and covered by fire detectors. They are bulky items and should never block escape routes
Fire doors – In 2019 over three quarters of all fire doors inspected were not fit for purpose. It is vital that fire doors are kept sufficiently well-maintained to hold back smoke and fire long enough to evacuate residents
Fire alarms – Care homes should generally have a system that includes fire detectors in all rooms as well as fire alarms in all bedrooms and throughout the home. All alarms should be properly maintained and regularly tested.
Risk assessments should be reviewed regularly – it’s good business sense as well as a legal requirement.
Who is the Responsible Person?
Any employer or person with responsibility for non-domestic premises has a responsibility to protect employees and occupants from fire hazards, and to ensure they can safely escape in the event of a fire.
It’s up to the designated Responsible Person to make fire safety measures proportionate to the conditions, the dimensions, and practicalities of how the building operates. Care homes need to pay particular attention to occupants’ capacity to respond to emergencies.
Regular evacuation drills are essential for instilling correct procedure into staff. When a real fire breaks out, ‘fight or flight’ instincts take over, and most people will default to the habits built up over months and years. This is how bottlenecks get created at main entrances, despite several other exits being available.
It is vital to get fire risk assessments right and the RRO empowers employers to appoint competent persons to assist them in identifying and controlling fire risks.
How is a Fire Risk Assessment put together?
A fire risk assessment must be carried out by a Competent Person. The RRO defines a Competent Person as someone who has sufficient training, experience, or knowledge of fire safety to enable them to properly assist a Responsible Person in risk assessing for fire.
The fire risk assessment itself can be broken down into five steps:
Identify the fire hazards on the premises. This could be sources of ignition, fuel, or oxygen. Think about the way residents use the building and live their lives. Do any of the residents smoke? Are fire doors checked regularly for unauthorised or accidental use?
Identify people at risk, including employees, occupants, visitors, and any passers-by who might be affected by a fire on the premises. Personal Emergency Evacuation Plans are a vital tool when it comes to assessing vulnerable individuals and agreeing targeted measures to ensure they’re not left behind.
Evaluate the risks by looking at preventative measures, such as removing sources of ignition, eliminating the need for highly flammable materials, and segregating flammables that are stored together. Protective measures are physical features of the building, such as fire alarms, fire detection systems, escape routes, or emergency lighting.
Record the findings in a fire risk assessment. Implement any changes, train, and instruct staff and occupants on what they must do.
Review your assessment and revise it as necessary on a regular basis.
Fire safety compliance should be every responsible person’s goal in the short term. For many types of buildings, compliance is enough to protect lives and get everyone out safely. The further up the risk scale your premises go, the closer the gap becomes between what you need to do and what you should do.
Best practice can be as simple as striving to be better than last year or as instrumental as someone stepping up and taking responsibility. It doesn’t have to be a lofty goal separated by enormous cost and idealistic ambition.
