CareTech Community Service HS-02 Health and Safety Manual · PDF file · 2017-02-15CARETECH COMMUNITY SERVICE LTD Policies & Procedures Manual Doc No: HS-02 Prepared by: ... HS-02-02-14

2 Arlington Court, Whittle Way, Arlington Business Park, Stevenage, SG1 2FS Telephone: +44 (0)1438 745 771 Fax: +44 (0)1438 745 772 Email: [email protected]

Website; www.acoura.com

CARETECH COMMUNITY SERVICE LTD Policies & Procedures Manual Doc No: HS-02

Prepared by: Acoura Issue No: 09 First issued: May 04 No. of Pages: 132

Reviewed by: Justin Rose Review Date: 20th January 2017 CONTROLLED COPY

CareTech Community Service HS-02 Health and Safety Manual January 2017

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Section Revision Tracker

Date of Last Full Manual Review*: 20th January 2017 *All sections were reviewed on the above date but only those that required updating were amended and are listed below. Sections that were not amended did not require any changes.

Section Number

Section Title Last

Amended Details of Revision

HS-02-01 PART 1 – GENERAL POLICY AND MANAGEMENT PROCEDURES

HS-02-01-01 General Policy and Management Procedures

January 2017 Policy Statement dated 20 January 2017

HS-02-01-02 Roles and Responsibilities

January 2017

HS-02-01-03 Monitoring and Review of Safety Policy and Arrangements

January 2017

HS-02-01-04 Consultation with Employees

January 2017

HS-02-01-05 Training in Health and Safety

January 2017

HS-02-01-06 Risk Assessments January 2017 References to PSN Direct changed to Acoura Assist

HS-02-02 PART 2 – GENERAL ARRANGEMENTS AND SAFE WORKING PRACTICES HS-02-02-07 Accident and Incident

Reporting Procedure January 2017 Reference to PSN Direct

changed to Acoura Assist Reference to ‘hotel’s’ changed to ‘premises’

HS-02-02-08 Accident Investigations January 2017

HS-02-02-09 Training in Health and Safety

January 2017

HS-02-02-10 Electricity at Work January 2017

HS-02-02-11 Gas Safety January 2017 TRANSCO replaced with National Grid Gas Emergencies

HS-02-02-12 Manual Handling January 2017 Additional information added to Good Handling Technique

HS-02-02-13 Medicine Administration January 2017 NHS Helpline changed to NHS 111

HS-02-02-14 Control of Infection/Clinical Waste

January 2017 References to PSN Direct changed to Acoura Assist.

HS-02-02-15 Personal Protective Equipment

January 2017

HS-02-02-16 Fire Safety January 2017

HS-02-02-17 High Level Access January 2017

HS-02-02-18 Pregnant Employees January 2017

HS-02-02-19 Office Safety January 2017

HS-02-02-20 Driving Safely January 2017 Paragraph on smoking added.

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Section Number

Section Title Last

Amended Details of Revision

HS-02-02-22 Kitchen Safety January 2017

HS-02-02-23 Passive Smoking January 2017 NHS smoking helpline details updated

HS-02-02-25 Water Temperature and Hot Surfaces January 2017

HS-02-02-26 First Aid January 2017

HS-02-02-28 Service Safety Checks January 2017 Section amended to refer to the new form HS-02-AP-08 Quarterly Safety Inspection

HS-02-02-29 Control of Substances Hazardous to Health (COSHH)

January 2017

HS-02-02-30 Violence at Work January 2017

HS-02-02-31 External Outings

January 2017 Disability Discrimination Act replaced with Equality Act 2010

HS-02-02-32 Falls from Height January 2017 New section added

HS-02-02-33 Safe Use of Bed Rails January 2017 New section added

APPENDICES

HS-02-AP-01 Accident Investigation Form January 2017

HS-02-AP-02 Visitor Registration Record January 2017

HS-02-AP-03 MAL1 Medicine Administration Log January 2017

HS-02-AP-04 MAL2 Medicine Administration Log January 2017

HS-02-AP-05 Types of Clinical Waste January 2017

HS-02-AP-06 Pregnant Employee Risk Assessment January 2017

HS-02-AP-07 Workstation Assessment Sheet January 2017

HS-02-AP-09 Health and Safety Induction Record Sheet

January 2017

HS-02-AP-10 First Aid Kit Contents January 2017

HS-02-AP-11 Questions and Answers Service Based Staff

January 2017

HS-02-AP-12 Questions and Answers Office Based Staff

January 2017

HS-02-AP-13 Stress Monitoring Programme January 2017

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CONTENTS

HS-02-01 PART 1 - GENERAL POLICY AND MANAGEMENT PROCEDURES

HS-02-01-01 GENERAL POLICY AND MANAGEMENT PROCEDURES

1.1 Statement of General Policy for Health and Safety 1.2 Health and Safety Policy

HS-02-01-02 ROLES AND RESPONSIBILITIES

2.1 Responsibilities of CareTech’s Board for Health and Safety 2.2 Responsibilities of Corporate Directors, Regional Directors,

Operations Managers, Senior Managers 2.3 Responsibilities of the Health and Safety Consultants 2.4 Responsibilities of Area Managers, Service Managers, Supervisory

Staff 2.5 Individual Employees Responsibilities

HS-02-01-03 MONITORING AND REVIEW OF SAFETY POLICY AND

ARRANGEMENTS HS-02-01-04 CONSULTATION WITH EMPLOYEES HS-02-01-05 TRAINING IN HEALTH AND SAFETY

5.1 Induction Training

HS-02-01-06 RISK ASSESSMENTS

HS-02-02 PART 2 - GENERAL ARRANGEMENTS AND SAFE WORKING PRACTICES

HS-02-02-07 ACCIDENT AND INCIDENT REPORTING PROCEDURE HS-02-02-08 ACCIDENT INVESTIGATIONS HS-02-02-09 TRAINING IN HEALTH AND SAFETY

9.1 Health and Safety Induction 9.2 Further Health and Safety Training

HS-02-02-10 ELECTRICITY AT WORK

10.1 Introduction 10.2 Scope 10.3 Hazards 10.4 Work Activities 10.5 Safe Ways of Working

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HS-02-02-11 GAS SAFETY


11.5.1 Installation, Maintenance and Servicing 11.5.2 Gas Shut Off Valves 11.5.3 Appliances 11.5.4 Pilot Lights 11.5.5 Ignition Devices

11.6 Bulk Storage of LPG

HS-02-02-12 MANUAL HANDLING 12.1 Introduction 12.2 Hazards 12.3 Work Activities 12.4 Safe Ways of Working

12.4.1 Lifting Loads 12.4.2 Lifting People 12.4.3 Lifting Equipment 12.4.4 Breakdown of Lifting Equipment 12.4.5 Examination of Lifting Equipment 12.4.6 Repairs of Lifting Equipment 12.4.7 Record Keeping

HS-02-02-13 MEDICINE ADMINISTRATION 13.1 Introduction 13.2 Scope 13.3 Hazards 13.4 Work Activities 13.5 Safe Ways of Working

13.5.1 Storage of Medicines 13.5.2 Administering Prescribed Medication 13.5.3 Non-Prescription Medication 13.5.4 Intravenous Medication 13.5.5 Remedial Action 13.5.6 NHS 111

HS-02-02-14 CONTROL OF INFECTION/CLINICAL WASTE 14.1 Introduction 14.2 Scope 14.3 Hazards 14.4 Work Activities 14.5 Safe Ways of Working

14.5.1 Identifying Potential Hazardous Material 14.5.2 Service Managing and Disposing of Clinical Waste 14.5.3 Universal Precautions for Employees 14.5.4 Spillage Procedures 14.5.5 Specific Risk and Immunisation

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HS-02-02-15 PERSONAL PROTECTIVE EQUIPMENT 15.1 Introduction 15.2 Scope 15.3 Hazards 15.4 Work Activities 15.5 Safe Ways of Working

HS-02-02-16 FIRE SAFETY

Refer to the Fire Safety and Fire Risk Assessment Manual

HS-02-02-17 HIGH LEVEL ACCESS


17.5.1 Use of Ladders and Stepladders

HS-02-02-18 PREGNANT EMPLOYEES

18.1 Introduction 18.2 Scope 18.3 Work Activities 18.4 Safe Ways of Working

18.4.1 Notification 18.4.2 Risk Assessment

HS-02-02-19 OFFICE SAFETY

19.1 Introduction 19.2 Scope 19.3 Work Activities 19.4 Safe Ways of Working

19.4.1 Working with Display Screen Equipment (DSE) 19.4.2 General Office Duties 19.4.3 Electrical Equipment 19.4.4 Welfare 19.4.5 Seating

HS-02-02-20 DRIVING SAFELY

20.1 Introduction 20.2 Scope 20.3 Hazards 20.4 Work Activities 20.5 Safe Driving Practices

20.5.1 Handbook 20.5.2 General Guidelines 20.5.3 General Driving Tips

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HS-02-02-21 CONTROLLING ACCESS TO SERVICE AND APPOINTMENT OF CONTRACTORS


21.5.1 Controlling Access to CareTech’s Premises by Unauthorised Persons

21.5.2 Roof Access, Access to Balconies etc 21.5.3 Daily Checks 21.5.4 Monitoring of Access and Access Control

21.6 Contractors 21.6.1 Appointing Contractors 21.6.2 Using Contractors 21.6.3 Construction Working in CareTech’s Premises

HS-02-02-22 KITCHEN SAFETY


HS-02-02-23 PASSIVE SMOKING

23.1 Introduction 23.2 Scope 23.3 Hazards 23.4 Safe Ways of Working

23.4.1 Vehicles 23.4.2 Home workers 23.4.3 Signage 23.4.4 Assistance for employees to give up smoking

23.5 Non-compliance 23.6 Maintaining this policy

HS-02-02-24 LEGIONELLA

24.1 Introduction 24.2 General Water Risk Management Policy 24.3 Roles and Responsibilities 24.4 Use of Competent Contractors 24.5 Training Provision for Water Risk Management 24.6 Legislation and Guidance 24.7 Background to the Diseases and Organisms 24.8 Health Risks 24.9 Water Risk Assessments 24.10 Monitoring and Corrective Action 24.11 System Operation and Procedures for Inspection and Checking

24.11.1 Identification 24.11.2 Evaluation and Control 24.11.3 Monitoring 24.11.4 Cold Water Storage and Distribution 24.11.5 Hot Water Storage and Distribution 24.11.6 Calorifiers 24.11.7 Showers

24.12 Independent Water Analysis

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24.13 Water Management Log Book 24.14 Monitoring and Review of Water Risk Management System 24.15 Emergency Procedures 24.16 Glossary of Water Risk Management Terms

HS-02-02-25 WATER TEMPERATURE AND HOT SURFACES

25.1 Introduction 25.2 Scope 25.3 Hazards 25.4 Safe Ways of Working

HS-02-02-26 FIRST AID

26.1 Introduction 26.2 Scope 26.3 Hazards 26.4 Safe Ways of Working 26.5 Risk Assessments Specific to a Service

HS-02-02-27 STRESS MANAGEMENT

27.1 Stress 27.2 Working Time

HS-02-02-28 SERVICE SAFETY CHECKS

28.1 Introduction 28.2 Scope 28.3 Responsibility and Frequency of Checks

HS-02-02-29 CONTROL OF SUBSTANCES HAZARDOUS TO HEALTH (COSHH)

29.1 Introduction 29.2 Assessment Process 29.3 After the Assessment

HS-02-02-30 VIOLENCE AT WORK

30.1 Introduction 30.2 Scope 30.3 Hazards 30.4 Work Activities 30.5 Safe Ways of Working 30.6 Incident Review Process

HS-02-02-31 EXTERNAL OUTINGS


HS-02-02-32 FALLS FROM HEIGHT 32.1 Introduction 32.2 Scope 32.3 Hazards 32.4 Work Activities 32.5 Safe Ways of Working

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HS-02-02-33 SAFE USE OF BED RAILS 33.1 Introduction 33.2 Scope 33.3 Hazards 33.4 Work Activities 33.5 Safe Ways of Working

APPENDICES HS-02-AP-01 Accident Investigation Form

HS-02-AP-02 Visitor Registration Record

HS-02-AP-03 MAL1 Medicine Administration Log

HS-02-AP-04 MAL2 Medicine Administration Log

HS-02-AP-05 Types of Clinical Waste

HS-02-AP-06 Pregnant Employee Risk Assessment

HS-02-AP-07 Workstation Assessment Sheet

HS-02-AP-08 Quarterly Safety Checklist

HS-02-AP-09 Health and Safety Induction Record Sheet

HS-02-AP-10 First Aid Kit Contents

HS-02-AP-11 Questions and Answers Service Based Staff

HS-02-AP-12 Questions and Answers Office Based Staff

HS-02-AP-13 Stress Monitoring Programme

HS-02-1P-14 Legionella checks – Water Temperatures HS-02-AP-15 Legionella checks - Calorifiers HS-02-AP-16 Legionella checks – Shower Head Cleaning Maintenance Thermometer Calibration HS-02-AP-17 Maintenance Thermometer Calibration

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CareTech Health & Safety Manual Last Reviewed January 2017

PART 1

GENERAL POLICY

AND

MANAGEMENT PROCEDURES

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CareTech Health & Safety Manual Last Reviewed January 2017


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CareTech Health & Safety Manual Page 1 of 2 HS-02-01-01 General Policy and Management Procedures Last Reviewed January 2017

HS-02-01-01 GENERAL POLICY AND MANAGEMENT PROCEDURES 1.1 STATEMENT OF GENERAL POLICY FOR HEALTH AND SAFETY

It is our policy to promote the highest standards of health and safety to prevent the people who use our service, employees and visitors suffering accidents and ill health. We consider the statutory requirements of the Health and Safety at Work Act 1974 and subordinate legislation to be the very minimum standards to be applied to the service we provide. We believe that the management of health and safety is one of the most important management functions. We expect management and supervisory staff and all employees to carry out their duties in the full knowledge that the Company considers health and safety to be a priority. The management in consultation with employees will define annual objectives for health and safety. Performance will be measured against those objectives. The Directors have appointed the Director of Compliance & Regulation as having particular responsibility for the implementation of the Policy and to whom reference should be made in the event of any difficulty arising in the execution of this Policy. The management and staff of the service will monitor the implementation and operation of this Policy. To assist them in this respect, in accordance with Regulation 7 of the Management of Health and Safety at Work Regulations 1999, the Directors have appointed Health and Safety Consultants to give advice on the requirements of the relevant statutory provisions and safety matters generally and to assist Managers and staff to understand and carry out their duties. This Statement of General Policy for Health and Safety will be displayed prominently at all Company premises. The complete service Health and Safety Manual detailing this organisation, risk assessments and arrangements for implementing this general Policy will also be available at each Service for reference by any employee. Signed:

Director of Compliance & Regulation Date: 20 January 2017

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CareTech Health & Safety Manual Page 2 of 2 HS-02-01-01 General Policy and Management Procedures Last Reviewed January 2017

1.2 HEALTH AND SAFETY POLICY Notwithstanding the Statement of General Policy for Health and Safety, CareTech will provide so far as is reasonably practicable, a safe and healthy working environment and endeavour to: 1. Acquire the appropriate knowledge of health and safety regulations and Codes of

Practice as they affect our business in order that they may advise and instruct our employees with that knowledge.

2. Ensure that a copy of the Policy Statement and any other relevant sections of the

Safety Policy is either given to or shown to every member of staff, and that it is fully explained and completely understood by them as part of the induction programme.

3. Adopt and maintain safe systems and procedures of work and comply with statutory

regulations and approved Codes of Practice. 4. Ensure that equipment and tools, which may be used by employees, are safe and

designed to minimise hazards. 5. Ensure that any safety devices are always fitted, properly adjusted as required, well

maintained and used correctly. 6. Identify actual or possible hazards and ensure that proper safety measures are met. 7. Provide all or any necessary warning signs. 8. Provide safety training to include the use of fire fighting equipment and systems,

emergency procedures to be followed, training in care of the person who uses our Service and the need for reporting any accidents or potential or actual hazards.

9. Ensure that regular reviews of health and safety are undertaken within the

organisation and that any improvements required are actioned. 10. Ensure that any comments or complaints concerning safety are promptly

investigated and that appropriate action is taken immediately. 11. Ensure that when and where necessary, protective clothing is issued and used. 12. In the case of any accident involving injury to any person on the premises, make a

full investigation and also comply with any statutory requirements relating to the reporting of such accidents.

13. Familiarise any new employees with all aspects of Health and Safety at Work Policy,

both by explanation and personal example. 14. Preserve the health and safety of persons who uses our Service and public so far as

they are affected by the work carried out in the Service. 15. Ensure that all employees work in a safe manner, for themselves and others. 16. Ensure that all employees are aware of potential hazards and that they recognise

them for what they are in order that action can be taken to avoid accidents.

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CareTech Health & Safety Manual Page 1 of 6 HS-02-01-02 Roles and Responsibilities Last Reviewed January 2017

HS-02-01-02 ROLES AND RESPONSIBILITIES 2.1 RESPONSIBILITIES OF CARETECH’S BOARD FOR HEALTH AND SAFETY 1. Prepare and keep up to date a Statement of General Policy for Health and Safety

and ensure that it is brought to the notice of all employees. 2. Ensure that resources, including financial budgets, are adequate to allow for proper

facilities, training, safe working methods and equipment to avoid injury, damage and wastage and that health and safety factors are considered in the selection of materials, equipment and contractors.

3. Prepare details of organisation and arrangements for carrying out the Company’s

Health and Safety Policy to make sure each person is aware of their responsibilities and the means by which they can carry them out.

4. Administer the Health and Safety Policy throughout the Service in conjunction with

Senior Managers and direct line management. 5. Know the appropriate statutory health and safety and related requirements affecting

the Service operations. 6. Ensure that appropriate training is given to staff as necessary. 7. Insist that sound working practices are observed as laid down by the Company’s

Policy arrangements, official guidance and Codes of Practice and that work is planned and carried out in accordance with the statutory provisions.

8. Ensure that there is liaison on health and safety matters between the Service and

others in or near the premises that may be affected by its work. 9. Instigate reporting, investigations and costing of injury, damage and loss, and

promote analysis of investigations to discover trends and eliminate hazards. 10. Ensure that appropriate disciplinary procedures are followed in respect of any

member of management or supervisory staff failing to discharge satisfactorily their responsibilities for health and safety.

11. Arrange for funds and facilities to be available in order to meet the requirements of

CareTech’s Safety Policy. 12. Make certain that all Managers and staff understand that good health and safety

performance will be taken into account during staff appraisals. 13. Set a personal example when visiting all Services, comment on acceptable or

unacceptable conditions in place. 14. Arrange for regular meetings with Managers, staff and the safety advisor to discuss

accident prevention, performance, possible improvements etc.

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2.2 RESPONSIBILITIES OF CORPORATE DIRECTORS, REGIONAL DIRECTORS, OPERATIONS MANAGERS, SENIOR MANAGERS

1. Ensure that the CareTech’s Statement of General Policy for Health and Safety is

brought to the notice of all employees. 2. Ensure that resources, including financial budgets, are adequate to allow for proper

facilities, training, safe working methods and equipment to avoid injury, damage and wastage and that health and safety factors are considered in the selection of materials, equipment and contractors.

3. Make sure each person is aware of his or her responsibilities with regard to

CareTech’s Health and Safety Policy. 4. Administer CareTech’s Health and Safety Policy throughout the Service in

conjunction with Senior Managers and direct line management. 5. Know the appropriate statutory health and safety and related requirements affecting

the Service operations. 6. Ensure that appropriate training is given to staff as necessary. 7. Insist that sound working practices are observed as laid down by CareTech’s Policy

arrangements, official guidance and Codes of Practice and that work is planned and carried out in accordance with the statutory provisions.


others in or near the premises that may be affected by its work. 9. Instigate reporting, investigations and costing of injury, damage and loss, and

promote analysis of investigations to discover trends and eliminate hazards. 10. Ensure that appropriate disciplinary procedures are followed in respect of any

member of management or supervisory staff failing to discharge satisfactorily their responsibilities for health and safety.

11. Instigate liaison with external accident prevention organisations and encourage the

distribution of safety literature throughout the Service. 12. Arrange for finds and facilities to be available in order to meet the requirements of

CareTech’s Safety Policy. 13. Make certain that all Managers and staff understand that good health and safety

performance will be taken in to account during staff appraisals. 14. Set a personal example when visiting all Services, comment on acceptable or

unacceptable conditions in place.

15. Arrange for regular meetings of Managers, staff and the safety advisor to discuss Service accident prevention, performance, possible improvements etc.

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2.3 RESPONSIBILITIES OF THE HEALTH AND SAFETY CONSULTANTS 1. To keep up to date with legislation and inform CareTech Directors of any issues

arising as necessary. 2. To give advice on the requirements of the relevant statutory provision and safety

matters generally and assist Managers and staff to understand and carry out their duties.

3. Assist management in regularly updating the Health and Safety Policy. 4. To liaise with enforcing authorities at management’s request. 5. To attend Company Health and Safety Meetings on a regular basis.

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2.4 RESPONSIBILITIES OF AREA MANAGERS, SERVICE MANAGERS, SUPERVISORY STAFF

1. Ensure that the Statement of General Policy for Health and Safety is brought to the

notice of all employees. 2. Ensure that there are safe working methods and equipment in place to avoid injury,

damage and wastage and that health and safety factors are considered in the selection of materials and equipment.

3. Make sure each person is aware of his or her responsibilities with regard to

CareTech’s Health and Safety Policy. 4. Administer CareTech’s Health and Safety Policy throughout the Service in

conjunction with direct line management. 5. Know the appropriate statutory health and safety and related requirements affecting

the Service operations. 6. Ensure that appropriate training is given to staff as necessary. 7. Insist that sound working practices are observed as laid down by CareTech’s Policy

arrangements, official guidance and Codes of Practice and that work is planned and carried out in accordance with the statutory provisions.


others in or near the premises that may be affected by its work. 9. Assist by reporting, supporting investigations and the costing of any injury, damage

and loss, promote analysis if investigations to discover trends and eliminate hazards. 10. Ensure that appropriate disciplinary procedures are followed in respect of any

member of staff failing to discharge satisfactorily their responsibilities for health and safety.

11. Make certain that staff understand that good health and safety practice will be taken

into account during staff appraisals. 12. Review Risk Assessments and amend them where necessary to reflect site-specific

hazards. 13. Area Managers will include an agenda on health and safety at their monthly

management meetings, the results of which will be fed back to the regional management meetings.

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2.5 INDIVIDUAL EMPLOYEES RESPONSIBILITIES Every employee has a responsibility for ensuring that they undertake the work they are required to do with due regard to the safety of themselves, their colleagues, those in the care of the Service and the general public. 1. Comply with the Health and Safety Policy.

2. Observe the Fire Evacuation Procedure and learn the position of all fire equipment and exit routes.

3. Attend, as requested, any training courses, meetings etc designed to further the interests of health and safety.

4. Observe all laid down procedures concerning work activities, materials and substances.

5. Become familiar with and conform to the relevant safety instructions at all times. Co-operate with the management and observe their instructions and advice with regard to health and safety matters.

6. Use protective clothing and equipment where and when necessary.

7. Not to interfere with or misuse anything that is provided in the interests of safety and health.

8. Avoid improvisation in any form that may create a risk to personal safety and to the safety of others.

9. Report to the management any incidents/accidents whether injury is sustained or not.

10. Give assistance as required in the investigation of accidents.

11. Conduct themselves in an orderly manner in the workplace and refrain from any form of horseplay.

12. Not to consume food or drink in areas where there is a risk of contamination.

13. Follow the control measures identified on the Risk Assessment for the task they are undertaking.

14. Ensure that they are familiar with the Risk Assessments for the tasks they undertake.

15. Report to the Service Manager any improvements which they believe may be necessary to the work practice or Risk Assessment, so as to further improve health and safety.

Failure by an employee to comply with the aforementioned requirements may be treated as an act of breach of discipline and may remove liability from the Proprietors in the event of an accident. Persistent breaching of the health and safety arrangements by an employee will, after appropriate warnings, invite Disciplinary Action.

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CareTech Health & Safety Manual Page 1 of 2 HS-02-01-03 Monitoring and Review of Safety Policy and Arrangements Last Reviewed January 2017

HS-02-01-03 MONITORING AND REVIEW OF SAFETY POLICY AND ARRANGEMENTS

Any person who believes the Health and Safety Manual is in some way inadequate or requires review, must report this to their immediate Line Manager or a Health and Safety Representative sitting on the Health and Safety Committee. CareTech will continuously monitor and review the Health and Safety Manual and from time to time carry out safety checks of their Service. The Manual may be updated to take into account new developments, Service, legislation and health and safety guidance etc. However, any such changes will be drawn to the attention of all employees wherever appropriate. Information on changes will be provided through memos or updates to Policy inserts with appropriate filing instructions. A copy of the most up to date Policy shall be maintained by the Service and be made available for access by employees. Any employee who intentionally ignores health and safety guidance, information and training provided by CareTech may be considered to be in breach of contract and disciplinary action may be instigated.

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CareTech Health & Safety Manual Page 2 of 2 HS-02-01-03 Monitoring and Review of Safety Policy and Arrangements Last Reviewed January 2017


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CareTech Health & Safety Manual Page 1 of 2 HS-02-01-04 Consultation with Employees Last Reviewed January 2017

HS-02-01-04 CONSULTATION WITH EMPLOYEES The Health and Safety (Consultation with Employees) Regulations 1996 require that an employer consults with employees in good time in matters relating to health and safety at work. This includes:

Introduction of any measure at the workplace which may substantially affect the health and safety of those employees.

Arrangements for nominating ‘competent persons’ in accordance with the Management Regulations to assist the employer on health and safety matters, and to take charge of measures to combat identified serious and imminent danger at the workplace.

Any statutory health and safety information which he has to provide.

Planning and organising of any health and safety training he has to provide, and;

Health and safety consequences for those employees of the introduction of new technologies into the workplace.

To meet the requirements of these regulations, CareTech have set up a Health and Safety Committee in which employees may raise matters relating to health and safety through their appointed representative on this group. A representative from each of the three regions will attend the meeting, which are to be held approximately three times a year. Attendance at the meetings should also include the Quality Performance Director, representatives from the Corporate Team and Human Resources, and also a representative from the Health and Safety Consultants. The meetings will also provide an opportunity for Management to update employees on the latest developments in terms of health and safety. Nominated persons from the recognised Unions represented in the workforce are also invited to attend the Health and Safety Committee meetings. The Health and Safety Committee will be formed for the period of one year and thereafter it’s composition and effectiveness will be reviewed. The minutes of the Health and Safety Committee meeting and any action taken as a result of the meeting will be issued to the regional Health and Safety Representatives and Regional Operations Directors. Representation should be rotated on an annual basis to enhance communication with regard to health and safety throughout the organisation. Representatives will preferably be by voluntary consent or by local nomination process.

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CareTech Health & Safety Manual Page 2 of 2 HS-02-01-04 Consultation with Employees Last Reviewed January 2017


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CareTech Health & Safety Manual Page 1 of 2 HS-02-01-05 Training in Health and Safety Last Reviewed January 2017

HS-02-01-05 TRAINING IN HEALTH AND SAFETY CareTech undertakes to train all their employees (and all other persons as appropriate) in all areas of health and safety relative to their normal day-to-day duties within the Company. It shall be the responsibility of each Service Manager to ensure that each member of his/her staff has received appropriate training before being allowed to carry out tasks unsupervised. The Service Manager should identify training needs relating to health and safety for individual employees. These needs will be largely defined by the training matrix, which CareTech have developed and will continue to update. Specific training requirements are also referred to in the Health and Safety Manual dependant on the particular section and the employee’s role and activities within the particular Service. Where a Manager considers health and safety training is required, it is recommended that they consult with the relevant section of the Health and Safety Manual for further guidance. Throughout the Health and Safety Manual, there are “key learning points” that each and every employee must be aware of. The process for doing so is via the Health and Safety Induction Programme, which is set out in the Manual. 5.1 INDUCTION TRAINING Every member of staff commencing work at CareTech should undergo induction health and safety training. Until this is undertaken the Service Manager will be ultimately responsible for closely supervising the activities of the new employee. The induction training involves the member of staff completing the Health and Safety Induction Programme. An assessment to check the employee’s knowledge and awareness of health and safety should be undertaken at the end of the induction training.

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CareTech Health & Safety Manual Page 1 of 2 HS-02-01-06 Risk Assessments Last Reviewed January 2017

HS-02-01-06 RISK ASSESSMENTS The Management of Health and Safety At Work Regulations 1999 require all employers to carry out risk assessments of all work activities that present a significant risk to health and safety. Generic risk assessment templates are provided on Acoura Assist. These are to be completed by the Service Manager. Further guidance is provided on Acoura Assist. Thereafter, Service Managers are responsible for reviewing the risk assessments at their Service on a 12 monthly basis or more often as required by any change in circumstances. The purpose of this review is to ensure that the assessments are still relevant and to make any amendments where necessary to reflect their own Service and/or operation. Service Managers will also be responsible for ensuring all relevant personnel are made aware of the significant findings of the risk assessments, and that the necessary control measures are implemented. This will be via the Health and Safety Induction Programme and then on an ongoing basis, via staff meetings and individual staff training on health and safety. Service Managers may also undertake some activities that do not appear in the generic risk assessments. In this event and where that activity presents a significant risk of injury or ill-health to an employee or other person, Managers should carry out a specific risk assessment using the form provided. The significant findings of the assessment should be recorded on Acoura Assist and drawn to the attention of those affected. Service Managers are also responsible for undertaking site/person specific risk assessments at various stages during the pregnancy of an employee. It is not necessary to forward copies of site-specific assessments to the Potters Bar Office. Young persons are considered to be at particular risk of injury or ill-health at work due to their lack of experience or possible immaturity. As such, young persons are not permitted to work within any CareTech Service, other than the office-based locations. Before any young person begins working with CareTech, an assessment of the risks to the health and safety of the young person must be undertaken. This will apply to any person under the age of 18 years and includes students on unpaid work experience. In addition to the generic risk assessments on Acoura Assist, there is also a Control of Substances Hazardous to Health (COSHH) Manual and a Fire Safety Manual. The Fire Safety Manual specifically identifies safe systems of work and fire precautions to reduce the likelihood of fires starting, and mitigating the effects of a fire should it break out. Managers are responsible for carrying out fire safety checks in accordance with the Fire Safety Manual. The COSHH Manual advises on the safe use of chemicals and requires Managers to carry out specific assessments on chemicals they use. The Manual provides full guidance on how such assessments should be carried out. In addition, the Health and Safety Manual package includes a Driver’s Handbook for those required to drive Company or other vehicles as part of their duties. This handbook is a practical guide on what to do if a breakdown or accident occurs whilst ‘on the road’. The Driving Safely section in the Manual supports it.

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CareTech Health & Safety Manual Page 2 of 2 HS-02-01-06 Risk Assessments Last Reviewed January 2017


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CareTech Health & Safety Manual Part 2 General Arrangements and Safe Working Practices Last Reviewed January 2017

PART 2

GENERAL ARRANGEMENTS

AND

SAFE WORKING PRACTICES

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CareTech Health & Safety Manual Part 2 General Arrangements and Safe Working Practices Last Reviewed January 2017


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CareTech Health & Safety Manual Page 1 of 2 HS-02-02-07 Accident and Incident Reporting Procedure Last Reviewed January 2017

HS-02-02-07 ACCIDENT AND INCIDENT REPORTING PROCEDURE GUIDELINES FOR MANAGERS FOR REPORTING ACCIDENTS / INCIDENTS UNDER THE REPORTING OF INJURIES, DISEASES AND DANGEROUS OCCURRENCES REGULATIONS 2013 The Reporting of Accidents/Incidents under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) require certain accidents to be reported to the Local Authority Environmental Health Department (or in the case of a Nursing Home, the Health & Safety Executive), who may come and investigate. All accidents and incidents, including if during an off-site activity, no matter how trivial, should be reported immediately to Acoura as soon as possible using Acoura Assist.

Major incidents and serious workplace injuries (known as ‘specified’ injuries) should be reported by telephone to Acoura immediately. Make sure a hard copy is printed and filed in the premises accident and incident file. However, always telephone Acoura if in doubt. Thereafter, Acoura will ensure compliance with RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations) by reporting accidents to the appropriate authorities. The Service Manager must contact the Regional Health and Safety Representative for all reportable accidents.

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CareTech Health & Safety Manual Page 2 of 2 HS-02-02-07 Accident and Incident Reporting Procedure Last Reviewed January 2017


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CareTech Health & Safety Manual Page 1 of 2 HS-02-02-08 Accident Investigations Last Reviewed January 2017

HS-02-02-08 ACCIDENT INVESTIGATIONS The Service Manager must investigate all notifiable accidents as soon as is practicable after the accident and once immediate first aid and preventative measures have been completed. Accidents and near misses mostly have a human cause; someone has either failed to follow procedures, misinterpreted information, failed to have had proper training, ignored safety signs and instructions or they may have been totally unaware of the hazards and risks associated with the tasks they have to do. In addition, accidents and near misses could be caused by poor maintenance, inappropriate use of equipment or other environmental factors. CareTech believes it important to review the causes of all accidents and incidents and to learn from the investigative outcomes so that a process of continuous improvement in health and safety management can be implemented. All notifiable accidents are to be investigated and the Accident Investigation Form (Appendix HS-02-AP-01) completed. All Managers are required to review the accident findings with their team members and are expected to implement any improvements to existing control measures or to implement new and improved control measures so as to minimise the risk of a similar accident recurrence. Significant findings of all investigated accidents shall be discussed at both the Company and Regional Health and Safety Group Meetings and common procedures, controls and preventative measures shall be adopted across all the Company’s activities and venues. The completed Accident Investigation Form shall be kept in the Accident and Incident Records file and both forms must be retained for six years. The Area Manager is to ensure that accident reports are available at each Health and Safety Committee meeting.

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CareTech Health & Safety Manual Page 2 of 2 HS-02-02-08 Accident Investigations Last Reviewed January 2017


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HS-02-02-09 TRAINING IN HEALTH AND SAFETY 9.1 HEALTH AND SAFETY INDUCTION Introduction The aim of this section is to provide guidance for Managers on the areas and topics which new employees to CareTech, (including employees who have moved from another Service) need to be made aware of. It also outlines the “Health and Safety Induction Programme” that new employees must work through over their first three months with CareTech and provides a question and answer check to allow Managers to assess the employee’s knowledge of relevant health and safety matters. The Health and Safety Induction Programme comprises of three main areas:

1) First day induction on health and safety 2) Key learning points for employees 3) Health and safety induction check

A level of health and safety induction training for new starters should be given on their first day at the new Service. Managers are responsible for ensuring that the new starter receives their induction training in full. As such, it is advised that specific time is set aside to carry out all the necessary health and safety training. If for any reason it is not possible to complete the health and safety training on their first day, then it is ultimately the Manager’s responsibility to ensure the new starter is closely supervised until their induction training is completed. All training received should be recorded and the employee signs to confirm that they have received the training. The following training should be covered on the new employee’s first day: Fire Safety Training Include location of emergency exits, fire extinguishers and types, location of the designated assembly point, the evacuation procedure and what to do in the event of a fire. First Aid Include location of first aid boxes and who the appointed first aiders or persons are. Lone Working Including dos and don’ts, the safety procedures that the Service operates to protect employees working alone or in isolation. Manual Handling Safe lifting techniques, how to assess a load before lifting and to highlight that help should be sought wherever necessary from another employee. Drug Administration and Control Including those who are responsible for administering medication and the general safety arrangements in this respect.

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Health and Safety Induction Programme The Health and Safety Induction Programme is intended to run over the first three months of a new starters post with CareTech and is based upon the Key Learning Points throughout the Health and Safety, COSHH and Fire Manuals. In their own time, (but within three months) each new starter should work through the ‘Key Learning Point’ sections of each section of the Health and Safety, COSHH and Fire Safety Manual. Once this has been completed and at the end of the three months, the Manager will issue a short question and answer check assessment in Appendices HS-02-AP 02 and 03. This is not an exam with ‘pass and fail’ criteria, however it is intended as a guide to the level of health and safety awareness that the employee has. The employee may complete this check using the Manuals as an ‘aide memoir’ however, the assessment must be completed in one session and not over a number of days. The Manager should discuss any incorrect answers with the employee on the same day of the assessment, understand whether further training is required and as such, ensure it is undertaken. Once staff have completed the Health and Safety Induction Programme Question and Answer Assessment in Appendices HS-02-AP-11 and 12, the Manager should log the date, employee’s name and the score that they achieved on the record sheet. Service Managers must however, remember that induction training is only the beginning. Health and safety training must be ongoing for employees to ensure that each has the most up-to-date knowledge and is aware of the current best practice to help keep themselves, the colleagues they work with and the people who use our Service, safe. Refresher health and safety induction training, based on Key Learning Points, should be undertaken with employees on a six monthly basis. It should be recorded on the training record sheet in Appendix HS-02-AP-09. 9.2 FURTHER HEALTH AND SAFETY TRAINING CareTech are committed to ensuring that all employees receive appropriate health and safety training commensurate with their job activities and the risks to which they are exposed whilst at work. Internal and external training courses are available and employees are able to take part in training covering the following health and safety topics:-

Manual handling

Stress awareness

Handling violent situations

Managing safety in public places

Risk assessments

Managing health and safety The Health and Safety at Work Etc Act 1974 requires that employers provide information, instruction and training to employees in order that they may undertake their job duties safely. CareTech will use a variety of mechanisms for delivering training and imparting information to employees on the subject of health and safety.

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CareTech Health & Safety Manual Page 1 of 4 HS-02-02-10 Electricity at Work Last Reviewed January 2017

HS-02-02-10 ELECTRICITY AT WORK 10.1 INTRODUCTION Electricity, whether from an industrial or domestic supply, presents a risk of death. As such it must be treated with respect and adequately controlled to minimise exposure to employees, people who use our Service and any other person who may have reason to be on CareTech Service. 10.2 SCOPE The purpose of this section is to provide basic rules for employees when faced with using electrical equipment in the course of their duties. 10.3 HAZARDS

Fatality - caused by electrocution

Injury - caused by electric shock

Fire - caused by faulty electric equipment, this may result in fatalities, injury or property damage.

10.4 WORK ACTIVITIES

Use of Portable Appliance (Appliances not provided by CareTech)

Use of Portable Appliance (Appliances provided by CareTech) 10.5 SAFE WAYS OF WORKING All electrical appliances provided by CareTech will be sourced from reputable suppliers and be approved to industry standards. Employees can use their own portable appliances but they should be PAT tested. Safety Checks Portable electrical equipment must be checked regularly by Managers to ensure it is visually in good condition and is being used correctly. They should check the following:

Sockets should not be overloaded, follow the simple rule – one plug, one socket.

Visually check plugs, cables, sockets and leads to ensure there are no signs of: o burn o cracks o loose plug pins or wires o coloured wires exposed o frayed flex or wire

Visually check cables and leads are kept away from wet surfaces

Check residual circuit devices (RCD’s) are fitted to electrical circuits

Ensure any defective/faulty equipment is taken out of use and put out of action to avoid accidental further use

Ensure all employees are aware of general principles of electrical safety and use of portable appliances (see Key Learning Points at end of the section)

The Safety Check Sheet for electrical equipment is provided with a number of simple, visual checks, which should be carried out and recorded on at least a quarterly basis.

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APPLIANCES Changing Fuses Managers should identify those employees who may be exposed, as a result of their duties, to the hazards identified above. All those employees identified as being at risk of exposure should be trained to spot potential hazards and therefore take steps to minimise any potential exposure. Check that the fuse is of correct capacity. Do not use anything as a replacement fuse. Rewiring Attempts to repair equipment must not be undertaken by employees. Only suitably qualified Electrical Engineers should attempt to repair equipment. Employees may only change plugs if they have received appropriate training and have been authorised to do so by the Manager.

When fitting plugs always ensure that the cable sheath is securely attached within the plug.

Wire plugs as follows: BROWN – LIVE

BLUE – NEUTRAL YELLOW/GREEN – EARTH

Portable Appliance Testing A portable electrical appliance is any piece of electrical equipment, which is not connected to the electrical circuit and can be moved, e.g. it is plugged into a socket. All portable electrical appliances provided by CareTech shall be subject to quarterly visual inspections by the Manager or other appropriately appointed person, in accordance with the Safety Checklist included in the section “Service Safety Checks”.

In addition, 100% of the portable equipment within the Service will be subject to annual Portable Appliance Testing (PAT) by a competent (NIC EIC/ECA registered) person, and records should be kept at the Service with all defects recorded and rectified within suitable timescales. All findings of these PAT activities will be brought to the attention of the Manager on the day, and any appliances presenting immediate risk shall be taken out of use with immediate effect. Changing Light Bulbs Where the fittings are in excess of three metres in height from floor level, then employees must not attempt to change light bulbs and suitable contractors should be appointed to undertake the task.

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If light bulbs are less than three metres in height, then Managers with the assistance of other staff, may undertake the changing of light bulbs following the guidance below (refer to High Level Access section of this Manual):

Whoever undertakes the job is competent and understands the risks of electricity and are familiar with the safe system of work for changing light bulbs.

Light bulbs to be changed must be accessible without creating unsafe working practices. Step ladders or ladders must be used for access to heights, NO stools, chairs, tables or crates are to be used for standing on (or anything similar).

The light fitting should be easily accessible with easily removable covers, diffusers etc.

The electrical supply to the light fitting MUST be switched off at the main light switch or control panel before touching it.

If turning off the lights places the area in darkness, then two persons shall be present, one with a torch for lighting purposes.

Remove the spent light bulb and replace with a similar new bulb. DO NOT use different types of bulbs, connections, wattage values etc.

Do not touch any metal casings or pull at the actual light fitting.

Replace any light bulb cover securely.

Stand clear of light fitting and switch on mains electrical supply. If the light fitting does not work do not investigate; report the problem to Potters Bar

Office. Appliances Owned by Persons Who Use Our Service From time to time employees may be asked to use or come into contact with the person who uses our Service own portable electrical equipment, for example, televisions, stereos etc. Employees should avoid where possible, use of person’s own portable electrical appliances. Where it is absolutely essential to use the person’s equipment, for example, during some cleaning tasks or if requested to ‘set’ a video recorder or similar, then employees must carry out a visual inspection of the equipment following the guidelines in this Manual (see Key Learning Points at end of the section). If there is any doubt whatsoever as to the safety of the equipment, employees should not touch the appliance. Only if it is safe to do so should an employee disconnect it from the main electricity supply.

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Key Learning Points for Employees

Any electrical item identified as faulty or where there is suspicion of a fault, should not be used and should be taken out of use wherever possible, by cutting off the plug or removing from the area.

Do not tamper with or abuse electrical equipment. Do not use with wet hands or near wet surfaces.

Visually inspect plugs, leads, sockets and cables prior to using any electrical equipment to check for:

- signs of burns/scalding - coloured wires exposed - frayed/damaged leads or cables - loose plug pins - cracked plugs or sockets

Be aware of the safe system of work for changing light bulbs, dependent on the Service that you work within and their classification for purposes of this Manual.

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CareTech Health & Safety Manual Page 1 of 6 HS-02-02-11 Gas Safety Last Reviewed January 2017

HS-02-02-11 GAS SAFETY 11.1 INTRODUCTION Gas is a potential source of fuel in the event of a fire. It contains a significant amount of potential energy, and is therefore very useful for cooking and heating homes and businesses. 11.2 SCOPE To provide general safety advice in respect of gas and gas appliances. To provide advice on the maintenance of gas appliances. 11.3 HAZARDS

Fire – caused by the gas igniting in an uncontrolled manner.

Explosion – caused by a build up of gas following a leak or similar, and that build up being ignited.


Cooking and heating service

Lighting gas fires

Lighting pilot lights

11.5 SAFE WAYS OF WORKING 11.5.1 Installation, Maintenance and Servicing All gas appliances must be installed, maintained and serviced by Gas Safe Registered Engineers on an annual basis. NOTE: Where CareTech acts as the landlord (i.e. where they are responsible for the property, including fixtures and fittings) but the property is lived in by others (i.e. people who use our Service) then the Manager must ensure all gas appliances are subject to an annual safety check which is to be arranged through the Potters Bar Office. Records of the annual safety check must be kept for a period of at least two years (Gas Safety Record Form). The service frequency of all gas appliances should be annual. Gas appliances include:

Boilers

Fires

Cookers

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11.5.2 Gas Shut Off Valves Managers should familiarise themselves with the location of the gas inlet unit and how to turn off the gas in the event of an emergency. Shut off valves to the gas supplies must be kept free from obstructions and be easily accessible at all times. If gas is detected: a) Do not use any naked light. b) Do not switch the lights or any other electrical equipment on or off. Switches produce

a spark that could ignite the escaping gas. c) Check whether gas is coming from a pilot or burner:

- if so, turn off the burner. - if not, turn off the gas supply to the appliance or at the main gas valve in the

kitchen or at the mains d) Open outside doors and windows to get rid of the gas and leave them open until the

leak has been stopped and any build up of gas dispersed.

d) Report the leak to the Service Manager/Area Manager and the Gas Board Emergency Service immediately.

f) Before reporting the leak to the Gas Board the Manager may try to identify whether gas is still leaking after the supply has been turned off (but not if it endangers themselves or others). If so CALL National Grid Gas Emergencies – 0800 111 999 (formerly TRANSCO).

g) Do not turn the gas back on where it enters the room or at the meter until the fault has been traced and repaired by a competent Gas Engineer.

h) Advise your Regional Director and Acoura of any gas leak, as this may be reportable to the Local Authority.

Defects with gas appliances should be reported to the manufacturer’s Service Engineers and to Regional Office / Head Office. 11.5.3 Appliances All gas appliances should be turned off at the end of each day where applicable (i.e. central heating/hot water boilers may be left on but cookers, fires etc must be turned off at night). If any gas appliances, including boilers and hot water units, are damaged or defects are noted, they should not be used. Any defects to boilers, hot water generators and gas fires must be reported through to the Area Manager. The appliance must also be labelled as ‘out of use’ to prevent others who may not be aware of the defects from using the appliance. Any defects to non-fixed appliances (e.g. cookers) must be reported to the Manager. It is then the responsibility of the Manager to arrange for a Gas Safe Registered Engineer to repair the defect. No other person should attempt to undertake repairs of gas appliances. Until the equipment has been repaired by a suitably qualified (Gas Safe Registered) Engineer, the appliance must not be used and be labelled ‘out of use’ to prevent it being used by others who may be unaware of the defect. 11.5.4 Pilot Lights Only Managers or other senior members of staff should be allowed to ignite pilot lights to gas appliances using tapers provided, but must ensure that they follow any written procedures associated with the appliance.

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11.5.5 Ignition Devices If an appliance, for example a cooker, has an ignition device that stops working this must be reported to the Manager for them to arrange repair by a suitably qualified Engineer. In the event of an ignition device failing, Managers should call out the competent contractor. If the risk assessment identifies unacceptable levels of risk or uncontrolled hazards, then the appliance should not be used. The risk assessment should identify the hazards that require controlling. All control measures identified in the specific risk assessment should be implemented to ensure there is a safe system of work. 11.6 BULK STORAGE OF LPG In the vast majority of cases, the LPG tank will be owned by the company that supplies the gas, but if you are unsure then you should check this with your own supplier. In general, the supplier will look after the tank and its fittings (their integrity and maintenance), but again check this with your supplier if you are unsure, as legally it needs to be maintained in a safe condition. However, the supply pipework running from the tank to the building will often be the responsibility of the premises occupier or owner. Supply Pipework The HSE now require that all buried, metallic pipework be replaced with polyethylene pipework, because of the real risk of corrosion, which can result in a gas leak followed by explosion. In the meantime, all metallic pipework must be subject to period inspection by a competent person, which includes visual inspection. Details of the inspection regime will be determined by local conditions. Advice must be sought for the LPG supplier or Acoura. Siting of the Tank There should be a minimum distance (called the ‘separation distance’) between the tank and any building, boundary line or fixed source of ignition. This should have been checked when the tank was first installed. This can be confirmed with the supplier. Modifications to the area may have been made since the tank was installed. These could include altering walls, building sheds or fences, installing electrical equipment near the tank or planting trees or shrubs nearby. These should not be any closer to the tank than this minimum distance and, if they are, then arrangements need to be made to move them. There should not be any drains or gullies near to the tank unless a water trap is provided to prevent gas entering the drains. This is because LPG is heavier than air and if a leak were to develop from the tank or its controls or pipework or when it is being filled then the vapour could accumulate in an untrapped drain or gully. Ignition of these vapours could then lead to fire/explosion. The tank should also not be painted in any colour other than originally supplied as this may increase the amount of heat it absorbs from the sun.

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Ventilation and Conditions Around the Tank In case of leaks there should be plenty of room around the tanks to ensure good air flow so that pockets of heavier-than-air LPG vapours cannot build up around them. It is also very important to keep the area around the tank free of rubbish, particularly if it is combustible or could reduce the levels of ventilation. For similar reasons keep weeds and grass cut down around the tank. The use of any weed killers must be restricted to those that are NOT chlorate-based. Tanker Access There should be a dedicated flat parking area for the tanker delivering LPG. This parking area should be clear on a delivery day and people should be kept away from the tank and tanker while the transfer of LPG is taking place. The supplier of the LPG will need to make sure that the tanker cannot drive away with the supply hose still connected, that there is no risk of an electrical spark being generated from static electricity or by other means. The LPG supplier should ensure that their drivers are suitably trained and have the correct procedures to follow. Security People not involved with the installation, for example workers with no responsibility for the LPG or visitors to the site, should be kept well away from it. No one should smoke, use electrical equipment or park vehicles near the tank. ‘No smoking’ and other signs should be clearly displayed and maintained. Ignition sources, e.g. bonfires and barbecues, should not be allowed near the tank. Temporary use of grass-cutting equipment within the vicinity of the tank is permitted. The tank should be protected from unauthorised access to reduce the chance of intentional or accidental interference. For larger tanks (i.e. four tonnes or higher LPG capacity) a security fence is required to keep it secure. This fence should allow natural air flow (e.g. made from wire mesh) and should be kept in good condition. Any gates should be kept locked unless access to the tank is required. For tanks below four tonnes LPG capacity, there may be certain circumstances where a fence may not be necessary. This can only be justified where the risk of interference is low, and there is no uncontrolled public access - for example due to tank location or other accessibility factors. Tank valve covers should be kept locked whether or not the tank is fenced. Impact Protection If possible, the tank (and its associated piping) should not be located in areas where there is vehicular traffic. However, where this is not possible, protection from a motor vehicle hitting the tank is required, such as crash barriers or bollards. A security fence and/or road markings (e.g. ‘no-parking’ notices, double yellow lines) are unlikely to provide this protection. Emergency Arrangements The LPG tank will have printed on it the supplier’s emergency number that should be called if there is a leak. If a fire breaks out, use the emergency plan to evacuate people from the premises and away from the storage tank. Always leave tackling any fire near the tank to the fire brigade, unless it is judged that it can be put out without endangering anyone. In the event of an emergency, and where it is safe to do so, the shut-off valve on the top of the tank and the emergency control valve (ECV) should be closed.

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Locate the gas shut off valve to the Service and ensure it is easily accessible and unobstructed.

Ensure all gas appliances are shut off at the end of each day.

In the event of an ignition device failing the Manager should carry out a specific risk assessment on the proposed method of lighting the appliance. All control measures identified must be implemented.

Know the procedure to follow in the event of a gas leak.

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CareTech Health & Safety Manual Page 1 of 6 HS-02-02-12 Manual Handling Last Reviewed January 2017

HS-02-02-12 MANUAL HANDLING

12.1 INTRODUCTION Manual handling is possibly one of the most common work place activities. A vast number of workers carry out manual handling tasks each day, of varying degrees of difficulty and involving a wide variety of loads. Not surprisingly therefore, manual handling is a common cause of work related injury. Typical injuries caused by poor manual handling include sprains and strains (particularly of the back), cuts, bruises, fractures and even amputations. Physical impairment and permanent disablement can be the ultimate result of poor manual handling. 12.2 HAZARDS Personal injury as a result of incorrect handling procedure. 12.3 WORK ACTIVITIES

Lifting and carrying loads at work

Lifting and moving people who use our Service

Lifting and carrying deliveries of goods, including groceries and food provisions

Lifting and carrying office equipment and supplies 12.4 SAFE WAYS OF WORKING 12.4.1 Lifting Loads The Regulations covering manual handling prohibit the employment of any person to lift, move or carry a load so heavy that it would be likely to cause injury. This seemingly looks only at weight as a measure, but other factors of the load must also be assessed. For example, the awkwardness, size (i.e. dimensions), bulk, whether the load can move around (i.e. liquids) may all present additional risk to the health and safety of employees attempting to lift them. There are three main principles to good manual handling operations and these are as follows: 1. AVOID manual handling operations where possible. 2. ASSESS any hazardous operation that cannot be avoided. 3. REMOVE or REDUCE the risk of injury, using an assessment of the job activity as

the basis for action. Before attempting to move any load you should refer to the CareTech guidance on safe lifting which is a flow diagram taking a step-by-step approach to lifting a load – see over page.

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Stop and think.

Do you have to lift and carry?

Can an aid be used?

How will you lift it.?

Where will it go?

Is it too heavy just for you?

Is the route you will take ok?

Do you need PPE, gloves or other?

Place the feet apart, giving a balanced and stable base for lifting. Be prepared to move your feet during the lift to maintain stability (tight skirts and unsuitable footwear make this difficult).

Leading leg as far forward as is comfortable.

Bend the knees as far as is comfortable.

Keep the back straight.

Stomach in.

Lean forward a little over the load to get a good grip. Keep shoulders level and the same direction as the hips.

Where possible, the load should be hugged as close as possible.

Take a secure grip that suits you.

At start of lift, slightly bend back, hips and knees.

If it is necessary to vary the grip as the lift proceeds, do this as smoothly as possible or you could wrench a muscle.

Don’t jerk. Carry out the lifting movement smoothly, keeping control of the load.

Move the feet. Don’t twist the body when

turning to the side.

Keep close to the load. Keep the load as close to the body as possible.

Keep the heaviest side of the load next to the body.

Keep head up and look ahead, not down at load, once it is held securely.

Put down, then adjust. If precise positioning of

the load is necessary, put it down first, then slide it into the desired position.

GOOD HANDLING TECHNIQUE

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Safe Lifting Assessment

Does the load need to be manually

lifted/handled?

Assess the load. Consider: * weight * awkwardness * size * distribution of weight

Assess the route you will take to carry the load. Consider: * obstructions by doors * trip hazards by steps * distribution of weights e.g. narrow corridors

Asses the destination of the load, consider if it is clear, unobstructed etc.

Obtain lifting equipment. Equipment must only be used if you have been trained in its safe operation of use.

Get help from a colleague

STOP No

Is there any available equipment to help me with the lift?

Can I lift the load safely alone?

Pick up load, keeping back straight, bend knees to lift, keeping good balance, obtaining a good grip and avoid twisting at the waist/hips.

Yes

Yes

No

No

Yes

START

Carry load to destination

Set down load, again protecting your back by keeping it straight and bending your knees and avoiding twisting type movements

STOP

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12.4.2 Lifting People External Occupational Therapists/Physiotherapists will carry out the Mobility Assessment for individual people who use our Service. If there is a delay in this Assessment being carried out then an Interim Risk Assessment can be completed by Managers. The Interim Risk Assessment requires Managers to find out the following information:

The person’s height.

The person’s weight.

The extent to which the person can support themselves (and any other factors associated with them supporting themselves; e.g. pain, fatigue, apprehension).

If the person has any problem with comprehension.

If the person has a history of co-operational behaviour.

Once these ‘person-based’ factors have been established, the Manager should identify the:

Method of movement relevant to the tasks needed to be completed (e.g. sitting, going to the toilet, bathing, transfer to bed etc).

Any equipment requirements; e.g. hoists, slide boards, slip sheets, etc.

Minimum number of staff required to perform the lift. Once the assessment has been fully completed, lifts or movements may be carried out once the correct control measures identified from carrying out the assessment are in place (i.e. the right number of people, correct lifting equipment etc). Each individual person who uses our Service will require specific assessment, as their needs are likely to be particular to themselves. This assessment procedure is designed to ensure the safety of people who use our Service as well as employees who are required to lift or move people as part of their duties. The procedure is based on three main principles to good manual handling listed above, but takes into consideration the load being lifted or moved by a person. The wishes of people who use our Service are an important part of any assessment and they must be respected wherever possible, to support their independence and autonomy as fully as possible. The risk assessments are to be reviewed every six months, or more frequently if circumstances change as determined by the person’s individual needs.

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12.4.3 Lifting Equipment When moving a person who uses our Service, the risk of injury to employees will be reduced by the provision of mechanical lifting devices where practicable, for example:

Manual and powered mobile hoists

Powered Ceiling Track Hoists Equipment that is used to lift people shall be inspected and tested on a six monthly basis (or more frequently, if the manufacturer’s instructions request this), as required by the Lifting Operations and Lifting Equipment Regulations 1998. These regulations apply to all work equipment for lifting and lowering of loads and it includes the attachments used for anchorage and fixing or supporting it. A load in this context includes a person. The lifting equipment provided must be suitable for the purpose it is intended for and shall where necessary, be installed by a competent person. All lifting equipment shall be marked conspicuously with the safe working load. Lift motor rooms (where applicable) will remain locked and not be used for any other purpose (i.e. storage). 12.4.4 Breakdown of Lifting Equipment Where lifting equipment becomes defective or breaks down, it shall be taken out of use immediately and marked conspicuously with a lift breakdown notice. Under no circumstances shall staff attempt to repair the equipment. It shall be isolated from the power supply if possible, to avoid accidental use. 12.4.5 Examination of Lifting Equipment Lifting equipment of all types must be thoroughly examined on a regular basis and always after: 1. Installation and before putting into service. 2. After assembly and before putting into service in a new Service. 3. After a six month period for any lifting equipment and accessories (including

passenger lifts) used for lifting or lowering or people. 4. After a 12 month period for any other lifting equipment and accessories. 5. Portable pieces of equipment to be reviewed by competent person. OR at any other period recommended by the equipment manufacturer. Only a competent person approved by CareTech shall carry out this thorough examination. Service Managers should regularly check any lifting equipment they have to ascertain that it is operating satisfactorily. If a fault is identified then CareTech’s Potters Bar Office must be notified without delay. Checks should include:

Visual assessment of the equipment to identify any worn or wearing parts.

Any interlocking devices (e.g. means of preventing doors from opening if it is not at the correct level with an opening) are working correctly.

That safety harnesses are fitted and in good working order.

Emergency alarm calls and cut out devices are working correctly where fitted.

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In the event of a lift or hoist breaking down or a defect being noted with the equipment, the Service Manager must ensure that that piece of equipment is taken out of use. It must be labelled to indicate to other employees that the equipment is defective and as such, cannot be used. 12.4.6 Repairs of Lifting Equipment Defective lifting equipment should be reported to the Regional Office without delay. Managers or employees should not attempt to repair lifting equipment themselves. 12.4.7 Record Keeping Records of thorough examination of lifting equipment by a competent person must be kept for a minimum of three years. Copies of such records should be kept at each Service address where that piece of equipment is located and used. In addition to the certificates of thorough examination there should be details of the lifting equipment examination contract (or written scheme of examination). This document should also be kept at the address of the Service.


Always assess any load before lifting it – get help if necessary.

Never lift a person who uses our Service before undertaking a Mobility Assistance Assessment with the Service Manager or finding out about the results of any assessment already undertaken on the person.

Remember the key points to safe lifting: 1. Keep your head up. 2. Knees bent when lifting/lowering. 3. Check your route before lifting. 4. Get help if required.

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CareTech Health & Safety Manual Page 1 of 4 HS-02-02-13 Medicine Administration Last Reviewed January 2017

HS-02-02-13 MEDICINE ADMINISTRATION 13.1 INTRODUCTION Many of the people who use our Service within CareTech Service are prescribed medicines from their Doctors, which need to be administered regularly. Each person’s medication requirements are likely to differ. It is the role of the employees within CareTech to ensure that the medicines are administered in the right doses and at the right frequency and at the appropriate time. 13.2 SCOPE The term medication in this section means any medicinal preparations specifically prescribed for the treatment of illness and non-prescribed medication for control of symptoms such as pain and temperature control. This section is intended for use primarily by employees who are involved in the administration of prescription medicines. It has equal value however in monitoring the administration of non-prescription drugs. 13.3 HAZARDS

Administering the incorrect medicine to a person who uses our Service.

Administering too much of a medicine to a person who uses our Service (over-dose).

Administering none, or too little of a medication to a person who uses our Service.

Administering medicines at the incorrect time.

Administering medication that should not be taken with another medicine that the person who uses our Service has recently taken.

13.4 WORK ACTIVITIES Administering medication to people who use our Service. 13.5 SAFE WAYS OF WORKING NOTE: It is acknowledged that the procedures for medicine administration vary across the CareTech organisation, and that some of this variance is in part due to Local Health Authority Departments. However, the Service must implement the following safe way of working unless the Director of Operations agrees specific exception. 13.5.1 Storage of Medicines Prescription medication will be stored in locked cabinets in an office or other location. All medication must be kept in their original containers and clearly labelled to indicate:

Patient’s name

Date of prescription

Expiry date of medication

Dosage

Any other relevant information Any medication not in a container containing the above information must not be stored in the medication cabinet and should not be administered by employees of CareTech.

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13.5.2 Administering Prescribed Medication Only employees authorised by the Manager may administer prescription medication to people who use our Service. Any person who uses our Service on medication must have their details entered on the appropriate Medicine Record by a member of the Management Team. Details of all the medication a person who uses our Service is taking must be entered onto the form (MAL1 and MAL2, Appendices 5 and 6), or another appropriate authorised record system such as MAR. When medication is administered the details must be entered into the chart at the bottom of the form. Continuation forms have been provided for the people who use our Service who are on long-term medication. This log must be maintained and kept up to date following any changes to prescriptions. If there is a change in medication then a new Record Form must be completed and the process should start afresh. Old records must be retained for at least six months, or as determined by the Health Authority. Prior to administration of any medicine, staff should check the Medicine Record. Details of the medication, the times and dosage for administration and the time of any previously administered medicines (whether they are prescription medicines or not) should be checked. They must also check the details on the label of the medication to ensure that the dose requested is due. On giving out a dose of medication the exact details of the medication prescribed, the dosage given, the date and time of its administration and the name of the person administering it must be clearly and legibly logged on the Medicine Record. The Medicine Record must be kept in either the lockable cabinet with the medicines or in an alternative equally accessible position, in the same area as the lockable drug cabinet to allow easy access to the information as required. 13.5.3 Non-Prescription Medication Employees should only administer non-prescription medication, for example, headache tablets, hay-fever treatments and other similar ‘over-the-counter’ medicines to people who use our Service authorised to do so by the Manager. People who use our Service may administer these themselves if this has been assessed in their Care Plan. Prior to the administration of any non-prescription medicines the Medicine Record must be consulted to determine the following:

1. Whether or not the non-prescription medication can be taken in conjunction with any other medication that person may be on, and;

2. When (or if) they had their last dose of the non-prescription medicine.

If there is any doubt about whether the medication can be given in conjunction with other medications (whether prescription or not) then the medication should NOT be administered and further advice sought either from the Manager, Pharmacist or the person’s Doctor as appropriate.

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13.5.4 Intravenous Medication Any people who use our Service who receives medication intravenously must have such medicines administered by a suitably qualified person. This will normally be a health care visitor (e.g. Community Psychiatric Nurse). Under no circumstances must CareTech employees administer medication intravenously unless they are suitably trained and qualified, and this task forms part of their contracted duties. The Medicine Record must be completed in full for any medication that is given intravenously, and visitors such as health care workers must report this to the Manager, indicating what drugs have been administered, or log them appropriately on the individual person’s Medicine and Administration Form. 13.5.5 Remedial Action In the event of an error occurring during the administration of medicine, the Manager must be informed without delay. Further advice must be sought as soon as possible from the doctor of the person who uses our Service, or Pharmacist. Any error in medicine administration must be recorded on the Medicine Record, including details of what was administered, the dose given and the time it was given so that information may be used by medical professionals to assess any effects to the person who uses our Service and to define any remedial action that needs to be undertaken. 13.5.6 NHS 111 Managers may wish to contact the NHS 111 service for advice and guidance on medical issues.

Tel No: 111


Only employees authorised by the Manager may administer medicines to people who use our Service.

Always refer to the Medicine Record for each person who uses our Service before issuing any medicines (authorised employees only).

Always complete the Medicine Record for each person who uses our Service after using any medicines (authorised employees only).

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CareTech Health & Safety Manual Page 1 of 4 HS-02-02-14 Control of Infection/Clinical Waste Last Reviewed January 2017

HS-02-02-14 CONTROL OF INFECTION/CLINICAL WASTE 14.1 INTRODUCTION Control of infection is an important consideration across the CareTech organisation. Employees may be at risk from a range of micro-organisms that may cause disease. As exposure to these organisms is as a result of a work activity, CareTech will assess the risk of cross-infection occurring and put in place all necessary control measures. 14.2 SCOPE This section will identify the work activities which may result in employees being infected by micro-organisms. It will also provide advice and guidance on how to avoid becoming infected. 14.3 HAZARDS

Employees being exposed to infected materials or people who use our Service.

Other people who use our Service being exposed to infected materials or people who use our Service,

e.g. Hepatitis B (blood and blood products) Tuberculosis (airborne) HIV (blood and blood products) MRSA.


Contact with infected persons.

Removing and dispensing of syringe needles.

Cleaning, handling and dispensing of human waste.

Cleaning, handling and disposing of bodily fluids, including blood.

Handling and storing clinical waste as defined below. 14.5 SAFE WAYS OF WORKING 14.5.1 Identifying Potential Hazardous Material In order to minimise any risk of infection, all relevant employees must be able to identify ‘clinical waste’, which may or may not contain the organisms capable of causing disease. This is covered in the LDAF Training Pack. Clinical waste has been graded into five groups A-E. The main groups that CareTech employees need to be aware of are A, B and E. These relate to:

A - Bodily fluids – such as blood and include soiled dressings and material.

B - Discarded syringe needles and any other contaminated sharp instruments and items.

E - Items used to dispose of urine, faeces and other bodily secretions or excretions that do not fall within Group A. This includes the use of disposable bedpans or bedpan liners, incontinence pads, stoma bags and urine containers.

(See Appendix HS-02-AP-05 for a sheet that can be displayed).

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All employees who come across any ‘clinical waste’ must exercise caution. If employees are unsure whether something they come across constitutes clinical waste, then it should be treated as clinical waste to minimise any possible risk of infection. This is called applying ‘universal precautions’. 14.5.2 Service Managing and Disposing of Clinical Waste Service Managers who have to deal with clinical waste at their Service must consider the physical logistics involved in moving and disposing of the waste material. The procedure for dealing with such waste should follow the principles laid down below. (Reference should also be made to the generic risk assessments on control of clinical waste and infectious disease in the relevant risk assessment supplied on Acoura Assist).

Provide designated equipment for use to clean up clinical waste. Include mops, paper towels, waste bags etc.

Equipment should preferably be colour coded (it is recommended that YELLOW be used as an identifier).

Ensure that there is a supply of colour-coded bags to put any clinical waste into. Yellow bags should be provided (these can be obtained from the Waste Authority or a Clinical Waste Contractor).

Clinical waste should be stored in lidded containers.

A secure, enclosed area should be provided for the storage of clinical waste awaiting collection. This must be locked and out of access to people who use our Service and members of the public wherever practicable. It should not be ‘left out’ for collection as household refuse might be. It should be under control of the Service Manager or their staff at all times.

Arrangements should be made with a Waste Contractor or the Local Waste Authority for the clinical waste to be collected. The details of collection must be specified to ensure that at all times the clinical waste is controlled.

Where there is a risk of sharps being found on the Service, arrangements should again be made to provide suitable sharps containers. These should be rigid, lidded containers. A specialist company should empty them once ¾ full, and the Service should have a second container to use in this instance. Sharps boxes must be kept locked away from access by people who use our Service. Soft drinks cans, plastic bottles or similar should not be used as sharps boxes. Arrangements for collection of sharps boxes should be made with the Waste Contractor or the Local Waste Authority, or Local Health Authority.

In all events, it is essential that the box be taken to the site of the sharp - never move the sharp to the container.

14.5.3 Universal Precautions for Employees All employees involved in handling of clinical waste should follow the guidelines below:

Employees should wear the Personal Protective Equipment (PPE) they are provided with for handling clinical waste. As a minimum they should wear suitable waterproof gloves and disposable waterproof aprons. If the PPE becomes contaminated, this should be disposed of as clinical waste

Employees should practice high standards of personal hygiene and wash hands thoroughly after handling any clinical waste with antibacterial soap, even if gloves were worn.

Cuts and grazes should be covered with waterproof dressings BEFORE commencing work.

The environment should be kept safe and hygienic. Any equipment that becomes contaminated should be thoroughly cleaned and disinfected, if it is not disposable.

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14.5.4 Spillage Procedures In the event of a ‘spillage’ of clinical waste, in particular those containing blood, employees should follow the cleaning procedure below:

A spillage kit should be held at the Service. This kit should contain: o Disposable aprons o Disposable waterproof gloves o Clinical waste disposal bag(s) o Paper towels o Sanitising solution

Spillages should be cleaned up as quickly as possible.

Employees must wear the PPE provided.

Large amounts of waste should be removed/soaked up with paper towels, which must be disposed of as clinical waste in the bag provided.

The sanitising solution should be applied to the spillage as a disinfectant. The instructions provided on the product used must be followed.

The area should be cleaned with paper towels (or a designated mop if more appropriate). Used paper towels must be disposed of as clinical waste. The mop (if used) should be disinfected with an appropriate sanitising solution.

Staff should wash their hands thoroughly after cleaning up clinical waste and dispose of PPE used along with the clinical waste.

The spillage kit must be replenished at the earliest opportunity.

The area should be ‘cordoned off’ so others are unable to enter it. 14.5.5 Specific Risk and Immunisation Service Managers should identify if their Service has a person who uses our service with Hepatitis B amongst the users. Such information should be found in the risk assessment for the person who uses our Service. In such cases, all staff employed at that Service will be immunised against Hepatitis B. It is the responsibility of the Service Manager in consultation with Senior Management as to whether immunisation is needed. (Further guidance can be found in the relevant risk assessments provided on Acoura Assist). If employees are immunised, routine checks should be carried out on these employees to ensure they remain adequately protected. This should be done in consultation with the Occupational Health Service or the employee’s own G.P. as appropriate. Even when immunised, universal precautions must apply still – even if an employee is immunised against Hepatitis B, this does not protect them from contracting HIV.

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Clinical waste may be any bodily fluid, including blood, faeces, urine etc. It is also any contaminated sharps, for example syringe needles.

Such clinical waste must be handled with caution and Personal Protective Equipment (PPE) must be worn to minimise risk of cross-infection (e.g. gloves and apron).

Clinical waste must be disposed of in colour-coded (yellow) bags, which can be obtained from the Waste Contractor or the Waste Authority.

Sharps must be disposed of only in sharps containers, which should be of rigid, lidded construction.

Spillages involving clinical waste must be cleaned up as quickly as possible using the ‘spillage kits’ provided. Any waste must be treated as clinical and dispensed of appropriately.

Services identified as having incidents of Hepatitis B amongst people who use our Service will require immunisation against the disease. Service Managers will discuss this with employees, where appropriate.

‘Universal precautions’ should always be applied.

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CareTech Health & Safety Manual Page 1 of 2 HS-02-02-15 Personal Protective Equipment Last Reviewed January 2017

HS-02-02-15 PERSONAL PROTECTIVE EQUIPMENT 15.1 INTRODUCTION Personal protective equipment (PPE) is equipment provided by CareTech only when there is no other way to protect employees from exposure to hazards, or in combination with other control measures. Examples of PPE include: gloves, goggles, safe and appropriate footwear, plastic aprons. 15.2 SCOPE To provide advice and guidance on the provision and use of PPE to CareTech employees. 15.3 HAZARDS

Use of chemicals.

Contact with biological (infectious disease) hazards (via blood, vomit, faeces, other body fluids).


Cleaning tasks i.e. kitchen, bathroom and the rooms of people who use our Service.

Washing clothing etc.

Using chemicals.

Disposing of/handling bodily fluids and clinical waste.

15.5 SAFE WAYS OF WORKING Training for Employees Managers should identify those employees who may be exposed, as a result of their duties, to the hazards identified above. All those employees identified as being at risk of exposure should be trained to spot potential hazards and therefore take steps to minimise any potential exposure. Equipment All Services should be provided with the following equipment:

Suitable waterproof gloves (‘washing up’ type gloves).

A set of goggles for protecting the eyes.

Suitable waterproof aprons. These pieces of equipment must be sited in the location where they are to be used, or in the most appropriate location. It is the responsibility of the Manager to ensure that all PPE is maintained in its correct position and that it is in good condition (e.g. not worn, damaged etc.). Managers should review the PPE available to employees during the quarterly safety checks to ensure it is suitable for the task it is intended for, and in good condition. This process should be undertaken in consultation with employees to ensure they are happy with the PPE provided and it’s condition.

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CareTech Health & Safety Manual Page 2 of 2 HS-02-02-15 Personal Protective Equipment Last Reviewed January 2017

If a new task is identified as requiring additional PPE to that already available, the Manager should carry out a specific risk assessment to determine the most appropriate and effective controls. It must be remembered that PPE should be the ‘last resort’ in terms of a control measure to minimise exposure to hazards. All other possible alternatives should be assessed to see if there are safer ways of working which are both reasonable and practicable.


Any damaged or defective PPE must be reported to the Manager without delay.

PPE must be worn where provided and in accordance with CareTech’s instructions.

PPE is the ‘last resort’ in terms of control measures.

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CareTech Health & Safety Manual Page 1 of 2 HS-02-02-16 Fire Safety Last Reviewed January 2017

HS-02-02-16 FIRE SAFETY Refer to the Fire Safety and Fire Risk Assessment Manual.

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CareTech Health & Safety Manual Page 2 of 2 HS-02-02-16 Fire Safety Last Reviewed January 2017


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CareTech Health & Safety Manual Page 1 of 2 HS-02-02-17 High Level Access Last Reviewed January 2017

HS-02-02-17 HIGH LEVEL ACCESS 17.1 INTRODUCTION Accessing areas of the Service or fixtures and fittings at high level adds increased danger to employees as, in the event of falling, serious injury or death may result. 17.2 SCOPE To provide guidance on carrying out or arranging for repairs and maintenance, including cleaning to high-level areas, for example, roof areas, windows and internal fixtures and fittings. 17.3 HAZARDS

Accessing high levels.

Falling from height.

Use of ladders and stepladders and other access equipment. 17.4 WORK ACTIVITIES

Cleaning e.g. ceilings, light fittings.

Decorating.

High-level storage.

17.5 SAFE WAYS OF WORKING Where possible, tasks should be undertaken with the employee standing on the floor. The use of long handled equipment, for example, will assist this. The use of ladders, steps etc should only be used if an alternative system cannot be operated. No member of staff should attempt to carry out any task at a height of three metres or more above floor level. Suitably trained and competent contractors should undertake any matters that require attention above three metres high, for example, cleaning or repair works. Service Managers should arrange for contractors through the Potters Bar Office. Matters requiring attention below three metres high from the floor level, may be attempted by CareTech employees if the following provisions are in place: 1. The correct equipment is available e.g. suitable stepladder at suitable height. 2. The equipment is in good condition. 3. There is sufficient space for the task to be undertaken safely. 4. Other employees are available to assist in the task whenever necessary. 5. Employees are trained in safe systems. If there is any doubt about the safety of the task, then employees should not attempt to work at height. For tasks that may be regularly repeated and will require working at height, the Service Manager should carry out a specific risk assessment. Other tasks should be risk assessed as they occur and before the task is undertaken.

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CareTech Health & Safety Manual Page 2 of 2 HS-02-02-17 High Level Access Last Reviewed January 2017

17.5.1 Use of Ladders and Stepladders Stepladders may be provided by Service Managers to help ensure the safety of employees required to undertake tasks at high level. Under no circumstances should any CareTech employee use any other item to climb on other than a stepladder to work at height. This includes chairs, tables, boxes or any other item of furniture (the only exception to this is if there is a ‘kick step’ which is stable and designed specifically for standing on). Service Managers, where they have stepladders at their Service, will ensure that the ladders are maintained in a good and safe condition on an ongoing basis, and also via the Quarterly Safety Checklist. Service Managers should check the condition of the stepladders on a regular basis, paying particular attention to the condition of the treads, the feet, the A-frame supports and any safety locking devices. If a Service Manager, or any other CareTech employee, notices any damage or defect to a stepladder, then the ladder must be taken out of use immediately. The ladders must also be suitably labelled to indicate to other employees that the stepladders are out of use. Work trays should be used and secured to a stepladder where tools or other items need to be taken up the ladder for use. Where appropriate, another member of staff should be in the vicinity to avoid lone working on a stepladder or where other risks can be foreseen e.g. people who use our Service in their vicinity, dark areas, working near steps or stairs. Never place the stepladders feet too near to an edge or set of stairs, always ensure the safety devices and A-frame supports are in their correct position before standing on the ladder. Do not use the ladder in the near vicinity of people who use our Service, or where the danger of falling is exacerbated by hot cooking equipment for example. Ensure such scenarios are avoided by ensuring cooking equipment is cooled. When working at high level the area should be ‘cordoned off’ to restrict access. Appropriate signage or warnings should be used to alert people who use our Service, employees and others of any danger. All employees undertaking tasks at high level should receive appropriate training and be aware of hazards and controls associated with the task being undertaken. Reference to task specific risk assessments should be made.


Never access anything above three metres in height.

Always survey the area and task before using the stepladder – do not use near to a balcony edge or hot cooking equipment for example.

Use work trays or similar secure means of holding tools other than in hands when climbing.

Ask for help or supervision when up the ladder if required e.g. to hold the foot of the ladder and to avoid people who use our Service coming near for example.

Never climb a stepladder without checking that it is secure and in good condition.

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CareTech Health & Safety Manual Page 1 of 2 HS-02-02-18 Pregnant Employees Last Reviewed January 2017

HS-02-02-18 PREGNANT EMPLOYEES 18.1 INTRODUCTION Employees who are pregnant will go through a number of relatively rapid and significant changes in their body during the term of their pregnancy. In turn, this may put additional strain on their body, which must be taken into account to prevent any harm occurring to either the expectant mother or the unborn child. Additionally, there may be a greater risk to the health, safety and welfare of ‘new mothers’ (those who have given birth within the past six months) and breastfeeding mothers when compared to other employees. 18.2 SCOPE To provide advice and guidance to Service Managers on identification of hazards relevant to expectant and new mothers and to provide advice and guidance on carrying out the specific risk assessment. 18.3 WORK ACTIVITIES Employee roles may differ widely across CareTech’s operations and as such, expectant and new mothers may arise in many different work areas. 18.4 SAFE WAYS OF WORKING 18.4.1 Notification It is the responsibility of employees to notify their Service/Line Manager that they are pregnant. Employees should ideally put this notification in writing. It is also the responsibility of the expectant mother to identify if there are any medical problems that may affect either herself or the unborn child, which may be exacerbated by the tasks they are requested to do at work. Any such concerns must be brought to the attention of the Service/Line Manager. It remains the responsibility of the expectant mother to notify the Service/Line Manager of any relevant medical issue, which may affect their work. 18.4.2 Risk Assessment For each expectant mother, breastfeeding mother or new mother, a risk assessment must be carried out. This is a legal requirement and it is the responsibility of the Service/Line Manager to undertake the assessment in connection with the member of staff. At least the following areas should be considered when carrying out the risk assessment:

Working environment

Manual handling

Working time

Shift working

Use of chemicals

Clinical waste/bodily fluids

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CareTech Health & Safety Manual Page 2 of 2 HS-02-02-18 Pregnant Employees Last Reviewed January 2017

The hazards may change and certainly the risk to the pregnant employee may change during the term of the pregnancy. As such, the risk assessment should be reviewed throughout the term of the pregnancy, at the following intervals:

1-3 months (first trimester)

4-6 months (second trimester)

7-9 months (third trimester)

New mother

Breastfeeding mother A Risk Assessment pro forma can be found in Appendix HS-02-AP-06. If the Service/Line Manager has any concerns, further information should be obtained from the Human Resources Department. The employee’s Manager should undertake the Risk Assessment with the employee. Actions should be agreed between both parties and others informed as required.


Pregnant employees are more likely to suffer from o Fatigue o Back strain o Posture problems

Pregnant employees must be subject to a specific risk assessment by law. This should be undertaken by the Service/Line Manager in conjunction with the pregnant employee.

Special provisions may be introduced to control the additional risk to pregnant employee.

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CareTech Health & Safety Manual Page 1 of 4 HS-02-02-19 Office Safety Last Reviewed January 2017

HS-02-02-19 OFFICE SAFETY 19.1 INTRODUCTION The office environment, although it generally does not present a high risk of injury it does contain a number of hazards which must be adequately controlled. Issues focus mainly on housekeeping, electrical hazards, storage or records or files, use of computers and display screen equipment for extended periods of time etc. This section is relevant to all Regional Offices, as well as the Service. 19.2 SCOPE This section will cover all elements of office safety and provide advice and guidance on how to identify employees who may be exposed to hazards. It will also provide information on how best to control employees’ exposure to the hazards identified. 19.3 WORK ACTIVITIES

General office duties, including filing, housekeeping etc.

Display Screen Equipment (VDUs) and typing.

Use of electrical equipment. 19.4 SAFE WAYS OF WORKING 19.4.1 Working with Display Screen Equipment (DSE) Display Screen Equipment, more commonly known as visual display units or VDUs, includes the monitors used in connection with computers. Using computers for typing or other activities for long periods at a time may give rise to adverse health effects if adequate controls are not put in place. Managers should identify any employee within their organisation who routinely (daily) sits down at a VDU for greater than one hour at a time to work, without interruption. Interruptions include both work (e.g. answering the telephone, filing etc) and non-work activities (i.e. breaks). Any employee falling into the category must have their workstation assessed against the assessment criteria on the Workstation Assessment Sheet, which can be found in Appendix HS-02-AP-07. Managers should undertake the assessment and it should be completed or reviewed each time:

a) A new employee is taken on to work at a VDU. b) New equipment is provided or when equipment is replaced. c) Working patterns change (i.e. longer periods of time spent at a VDU). d) The work area is rearranged, moved or relocated.

Once the Workstation Assessment Sheet has been completed, any improvements that are identified as required should be implemented as soon as they reasonably can be. The Workstation Assessment Sheet should always be completed with the employee who will be using the workstation.

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Where an employee who is deemed a “user of display screen equipment” requires an eyesight test, CareTech will pay for the eye examination. Where corrective spectacles are required for working with DSE then CareTech shall pay either the whole cost or contribution towards the cost of the corrective spectacles. It is recommended that all staff who work with VDU’s or all workstations complete an assessment and are assessed to ensure any risk is reviewed/controlled or eliminated. 19.4.2 General Office Duties There are a number of issues relating to office safety. One of the most important general issues is that the office should be kept tidy and the following should be ensured:

a) Items must not be stored in walkways where they may present tripping hazards. b) Cables and leads from equipment must be carefully located. Ideally they should not

cross walkways. Where it is necessary for cables to cross walkways, they should be suitably secured using heavy-duty tape or, ideally, specifically designed cable covers that in turn, should be secured.

c) Items should be properly and safely stored. Filing cabinets should not be over-filled or over-loaded at the top – ideally they should have interlock devices to avoid more than one drawer being opened at any one time. Shelving or racking must be stacked safely. Boxes, for example, should not be stacked too high one on top of another.

d) Items should not be stored underneath desks. e) Handling of heavy items of stock (e.g. bulk paper deliveries) or movement of

equipment must be undertaken safely. Refer to the Manual Handling section of this Manual.

f) Safe practices should be adopted, for example not leaving drawers open or leaving bags in walkways.

19.4.3 Electrical Equipment Refer to the Electricity at Work section of this Manual. 19.4.4 Welfare Offices should be adequately lit, well ventilated and heated. Temperatures maintained should be ‘reasonable’. Lighting must be carefully considered to ensure shadows are not cast over work areas and that there is adequate natural or artificial lighting provided. 19.4.5 Seating Each workstation should be provided with a suitable seat. Suitability of seating will depend upon what work activities are undertaken at the workstation. Ideally workstations that may be used by a number of persons or where staff are likely to be seated for long periods should be adjustable, to allow the user to find the most comfortable position for them. If staff have any concerns relating to their office accommodation, they should report those through to the Manager.

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Employees should be aware of general office safety principles and how to spot hazards including trailing cables, items stored under desks, overloaded filing cabinets/drawers.

Employees should be aware that certain staff are classed as ‘users’ of display screen equipment and should be subject to a specific risk assessment by the Manager.

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CareTech Health & Safety Manual Page 1 of 8 HS-02-02-20 Driving Safely Last Reviewed January 2017

HS-02-02-20 DRIVING SAFELY 20.1 INTRODUCTION Employees within CareTech may be required to use either Company vehicles or possibly their own vehicles on Company business, for example, to go on shopping trips with people who use our Service etc. When using their own car, appropriate insurance must be provided. In addition to the risk of road traffic accidents, there is also the risk of breaking down or violence and aggression from other road users being directed at employees. 20.2 SCOPE The aim of this section is to provide some general guidelines to help ensure that employees can successfully cope in the event of a problem or accident occurring whilst driving as part of their role within the CareTech organisation. 20.3 HAZARDS

Breaking down

Road traffic accident

Subjected to violent or aggressive behaviour

Other drivers

Being distracted whilst driving

Use of alcohol, drugs (medicinal, or other)

Fatigue, illness

Second hand smoke 20.4 WORK ACTIVITIES The use of their own or Company vehicles whilst undertaking tasks on behalf of CareTech e.g.:

Shopping trips

Social excursions

Travel to meetings, etc. 20.5 SAFE DRIVING PRACTICES 20.5.1 Handbook The safe ways of working for this section has, in part, been provided in a handbook. The reason for this is primarily that the information contained in the handbook will be needed by the driver when a situation occurs. The handbook should therefore be kept with the vehicle ‘owner’s manual’ in the glove compartment (or similar) as a reference guide. 20.5.2 General Guidelines There are some general guidelines provided here which all employees who are authorised to drive on behalf of the Company should familiarise themselves with. Additional Equipment: It is the driver’s responsibility to ensure that suitable child car seats or restraints are fitted that conform to current legislation (revised 18 September 2006) if children travel in their vehicle. These may not be fitted to a Company vehicle without requesting permission from the Fleet Manager.

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Staff will not fit or attach to a Company vehicle any additional equipment (including a caravan, trailer or roof rack) without prior authorisation from the Fleet Manager. If employees use a Company vehicle for the purpose of towing it is their responsibility to ensure that the Company vehicle is suitable to tow the attached vehicle and that the latter is correctly insured and maintained. Alcohol & Drugs (legal/illegal): Staff are not permitted to carry out their duties whilst under the effects of drugs or alcohol.

If a driver feels they are unfit to drive due to the effects of drugs (legal/illegal), alcohol or noxious substances or fumes, they must inform management immediately. They must not attempt to drive.

Staff need to be aware of the effects of some prescribed drugs and/or alternative remedies and act upon the warnings given on the label or from a medical professional. They should inform their Area Manager/Line Manager when necessary. Authorised Drivers: Only the employee and his/her spouse/partner are allowed to drive a Company vehicle. Any other person may only drive with written approval from the Financial Director. All are subject to licence checks. Breakdown/Emergency Assistance: Drivers of Company vehicles will summon assistance from the breakdown/recovery organisation; details of which (including the name and telephone number of the organisation) are kept in the car at all times. Drivers using their own vehicles for Company business should ensure that they have adequate breakdown cover, at their own expense. Drivers of all vehicles should ensure if possible, that the vehicle is safely parked at all times, including whilst waiting for assistance from the breakdown/recovery organisation. Cleaning: In respect of a Company car, the employee is responsible for keeping it clean (internally and externally). Any costs incurred in cleaning or valeting will the employee’s responsibility. The vehicle is subject to inspection at any time. Conviction/Penalty Points/Disciplinary Procedures: Any conviction incurred must be notified to the Fleet Manager (Telephone 01707 652053 / Fax 01707 662978 Mobile 0797 3637 830) immediately for recording. Some offences (such as Drinking and Driving, and Reckless or Dangerous Driving) could lead to disciplinary action, including dismissal. Drivers will be actively encouraged to take part in any driver rehabilitation training as an alternative to prosecution (e.g. National Driver Improvement Scheme and Speed Awareness Workshop).

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Driver Selection: During the recruitment and selection process, all new drivers, even those expected to drive only occasionally, will be required to provide a correct driving licence for the type of vehicle to be driven.

They will have to successfully complete an evaluation process, which may include any or all of the following: -

A medical (including eyesight check), to be carried out by the driver’s GP or a doctor chosen by the Company

A check on accident and prosecution history

Testing on appropriate specialist equipment and specific tasks required of them.

Any training received by drivers will be documented in their records. Driving Abroad: Should it be necessary to take a Company car abroad, for business or personal use, the driver must send an e-mail, as far in advance of the date of travel as possible, to the Fleet Manager, advising: -

The names and home addresses of anyone who will be driving the car abroad

The countries to be visited

The dates of departure from, and return to, the UK. The Fleet Manager will then arrange for the driver to be supplied with: -

A Certificate of Insurance covering the vehicle whilst abroad

Documentation from the Contract Hire Company authorising the driver to use the vehicle outside the UK

And will advise the driver whether or not Breakdown/Emergency Assistance cover is in place.

It is important that the vehicle is covered by a Breakdown/Emergency Assistance organisation whilst abroad. All Company vehicles are covered when in the UK but, depending upon the contract hire arrangement relating to the vehicle, not all are covered outside of the UK. If no such cover is in place it is the driver’s responsibility to arrange such cover (AA 5-Star or similar).

If the journey is for business purposes the Company will meet the cost of that cover

If the journey is for personal purposes the cost must be met by the driver

If no such cover is arranged and repair/recovery is required whilst abroad, the cost of such repair/recovery must be met by the driver

Should it be necessary to take a private car abroad for business purposes it is the driver’s responsibility to ensure that they have suitable and sufficient insurance and Breakdown/Emergency Assistance cover in place. Fatigue/Illness: All drivers are responsible for ensuring they are fit to drive. Where a driver feels they are not fit to drive, they must inform their Area Manager/Service Manager immediately. Drivers must report unreasonable scheduling issues as soon as they arise. Management must respond to any such reports with urgency and review.

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Drivers should take a minimum 15-minute break every 2 hours. Use this time to check messages on mobile phones. Alternative means of transport should be considered where practicable. Eliminate the journey wherever possible. Consider whether telephone or e-mail contact will suffice. Incident Data: Anyone driving for or on behalf of Caretech Holdings and the subsidiary companies will record all accidents/incidents occurring, regardless of the vehicle type driven i.e. Company vehicle, hired or privately owned. Employees will report as soon as possible all accidents/incidents occurring whilst driving for work purposes to the Fleet Manager, who will in turn inform the Health & Safety Officer. The Fleet Manager will telephone details through to the insurance company. Under no circumstances should a driver make any admission of liability in respect of any accident. Any driver involved in an accident whilst driving a Company vehicle, or on Company business, should stop. After stopping, and if required by any persons having reasonable grounds, the driver should give the following details: -

(a) His/her name and address (b) The Company name and address (c) The car registration number (d) Insurance company name, address and policy number

The driver is responsible for obtaining particulars of the accident, e.g. registration, colour and description of other vehicle involved; name and address of other parties involved and details of their insurance; place, time and date of accident; weather conditions; road surface conditions; details of persons injured; details of independent witnesses and details of passengers in the vehicle. If for any reason the driver does not give his/her name and address to any person who has reasonable grounds for so requesting at the time of the accident, the driver must report the accident to a police officer or at a police station within twenty four hours of the occurrence. If the accident involves injury to a person other than the driver, he/she should immediately inform the police and must produce a copy of the Certificate of Motor Insurance for inspection (copy obtainable from the Fleet Manager). Insurance: Employees may be required to pay the insurance policy excess (currently £250) on each and every claim made where the driver of the car is the spouse/partner and he/she is negligent and/or the Company is unable to recover that sum from any third party or their insurers. Such sums may be deducted from the employee’s salary or other payments due from the employee to the Company.

Licence checks: On employment those required to drive must hold a current/full and valid driving licence (UK). Drivers will not be permitted to drive the Company vehicle until such a licence has been produced and the driver has been given the Company’s approval. Follow up checks will be carried out on a regular basis. Employees who wish their spouse to drive the Company vehicle shall (subject to the spouse/partner being more than 25 years of age) submit a copy of the spouse’s/partner’s valid driving licence to the Fleet Manager.

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Driving licences will be checked annually. This includes Company car drivers, their spouse/partner, and any employee driving a private car on Company business. Random checks may be carried out on all drivers without notice and at any time. Maintenance: Vehicle maintenance should be carried out in line with the manufacturers’ schedules, whether Company or private vehicle. Daily and weekly checks should be carried out by all drivers on their vehicles – including (but not limited to) checks on tyre pressure, oil, water, battery and exhaust. The driver is responsible for ensuring any defects found are rectified immediately. If the vehicle is a Company vehicle the Contract Hire Company will be responsible for covering the cost of any repairs and approving the cost of these repairs before the work is carried out. If it is a private vehicle the employee will be responsible. It will be made clear to all drivers of Company cars that they are legally responsible for the roadworthiness of their vehicle once they have taken possession of it. Tyres should be replaced before tread depth reaches the legal minimum of 1.6 mm. Hired vehicles will be checked on collection/delivery by the driver. Any faults will be notified to the hiring Company immediately. It is the driver’s responsibility to ensure the hire vehicle remains in excellent condition. Mobile phones: Mobile phones must only be used when the vehicle is stationary and the engine is turned off. Text messages, verbal messages, video and picture texting, faxing and accessing the Internet are all forbidden whilst driving. Mobile phones may be left switched on in a vehicle in use but only to let the driver know that a message has been received or for passenger use. Drivers will park to collect any messages and respond – at no time shall drivers stop on a hard shoulder to answer/make a call. Drivers should be aware that mobile phones should not be used while waiting at traffic lights or in other delays where the driver may need to move on after a short period. Where someone who is driving needs to be contacted, staff will leave a brief message, or ask them to call back for details. They will not, under any circumstances, speak to someone who is driving at the time of the call. If a driver answers the phone and it is obvious the vehicle is being driven, the driver must be asked to stop when convenient and call back. The call should be terminated at once. Drivers found to be using a mobile phone in contravention of these policies or other employees encouraging drivers to use them when driving will face strict disciplinary action and possibly dismissal.

If a hands free kit is fitted to the vehicle it is recommended that the above rules are followed. It is not against the law to use a hands free phone, but it must be at the driver’s discretion to do so, whilst ensuring that they are not infringing upon other traffic regulations i.e. driving without due care and attention. Tucking the telephone between your shoulder and ear is strictly forbidden.

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Recorded driver details: The HR Director will keep an accurate, up to date, record of all relevant details for each driver including recruitment date, assessment/training dates and outcomes, incident involvement and classes of vehicles driven. Additionally a record of driving licence details and, where applicable for own vehicle use, M.O.T. expiry. Spot checks may be conducted to ensure drivers are still entitled to drive. Health checks including eyesight checks may be conducted and recorded. Risk assessment: All drivers should regularly assess the risks for themselves, the vehicle and the journeys that they undertake. Following an accident/incident a risk assessment must be done to minimise the possibility of reoccurrence. A risk assessment may be conducted by any Manager/Supervisor and/or the Health & Safety Officer. Road Traffic Offences: Drivers must ensure that the Vehicle Licence is displayed at all times. All traffic signs must be observed and drivers must not park in breach of regulations. Drivers will be expected to comply with all legal requirements, observing the provisions of The Highway Code and driving in a safe and appropriate manner at all times. Drivers will familiarise themselves with the Company’s policies and guidelines. Employees will be responsible for all fines relating to speeding, parking and Road Traffic Act offences they have committed and for any administration charges resulting from these. If prosecuted for a road traffic offence, employees will be responsible for legal costs, except in exceptional circumstances. Smoking: The law states that smoking isn’t allowed in any work vehicle that more than one person uses. A no smoking sign must be displayed in all such work vehicles. CareTech employees are not permitted to smoke in any company car or work vehicle that they use. Speed: This Company does not accept breaking speed limits as an acceptable business risk. Any staff found habitually using inappropriate speed may be dismissed. All scheduling of journeys will take account of rest breaks, total mileage travelled each day, total hours worked (including driving time), congestion and weather conditions. Staff should never accept a position where speeding is inevitable due to unrealistic scheduling. Stress: Journey planning and scheduling will take account of stressful situations for staff. Staff will be monitored for the effects of stress and those situations that may cause stress.

Theft: In respect of Company vehicles, drivers should immediately report the theft of the Company vehicle, or its contents (if of Company property), or any car parts or accessories to the police and obtain a police report reference number. Employees should also report the theft to Joseph Chandrakumar as soon as possible. All items of Company property must be kept locked in the boot or, if an estate car, under the luggage cover when the vehicle is unattended.

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20.5.3 General Driving Tips Following these general driving tips will help to keep employees safe whilst out on their journeys. Before driving away:

Ensure the car is well maintained and serviced regularly.

Be familiar with the workings of the car. Particular attention should be given to the controls, layout of dials, operation of lights, windscreen wipers etc.

If the car is a shared vehicle used by others, employees must ensure that the seat is in the correct position for them and that all of the mirrors are adjusted accordingly.

Locate the spare wheel and jack in case they are needed.

Ensure the vehicle has sufficient quantity of fuel for the intended journey.

Ensure that someone at the Service base or office knows where you are going, the intended route to be taken and an estimated arrival time, or time that you are expected to return.

Ensure you have a mobile telephone. NOTE: the mobile telephone must NOT be used whilst driving you should STOP and park safely when it is convenient to do so before making or taking a phone call.

Use the seatbelt provided and ensure any passengers do the same. If people who use our Service are to be transported and are likely to cause distraction to the driver, always take another employee to deal with the person(s) in question, to keep the driver focused on driving. Reference should be made to the person-specific risk assessment. All relevant employees should:

Plan to keep to ‘main’, well-lit roads.

When stopping, keep a reasonable distance from vehicles in front of you to allow space for you to drive away if necessary. As a rule, you should be able to see the bottom of the rear wheels on the vehicle in front sitting on the road surface.

Always keep a reasonable distance away from the vehicle in front when driving. Follow the “two-second” rule, i.e. the time it takes you to arrive at a point on the road should be no sooner than two seconds after the vehicle in front has cleared that same point.

Always park by reversing into spaces so that you can leave in a hurry if necessary.

Park in well-lit and ‘populated’ areas.

Always be aware of your surroundings.

Avoid asking for directions. Carry a map. If you need to refer to the map, pull over when it is safe and convenient to do so.

If you do need to ask for directions or assistance, it may be better to stop at a garage or shops where you are less likely to draw attention to yourself.

Avoid eye contact with other drivers, particularly if they are being aggressive towards you.

Keep well away from aggressive drivers and drive at a moderate speed.

If you are followed, stop at the nearest petrol station or busy place (i.e. shops). Wait until they have gone or call the police. Keep doors locked and windows shut. Do not turn off your engine.

If someone does attempt to get into your car or is behaving aggressively, sound your horn and flash your lights to attract attention.

Never leave valuables on show in the car. Lock everything in the boot.

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Ensure you are familiar with the vehicle, its control and dials. Ensure that you set the vehicle up before you begin your journey (e.g. seat position and mirrors).

Ensure that you tell another employee at the Service or office where you are going and what time you are expected to arrive. You should also inform them of your route.

Always carry the CareTech’s ‘Driver’s Handbook’ with you as this provides a guide of what to do in the event of a breakdown or accident.

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CareTech Health & Safety Manual Page 1 of 6 HS-02-02-21 Controlling Access to Service and Appointment of Contractors Last Reviewed January 2017

HS-02-02-21 CONTROLLING ACCESS TO SERVICE AND APPOINTMENT OF CONTRACTORS

21.1 INTRODUCTION Security management at CareTech’s premises is important for the following reasons:

Preventing access by unauthorised persons

To allow CareTech employees to ensure the safety of their people who use our Service whilst they are in their care

To ensure that Service Managers provide information to contractors prior to them entering their Service in order to control risks to their health and safety.

21.2 SCOPE This section will provide advice and guidance on systems and procedures, which may be implemented at CareTech’s premises to manage access of unauthorised persons. It will also cover access to rooftops, balconies and other similar high-level points that the Service may wish to control. 21.3 HAZARDS

Evacuation of the building

Accessing high level ‘vantage points’

Access to CareTech’s Service by unauthorised persons

Introduction of unknown risks or hazards 21.4 WORK ACTIVITIES

Supervision of people who use our Service

Maintenance and care of the Service buildings 21.5 SAFE WAYS OF WORKING 21.5.1 Controlling Access to CareTech’s Premises by Unauthorised Persons All external doors and windows (particularly those on the ground level) should be kept locked to persons wishing to gain access from the outside. Windows that will open sufficiently to allow a person to pass through should be fitted with window locks or restrictors to restrict their opening, or be guarded in order to allow ventilation but to prevent access. 21.5.2 Roof Access, Access to Balconies etc All access points to roofs or balconies or similar vantage points should be kept locked when not in use (unless it is a fire escape). Such areas should only be used by a person who uses our Service if supervised by a staff member.

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21.5.3 Daily Checks The duty employee should check the property is secure before going to bed or leaving the building. Any defects to doors or windows or the locking devices to doors or windows should be reported to the Service Manager as soon as is reasonably practicable and to the Potters Bar Office if repairs are necessary. Interim/temporary arrangements to secure the building should be made in the meantime. 21.5.4 Monitoring of Access and Access Control A register should be kept in the administration office or by the main entrance door for use by visitors (e.g. contractors). A Registration Record can be found in Appendix HS-02-AP-02. Employees based at the Service are not required to sign in and out. People who use our Service are not required to sign in or out. Any other visitor, contractor or visiting CareTech employees must sign the register and complete all relevant columns. The register must also be completed when they leave the Service. The register should be taken by the duty employee in the event of an evacuation. 21.6 CONTRACTORS CareTech recognises its responsibilities under current Health and Safety legislation to both its employees and other persons not in its employment, including contractors appointed to carry out works in any of the Company's premises. CareTech will ensure contractors are assessed in terms of competency to be approved by them for Company use, to a level dependent on the tasks/jobs involved.

Selecting a suitable contractor

CareTech needs to satisfy itself that contractors are competent (i.e. they have sufficient skills and knowledge) to do the job safely and without risks to health and safety. The degree of competence required will depend on the work to be done. Contractors must know and understand what performance expected of them. Explain your health and safety arrangements to them. They must be shown all relevant procedures and permit systems, as well as the health and safety policy statement. Contractors must ensure they understand and will act in accordance with it.

CareTech will determine a contractor’s competence by determining: -

a) what experience they have in the type of work to be done; b) what their health and safety policies and practices are; c) about their recent health and safety performance (number of accidents etc); d) what qualifications and skills they have; e) their selection procedure for sub-contractors; f) their safety method statement; g) what health and safety training and supervision they provide; h) their arrangements for consulting their workforce; i) if they have any independent assessment of their competence; j) if they are members of a relevant trade or professional body; or whether they or their

employees hold a ‘passport’ in health and safety training.

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Further information (e.g. references) may also be needed to seek in support of what prospective contractors have stated. Further information can be obtained from Acoura.

Selecting a suitable sub-contractor The selection of any sub-contractors is probably best left to the contractor. It is a condition of any contract entered into by CareTech and its contractors appointed to carry out works that the requirements of the Company's Health and Safety Policy are complied with at all times. It is the responsibility of Head Office to issue all contractors with a copy of the relevant health and safety information pertaining to the Company’s operations. 21.6.1 Appointing Contractors Either the relevant Regional Office or Head Office is responsible for the appointment of contractors for building work and are to only use contractors that are included on CareTech’s panel of approved contractors. Service Managers are able to appoint contractors for minor building repairs and maintenance e.g. portable appliance testing, cooker repairs, gardening, carpeting, furniture assembly, white goods etc. All contractors are to have:

1. Public Liability insurance cover of at least £1 million 2. Certificate confirming Employers Liability insurance 3. Health and Safety Policy 4. Equal Opportunities Policy

Prior to the contractor starting work the Service Manager must obtain a relevant method statement including a risk assessment of the work they are going to undertake. The method statement and risk assessment should detail how they are going to undertake the work and the safety measures they will employ. The Service Manager must ensure that this meets their minimum requirements. For work of a minor or short-term nature this assessment may be verbal. Further advice can be sought from the Regional Office, Head Office, or the Company’s Consultants. The following Safety Rules therefore apply: 1. Prior to the commencement of any work activity, the contractor will have been

assessed in terms of competency by CareTech and have successfully achieved the required standard.

2. No faulty equipment or tools shall be brought onto the site. Evidence of current safety

may be required for certain items such as portable and transportable electrical equipment, pressure systems and any other items specified by the company at the time of the works.

3. No hazardous substances will be used on site until valid Control of Substances

Hazardous to Health Assessments (COSHH) have been produced.

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4. Personal Protective Equipment shall be worn on site where necessary and all such

equipment shall be suitable and sufficient. 5. All persons working on CareTech’s premises shall be properly trained and competent

to undertake the tasks in hand without exposing any persons, including themselves, to danger or risks.

6. All 'high risk' activities including the bringing onto site of flammable materials or heat

producing equipment, shall only be undertaken if a 'Permit to Work' system operates. 7. All contractors and persons under their control shall:

a) Familiarise themselves with the work site and the fire precautions/fire evacuation procedures

b) Note the location of the nearest First Aid site unless they carry adequate first

aid provision

c) Act upon audible alarms, notices and signs of instruction d) Follow the instructions of the Service Manager acting on behalf of CareTech.

e) Report immediately to the Service Manager any accident or incident which

causes physical harm, damage to property and creates a "near miss" situation and which occurs on the Company's premises. Contractors are thereafter required to report the accident/incident in accordance with their own Company procedure.

8. Whilst the contractors are on site, the Service Manager shall:

a) Ensure that the contractor has signed the relevant work sheet when they have finished their work

b) Make sure that if the contractor is seen to be presenting a risk to the health and/or

safety of any person that action is undertaken to contact the Surveyors department immediately.

Failure of any contractor to observe the above Safety Rules may result in the contract being suspended or terminated at the Contractor’s own expense.

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21.6.2 Using Contractors Where contractors are working within CareTech’s premises, Service Managers have a duty to provide them with any relevant information that may affect their health and safety. Service Managers must refer to people who use our Service specific risk assessments and identify any information that may impact on the health and safety of the contractors for example, if people who use our Service have a history of violence or aggressive behaviour. Contractors must also be made aware of the nature of the people who use our Service within the Service. It is the responsibility of the Service Manger to inform any contractor of this information before they start work. Depending upon the person and the work required to be undertaken by a contractor (e.g. location, length of time needed etc), the Service Manager must arrange appropriate monitoring of the contractor and their work. This may simply be a ‘walk-by’ periodically, but will depend on the nature of the task they have been appointed to carry out. The contractor should also be made aware of the fire alarm and evacuation procedures. They should also be made aware of the location of the first aid kit. The Service Manager should review any relevant risk assessments and amend as necessary whilst works are being undertaken. Certain procedures may also require amendment, for example, if an escape route is restricted. 21.6.3 Construction Working in CareTech’s Premises Whilst working on CareTech’s premises, all contractors must abide by CareTech’s Health and Safety Policy. As such, the following safety rules will apply:

No faulty equipment or tools shall be brought into any CareTech premises.

No hazardous substances will be used or any processes undertaken that generate hazardous substances on site until valid Control of Substances Hazardous to Health Assessments (COSHH) have been produced (refer to COSHH section of this Manual for definition of a hazardous substance).

Personal protective equipment shall be worn on site where necessary and all such equipment shall be suitable and sufficient.

The persons working in CareTech’s premises shall be properly trained in the activities they are undertaking.

All contractors and persons under their control should: o Familiarise themselves with the work site and the fire precautions/fire evacuation

procedures. o Note the location of the nearest first aid site. o Act upon all available alarms, notices and instructions. o Report immediately to the Service Manager any accident or incident which

causes physical harm, damage to property or creates a “near miss” situation which occurs in CareTech’s premises. Contractors are thereafter required to report accidents in accordance with their own Company’s accident reporting procedure.

Failure of any contractor to follow the above safety rules may result in the contract being suspended and any extra costs thus incurred may be set against the contractor’s account.

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Always ask contractors/visitors to sign in and out. Notify them of any issues they need to be aware of, including: o Issues related to the person using our Service, e.g. violence. o Property issues e.g. keeping plant doors locked. Advise the Service Manager of their arrival.

Keep ‘vantage points’ that may present opportunity for access by people who use our Service locked unless they (the people who use our Service) are supervised (do not lock fire exit routes however).

Only appoint competent contractors to undertake works in the Service.

Service Managers must obtain a suitable method statement from contractors before they start work.

It is the duty of the Service Manager to provide contractors with any relevant information regarding the people who use the Service to help ensure the safety of the contractors.

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CareTech Health & Safety Manual Page 1 of 4 HS-02-02-22 Kitchen Safety Last Reviewed January 2017

HS-02-02-22 KITCHEN SAFETY 22.1 INTRODUCTION The kitchen is potentially one of the most dangerous areas within a Service. It contains hot liquids and surfaces, flammable liquids and gases. They often have a number of people working in there, and floors are likely to be wet and slippery. There are also numerous pieces of dangerous equipment such as knives, mixers etc. 22.2 SCOPE This section will provide advice and guidance on safe ways of working in kitchens and how to control the hazards that exist there. 22.3 HAZARDS

Slips, trips and falls due to wet floors etc

Cuts/abrasions from dangerous equipment

Burns and scalds

Chemicals present and used 22.4 WORK ACTIVITIES All associated kitchen duties including:

Preparation of food

Cooking of food

Storage of food

Use of kitchen equipment

Cleaning of surfaces and equipment

Supervising people who use our Service 22.5 SAFE WAYS OF WORKING Equipment Many pieces of equipment are frequently used in the kitchen and present a risk to health and safety. All equipment must be used in accordance with the following guidelines: a) All equipment must be used for the purpose it is intended. This includes selecting the

most appropriate knife for the task to be carried out. Knives should be kept sharp to help prevent accidents. (A sharp knife cuts food easier than a blunt one, and helps to prevent associated accidents).

b) All equipment, where applicable, must be properly guarded for example, meat slicers, mixing machines etc.

c) Training and/or instruction should be provided to those employees required to use any dangerous pieces of equipment. Only those employees who have received such training and/or instruction should be allowed to operate those pieces of equipment. It is the responsibility of the Service Manager to identify training needs and arrange for the relevant training/instruction to be provided.

d) Any defective equipment should be taken out of use and all relevant staff informed that the equipment is defective.

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Structure Employees must report any defect to the structure of the kitchen to the Service Manager as soon as possible. Consideration must be given to the safety of users of the kitchen. If the damage is such that serious injury may result, i.e. if there is a broken electrical plug socket, then that item must not be used, and where possible, the item isolated to minimise any risk of injury to employees or people who use our Service. Cleaning Cleaning is an integral part of each kitchen and vital in ensuring safe food production. In order to maintain the kitchen in a safe and efficient state, cleaning must be carried out on a regular basis, and wherever the floor becomes slippery/greasy. Chemicals Only chemicals, which have been assessed by the Service Manager and have been subject to a COSHH Assessment, should be used in the kitchen. Employees must wear the appropriate personal protective equipment provided. Condition of Floors Floors in kitchens may cause slips and falls as they are likely to become wet or contaminated with food or grease. As such, care must be taken when moving around in kitchens. Floors should be kept dry as far as is reasonably practicable. Cleaning floors should be carried out at times when people are not likely to be working in the kitchen, to minimise the risk of slips and falls occurring. Staff working in kitchens should wear sensible and suitable footwear. No high heels or open-toe shoes may be worn. Flat rubber-soled shoes should be worn to minimise the risk of slips and falls occurring. Spillages Spillages must be cleaned up as quickly as possible and where possible, a ‘dry spot cleaning’ technique should be used. ‘Dry spot cleaning’ is the use of paper towels/kitchen towel or similar to simply clean away spillages, leaving the floor surface dry. This is as opposed to mopping or ‘wet wiping’, which spreads moisture over a larger area, presenting an increased risk of slips and falls occurring. Common sense must be used. Clearly it is not always practical to use a ‘dry spot cleaning technique’ however, where wet wiping or mopping is used, all those persons, both employees and people who use our Service, must be notified that the kitchen floor is wet so they know to take extra care when working and moving around in that area. A wet floor sign should be available and used in this event. Hot Surfaces and Liquids/Foods Employees responsible for handling hot liquids and food or operating in close proximity to hot surfaces or equipment, must take care not to injure themselves or others. As far as is reasonably practicable, hot liquids should not be manoeuvred or handled in bulk. In any case, they should be moved as little as possible. Handling and manoeuvring hot oil from fryers (and other equipment) should also be avoided. Sufficient time must be allowed for the oil to cool before it is drained to minimise the risk of burns and scalds. Any ‘hot’ equipment such as fryers, cookers, hobs, hot cupboards etc must be allowed sufficient time to cool before any attempt to clean them is made. Employees should always use appropriate oven cloths or gloves when handling hot equipment, plates etc. These and tea towels must not be left on top of cookers. Care must be taken not to ‘trail’ them over gas hobs when lit.

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Common hazards in the kitchen are: o Slips and falls on wet or contaminated floors o Burns and scalds from hot liquids and surfaces o Cuts and abrasions from use of knives and other dangerous equipment

Any defective equipment must not be used. It should be taken out of service and conspicuously labelled to warn others from using it.

Cleaning of spillages should be done immediately (where practicable). The ‘dry wiping’ technique should be adopted if practical.

Only chemicals that have been assessed in the COSHH Manual may be used in the kitchen.

Hot liquids should not be moved in bulk and should be allowed to cool before moving wherever practical. Equipment must not be cleaned if still hot.

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CareTech Health & Safety Manual Page 1 of 4 HS-02-02-23 Passive Smoking Last Reviewed January 2017

HS-02-02-23 PASSIVE SMOKING 23.1 INTRODUCTION The Company recognises that the health, safety and welfare of employees, sub-contractors and anyone else directly affected by the Company's operations are of prime importance. The Company has therefore developed and enforces a dedicated smoking policy, conforming to the requirements of the Smoke-free (Premises and Enforcement) Regulations 2006, Smoke-free (Exemptions and Vehicles) Regulations 2007, Smoke-free (Signs) Regulations 2007, and other related legislation. Passive smoking is defined as the inhalation of smoke from a third person. This may either be from smoke directly from their cigarettes or exhaled smoke from the smoker. Repeated and consistent exposure to tobacco smoke may have adverse health effects. As such, CareTech are committed to protecting employees and people who use our Service from the hazards associated with passive smoking. 23.2 SCOPE This Policy is designed to provide advice and guidance on minimising exposure to tobacco smoke for those who are non-smokers. It is applicable to all employees at whatever level of the Company's hierarchy, people who use our Service, as well as sub-contractors who undertake activities on behalf of the Company and any visitors to the Company's premises. This Policy and its mandatory application will be communicated to all employees, sub-contractors, visitors, customers and interested parties. As part of the Company's induction process, new starters should be told about this Policy and shown where it is located. The Human Resources Department is responsible for informing job applicants of this Policy. Employees are responsible for informing their visitors to the premises of this Policy. 23.3 HAZARDS

Inhalation of tobacco smoke from third persons. 23.4 SAFE WAYS OF WORKING Smoking is prohibited within the Company's premises, except in certain designated outside areas. Employees may smoke only in the Company's outdoor smoking shelters. The Company provides receptacles for smokers to dispose of cigarette butts and other smoking waste at all outside locations where smoking is allowed. Employees who go outside to smoke are restricted to taking one short smoking break in the morning and one in the afternoon, with a maximum of ten minutes per break. Employees should inform their Manager if they wish to take a smoking break and ensure that there is sufficient cover before taking a break. 23.4.1 Vehicles The Company does not permit workers to smoke in Company cars. There are no limitations on employees smoking in vehicles that they own, even when they do so in the course of their work.

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23.4.2 Home workers Home workers are not required to refrain from smoking during the course of work that is carried out for the Company in their home, unless they invite others into an area of their home for work purposes. 23.4.3 Signage The Company displays signs that make it clear that smoking is prohibited on its premises. These signs are located at all entrances to its buildings. The Company also requires that no-smoking signs be displayed in those of its vehicles that are subject to the ban. 23.4.4 Assistance for employees to give up smoking The Company recognises the difficulty that employees who wish to give up smoking may face. The NHS provide a free Smokefree National Helpline 0300123 1044 and CareTech offer employees as part of the flexible benefits a counselling and advise 24 hour help line. The Company have an ‘Employee Assistance Helpline’ as part of our employee benefits package, which is available 24 hours a day and provides a variety of services including counselling and legal advice. You may wish to telephone 0870 121 0810 and quote 71529, for any impartial support and advice that you may require during this time. People who use our Service will also be encouraged to give up smoking. 23.5 NON-COMPLIANCE Any infringement of these rules by an employee may result in appropriate disciplinary action, which will be dealt with in accordance with the Company's disciplinary procedure. Employees are also reminded that it is a criminal offence for employees to smoke in smoke-free areas, with a fixed penalty of £50 or prosecution and a fine of up to £200. People who are smoking in smoke-free areas should be reminded of the no-smoking signs and asked to stop. If a person continues to smoke, employees should explain that the person is committing a criminal offence. If the person still refuses to stop smoking, staff should ask them to leave the premises and, where relevant, direct them to where they can smoke. As a last resort, the Company's procedure for dealing with illegal behaviour on its premises will be used. 23.6 MAINTAINING THIS POLICY The Company will monitor the effectiveness of this Policy and its general compliance within the organisation. This Policy will be kept up to date and amended accordingly to reflect any changes in response to revised legislation and applicable standards and guidelines. This Policy is fully supported by the Senior Management of the Company. In support of this intent, the Policy will be reviewed at least annually. The Company will provide sufficient financial support and all other necessary resources for the full implementation of this Policy.

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Smoking in not permitted on Company premises, nor in company vehicles.

Smoking is permitted outside only, irrespective of whether the smoker is a person using our Service, or an employee.

Passive smoking is exposure to tobacco smoke exhaled by third persons or from their tobacco products.

Non-smoking employees should not be repeatedly or consistently exposed to third persons’ tobacco smoke.

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CareTech Health & Safety Manual Page 1 of 12 HS-02-02-24 Legionella Last Reviewed January 2017

HS-02-02-24 LEGIONELLA 24.1 INTRODUCTION This section relates to all relevant water systems under the control of Caretech Community Services Limited. Water systems covered by this section include hot and cold water systems, swimming pools and spas. The aim of this Water Risk Management System is to outline the procedures that each of Caretech Community Services’ premises should ensure are followed to maintain a safe water system. The frequency and extent of the routine monitoring will be dependant upon the physical characteristics of the water system in operation in each premises. Any Legionella risk assessment completed for a premise will be an evolving document. On completion of any works carried out that result in a change to the risk assessment (e.g. water tanks disconnected, dead-legs removed etc), the risk assessment must be updated – see Section 24.9. The risk assessment, log book and schematic drawings should be accessible and available to any persons who may require them (contractors etc). It is the responsibility of the Care Home Manager to manage the responsibilities and actions required to maintain a safe water system. Actions required as detailed in the risk assessment (e.g. flushing pipes, disinfecting showerheads, etc) should be recorded and monitored to ensure compliance. 24.2 GENERAL WATER RISK MANAGEMENT POLICY Caretech Community Services recognises its responsibilities for the management of control measures associated with Legionella both as the employer and also in discharging its duty of care to the public, including service users and visitors who may be affected by Caretech Community Services’ undertaking. As a minimum standard Caretech Community Services will comply with the requirements of the following legislation:-

Health and Safety at Work Etc Act 1974

Management of Health and Safety at Work Regulations 1999

The Approved Code of Practice (ACOP) and Guidance L8: Legionnaires’ Disease – The Control of Legionella Bacteria in Water Systems.

COSHH Regulations 2002 So far as is reasonably practicable, Caretech Community Services will ensure that employees and others who may be affected by its undertaking are not put at risk from Legionellosis. It will also be mindful of the duties of any designers, manufacturers, importers, suppliers, installers and contractors involved in the specification, design, installation, maintenance and repair of systems for which Caretech Community Services is responsible. Risk assessments will be undertaken as required under the Management of Health and Safety at Work Regulations 1999 and the Control of Substances Hazardous to Health Regulations 2002, to determine the presence and extent of the risk and to inform the control strategy.

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Control measures will be implemented and maintained in accordance with the Approved Code of Practice (L8) on the Control of Legionella Bacteria in Water Systems which lays down the standards required to achieve compliance. All works will conform to the approved practices and standards in force at the time. In all aspects of Legionella management, Caretech Community Services will take account of current best practice and strive to continually improve the management system. Legionella will be managed through a process of risk assessment, control, monitoring, and review. 24.3 ROLES AND RESPONSIBILITIES

Section HS-02-01-02 of this manual should be referred to for full details of all persons’ roles and responsibilities.

Those persons referred to in this Water Risk Management System will be deemed competent to undertake the responsibilities given to them. If any of these persons feel that they do not have sufficient competency in the responsibilities allotted to them, then they may request further appropriate training from the Group Quality and Performance Director. However, it is acknowledged that competence does not necessarily imply any formal training or evaluation, merely good understanding of the hazards and risks associated with the operation of the business premises. 24.4 USE OF COMPETENT CONTRACTORS Where Caretech Community Services chooses to engage a third party water treatment specialist to assist them in meeting their obligations, they will be asked to provide proof of adequate level of competence in this area of work. The level of service provided by water treatment specialists must meet the Code of Conduct developed jointly by the Water Management Society and the British Association for Chemical Specialities. Analysis of water samples for Legionella must be carried out by a UKAS accredited laboratory which takes part in the PHLS Water Microbiology External Quality Assessment Scheme for the Isolation of Legionella from Water. The interpretation of any results will be carried out by experienced Consultants. A Legionella Management Plan contained within the water risk assessment will be held by the Care Home Manager. Any Contractor coming onto site will be shown the plan and made aware of its requirements, in relation to the prevention of Legionella risk on site. 24.5 TRAINING PROVISION FOR WATER RISK MANAGEMENT All parties involved in the management of Caretech Community Services’ premises and water systems will be adequately informed of their role, responsibilities and the actions required of them to maintain the Legionella control arrangements. Appropriate training will be provided to ensure the competence of Managers and other employees involved in the Water Risk Management System and to maintain an up-to-date knowledge base. General information and advice will be available through Caretech Community Services’ Environmental Health Consultants and Water Management Consultants.

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24.6 LEGISLATION AND GUIDANCE Management of Health and Safety at Work Regulations 1999 (“MHSWR”) As well as requiring risk assessments and control the MHSWR also require employers to have access to competent help in applying the provisions of the law and co-operation and co-ordination where workplaces are shared by two or more employers or self-employed people. The Control of Substances Hazardous to Health Regulations (COSHH) 2002 Harmful bacteria such as Legionella pneumophila (biological agents) are subject to controls of COSHH. The COSHH framework provides actions designed to control the risk and requires that:

1. Risk assessments are carried out; 2. Steps are taken to prevent exposure where total removal of the hazardous

substance is not reasonably practicable; 3. Maintenance, examination and testing of control measures, e.g. automatic dosing

equipment for delivery of biocides and other treatment chemicals; 4. Provision of information, instruction and training for employees; and 5. Where it is appropriate, that health surveillance is carried out.

Legionnaires' Disease - The Control of Legionella Bacteria in Water Systems Approved Code of Practice L8 The Approved Code of Practice applies to the control of Legionella bacteria in any undertaking involving work activity and to premises controlled in connection with trade or business whose activity gives rise to a risk of harmful exposure to Legionella bacteria. There is a reasonably foreseeable risk of harmful exposure to Legionella bacteria in any premises where water is used or stored and where there is a means of creating and transmitting water droplets which may be inhaled. These include the following:

1. Water systems incorporating an evaporative condenser; 2. Hot and cold water systems; and 3. Other plant and systems containing water which is likely to exceed 20°C and which

may release a spray or aerosol during operation or maintenance such as vehicle washers, humidifiers and spa baths.

The Approved Code of Practice provides a basic framework for preventing further outbreaks of the disease, giving advice on how to comply with the requirements of the Health and Safety at Work etc Act 1974 and the Control of Substances Hazardous to Health. It places responsibility on employers and others to:

1. Identify and assess risks of Legionellosis; 2. Avoid the use of systems that give rise to a foreseeable risk of Legionellosis or,

where this is not reasonably practicable, prepare a written scheme for minimising the risk from exposure;

3. Implement and manage the scheme of precautions including the appointment of a person or persons, to take managerial responsibility and to provide supervision; and

4. Keep appropriate records. It also gives advice on the management, selection, training and competence of personnel.

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24.7 BACKGROUND TO THE DISEASES AND ORGANISMS Legionella bacteria are common and can be found naturally in environmental water sources such as rivers, lakes and reservoirs, usually in low numbers. Legionella bacteria can survive under a wide variety of environmental conditions and have been found in water at temperatures between 6°C and 60°C. Water temperatures in the range 20°C to 45°C seem to favour growth. The organisms do not appear to multiply below 20°C and will not survive above 60°C. They may, however remain dormant in cool water and multiply only when water temperatures reach a suitable level. The level of water temperatures may also have an influence, for example, Legionella bacteria held at 37°C have greater virulence than the same Legionella bacteria kept at a temperature below 25°C. Legionella bacteria also require a supply of nutrients to multiply. Sources can include, for example, commonly encountered organisms within the water system itself such as algae, amoebae and other bacteria. The presence of sediment, sludge, scale and other material within the system, together with bio-films, are also thought to play an important role in harbouring and providing favourable conditions in which the Legionella bacteria may grow. A bio-film is a thin layer of micro-organisms which may form slime on the surfaces in contact with water. Such bio-films, sludge and scale can protect Legionella bacteria from temperatures and concentrations of biocide that would otherwise kill or inhibit these organisms if they were freely suspended in the water. 24.8 HEALTH RISKS Legionnaires' disease was first identified following a large outbreak of pneumonia among people who attended an American Legion Convention in Philadelphia in 1976. A previously unrecognized bacterium was isolated from lung tissue samples which was subsequently named Legionella pneumophila. Not everyone exposed will develop symptoms of the disease and those that do, may not develop a severe case. The incubation period is between 2-10 days (usually 3-6 days). The initial symptoms of Legionnaires' disease include high fever, chills, headache and muscle pain. Patients may develop a dry cough and most suffer difficulty with breathing. About one third of patients infected also develop diarrhoea or vomiting and about half become confused or delirious. L. pneumophila is also responsible for a short feverish form of the illness without pneumonia, known as Pontiac fever. Its incubation period is typically between 2-3 days. Another species of Legionella, L. micdadei, is responsible for a similar form of the illness without pneumonia called Lochgoilhead fever after an outbreak in Lochgoilhead, Scotland. The incubation period can be up to 9 days. A high percentage of those exposed to this agent tend to be affected. However, there have been no recorded deaths associated with either Pontiac or Lochgoilhead fevers. Infection with Legionella bacteria can be fatal in approximately 12% of reported cases. This rate can be higher in a more susceptible population; for example immuno-suppressed patients or those with other underlying disease. Certain groups of people are known to be at higher risk of contracting Legionnaires' disease; for example, men appear more susceptible than women, as do those over 45 years of age, smokers, alcoholics, diabetics and those with cancer or chronic respiratory or kidney disease.

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It is normally contracted by inhaling Legionella bacteria, either in tiny droplets of water (aerosols), or in droplet nuclei (the particles left after the water has evaporated) contaminated with Legionella, deep into the lungs. The Public Health Laboratory Services data showed that the 25% of outbreaks between 1980 -1998 resulted from hot water systems and 3% attributed to both cold water systems and whirlpool spas the remainder came from unknown sources. There is evidence that the disease may also be contracted by inhaling Legionella bacteria following the ingestion of contaminated water by susceptible individuals. Person-to-person spread of the disease has not been documented. Legionnaires' disease can be treated effectively with appropriate antibiotics. On average there are about 200-250 reported cases of Legionnaires’ disease each year in the UK of which half are contracted abroad. It is thought the number of cases is underestimated because the symptoms are similar to other illnesses and cases are not generally reported. Outbreaks have been associated with hot and cold water systems in factories, hotels, hospitals and other establishments. Cases of Legionnaires’ disease have occurred among staff in the workplace, visitors, customers and guests. Legionellosis (including Legionnaires’ disease) is contracted when inhaling tiny droplets of water contaminated with the bacteria. Sources of droplet formation include showers, spray taps, water features, sprinkler systems, wash systems, hoses and any other similar spray forming device. The illness usually starts with a fever, chills, headache and muscle pain. This is followed by a dry cough and breathing difficulties that may progress to severe pneumonia. About 30% of those infected will also have diarrhoea or vomiting and about 50% become confused or delirious. Accurate diagnosis requires specific laboratory tests, which often will not be done until the guests have returned home. 24.9 WATER RISK ASSESSMENTS Caretech Community Services have completed water risk assessments for Legionella (Legionella Risk Assessment) at certain premises within the estate. Subsequent to the initial risk assessment and provision of the Legionella Management Plan, the Care Home Manager will ensure that the risk assessment is reviewed on a two-yearly basis unless there has been reason to review it sooner, for example:

When there is any significant change to the system in use;

When there are changes to the use of the building;

When the result of checks indicate that control measures are no longer effective; and

If for any other reason it is believed that the original assessment may no longer be valid.

The review will be carried out by a competent contractor on behalf of Caretech Community Services. Where there are modifications or changes to the system as above, the Care Home Manager will ensure that the system is re-surveyed and re-assessed and that a revised written scheme is in place. 24.10 MONITORING AND CORRECTIVE ACTION The operation of the water risk management procedures on site will be monitored and audited on a periodic basis by technical staff from the external Consultants.

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24.11 SYSTEM OPERATION AND PROCEDURES FOR INSPECTION AND CHECKING 24.11.1 Identification Risk arises in water systems such as hot and cold water systems, evaporative condensers and other plant or systems containing water which is likely to exceed 20oC and which may release a spray or aerosol. Risk assessments shall be carried out on all relevant water systems falling under the responsibility of Caretech Community Services. Any additional premises acquired by Caretech Community Services will be assessed for risks arising from any relevant water systems as part of the procurement process. Roles and responsibilities will be clearly defined at this stage and they will then be included into the Water Management Log Book. 24.11.2 Evaluation and Control On the basis of the initial risk assessment, the Responsible Person as detailed in the Water Management Log Book will ensure via the Developments Operations Director that immediate actions are taken as required (e.g. Removal of dead-legs, purging etc) to ensure the risk is reduced to an acceptable level. Where the risk assessment indicates that risk is unlikely, no further action need be taken other than review of the risk assessment as indicated in the Management Review section below. Where the risk assessment shows that there is a reasonably foreseeable risk and this cannot be eliminated, the Approved Code of Practice (ACOP) and Guidance L8: Legionnaires’ Disease – The Control of Legionella Bacteria in Water Systems requires that a written scheme is produced, which will include schematic drawings of the systems in each building. This will specify control measures to be taken to ensure that risk remains at an acceptable level. These control measures will be specific to the water systems in place at each particular premises. The written scheme will form the basis of the Legionella Management Plan for each water system which will be held on-site. 24.11.3 Monitoring The frequency and extent of the routine monitoring will depend on the operating characteristics of the system. The Care Home Manager will ensure that the daily, weekly, monthly and annual checks and tasks detailed in the written scheme and referred to in the risk assessment are carried out. The Care Home Manager will be responsible for ensuring the integrity of control measures for Legionella and the condition of the water systems at all times and must inform the Responsible Person of any event which affects these conditions e.g. alterations or building extensions. 24.11.4 Cold Water Storage and Distribution All storage tanks must be fitted with lids, adequately ventilated and arrangements made to prevent birds, vermin etc entering the overflow or vent pipes by fitting fine wire mesh/or alternative to outlet. Storage tanks will be inspected and cleaned if necessary on an annual basis in accordance with relevant guidance notes. To be conducted by competent persons. Arrangements should be made by lagging, shading or other means to ensure the

temperature of cold water storage tanks is maintained below 20C at all times.

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Cold water temperatures will be checked at least monthly. All taps will be checked at least once per year and a representative number, ideally those nearest to and furthest from the

storage tank must be checked monthly. The temperature should not exceed 20C and should be measured after the tap has been running for one minute. Frequency and the scope of checks will be recommended and records shall be kept as per the requirements in the water management log book. In order to prevent possible stagnation, dead legs in the distribution systems should be removed by redesign of the system if necessary as recommended in by the Legionella Risk Assessment. Detailed plans of the storage and distribution system must be maintained. Any changes to or additions to storage and distribution systems must be recorded.

24.11.5 Hot Water Storage and Distribution The temperature of the hot water generating source should be maintained at a minimum

temperature of 60C and should not be allowed to fall to below 50oC at the outlet that is the furthest distance away. The lagging of all hot water pipes should be present and in good condition to ensure that these temperatures are achieved and maintained. Hot water temperatures at a tap should be measured after the water has been running for one minute. Water temperatures must be checked at least monthly and records kept as per the requirements in the water management log book. If part of a system is not used for a long period of time e.g. refurbishment, the procedure outlined in the British Standard for Chemical Disinfection should be followed before using the facility. Even when bedrooms have not been occupied regularly, it is recommended that water is drawn from taps in these bedrooms periodically. 24.11.6 Calorifiers The calorifiers should be thoroughly cleaned and scaled at least annually (more frequently in hard water areas). Sludge should be drained from the calorifiers quarterly, or as otherwise recommended in the risk assessment. To disinfect the interior of the calorifiers after cleaning, refill with water and raise the

temperature to 60C for one hour. Keep the flow valve closed. Chemical disinfection may also be used specific to each buidling’s water system. Disinfection shall take place after cleaning, after any alterations to the system or after any allegation or evidence of an outbreak of Legionnaires disease. Where standby calorifiers are kept for emergency use they must be subjected to the annual clean. They will also be disinfected before use. Non-return valves will be fitted on the cold feed and hot water return more than 300mm from the calorifiers. Records of all cleaning must be recorded.

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24.11.7 Showers Shower heads and associated hoses should be cleaned every three months by removing scale and other deposits and soaking in a chlorine solution. Where brass shower heads are used they should be sanitised by emersion in boiling water for five minutes. Internal sieves and other relevant components of shower mixers tap should be cleaned at the same time as shower heads. It is recommended that spare shower heads are obtained so that on a routine basis a given number of clean shower heads can replace an equal number of those being chlorinated. This cycle can be ongoing and should be designed to achieve total treatment over not more than a three month period. Records of all cleaning must be recorded. 24.12 INDEPENDENT WATER ANALYSIS Testing for Legionella (which is not compulsory) in domestic water systems can be misleading. Samples should only be collected by trained personnel and examined by laboratories accredited for testing water for Legionella bacteria. A negative test does not necessarily mean that the hotel is clear of Legionella or that there is no risk. Monitoring is to be undertaken by sampling outlets, this will be carried out by the external Consultants on an annual basis. Should the results of such analysis require any action by the Care Home, guidance will be given by the external Consultants, as appropriate.

24.13 WATER MANAGEMENT LOG BOOK Following survey and risk assessment of the premises by professional contractors a log book will be kept securely within each Care Home. The log book contains the following:

Responsible Persons

Record System Inspection Sheet

Risk Assessment and Written Scheme for Controlling Exposure

Water System Schematics

Annual Programme

Control Measures

External Contractors Visit

Water Quality Analysis

Clean and Disinfection Certificates

Method Statements

Safety Data Sheets

Personnel Training Records

Designated Responsibilities Sheet

Capabilities List

Code of Conduct/Reference Documents The log book will be available for inspection at any time by authorised employees or others who may require this information such as contractors or HSE Inspectors or EHOs.

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The Care Home Manager will have overall responsibility for ensuring that the following records are kept up to date and completed at all times:

1. Record of Legionella Risk Assessment Reviews 2. Water Management Log Book Checks

Each premises will keep a set of records available for inspection by any person who is authorised to review them. All maintenance/log book records will be reviewed during routine audits and workplace inspections. Any deficiencies will be noted in the audit report, remedial actions recommended and the matters forwarded to the Group Quality and Performance Director. 24.14 MONITORING AND REVIEW OF WATER RISK MANAGEMENT SYSTEM The Board of Directors through its Executive Management Team is responsible for ensuring that the Water Risk Management System is reviewed and kept up to date and they must therefore make available appropriate funds for this task to be undertaken. Any areas of concern regarding water risk management will be investigated and resolved by the Group Quality and Performance Director, who will identify persons responsible for progressing any defects in any action plan. The Care Home Manager is responsible for ensuring that actions are completed or ordered and subsequently monitored until completed. Caretech Community Services operate a six-monthly health and safety committee meeting and significant matters of water risk management will be reviewed at this meeting. Care Home Managers and Regional Directors are responsible for being fully conversant with the Water Risk Management System for their home / region and they will be expected to keep the Water Management Plan(s) under constant review so that it reflects procedures and activities undertaken in each premises. Relevant comments/feedback on the Water Risk Management System will be reported to the health and safety committee for its consideration and recommendations. 24.15 EMERGENCY PROCEDURES In an emergency where an outbreak of Legionella is suspected or confirmed the Group Quality and Performance Director, Managing Director and Company’s Environmental Heath Consultants should be informed immediately. Thereafter the appropriate authorities, local Environmental Health department, will be advised as a matter of course. In the event of an outbreak, any suspected infected systems will be immediately closed down until sampling, remedial cleaning or other work has been carried out. Clearance testing will be required. Further investigations into team member health may be required to identify undiagnosed cases of the illness.

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24.16 GLOSSARY OF WATER RISK MANAGEMENT TERMS

Term Definition

Aerosol

A suspension in a gaseous medium of solid particles, liquid particles or solid and liquid particles having negligible falling velocity.

Algae

A small, usually aquatic, plant which requires light to grow, often found on exposed areas of cooling towers.

Air-conditioning

A form of air treatment whereby temperature humidity and air cleanliness are all controlled within limits determined by the requirements of the air-conditioned enclosure.

Antibodies

Substances in the blood which destroy or neutralize various toxins or components of bacteria known generally as antigens. The antibodies are formed as a result of the introduction into the body of the antigen to which they are antagonistic as in all infectious diseases.

Bacteria

(singular bacterium) a microscopic, unicellular (or more rarely multicellular) organism.

Biocide A substance which kills micro-organisms

Biofilm

A community of bacteria and other micro-organisms, embedded in a protective layer with entrained debris, attached to a surface.

Blow-bleed-off Water discharged from the system to control the concentration of salts or other impurities in the circulating water; usually expressed as a percentage of recirculating water flow.

Calorifier

An apparatus used for the transfer of heat to water in a vessel by indirect means, the source of heat being contained within a pipe or coil immersed in the water.

Chlorine An element used in disinfection.

Cold water service (CWS)

Installation of plant, pipes and fitting in which cold water is stored, distributed and subsequently discharged.

Cooling tower

An apparatus through which warm water is discharged against an air stream; in doing so part of the water is evaporated to saturate the air and this cools the water. The cooler water is usually pumped to a heat exchanger to be reheated and recycled through the tower.

Concentration factor

Compares the level of dissolved solids in the cooling water with that dissolved in the make-up water (also known as cycle of concentration). Usually determined by comparison of either the chloride or magnesium hardness concentration.

Corrosion inhibitors

Chemicals which protect metals by: (a) passivating the metal by the promotion of a thin metal oxide film (anodic inhibitors); or (b) physically forming a thin barrier film by controlled deposition (cathodic inhibitors).

Dead end blind end

A length of pipe closed at one end through which no water passes.

Deadleg

Pipes leading to a fitting through which water only passes when there is draw-off from the fitting.

Dip slide(s)

Means of testing the microbial content of liquids. It consists of a plastic carrier bearing a sterile culture medium which can be dipped in the liquid to be sampled. It is then incubated to allow microbial growth. The resulting microbial colonies are estimated by reference to a chart.

Disinfection

A process which destroys or irreversibly inactivates micro-organisms and reduces their number to a non-hazardous level.

Distribution circuit

Pipe work which distributes water from hot or cold water plant to one or more fittings/appliances.

Domestic water services

Hot and cold water intended for personal hygiene, culinary, drinking water or other domestic purposes.

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Term Definition

Drift

Circulating water lost from the tower as liquid droplets entrained in the exhaust air stream; usually expressed as a percentage of circulating water flow but for more precise work it is parts of water per million by weight of air for a given liquid to gas ratio.

Drift eliminator

More correctly referred to as drift reducers or minimisers - equipment containing a complex system of baffles designed to remove water droplets from cooling tower air passing through it.

Evaporative condenser

A heat exchanger in which refrigerant is condensed by a combination of air

movement and water sprays over its surface.

Evaporative cooling

A process by which a small portion of a circulating body of water is caused to evaporate thereby taking the required latent heat of vaporisation from the remainder of the water and cooling it.

Fill packing

That portion of a cooling tower which constitutes its primary heat transfer surface; sometimes called ‘packing’ or ‘pack’.

Fouling

Organic growth or other deposits on heat transfer surfaces causing loss in efficiency.

Half-life Ratio of system volume to purge rate.

Hot water service (HWS)

Installation of plant, pipes and fittings in which water is heated, distributed and subsequently discharged (not including cold water feed tank or cistern).

Legionnaires’ disease

A form of pneumonia caused by Legionella bacteria.

Legionellae

The genus Legionella belongs to the family Legionellaceae which has over 40 species. These are ubiquitous in the environment and found in a wide spectrum of natural and artificial collections of water.

Legionella

Type of aerobic bacterium which is found predominantly in warm water environments (singular of Legionellae).

L. pneumophila One of the causative organisms of Legionnaires’ disease.

Legionellosis Any illness caused by exposure to Legionella.

Pontiac fever

A disease caused by species of Legionella, an upper respiratory illness less severe than Legionnaires’ disease.

Make-up water

Water which is added to a cooling water system to compensate for wastage (eg via system leaks), evaporative loss and bleed.

Micro-organism

An organism of microscopic size including bacteria, fungi and viruses.

Non-oxidising biocide

A non-oxidising biocide is one that functions by mechanisms other than oxidation, including interference with cell metabolism and structure.

Nutrient A food source for micro-organisms.

Oxidising biocide

Agents capable of oxidising organic matter, eg cell material, enzymes or proteins which are associated with microbiological populations resulting in death of the micro-organisms. The most commonly used oxidising biocides are based on chlorine or bromine (halogens) which liberate hypochlorous or hypobromous acids on hydrolysis in water. The exception is chlorine dioxide, a gas which does not hydrolyse but which functions in the same way.

Pasteurisation Heat treatment to destroy micro-organism usually at high temperature.

Planktonic Free floating micro-organisms in an aquatic system.

PPm

Parts per million: a measure of dissolved substances given as the number of parts there are in a million parts of solvent. It is numerically equivalent to milligrams per litre mg/l with respect to water.

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Term Definition

Pond sump Collection of cooling water at the base of a cooling tower.

Retention time Time a chemical is retained in the system.

Scale inhibitors

Chemicals used to control scale. They function by holding up the precipitation process and or distorting the crystal shape, thus preventing the build-up of a hard adherent scale.

Sero-group A sub-group of the main species.

Sentinel taps

For a hot water services - the first and last taps on a recirculating system. For cold water systems (or non-recirculating hot water systems), the nearest and furthest taps from the storage tank. The choice of sentinel taps may also include other taps which are considered to represent a particular risk.

Sessile

Aquatic micro-organisms adhering to a surface normally as part of a biofilm.

Sludge

A general term for soft mud-like deposits found on heat transfer surfaces or other important sections of a cooling system. Also found at the base of calorifiers and cold water storage tanks.

Shunt pump

A circulation pump fitted to hot water service/plant to overcome the temperature stratification of the stored water.

Slime

A mucus-like exudate which covers a surface produced by some micro-organisms.

Stagnation

The condition where water ceases to flow and is therefore liable to microbiological growth.

Strainers

A coarse filter usually positioned upstream of a sensitive component such as a pump control valve or heat exchanger to protect it from debris.

Thermal disinfection

Heat treatment to disinfect a system.

Thermostatic mixing valve

Mixing valve in which the temperature at the outlet is pre-selected and controlled automatically by the valve.

Total viable counts

The total number of culturable bacteria (per volume or area) in a given sample (does not include Legionella).

Risk assessment

Indentifying and assessing the risk from Legionellosis from work activities and water sources on premises and determining any necessary precautionary measures.

Windage

Physical loss of water from a cooling tower caused by draught of air or wind - water is lost around the base of the cooling tower as a result of cross winds as opposed to drift.

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CareTech Health & Safety Manual Page 1 of 4 HS-02-02-25 Water Temperature and Hot Surfaces Last Reviewed January 2017

HS-02-02-25 WATER TEMPERATURE AND HOT SURFACES 25.1 INTRODUCTION Hot water systems often run much hotter than they need to for a variety of reasons, not least to help control Legionella bacteria. However, having water temperatures in excess of 44º centigrade being discharged at washbasins, baths and showers presents a risk of scalding. Some incidents have even been fatal, when whole body immersion is involved, and the people involved are particularly vulnerable. Serious injury can also result from exposure to hot surfaces for example, hot pipes or radiators. Those at greatest risk are vulnerable people such as the elderly, people with mental illness and anyone with reduced sensitivity to temperature or who cannot react appropriately or quickly enough to prevent injury. 25.2 SCOPE To provide advice and guidance on the provision of measures to minimise the risk of burns and scalds as a result of contact with hot water and surfaces. 25.3 HAZARDS

Burns (caused by exposure to hot surfaces e.g. radiators).

Scalds (caused by exposure to hot water from the Service’s hot water system). 25.4 SAFE WAYS OF WORKING Assessment Service Managers should assess the needs and abilities of the people who use our Service to determine whether they are vulnerable to risk from burns or scalds resulting from exposure to the hot water system when washing, bathing or showering, or being exposed to hot surfaces e.g. pipes or radiators. Information from the risk assessment specific to the person who uses our Service should help Service Managers make an informed judgement. Questions to consider may include:

Can the person get in/out, sit up and/or wash themselves unaided?

Is the person’s sensitivity to temperature impaired?

Is the person’s mental state such that they can’t recognise a bath/shower/water is too hot?

Can the person who uses our Service summon assistance?

Is the person liable to try and run him or herself a bath or add water when unattended?

These questions should be considered when the risk assessment specific to the person who uses our Service is being undertaken. Supervision Where people who use our Service are identified as being at risk of injury from the hot water, then Service Managers should consider supervising those who may be at risk. Supervision may involve simply a member of staff running a bath and testing the water for a person using our Service prior to them bathing.

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Thermostatic Mixing Valves Where people who use our Service are likely to run baths or add water on their own, and they are vulnerable to burns and scalds, it may be appropriate to fit ‘thermostatic mixing valves’. These prevent water at greater than 43º centigrade from being discharged. These will only generally be necessary where whole body immersion is to take place, for example, during bathing or showering. Installation of such devices has implications for the control of Legionella. In this instance, it will be necessary for the Potters Bar Office to be consulted, to agree a specific strategy for Legionella control, possibly including:

Sampling and analysis of water

Periodic thermal flush of water system

Periodic chlorination of water system Maintenance Where thermostatic mixing valves are installed, they need to be maintained in good working order to ensure they offer a sufficient level of protection. Any faults should be reported to the Service Manager and then the Service Manager must take action to isolate the area/supply if necessary. On a weekly basis the temperature of the water should be monitored to ensure that the valves are operating correctly. Hot Surfaces Where people who use our Service are identified as being at risk from sustaining burns from hot surfaces, the Service Manager should guard those surfaces as appropriate to prevent people who use our Service from gaining access to them, this may be by providing radiator covers or enclosing exposed pipe work. When considering guarding as a control measure to protect vulnerable people who use our Service, Service Managers should prioritise the surfaces in terms of where the person is most likely to sustain injury, for example their bedroom, the bathroom etc. It is these areas that must be guarded before other more generally accessible surfaces. An alternative and equally effective control measure is to provide a hot water system that is designed to distribute water at a temperature no higher than 43o centigrade, as this will minimise the risk of injuries being sustained should contact occur. NOTE: Alternative controls must be implemented to control the growth of Legionella in systems that distribute water at temperatures of less than 60o centigrade. Service Managers must consult with the Potters Bar Office before alterations or installations of this kind are undertaken.

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Water temperatures that are too hot can lead to fatalities, particularly when concerned with whole body immersion (i.e. bathing or showering).

Service Managers are responsible for identifying people who use our Service who may be at risk from scalding or burns as a result of reduced sensitivity to temperature or those who cannot respond quickly enough to avoid injury.

Thermostatic mixing valves can be used to control the water temperature at showerheads and bath taps.

Hot surfaces in the Service should be guarded where people who use our Service are identified as being vulnerable to sustaining injury through contact with them.

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CareTech Health & Safety Manual Page 1 of 2 HS-02-02-26 First Aid Last Reviewed January 2017

HS-02-02-26 FIRST AID 26.1 INTRODUCTION Employers are obliged to provide first aid provisions under the Health and Safety (First Aid) Regulations 1981. It must be remembered that first aid is exactly what it says. It is not intended as professional aid, but to administer a potentially life-saving interaction to someone requiring assistance. The requirements of the Care Standards Agency may take precedence over this guidance. 26.2 SCOPE To set out the first aid arrangements across CareTech’s operations. This section will also detail the first aid training requirements for employees and how much ‘first aid cover’ is required in CareTech’s Service. 26.3 HAZARDS

No first aider on a CareTech site

Inadequate first aid provisions, including lack of equipment

Inadequately trained employees having to administer first aid 26.4 SAFE WAYS OF WORKING Appointed Persons Each CareTech Service should operate as a minimum, an appointed person system for first aid. This requires each Service Manager to nominate a member of his or her team to be responsible for taking charge of any incident that occurs on the Service. Service Managers should consider the staff they have and it is suggested that an employee who has previous experience or is medically trained (i.e. a nurse) is selected as the appointed person. Training The appointed person does not have to be a trained first aider. However, if the expertise exists within the Service, it is beneficial that they have first aid training. It may also be beneficial to provide first aid training or refresher training to the appointed person, if they require it. Equipment The appointed person shall be responsible for ensuring that there are enough first aid kits:

Service and offices with less than 20 (combined) staff and people who use the service o 1 small kit provided in the kitchen o 1 small kit provided in the administration office

Service with more than 20 (combined) staff and people who use the Service o 1 large kit in the kitchen o 1 small kit in the administration office

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CareTech Health & Safety Manual Page 2 of 2 HS-02-02-26 First Aid Last Reviewed January 2017

It is the role of the appointed person to monitor the first aid kits regularly. They must ensure that the kits contain what is listed on the contents sheet. A ‘reminder sheet’ detailing the recommended contents of both a large and small first aid kit is provided in Appendix HS-02-AP-10. If any of the kits are depleted, it will be the responsibility of the appointed person to arrange for replacement items to be obtained. First aid kits should remain fully stocked. Equally as important, the first aid kits must be kept free from any other items not listed on the Contents list. This includes any tablets (including Paracetamol and Aspirin), creams and sprays. If the appointed person identifies such items then they should be removed from the first aid kits. Information to Employees All employees at the individual Service should be notified by the Service Manager who the appointed person(s) is/are. Employees should also be notified of the location of the first aid kits. 26.5 RISK ASSESSMENTS SPECIFIC TO A SERVICE If there is any doubt as to the level of first aid provision then a risk assessment approach must be used. Factors to consider during the risk assessment:

Number of employees

Number of people who use the Service

Type of work

Likelihood of first aid being needed

Likelihood of other staff members being available to assist (i.e. peripatetic workers)


Service Managers should nominate an appointed person to look after first aid arrangements.

First aid kits must be available to employees. They should not contain anything other than what is listed on the contents sheet, especially NO tablets, creams, sprays or pills.

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CareTech Health & Safety Manual Page 1 of 2 HS-02-02-27 Stress Management Last Reviewed January 2017

HS-02-02-27 STRESS MANAGEMENT 27.1 STRESS

Stress occurs where work demands exceed the employee’s capacity and capability to cope. It is now recognised as a significant cause of illness and disease and is known to be linked with high levels of sickness absence, staff turnover and other indicators of organisational underperformance - including human error. In some cases, the way to deal with work-related stress is to diagnose and help those people who experience it. In other cases, it is better to review and amend the existing work system or organisation. Prompt and effective action reduces the risk of future failure and the likelihood of future work-related ill-health. Benefits The benefits of dealing with work-related stress include: -

Lower risks of prosecution Improved return on investment in training and development Improved customer care and relationships with clients and suppliers Reduced costs of sick pay, sickness cover, overtime and recruitment

Higher morale and a better motivated workforce.

Higher performance, making employees feel that they are part of a team and the decision-making process, so accept change better

Reduced staff turnover and intention to leave, so improving retention Better absence management Fewer days lost to sickness and absenteeism Fewer accidents Improved work quality Improved organisational image and reputation Better staff understanding and tolerance of others experiencing problems

All employers have legal responsibility under the Health and Safety at Work Act 1974 and Management of Health and Safety at Work Regulations 1999 to ensure the health safety and welfare at work of their employees. This includes minimising the risk of stress-related illness or injury to employees.

Managers

Managers have an important role in assisting employers to proactively address work related

stress, and in doing so reduce the likelihood of employees suffering from work related stress. Examples of issues line managers may wish to consider include:

Whether stress may be a factor in relation to frequent or long-term absenteeism for individual employees

How they will monitor and address potential sources of stress Identify what medical and other evidence is required to determine whether the

employee may have a disability within the meaning of the Disability Discrimination Act. If so, consider whether the employee is being treated less favourably for a reason related to the disability and whether there are reasonable adjustments that could be made

Report their concerns to appropriate senior personnel while maintaining any obligations of confidentiality.

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CareTech Health & Safety Manual Page 2 of 2 HS-02-02-27 Stress Management Last Reviewed January 2017

Employees Employees also have a duty to take reasonable care for their own health and safety and of others who may be affected by their actions. Employees should:

Inform their employer if they feel the pressure of the job is putting them or anyone else at risk of ill health

Suggest ways in which the work might be organised to alleviate the stress Inform their employer if they are suffering from a medical condition that appears to be

long-term and is affecting their ability to carry out day to day tasks, including memory and learning

Discuss any reasonable adjustments that could be made to assist them in performing their job.

Where an employee is believed to be suffering from stress or one of the causal factors, the matter should be referred immediately to their Service Manager. A Stress Monitoring Record to record actions is provided in Appendix HS-02-AP-13. 27.2 WORKING TIME In respect of working hours, the Working Time Regulations set a working time limit of an average of 48 hours per week calculated over a 17-week period. The Regulations also include provisions in respect of holidays and maximum shift lengths in any 24-hour period for night workers whose work involves special hazards or physical strain. Further guidance on these and other issues covered by the Regulations can be obtained from Area Managers and/or the Operations Director.


Always notify your Service Manager if you are experiencing symptoms of physical or mental work related pressures.

Identify ways in which you can help your Service Manager in helping you to manage this pressure.

Communicate! Talk to your Service Manager and peers at peer review meeting.

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CareTech Health & Safety Manual Page 1 of 2 HS-02-02-28 Service Safety Checks Last Reviewed January 2017

HS-02-02-28 SERVICE SAFETY CHECKS 28.1 INTRODUCTION In order to ensure that CareTech’s Service are safe for both the people who use our Service to live in and our employees to work in, it is essential that regular safety checks are made at each premises. Checks will include all areas within premises including offices, living accommodation, kitchens, access routes etc. 28.2 SCOPE This section will identify what checks are required at the Service and who is responsible for undertaking them. It will also advise on what action is required if problems are found. 28.3 RESPONSIBILITY AND FREQUENCY OF CHECKS Service Managers will be responsible for undertaking the regular safety checks at their Service. The Safety Checklist can be found in Appendix HS-02-AP-08. The safety checks should be completed every quarter. Any problems identified should be actioned by the Service Manager except in cases where a contractor is required to attend. In these circumstances the repair requirement should be reported to the Regional Office for action. If more serious problems are identified then the matter should be reported through to the Regional Office or Head Office as appropriate. If the Service Manager identifies something that presents an imminent danger during a check, then they should take the most appropriate action to ensure the safety of both their employees and the people who use our Service (e.g. by taking a piece of defective/dangerous equipment out of use). It is important that Service Managers complete the entire Safety Inspection form, including what actions are taken, and the date when they were completed. The completed Quarterly Safety Inspection forms must be kept at the premises for a period of three years.


Service Managers must ensure that Quarterly Safety Inspection forms are completed every quarter.

Any serious defects must be actioned, where possible, by the Service Manager.

Where the Service Manager is unable to deal with the problem/defect then they must be reported through to the Regional Office, or Head Office.

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CareTech Health & Safety Manual Page 2 of 2 HS-02-02-28 Service Safety Checks Last Reviewed January 2017


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CareTech Health & Safety Manual Page 1 of 4 HS-02-02-29 Control of Substances Hazardous to Health (COSHH) Last Reviewed January 2017

HS-02-02-29 CONTROL OF SUBSTANCES HAZARDOUS TO HEALTH (COSHH)

29.1 INTRODUCTION The Control of Substances Hazardous to Health Regulations 2002 require employers to prevent employees from being exposed to hazardous (dangerous) substances. If it is not possible to prevent exposure, then it must be controlled. Hazardous substances include the following: -

Chemicals

Dust

Fumes

Micro-organisms (biological hazards)

Asbestos (refer to HS-03 Asbestos Management Policy Manual) Within CareTech, the two main areas in relation to hazardous substances that require attention are: -

1. Exposure to chemicals 2. Exposure to micro-organisms via clinical waste etc

The above-mentioned Regulations place duties upon all employers and on the employees themselves. CareTech need to be aware of the chemicals they use on site, so that they can assess any risk to the health or safety of employees or people who use our Service who may come into contact with them. 29.2 ASSESSMENT PROCESS In order to achieve compliance with COSHH 2002, Service Managers must work through the following steps: STEP 1 Service Managers need to identify all products in use at their Service that

have a hazard warning label on them, and list them on the Hazardous Substance Log Sheet (see COSHH Manual HS-02-AP-11). Remember, this is not only for chemicals but may cover products used for decorating, maintenance or the garden.

Chemicals without such a label will be safe to use without an assessment, (this would include washing up liquid, for example), although general principles of chemical safety must apply and instructions on product labels must be followed.

STEP 2 Once a chemical has been identified with a hazard warning label, it is

important to know what the product is used for, for example cleaning the toilet, descaling the washing machine etc. This information must be added to the Hazardous Substance Log Sheet.

STEP 3 Identify who uses the chemical (e.g. all employees, specific employees or

persons e.g. cleaner, people who use our Service and employees).

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STEP 4 Investigations should be made into whether it is necessary for that particular chemical to be used at all or whether an alternative (safer) product could be used. Again, this should be indicated on the Hazardous Substance Log Sheet.

(Repeat steps 1 4 for all new/alternative products in the Service). STEP 5 If it is not possible to substitute the product for an alternative, then measures

need to be implemented to minimise exposure to employees and to ensure the product is used safely.

Control methods can include personal protective equipment or other operational methods. Information on the products’ label should be followed when assessing what precautions are needed. All such safety measures should be recorded on the Hazardous Substance Log Sheet.

As the label contains so much crucial safety information, all chemicals used on site should be labelled. Labels must not be removed from any chemical. Chemicals must not be decanted into smaller bottles or trigger sprays, unless they are properly labelled and designed for chemicals. Drinking bottles etc must NOT be used. Service Managers should also note and make employees aware that the Assessment carried out here is only concerned with the chemicals as they are provided. Chemicals that are mixed together either deliberately or accidentally may produce hazardous fumes or gases, or react violently. Even if the chemical does not have a hazard warning label, it may create a dangerous gas or fume etc when mixed with other chemicals. Therefore, chemicals must be stored safely and used only in accordance with the information on the product’s label. 29.3 AFTER THE ASSESSMENT Once the assessment has been completed then the Service Manager should:

1. Make the findings of the Hazardous Substance Log Sheet available to all those employees who are affected by it (i.e. those who were identified as users in STEP 3).

All those ‘users’ should then sign to acknowledge they have seen and are aware of the Hazardous Substance Log and the identified controls, by signing against the staff training record.

2. Maintain and update the Hazardous Substance Log Sheet. For example, if new chemicals are introduced they may require adding to the sheet.

The Quarterly Safety Checklist in the Health and Safety Manual contains a section on COSHH. This provides the opportunity to review and ensure the Hazardous Substance Log Sheet is accurate.

3. Ensure all precautions as identified as necessary on the Hazardous Substance Log Sheet are put in place and/or provided. In the case of personal protective equipment, it is up to the user to ENSURE THEY WEAR THE PERSONAL PROTECTIVE EQUIPMENT PROVIDED. Failure to comply fully with the findings of the assessment may result in DISCIPLINARY ACTION.

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Key Learning Points for Employees (Chemicals)

Employees must familiarise themselves with the hazard warning labels.

Where possible, a hazardous substance should be substituted for a safer alternative, such as another chemical that is less dangerous or an alternative to chemicals e.g. hot water. The Service Manager should be advised if such an alternative is identified.

All employees identified as ‘users’ in the Hazardous Substance Log Sheet (see COSHH Manual HS-02-AP-11) must read and sign the COSHH Training Record (see COSHH Manual HS-02-AP-12) as and when the log is updated with information relevant to them.

Always read the label before using products to ensure the correct protective equipment is available and being used.

Always follow the manufacturers instructions.

Never mix chemicals together.

Always label chemicals – never use an unlabelled chemical.

Employees MUST wear the PPE they are provided with.

Store chemicals safely (e.g. in a locked/secure area) and with lids on.

Never use a chemical for any task other than that identified on the Hazardous Log Sheet.

Never use any other chemical other than that identified on the Hazardous Log Sheet.

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CareTech Health & Safety Manual Page 1 of 2 HS-02-02-30 Violence at Work Last Reviewed January 2017

HS-02-02-30 VIOLENCE AT WORK

30.1 INTRODUCTION

CareTech employees may, on occasions, be exposed to violence from people who use our Service whilst they are at work. People who use our Service often have little perception that the behaviour they show is unacceptable and it is part of every Care Workers training to be able to recognise and diffuse violent situations within the workplace. 30.2 SCOPE

The purpose of this section is to provide the basic rules of good practice for employees to follow when faced with a violent situation, which may affect their health and safety. 30.3 HAZARDS

Physical injuries – to both employees and people who use our Service

Stress

Damage to property, fixtures etc resulting in unsafe environments

Damage to clothing 30.4 WORK ACTIVITIES

General personal care of people who use our Service within the Service. 30.5 SAFE WAYS OF WORKING People who use our Service with the potential to exert violent or aggressive behaviour will have been identified through the risk assessment process. Such persons will be made known to all members of staff through the review/management process for the people who use our Service. The Service Manager will identify any specific events which are likely to cause specific violent reactions with people who use our Service. Wherever possible, these events will be avoided or the processes will be adapted to reduce the incidence of violence or aggressive behaviour. The policy intent of CareTech Community Service is to reduce the risk of a violent or aggressive situation occurring with people who use our Service by ensuring that all care staff are fully aware of each individual person’s behaviour patterns and trigger points. Staff are expected to be trained sufficiently so as to avoid confrontational situations. Violent or aggressive behaviour can be diffused by calm, confident actions, which convey the message to the person that such behaviour is unacceptable. Where a particularly aggressive or violent person is residing in a Service, the Service Manager will identify through a risk assessment, any situations where one member of staff would not be sufficient and a minimum of two Care Workers would need to be present. Where members of staff have encountered a violent, aggressive or verbally aggressive situation with a person who uses our Service (or any other person), they must inform the Service Manager or senior person on duty immediately and enter the details on the appropriate record. Any physical injuries will need to be assessed by the first aider and where necessary, the employee (or other person) will need to be taken to hospital.

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CareTech Health & Safety Manual Page 2 of 2 HS-02-02-30 Violence at Work Last Reviewed January 2017

Any incident which results in a physical injury to a member of staff must be assessed to identify whether it is a reportable accident/incident or not. The Service Manager should do this. Should any situation occur which puts a member of staff at severe risk of personal injury, or other people who use our Service, the alarm shall be raised in accordance with standard emergency procedures. In all circumstances, actions shall be taken to “take the heat out of the situation”. All members of staff shall be aware of the risks of physical injury from items such as knives, heavy ornaments, sharp objects etc. These should be removed or kept secure (e.g. kitchen knives) when a risk assessment has identified that a person who uses our Service may have a specific tendency to utilise these items. 30.6 INCIDENT REVIEW PROCESS All incidents of violent physical attack or excessive verbal abuse will be reviewed by the Service Manager so as to identify steps which could be taken to reduce future occurrences. A Case Review Meeting or similar will be held after each incident involving physical assault.


Ensure that you have received appropriate training in how to manage violent or aggressive situations.

Always endeavour to diffuse all situations which look as if they could result in physical or verbal abuse. If you feel threatened at all, seek assistance from a colleague. Sometimes other individuals will be able to placate a person who uses our Service, or diffuse a situation where you cannot.

Report all incidents no matter how minor to the Service Manager or Senior Manager.

Remove objects that could be used for physical assault.

Share information at the Case Review/Management Meetings.

Don’t take matters personally, people who use our Service may not be able to recognise the severity of their actions.

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CareTech Health & Safety Manual Page 1 of 2 HS-02-02-31 External Outings Last Reviewed January 2017

HS-02-02-31 EXTERNAL OUTINGS 31.1 INTRODUCTION An important part of any Care Plan for people who use our Service and freedom of choice will be the opportunity for external outings. These could range from accompanied shopping trips to planned holidays or day trips to leisure facilities etc. CareTech Community Service wish to encourage all people who use our Service to benefit from the experiences of every day living and recognise that members of staff will often be expected to accompany people who use our Service on these outings. 31.2 SCOPE The purpose of this section is to provide information for employees on safe practices in respect of external outings, thereby minimising the risk of a health and safety incident. 31.3 HAZARDS

Physical injuries

People who use our Service absconding

Verbal abuse to members of the public

Road traffic, public transport activities

Exposure to hazards in other environment 31.4 WORK ACTIVITIES

General provision of care when accompanying people who use our Service on outings

Taking part in activities in order to support people who use our Service

Accessing and travelling on public transport

Driving vehicles 31.5 SAFE WAYS OF WORKING Assess each person who uses our Service in respect of his or her capability to take part in external activities and include information in the Care Plan. Ensure adequate members of staff are available to accompany people who use our Service on outings. If a person who uses our Service has one-to-one care within the Service they must have at least one to one care when on external outings. Review each person’s Care Plan as necessary and update with any information regarding external situations which could create hazards for the people who use our Service, or members of staff e.g. a person who uses our Service may become agitated in crowds – this should be noted. Review the venue that is proposed for any outing and ensure that facilities will be suitable for a person who uses our Service. Assess the venue in respect of its compliance with the Equality Act 2010. Identify whether there will be any specific hazards which a person who uses our Service may be affected by e.g. water and ensure that everyone is aware of the hazards and risks and any control procedures necessary to safeguard the person.

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CareTech Health & Safety Manual Page 2 of 2 HS-02-02-31 External Outings Last Reviewed January 2017

Consider the capability of the person who uses our Service to understand instructions, especially regarding safety. If a person cannot understand the need for keeping a safety bar in place on a leisure ride for instance, then it would be unsafe to allow the person who uses our Service to use the ride, etc. When visiting other buildings/venues, consider what the emergency evacuation plan will be – check fire evacuation procedures, exit routes etc. The Care Worker will be the responsible person for ensuring that people who use our Service are safeguarded in an emergency. Again, check a premises’ compliance with the Equality Act requirement. All people who use our Service have the right to individual freedom to experience all aspects of life, including access to leisure pursuits, facilities, tourist venues etc. However, there may be times when due to a person’s disability, it is inherently unsafe for them to pursue a particular activity or facility. In these circumstances, safety must over-ride freedom of choice and human rights and the Care Worker is expected to exercise this judgement when accompanying a person who uses our Service on external outings. Should any doubts exist about suitability of an activity then the senior person in charge must be consulted. In many circumstances a specific person-related and/or task risk assessment should be completed prior to the activity and/or outing taking place. The Service Manager must ensure that these have been completed as required and all staff involved have been made aware of the risks, hazards and controls required.


Plan in advance what outings will take place, how they will be arranged, how many staff there will be and the capability of the people who use our Service.

Ensure that adequate staff numbers are available for each outing.

Assess any hazards within the venue to be visited, or for the activity to be undertaken.

Individual choice for people who use our Service is important, but safety must take priority.

Ensure you have appropriate training in how to conduct risk assessments and how to implement control measures.

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CareTech Health & Safety Manual Page 1 of 2 HS-02-02-32 Falls from Height Last Reviewed January 2017

HS-02-02-32 FALLS FROM HEIGHT 32.1 INTRODUCTION Service user falls from windows, balconies or stairs can result in serious or fatal injuries. Falls may also occur when employees or contractors carry out maintenance activities, including window and gutter cleaning, minor roof repairs, and internal decorating. 32.2 SCOPE The purpose of this section is to provide information for employees on the safe practices in respect of reducing the risks of falls from height. 32.3 HAZARDS

Accidental falls

Falls arising out of confused mental state

Deliberate self-harm

Unsafe working practices 32.4 WORK ACTIVITIES

General personal care of people who use our Service within the Service.

General safety of employees when working at height and other persons such as contractors.

32.5 SAFE WAYS OF WORKING Each person who uses our Service will be assessed in respect of their risks of falls from height. Where service users are at risk, measures will be needed to prevent them falling from height. Windows Windows that can be fully opened and are accessible to people at risk of falling or climbing out must meet appropriate standards (see below). In assessing the risks, you should consider furniture or other items that may enable service users to climb over barriers, or access windows, which might otherwise be inaccessible.

Window Restrictors - Where vulnerable service users have access to window openings large enough to fall through, and at height that could cause harm (e.g. above ground level), those windows should be restrained sufficiently prevent such falls. The window restrictors should restrict the window opening to 100mm or less; be suitably robust to withstand foreseeable force applied and damage; and be robustly secured using tamper proof fittings so they can be removed or disengaged.

Window Design – The window frames and fittings must be sufficiently robust. The bottom edge of opening windows should normally be at least 800mm above floor level, unless there is a barrier to prevent falls.

Balconies Where service users are at risk of falling, sufficient protection should be provided to prevent them from accessing balconies and external fire stairs, or climbing over the balcony edge protection. Take into account furniture or features with footholds, which may allow access over the rail/barrier (e.g. chairs, tables, plant pots and walls).

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CareTech Health & Safety Manual Page 2 of 2 HS-02-02-32 Falls from Height Last Reviewed January 2017

Stairs Stairs can present a hazard to everyone. Stairs should be in a safe condition, kept free of obstructions and well lit. If our service users lack mobility and require extra support, then the stairs should have suitable hand rails on both sides. Ideally, stairs should not be steep, winding, curved, or have open risers. It may be appropriate to restrict access to some stairs, e.g. steep cellar stairs or upper floor levels where service users are at risk of falls. Further advice may be required if it impacts on fire evacuation. You may also need to think about how to prevent access through external fire doors so they can be released and quickly accessed in the event of a fire. Controlling the risks to employees Before working at height employees should follow the steps below:

Avoid work at height where it is reasonably practicable to do so;

Where work at height cannot be avoided, prevent falls using either an existing place of work that is already safe or the right type of equipment;

Minimise the distance and consequences of a fall, by using the right type of equipment where the risk cannot be eliminated.

To reduce the risks employees we will:

Do as much work as possible from the ground;

Ensure they can get safely to and from where they work at height;

Ensure equipment is suitable, stable and strong enough for the job, maintained and checked regularly;

Make sure they don’t overload or overreach when working at height;

Take precautions when working on or near fragile surfaces;

Provide protection from falling objects;

Consider your emergency evacuation and rescue procedures. If a ladder is the right piece of equipment for these activities you should ensure it is the right type, and that it is checked, in a safe condition, and used safely. Where safety fixtures and fittings are installed, you must ensure they are functioning effectively and have not deteriorated as a result of use, wear or tampering.

If you are using a contractor to do work at height you must ensure they are doing the work safely and are not putting others at risk, e.g. taking safe access into account and providing protection from falling objects.


Are any of our service users at increased risk of falls from windows, balconies or other areas?

If so, are the controls adequate, suitably robust and properly maintained?

When you are working at height, are activities properly planned and organised

Is access equipment used for working at height suitable, maintained and inspected?

Are you trained and competent to do the work?

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CareTech Health & Safety Manual Page 1 of 4 HS-02-02-33 Safe Use of Bed Rails Last Reviewed January 2017

HS-02-02-33 SAFE USE OF BED RAILS

33.1 INTRODUCTION

Bed rails, side rails and cot sides are commonly used to reduce the risk of falls from beds. They can be a very effective means of preventing falls when used with the right bed, in the right way, for the right resident.

Poorly fitted bed rails have caused asphyxiation where a service user’s neck, chest or limbs have become trapped in gaps between the bed rails, or between the bed rail and the bed, headboard or mattress.

33.2 SCOPE

The purpose of this section is to provide information for employees on the safe use of bed rails where these are available and used.

33.3 HAZARDS

Accidental falls

Entrapment

Asphyxiation

Climbing over rails

Forceful contact with bed rail parts


General personal care of people who use our Service within the Service.

33.5 SAFE WAYS OF WORKING

Each person who uses our Service will be assessed in respect of their risks of falls from bed and whether bed rails would be the appropriate means of managing that risk.

When considering the use of bed rails, you should bear in mind that they are not intended to:

Limit freedom of movement;

Restrain people;

Be used as grab handles.

Every effort should be made to involve the service user or their family in the decision-making process and to explain why and how bed rails are used.

Where bed rails are fitted, employees will need to be aware of the risks and how to ensure the resident’s safety. Information on whether bed rails are used should be included in the service user’s care plan.

Key Points for Consideration When Using Bed Rails

Entrapment underneath the rail The service user can become trapped between the bottom of the rail and the mattress if the gap beneath the rail is too large. This could be due to:

Incompatibility of bed rail and bed;

Using an airflow mattress in conjunction with a thin-base mattress;

using easily compressible base mattresses or a mattress which is too small for the bed.

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British Standard BS EN 60601-2-52:2010 states that the gap from any accessible opening between the bottom of the side rail and the mattress platform should be no more than 60 mm. When assessing this gap, you should take into consideration whether mattresses are thin, easily compressible at the edge and whether the individual’s dimensions increase the risk of slipping underneath the rails. In addition, mattresses should always fit snugly, with no significant gap, between both bed rails. Entrapment between the end of the rail and the headboard or footboard Service users can become trapped between the end of the bed rail and the headboard or footboard if the rails are not secured in a safe position. British Standard BS EN 60601-2-52:2010 states that:

The gap between the end of the bed rail and headboard should be no more than 60 mm;

The gap between the footboard and end of the bed rail should either be 60 mm or less, or greater than 318 mm, to prevent asphyxiation;

Likewise, where two-section split rails are used, the gap between the two sections should be 60 mm or less, or greater than 318 mm.

Entrapment between the bed rail and the side of the mattress Entrapment in the space between the side of the mattress and the rail can be caused by:

A poorly fitting mattress;

Poorly fitting bed rail system and/or insecure fittings that allow the bed rail to move away from the side of the bed;

Bed rails only being used on one side of the bed, allowing the mattress to move away from it.

Replacement mattresses that are narrower than the original mattress, or smaller speciality mattresses used on top of existing mattresses, may result in an excessive gap between the mattress and the bed rail. Poorly maintained bed rails may be too flexible, may deform under force or have too much play in their fixings, resulting in a gap between the mattress edge and rail.

The mattress should fit snugly between both rails so it does not allow entrapment of the occupant’s head or body. You should check this gap, taking into account the resident using the bed rails. If you require further advice, contact your bed rail supplier – they should be able to carry out the tests detailed in the British Standard. Accessories such as bed-rail bumpers or gap fillers can be used in conjunction with bed rails. If used (in conjunction with a correctly fitted bed rail), accessories should be robust, so they cannot accidentally be displaced or easily damaged. Risk of falls when using bed rails Falls can occur if a service user climbs or rolls over the top of the rails. The height of a bed rail above the level of the compressed mattress can prevent an inadvertent fall from a bed. BS EN 60601-2-52:2010 quotes a minimum height of 220 mm, measured vertically from the top edge of an uncompressed mattress to the top of the bed rail. Replacing a mattress with one significantly thicker than that intended by the bed manufacturer, placing one mattress on top of another, or using mattress overlays or airflow mattresses, may reduce the effectiveness of the bed rails because the relative height of the rail is reduced. This could increase the risk of a person involuntarily rolling or falling over the top of the bed rail. Service unit managers should check whether the bed rails are high enough to take into account any increase in mattress thickness or additional overlay.

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BS EN 60601-2-52:2010 states that, where a ‘speciality’ or ‘mattress overlay’ is used and the side rail does not meet the minimum height of 220 mm above the mattress, a risk assessment should be carried out to assure equivalent safety.


Are bed rails only provided where they are the most appropriate solution to prevent falls?

Are you trained in the risks and safe use of bed rails?

Are rails and any accessories compatible with the bed, mattress and occupant?

Does the mattress fit snugly between the rails?

Are rails correctly fitted on both sides of the bed, secure, regularly inspected and maintained?

Are checks completed to ensure that gaps that could cause entrapment of neck, head and chest are eliminated?

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