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Managing Health and Safety in care homes the plan, do, check and act approach

All managers of care homes are aware of the need for a systematic approach to health and safety. The Plan, Do, Check and Act approach provides the manager with an ideal systematic approach.

Plan: requires staff to say what needs to happen and say how you will achieve it.

Do: staff need to profile the risks that are identified and organise activities to deliver the plan, this will include the preventive measures required, and ensure there are systems and equipment in place to do the job safely.

Check: staff monitor the work to see if it’s being done safely and investigate the causes of accidents, incidents or near misses.

Act: staff review performance and take action on lessons learned, including those from audit and inspection.


The manager should say what they want to happen and write a health and safety policy that sets out arrangements for managing health and safety in the home to let staff and others know the commitment.

The health and safety policy does not need to be long or complicated, but it should clearly say who does what, when and how.

The manager should decide who will help to carry out their health and safety duties. This should be someone who is competent. A competent person is not someone who simply has the competence to carry out a particular task safely. In general terms, the definition of a competent person is someone who has the necessary skills, experience and knowledge to manage health and safety.

To help the manager to manage the health risks to employees, using an occupational health service can help identify risks, advise on suitable precautions and control measures, and provide services such as: health surveillance programmes; feedback and advice to employers following employee health assessments, e.g. pre-employment, following sickness absence, or rehabilitation and return to work; clinical services such as immunisations; employee information and training in the health aspects of their work.

The manager must consult with employees, in good time, on health and safety issues. This is a two-way process, as it allows staff to raise concerns and influence decisions on health and safety management. The consultation should include: risks arising from their work; proposals to manage and/or control these risks; the best ways of providing information and training.


The manager should make sure systems are in place to provide the tools and equipment to do the job safely and control the risks. Assess the risks and decide whether enough is being done to prevent harm to people. Decide what the priorities are and identify the biggest risks. The typical hazards found in a social care setting are all covered in the publication Health and Safety in Care homes.

Risk assessment is not about creating huge amounts of paperwork, it’s about: identifying the significant hazards; deciding who might be harmed and how. Evaluating the risks and deciding on precautions; recording significant findings; reviewing assessments and updating as necessary. Different risks need to be considered including: the common risks to everyone on the premises, e.g. risks from legionella, asbestos, electrical equipment, challenging behaviour and moving vehicles; common risks to service users, e.g. risks from falls from height or scalding, and general precautions capable of preventing harm to the most vulnerable; risks to workers arising from the tasks they undertake, e.g. moving and handling service users, responding to challenging behaviour, using hazardous substances, maintenance activities etc. risks to particular staff, e.g. expectant mothers, young employees, or those with pre-existing injuries which may impact on work; risks to particular service users, e.g. the risk of them falling out of bed or needing help with bathing or to move around safely.

Key points to consider when balancing risk include: concentrating on real risks that could actually cause harm; close liaison with the service user, carer and family/representative when carrying out risk assessments, which is essential to achieve outcomes that matter to them; how the risks flowing from a service users choice can best be reduced, so far as reasonably practicable, by putting sensible controls in place, e.g. when organising group activities, thinking how the most vulnerable can be protected without unnecessarily restricting the freedoms of the most capable.

The manager should provide clear instructions, information and adequate training for employees.

Everyone who works in the care home needs to know how to work safely and without risks to health.

Attention should be paid to: the induction and training of new employees (permanent and temporary), young workers, and nightshift employees.


Make sure the work is being done safely and risks are being controlled in the service. This is a vital, sometimes overlooked step. It will give the manager confidence that they are doing enough to keep on top of health and safety.


The manager and staff should learn from problems and successes, and make improvements. Plans should be revisited to confirm whether the health and safety arrangements are still appropriate and are achieving what they were designed to achieve. This should enable the manger to see: what has changed; and any new actions that are needed.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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