Care homes and supported living, UK wide
Care Home Health and Safety
A care home is the rare workplace where the people most exposed to its hazards live in it, sleep in it and mostly cannot leave it unaided. AL23 Safety provides health and safety and fire safety support to care home operators, extra care schemes and supported living providers across the UK.
Why it matters in care homes
The risks are real and so are the duties
Two regulators share this sector and they do not overlap neatly. The Care Quality Commission registers and regulates providers. Local authority environmental health officers enforce the Health and Safety at Work etc. Act 1974 in residential care homes, with HSE taking that role where the local authority is itself the employer and in NHS settings. The memorandum of understanding between CQC and HSE dated 6 March 2024 draws the boundary. CQC leads on service user safety at registered providers, covering falls, scalding, restraint injuries, unsafe premises affecting service users and wilful neglect. HSE and local authorities lead on worker, visitor and contractor safety in every setting, on service user incidents at unregistered providers and on matters such as employee manual handling injury, Legionnaires' disease in staff and construction risk. Police primacy overrides both. One incident can therefore be examined from two directions at once.
This page covers registered care homes, extra care and supported living. Hospitals, clinics and primary care sit on our health and safety in healthcare page, where the risk profile is clinical rather than residential. The regulatory picture is also moving. Following the Dash and Richards reviews, CQC has restructured into four sector inspectorates and is redesigning assessment through its Better regulation, better care programme. Final sector-specific assessment frameworks were due in summer 2026 with implementation by the end of 2026, against a target of 9,000 assessments by September 2026. Wider transformation runs to the end of 2028. Expect the questions to change before the underlying law does.
The main risks
Where the harm comes from
Moving and handling
Single-handed hoisting, drag lifts and residents moved without an individual handling plan injure staff and residents alike. They remain the most enforced failing in the sector.
Hoists, slings and lifting equipment
Sling and hoist mismatch is common. Lifting equipment used to lift people must be thoroughly examined at least every six months.
Scalding and hot surfaces
Unregulated hot water at outlets used by residents with reduced sensation produces severe burns. Exposed pipework and radiators do the same.
Window falls
Restrictors that have been removed for cleaning, defeated by a resident or never fitted to an upper floor window remain a recurring cause of fatal falls.
Legionella in low flow systems
Unused bedrooms after a resident leaves, long dead legs and blended low temperature water combine to produce ideal growth conditions.
Compartmentation and door wedging
Cable penetrations made after handover and fire doors wedged for sightlines undo the exact strategy the building relies on at night.
The regulations that apply
Your legal framework, in plain terms
The Health and Safety at Work etc. Act 1974 and the Management of Health and Safety at Work Regulations 1999 set the general duty. On top of that the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 apply to you as a registered provider. Regulation 12, safe care and treatment, requires you to assess risk, provide safe premises and equipment, manage medicines safely and control infection. Regulation 15, premises and equipment, requires the premises to be clean, secure, suitable and properly maintained. Regulation 13 covers safeguarding, regulation 17 good governance and regulation 20 the duty of candour. The Care Quality Commission (Registration) Regulations 2009 then require notification of a death under regulation 16 and of other incidents under regulation 18, including serious injury, abuse or an allegation of abuse, police involvement and Deprivation of Liberty Safeguards outcomes.
The operational detail comes from the Manual Handling Operations Regulations 1992 with guidance L23, the Lifting Operations and Lifting Equipment Regulations 1998, the Provision and Use of Work Equipment Regulations 1998 and Approved Code of Practice L8 with HSG274 for legionella. HSG220, Health and safety in care homes, is still HSE's core text although the second edition dates from June 2014 and shows its age.
One point is worth stating plainly. Reporting under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 and notification to CQC are separate duties with separate tests. They are not interchangeable and dual reporting is normal. The common failing we find is a provider that filed one and assumed it had covered the other.
Fire safety in care homes
When getting everyone out is not an option
Simultaneous evacuation is almost never workable in a care home. Getting every dependent resident out of the building at three in the morning with the staff on shift is not achievable. The standard approach is progressive horizontal evacuation, moving residents sideways into an adjoining fire compartment and only downwards if the fire develops. That strategy makes three demands. Compartmentation must be genuinely intact, including above ceilings and through service risers. The adjoining compartment must have capacity for the people moved into it. Night staffing must be able to move the residents you actually have, assessed against real dependency rather than an average. Fire compartmentation surveys are usually where the strategy either holds up or falls apart.
The design side has moved. The Approved Document B amendment effective 2 March 2025 requires sprinklers in all new care homes. Care homes are also in scope for the Building Safety Act 2022 design and construction gateways under Part 3 while being excluded from the in-occupation duties in Part 4. That distinction is a common source of error. A new or substantially altered care home can face a Gateway 2 hard stop before construction begins, even though the finished building will have no accountable person and no safety case report.
For sheltered, extra care and supported housing the NFCC guidance Fire Safety in Specialised Housing, launched in May 2017 with the Local Government Association, remains the reference document. Note its limits. It is written for neither registered care homes nor general needs blocks. Research published for the Building Safety Regulator on 17 September 2025 found Approved Document B inadequate for five specialised housing typologies, with half the case studies requiring fire-engineered deviations. Named gaps included extended evacuation times, limited 24-hour staffing and the absence of any guidance on mobility scooter storage and charging. Supported living and extra care blocks with two or more domestic premises may also fall within the Fire Safety (Residential Evacuation Plans) (England) Regulations 2025, in force since 6 April 2026. Registered care homes are generally handled through the person-centred fire risk assessment route under the Fire Safety Order instead.
How we help
Built around your operation
We work around handover, mealtimes and medication rounds rather than through them. Every report separates what the law requires from what is simply good practice. A registered manager can then defend the difference to an inspector.
- Fire risk assessment across the home, tested against your evacuation strategy and your real night staffing rather than the establishment on paper.
- Compartmentation and fire door survey work, with a defect schedule ordered by the compartments the strategy leans on hardest.
- Moving and handling assessment, including individual handling plans, sling and hoist matching and competence checks on the people doing the transfers.
- Thorough examination scheduling for hoists, slings, stairlifts and bath hoists at the six month interval that applies to equipment lifting people.
- Legionella risk assessment and written scheme, including the thermostatic mixing valve regime and the low use outlet flushing that goes with void bedrooms.
- Scalding and hot surface review across bathing, handwashing and heating, reconciled with the water temperatures legionella control requires.
- Accident and incident procedure that routes each event correctly to RIDDOR, to CQC or to both.
- Support at inspection and, where enforcement follows, help responding to notices and correspondence.
Why AL23 Safety
Sector-aware support that gets used
Accountable
If your evacuation strategy cannot be delivered by the staff rostered at night, we will tell you that in writing rather than record the strategy and move on.
One team, three disciplines
Health and safety, fire safety and fire engineering in-house, which matters when progressive horizontal evacuation needs an engineering judgement about a real compartment rather than a tick.
Practical, not just compliant
Documents written for registered managers and maintenance staff, short enough to be read and specific enough to be acted on.
Nationwide
We support care homes and supported living providers across the UK from our Manchester base.
Get in touch
A second opinion before the inspector forms a first one
Most providers already know where their weak point is. A short conversation is usually enough for us to say whether it is the one an inspector will find.
Common questions
Answers, up front
Cannot see your question? Get in touch and we will answer it directly.
Contact usBoth have a role. Under the memorandum of understanding of 6 March 2024, CQC leads on service user safety at registered providers. HSE or the local authority leads on worker, visitor and contractor safety and on service user incidents at unregistered providers. In most residential care homes the health and safety enforcing authority is the local authority rather than HSE. Police primacy overrides both.
Usually yes. They are separate duties with different tests and different recipients. A CQC notification under regulation 16 or regulation 18 does not discharge a RIDDOR report. The reverse is equally true. Filing one and assuming it covered the other is the most common reporting failure we see.
All new care homes require sprinklers following the Approved Document B amendment effective 2 March 2025. Existing homes are not retrospectively caught by that change. On the Building Safety Act, care homes are in scope for the Part 3 design and construction gateways yet excluded from the Part 4 in-occupation duties. A build or major refurbishment therefore carries gateway obligations that the occupied building does not.
Cost is driven by bed numbers, the number of compartments, dependency levels and whether you want a one-off assessment or ongoing support across a group. A single home fire risk assessment with an evacuation strategy review is normally a day on site and a report within a fortnight. A group wide programme is priced per home and phased. Retainers start at £95 per month plus VAT on a minimum twelve month term. Call us and we will scope it properly.
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