Care Home Legionella Death Highlights Why Water Safety Compliance Cannot Be Left to Chance
The death of a 91 year old care home resident from Legionnaires’ disease has once again highlighted the importance of effective Legionella management in care settings.
As reported by the BBC, Rhoda Freedman contracted Legionnaires’ disease while living in a care home. At the subsequent inquest, a jury concluded that her death followed “numerous missed opportunities” which gave rise to the presence of Legionella bacteria within the home’s water system.
It is a deeply concerning case and, for those responsible for care homes and other settings accommodating vulnerable people, an important reminder of just how serious failures in water hygiene management can become.
Why are care home residents particularly vulnerable?
Legionella bacteria can develop within hot and cold water systems, particularly where water temperatures and conditions allow bacteria to multiply.
Legionnaires’ disease is a potentially fatal form of pneumonia. Infection usually occurs when a person inhales tiny droplets of contaminated water, which can be produced by showers, taps and other water outlets.
The Health and Safety Executive specifically identifies care homes as environments where occupants are likely to be at increased risk.
Older people and those with existing health conditions, weakened immune systems, chronic respiratory disease, kidney disease, diabetes or cancer can be particularly susceptible.
This means the management of Legionella within a care environment requires particular care and attention.
What does the HSE require?
For care home operators, managing Legionella is not simply a matter of good practice.
Employers and those responsible for premises have legal responsibilities under health and safety legislation, including the Health and Safety at Work etc. Act 1974 and the Control of Substances Hazardous to Health Regulations.
The HSE’s Approved Code of Practice L8 and its HSG274 technical guidance provide the framework for managing and controlling the risk.
Health and social care providers should carry out a suitable and sufficient COSHH risk assessment of their hot and cold water systems to establish who may be at risk and whether appropriate controls are in place.
A competent person should be appointed to take responsibility for controlling identified Legionella risks.
Where risks are identified, an appropriate written control scheme should be implemented. Monitoring, inspections and maintenance must then actually be carried out and properly recorded.
A risk assessment sitting in a file is not enough. The control measures identified within it have to become part of the ongoing management of the building.
Hot water hot. Cold water cold. Keep water moving.
Temperature remains one of the primary methods of controlling Legionella.
Current HSE guidance states that cold water should, where possible, be maintained below 20°C.
Hot water should be stored at 60°C or above.
For general hot water systems it should reach at least 50°C within one minute at outlets. HSE technical guidance specifies 55°C for healthcare premises, reflecting the increased vulnerability of people within these environments.
Care must also be taken to manage the risk of scalding, particularly where vulnerable residents are concerned, which may require appropriate thermostatic mixing valves.
Temperature is only part of the picture.
Water stagnation can create conditions in which bacteria are able to proliferate. Little used outlets therefore need to be identified and appropriately flushed, while showerheads should be cleaned and descaled.
Water storage, pipework, calorifiers and the overall condition and design of the system also need to form part of an effective Legionella management programme.
Monitoring and records matter
One of the important messages from cases involving Legionella failures is that identifying a risk is only the beginning.
The HSE expects organisations to be able to demonstrate that their control measures are being implemented.
Depending on the system and the findings of the risk assessment, this can include:
- Routine temperature monitoring
- Inspection of water storage systems
- Flushing of infrequently used outlets
- Showerhead cleaning and descaling
- Inspection and maintenance of calorifiers
- Water sampling where appropriate
- Remedial works where problems are identified
- Recording actions and monitoring results
- Reviewing the risk assessment when circumstances change
Changes to a building, its water system or the people using it can all affect the level of risk and should prompt consideration of whether the existing assessment remains suitable.
How LFS supports care providers
At Legionella & Fire Safe Services, we work with care providers, housing organisations, local authorities and organisations across the UK to manage water hygiene and Legionella risk.
With over 40 years of industry experience, our teams provide practical support from the initial assessment of a water system through to ongoing monitoring and remedial works.
Our Legionella and water hygiene services include:
Legionella Risk Assessments
Detailed assessment of hot and cold water systems to identify potential areas of risk and establish appropriate control measures.
Water Hygiene Monitoring
Ongoing monitoring programmes designed around the building, its water system and the level of risk identified.
Temperature Monitoring
Checking that hot and cold water systems are operating within the appropriate control parameters.
Water Sampling and Testing
Sampling programmes where required, with results used alongside the wider water management and control strategy.
Tank Cleaning and Disinfection
Inspection, cleaning and disinfection of cold water storage tanks and associated systems where required.
Flushing Programmes
Management of little used outlets to reduce stagnation and maintain water movement.
Remedial Plumbing Works
Identification and correction of problems such as redundant pipework, dead legs and other system issues that may increase Legionella risk.
Training and Compliance Support
Helping responsible persons and site teams understand their responsibilities and the practical measures required to manage water hygiene effectively.
Care home compliance extends beyond water safety
LFS also provides comprehensive fire safety services, allowing care providers to work with one experienced compliance partner across two of the most important areas of building and resident safety.
Our fire safety services include fire risk assessments, fire door inspections and surveys, fire door maintenance and installation, passive fire protection and fire stopping works.
For care providers, both areas require more than paperwork. They require active management, competent people and clear evidence that identified risks are being addressed.
Compliance protects people
The circumstances surrounding the death of Rhoda Freedman are a sobering reminder of why Legionella controls exist.
Care homes accommodate some of the people most vulnerable to the effects of Legionnaires’ disease. Water safety therefore cannot become something that is reviewed once and then forgotten.
Risk assessments need to remain current. Monitoring needs to happen when it should. Records need to be maintained. Problems need to be acted upon.
Most importantly, the people responsible for those systems need to understand the risks they are managing.
At Legionella & Fire Safe Services, our role is to help organisations understand those risks, put the correct controls in place and maintain them over the long term.
If you are responsible for a care home or healthcare setting and would like to review your current Legionella risk assessment, monitoring programme or water hygiene compliance, speak to the LFS team.
Legionella & Fire Safe Services
0800 080 3045
Keeping buildings compliant and people safe.
Everyone at Legionella & Fire Safe Services would like to extend our sincere condolences to the family and loved ones of Rhoda Freedman. Behind the findings of an inquest is a family who have lost someone they loved, and our thoughts are with them. We hope that the lessons highlighted by this tragic case lead to greater awareness and help prevent another family experiencing such a devastating loss.
