CHAPTER 3: CARE HOME RESIDENTS AND STAFFING
59. Care homes often pose special problems in respect of fire as a result of the nature of the residents. Many homes accommodate residents who require assistance, and in some cases considerable assistance, due to infirmity, lack of mobility, impaired awareness and/or lack of understanding. Elderly and infirm persons are also particularly susceptible to the effects of smoke and toxic gases produced in a fire.
60. Even mobile residents may present difficulties. They may be asleep or on medication when a fire starts and this may affect their ability to respond to an emergency.
61. In this guide, the term 'dependency' is used to mean a resident's ability to understand and physically respond to a warning of fire. The provision of fire safety measures will be influenced by the dependency category of residents. For the purposes of this guide, three categories of dependency are used:
- Low dependency describes residents who have the physical and mental capability to respond to a fire emergency and exit the premises unaided or with minimal staff assistance.
- Medium dependency describes residents who either:
(a) require physical assistance or guidance from a staff member to respond appropriately in a fire emergency; or
(b) can exit the premises unaided, but will take an extended time to achieve this.
- High dependency describes residents who are totally dependent on staff and may require the assistance of two or more staff members in a fire emergency.
62. In some cases, a person's dependency will be influenced by their particular circumstances and by their location in, and familiarity with, the premises.
63. The personal evacuation needs of residents should be considered. Many care homes will have residents with varying levels of dependency, and their mobility and responsiveness should be considered. The assistance required and the method of movement in an emergency should be established. Needs may vary over time as the mental and physical capability of residents change and evacuation needs should therefore be kept under review.
64. One of two recognised evacuation strategies may be appropriate for the premises, either Immediate Evacuation or Progressive Evacuation. The strategy adopted will depend principally on the dependency of residents, the number of staff available to assist with evacuation and the layout and construction of the premises.
65. Immediate evacuation describes a situation where, upon discovery of a fire and a warning being given, the emergency fire action plan (see Chapter 4) involves immediate evacuation of the whole building.
66. Progressive evacuation is evacuation in a controlled sequence, with those within the building who are at greatest risk being evacuated directly to another part of the building through a fire door(s) into another sub-compartment (see Chapter 6) within the building where, for a time, they would be relatively safe from the effects of fire in its initial stages. This movement would normally be to a separate sub-compartment on the same floor, if the premises layout and the location of the fire allowed this option.
67. Upon discovery of a fire and a warning being given, progressive evacuation involves:
a. Carrying out an assessment of the situation to determine the fire location and who may be at immediate risk;
b. Deciding if there is a need to evacuate the sub-compartment involved;
c. Deciding if there is a need to evacuate any other persons threatened by fire; and
d. Progressive movement of residents to lower risk areas (including the open air), as needed, as the situation develops.
68. For care homes with high dependency residents, a progressive evacuation strategy will be the only realistic option due to the difficulty in moving residents and the extended evacuation time. A progressive evacuation strategy needs to be accompanied by suitable fire safety measures which will ensure that the development and spread of fire is restricted, that early warning of fire is given, and that appropriate action is taken by staff.
69. The level of fire safety measures may dictate which evacuation strategy could be achieved and subsequently what category of resident can be accommodated. Certain parts of a building may not be suitable for high dependency residents. This can pose difficulty in the long term where a resident's dependency may change over time.
70. The evacuation of residents when fire occurs is the responsibility of staff and not the Fire and Rescue Service, the role of which is to tackle the fire, and rescue residents only if the pre-defined evacuation strategy has failed.
71. The care home management should have an evacuation strategy and have evidence that staffing levels in relation to implementation of the emergency fire action plan has been considered. In all cases, there should be sufficient staff available to ensure the safety of residents and that residents can be moved safely (from any sub-compartment to an adjoining sub-compartment or other safe place from which further escape is possible or to a place of ultimate safety), consistent with the strategy adopted.
72. The demands on staff to provide physical assistance during an evacuation of residents may be challenging. It can be difficult to assess what staff may be able to physically achieve if confronted with a fire situation, particularly where there is a need to move residents urgently.
73. Although staffing levels may be determined purely for care provision needs, there also needs to be consideration of the number of staff required to carry out an evacuation and consider the time and effort required to move residents with varying degrees of dependency to a place of temporary safety if a fire occurs. A small number of staff cannot be expected to move large numbers of high dependency residents. Difficulties are likely to be more severe at night with reduced staffing levels. In some homes, there may be a complex relationship between the dependency of residents, the potential for different fire scenarios, the effectiveness of fire safety measures and the ability of staff to deal with the situation.
74. The number of high dependency residents in a single sub-compartment should be capable of being evacuated by the members of staff on duty at night, before fire makes evacuation impractical. Having a mix of low dependency and high dependency residents may allow easier evacuation.
75. Each individual resident should be considered in respect of where they could be located to minimise their dependency in the event of fire. Where there is a mix of residents with different dependencies, there may be potential to locate high and medium dependency residents in rooms which offer the least difficulty for evacuation or where the threat from fire is least. This may be on the ground floor and/or in the smallest sub-compartment. It may be difficult to relocate residents from existing locations and friends, since a move could cause confusion and isolation.
76. There is a need to consider the supervision and welfare needs of residents in the event of evacuation and what effect the supervision requirements of early evacuees may have on staff actions.
77. Care providers should consider any issues that may arise with high staff turnover or where there is infrequent use of bank staff.
78. Staff should be made aware if residents have known behavioural issues relevant to fire safety. This could be behaviour such as careless use of smoking materials, attempts to start fires, potential for wandering off, or an agitated or confused reaction to the sound of the fire warning system. Some residents in care homes may, prior to admission, have been identified as being particularly at risk from fire when in their own home. Where known, this type of background information should be passed on to the care home manager to enable suitable risk control measures.
79. There may be a need to protect some residents from harm where there is the potential for falls or wandering off. In such cases, and in the case of security against unauthorised entry, it is important that measures do not compromise the operation of the emergency fire action plan or potential fire and rescue service operations. Equally, the design and operation of fire safety measures should not cause risk to residents from hazards other than fire.
80. There are two elements of residents' record keeping that may be necessary:
i A 'fire register' containing up-to-date operational information on residents as may be necessary for use during a fire evacuation; and
ii. Within the assessment record of each person in care, a record of the specific consideration given to fire safety issues and personal evacuation needs as necessary
to meet management's needs for pre-planning.
81. Additionally, it is good continuity practice to have a grab bag of essential information on residents that would be needed if evacuation required the relocation of residents. Alternatively such information could be kept accessible at another physical location.
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