Are you in control of your stair access points?

Introduction

Most care homes have staircases between the various building levels. Whilst some residents may be mobile enough to use staircases, most will use a passenger lift either by themselves or with staff assistance. Stairs can be dangerous for those who are unsteady on their feet or who have poor vision, though a number will want to keep their independence even if it is difficult for them to negotiate. At times, residents could lose their balance, misjudge a step or simply trip causing them to fall, sometimes with devastating or fatal consequences. Managers and staff need to be aware of the impact stairs pose on vulnerable adults, not only those who are unsteady, but those who wander in a state of confusion.

What factors do I need to consider?

As part of weekly maintenance checks, you should include staircase conditions and their surrounding environment. In particular, you should consider the following:

• Is the area well lit (do any lights need replacing) – this includes ensuring there are sufficient emergency lights which are working. (Remember in an evacuation, passenger lifts cannot be used, resulting in the need for evacuation chairs or sledges)
• Check for shadows created from skylights affecting visibility (consider blinds to reduce glare)
• Check handrails which must be firmly attached on both sided – check that they are not loose or damaged. Handrails must be in line with each other and at least 910mm high from step to rail, thus preventing the likelihood of falling over the rail
• Check the stair treads (steps) for damage or wear, check for shiny or slippy surfaces, and ensure that nose cappings are non-slip and a different colour to the steps so levels are clearly defined. Nose cappings must also be of photoluminescent material
• Remove any obstacles from stairs and stairwells. Have designated wheelchair, mobility scooter and walking frame bays so they do not obstruct stairwells
• Consider the height of each step and that the gradient is not too You must not have open risers or be curved stairs. Any mid-point landing must not be too short and stairs need to be wide enough to access
• For details of stair construction and design, the Building Regulations 2010 Approved Document K sets out the requirements needed.

Further guidance can be found from ‘Reducing the risk of falls on stairs’ from the HSE website at here

What safeguarding issues do I need to consider?

Falls of frail and vulnerable residents can be a real consideration in care homes and residential units, given that some can get confused and wander the corridors. A number of safeguards need to be in place to protect residents from harm, as well as keeping unwanted visitors to the home.

In order to safeguard vulnerable residents, the following need to be considered:

• All access doors to staircases need to be secured via keypads – in fact, all areas of risk i.e. kitchens, cellars, externals doors, plant rooms, workshops etc. must be secured via keypads
• Staff need to be vigilant at all times, be mindful of possible tailgating and suspicious activities
• All access doors should be alarmed to alert staff of movement that could pose risk and should be able to respond
• CCTV monitoring of external building and communal areas can assist in monitoring potential accident trends and security considerations. Remember you must comply with CCTV legislation, data protection and display appropriate signage
• All access doors must have emergency release systems to comply with fire regulations should be fire alarm be raised
• Resident rooms should be on a nurse call alarm to monitor resident movement

Risk Assessment and Care Planning

Like all safety control measures to ensure the protection and welfare of vulnerable residents, individual resident risk assessments and care plans should outline the residents need and what measures need to be put in place for their safety and wellbeing. Consideration should be given to maintaining as fuller independence as possible and assessments should be done with the resident, care professionals and family representatives. All assessments are live and thus reviewed periodically, when a significant change takes place or should the resident, family representative or care professionals wish to consult, regarding the current measures in place. A simple solution could be assistance to walk up and down the stairs with a carer.

Show me the legislation?

All care providers and home care managers have a legal duty to ensure the safety and wellbeing of the resident. The key piece of legislation is the Health and Safety at Work Act Section 3 (1) which cites the following:

“It shall be the duty of every employer to conduct his undertaking in such a way as to ensure, so far as is reasonably practicable, that persons not in his employment who may be affected thereby are not thereby exposed to risks to their health or safety.”

The resident would be the person “not in the employer’s employment” who could be exposed to risk.

Summary

Health and Social Care providers and managers are responsible for ensuring that stairs of their premises are safe to use and that residents are not exposed to undue risk by having proportionate and reasonable control measures in place for their safety and wellbeing. This does not mean withdrawing a resident’s independence from them, however having measures in place that ensures residents can lead fuller lives as much as possible.