Reading Borough Council (RBC) has been fined £100,000 following an investigation into the death of a pensioner who died from exposure to legionella. The resulting investigation discovered failings which were systemic and continued over a period of time.
During the Health and Safety Executive (HSE) prosecution, Reading Magistrates’ Court heard how Mr Lewis Payne, a 95-year-old vulnerable gentleman, arrived at RBC operated care facility, The Willows, on 24 September 2012.
Mr Payne was attending The Willows to receive immediate care having previously been in hospital after suffering a broken leg.
However, during his stay he began feeling unwell, complaining of aches and pains including tightness of the chest, shortness of breath and difficulty in breathing. He was also suffering from nausea.
On 16 October 2012 he was re-admitted to hospital and a sample proved positive for the presence of Legionella. He underwent treatment for Legionnaire’s disease, but died on 1 November 2012 from pneumonia related to legionella.
The prosecution said robust controls and management arrangements are needed to ensure that the risk of legionella is minimised. The court was told, prior to November 2012, RBC’s arrangements were not robust enough in a number of areas.
The findings were as follows:
- The level of Legionella training for the key personnel at The Willows was significantly below the standard required;
- there were inadequate temperature checks and some of those done with respect to Thermostatic Mixer Valves (TMVs) were done incorrectly;
- Descaling and disinfecting of showerheads were not conducted on a quarterly as required;
- Procedures for flushing of little used outlets were ineffective when the sole person who conducted the checks were absent.
- The premises which was formally known as Tanfield Care Home had a history of previous problems with Legionella which had not been suitably addressed.
- There was no system in place to cover the handyman when he was away so that the requisite checks were not done.
Reading Borough Council, Civic Offices, Bridge Street, Reading admitted breaching Section 3(1) of Health and Safety at Work etc. Act 1974 and was fined £100,000 with £20,000 costs in Reading Crown Court.
On the HSE’s website it was said: “The risks from legionella in nursing and care homes and the required control measures to manage those risks have been know and publicised in HSE publications since May 2000. It is really disappointing to find a local authority not managing those risks. It is important for all care providers to ensure they are managing the risks from hot and cold water systems with respect to both legionella and scalding risks especially due to likely exposure of more vulnerable people.”
Requirements to limit exposure to prosecution:
1) Ensure that company health and safety policy in relation to Legionella management is reviewed on a routine basis.
2) A Legionella risk assessment must be conducted with reviews to be conducted at least on an annual basis.
3) The relevant members of the team who are responsible for management of Legionella controls to be trained to the appropriate level.
4) Suitable staffing cover to always be available for Legionella management in the likelihood where the competent person goes on holiday or is away from the business. Again ensure that any person fulfilling this function is trained to the required level.
5) Ensure that routine hot and cold water temperature holding checks are conducted on an monthly basis with any defects immediately attended to. Hot water to be held above 50 deg.C and cold water to be held below 20 deg.C.
6) All shower heads to also be cleaned and descaled in the specified time scales.
7) Ensure that all internal health and safety checks are documented with corrective action taken where required. All planned maintenance and statutory inspections requirements pertaining to the water heating/cooling systems must be complied with.
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