Mast Safety has recently been carrying out the annual Health & Safety audit programme for Lodge Group Care, a care provider running residential homes, supported living and domiciliary care services across London and Essex. It is work that has prompted us to set out our thinking on a sector we are increasingly active in, because care settings raise a compliance problem that almost no other workplace does.
In a factory, the people at risk are the people being paid to be there. In a care home, they are not. The building is a workplace and somebody’s home at the same time, and the people most likely to be seriously hurt in it are often the people least able to protect themselves. That single fact changes how every duty in the Health and Safety at Work etc. Act 1974 lands.
Care settings carry two sets of duties at once
Every employer owes a duty to its staff. Care providers owe that duty in an unusually demanding form, because care work is physically heavy, emotionally draining, frequently carried out alone and often carried out at night. Musculoskeletal injury, work-related stress, violence and aggression, and lone working all sit near the top of the risk profile.
Alongside that sits a second duty, under section 3 of the Act, to people who are not employees but who are affected by the work. In a care setting that means residents, service users, visiting families and contractors. Unlike most section 3 duties, this one applies to people who may have limited mobility, cognitive impairment, unpredictable behaviour, or no capacity to recognise a hazard at all.
The result is that a control measure which would be perfectly adequate anywhere else can be inadequate here. A hot tap is a hot tap in an office. In a care home it is a scalding fatality waiting to happen.
The regulator question: who actually enforces what
This is the part providers most often get wrong, and it matters because it determines who turns up after an incident.
Under the memorandum of understanding between the Care Quality Commission, the Health and Safety Executive and local authorities in England, which has been in force since April 2015 and was refreshed more recently, responsibility splits according to who was harmed rather than what harmed them.
- A service user is harmed by unsafe care or treatment at a registered provider. CQC normally leads. It can prosecute directly for breaches of the fundamental standards, including Regulation 12 on safe care and treatment and Regulation 15 on premises and equipment, without serving a warning notice first.
- A member of staff is harmed. That is worker safety, and it stays with HSE or the local authority depending on the setting.
- The activity is not a registered one. HSE or the local authority leads.
- A children’s home is involved. That is Ofsted, under an entirely separate regime.
So a single defective hoist can be a CQC matter or an HSE matter depending on whether it drops a resident or injures the carer operating it. Providers running a mixed portfolio can find themselves accountable to three or four different bodies for what is, in engineering terms, exactly the same failure. RIDDOR reports are also passed on: CQC inspectors receive them via HSE and local authorities, so a worker injury report does not stay in the worker safety lane.
None of that is a reason to despair. It is a reason to audit against the underlying hazard rather than against any single regulator’s checklist, because the hazard is what all of them are ultimately looking at.
A Health & Safety audit is not a CQC inspection
It is worth being blunt about this, because the two get conflated constantly.
A CQC assessment looks at the quality and safety of care against the key questions, currently through the single assessment framework and, from later this year, through sector-specific frameworks with new lines of enquiry and rating characteristics in place of numerical scoring. It is a judgement about the service.
A Health & Safety audit is a different instrument. It tests whether your statutory Health & Safety arrangements are actually working: whether the risk assessments are suitable and sufficient, whether the controls they specify exist in the building, whether the inspection and maintenance records support what the policy claims, and whether the people doing the work know any of it. It produces evidence, and evidence is what both regulators want to see.
The two are complementary rather than interchangeable. A strong audit programme feeds a CQC assessment, because it generates exactly the documented, dated, closed-out proof that inspectors ask for. But passing one does not mean you would pass the other.
What an annual audit should cover in a care setting
A generic workplace audit will miss most of what matters here. These are the areas that a competent audit of a care service should reach.
Moving and handling
The single largest source of injury to care staff, and a significant source of harm to service users. An audit should look past the training certificates to whether hoists, slings and profiling beds are correctly matched to the individual, whether slings are being inspected and withdrawn when worn, and whether handling plans in care records match the equipment actually in the room. Hoists used to lift people are lifting equipment for persons under LOLER, which means thorough examination every six months rather than annually. That interval is missed more often than any other in the sector.
Scalding, hot surfaces and the legionella tension
Where vulnerable people are at risk during whole body immersion, water temperature at the outlet must not exceed 44°C. Hot surfaces such as radiators and exposed pipework should not exceed 43°C where a vulnerable person could sustain a burn, which typically means covers or insulation.
Here is the complication that catches providers out. Legionella control pushes water temperatures up, with storage above 60°C and distribution above 50°C. Scalding control pushes them down. The two duties genuinely pull against each other, and the resolution is thermostatic mixing valves at the outlet, correctly specified, monitored and maintained. An audit that checks the legionella regime and the scalding regime separately, without checking that the TMVs reconciling them are actually working, has missed the point. This is also why care settings sit at the high-risk end for legionella generally: vulnerable occupants, and rooms that stand empty between placements with water sitting in the pipework.
Falls from windows
A recurring cause of fatalities in health and social care. Restrictors should limit the opening to 100mm or less and should be robust and of an approved type. Initial-opening restrictors, the kind that can be released to open the window fully, are not suitable in social care premises where people are at risk of falling or climbing out. HSE has also issued a safety alert about side-stay restrictor mechanisms failing in service, so the audit question is not only whether restrictors are fitted but whether they have been physically tested recently. Assessments should account for furniture that a resident could climb, and any restriction needs to be balanced with adequate ventilation in warm weather.
Fire
Care premises are among the most demanding fire safety environments in the country, because the strategy usually cannot be simultaneous evacuation. Progressive horizontal evacuation, dependable compartmentation, personal emergency evacuation plans for individual residents and staffing levels that make the strategy deliverable at three in the morning all have to hold together. This sits under the Regulatory Reform (Fire Safety) Order 2005 and is assessed through a fire risk assessment rather than through a Health & Safety audit, but an audit should confirm that the assessment exists, is current, and that its action plan has actually been closed out.
Slips, trips and falls
Wet floors during personal care and cleaning routines, thresholds, trailing equipment leads, lighting levels and floor surface changes. Ordinary hazards with far higher consequences given the occupants.
Violence, aggression and lone working
Distressed behaviour is a foreseeable occupational risk in many care settings, not an unfortunate surprise. Domiciliary carers working alone in other people’s homes, and night staff working with minimal cover, need arrangements that have been assessed and tested rather than assumed.
Equipment, premises and competence
Electrical installation and portable appliance testing, gas safety, lifting equipment, window and door safety, asbestos management in older buildings, and evidence that whoever is discharging the Health & Safety function has the training and standing to do it. Every employer must appoint one or more competent persons to assist with statutory duties, and in a care group that role frequently lands on a registered manager who is already carrying a full clinical and regulatory workload.
Portfolios are harder than single sites
Providers rarely operate one building. Lodge Group Care is fairly typical of the pattern: residential care for adults, a children’s home, supported living delivered with housing association partners, and domiciliary care into people’s own homes. Each of those carries a different regulator, a different physical environment and a different risk profile, and the domiciliary side involves no Mast-controlled premises at all.
Auditing that consistently is a different exercise from auditing one care home well. The value is not only in finding faults at each site but in seeing which faults repeat, because a control that has failed at three sites out of five is a management system problem rather than a maintenance problem, and it will be fixed at the system level or not at all.
Why 2026 is a poor year to leave this alone
Regulatory visibility in adult social care is rising sharply. CQC is working through a substantial recovery and reform programme following the Dash and Richards reviews, has committed to publishing 9,000 assessments by the end of September 2026, and reported inspection activity running roughly 50% higher in late 2025 than the year before. At the same time the assessment framework itself is being rebuilt, with sector-specific frameworks expected towards the end of the year.
The practical read for providers is straightforward. The quiet period is over, the chance of an assessment in the next twelve months is materially higher than it was, and the framework you are assessed against is going to shift underneath you. The fundamentals of safe premises and safe work do not shift, which is precisely why building the evidence base now is the sensible response to a moving target.
If you would like to understand the process in general terms, our Health & Safety audits page sets out how we approach it. We have taken a similar sector-first view of Health & Safety in hospitality, where the same logic of recurring, multi-duty compliance applies.
