Care home at night: stay-put under strain
A 60-bed residential care home over two floors was built in 1985 and uses a 'stay-put' evacuation strategy. Each bedroom has a 30-minute fire door and the building is divided into four 30-minute compartments; the alarm is L1 with detection in bedrooms and communal areas. At night, two carers and one nurse are on duty for 60 residents; 22 residents have dementia and 14 are unable to walk without assistance. The home has no sprinklers. During a night visit you observe: a fire door to a linen store is held open with a wedge; a resident's electric recliner chair is plugged into an extension lead under a carpet; the nurse cannot locate the fire plan or the personal emergency evacuation plans for three new residents; the external escape stair from the first-floor lounge has a broken handrail and leaves are piled at the bottom; and staff have not had a fire drill at night for over two years. The local fire and rescue service has not visited for four years.
1. Evaluate whether the stay-put strategy remains appropriate, supporting your judgement with the deficiencies observed.
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Stay-put can be appropriate in a care home where compartments are maintained and staff can support residents, but it is conditional. The building has 30-minute compartments and an L1 alarm, which are positive features. However, the observed deficiencies undermine the strategy:
- A wedged linen-store door and a defective self-closing flat door can let smoke into a compartment or escape route.
- Three new residents have no PEEPs, and 22 residents have dementia; staff may not know who needs help or how to move them.
- Night staffing of two carers and one nurse for 60 residents, including 14 non-ambulant people, is unlikely to support timely progressive horizontal evacuation if a compartment is affected.
- The external stair handrail is broken and the bottom is obstructed, so horizontal evacuation may be possible but vertical evacuation is not.
- No night drill for over two years means staff competence is unproven.
The judgement is that stay-put cannot be relied on as currently managed. It may remain the basis of the emergency plan only if the fire doors, compartments, staffing, PEEPs and drills are made robust and the fire and rescue service is consulted. Until then, the home should plan on progressive horizontal evacuation to a protected compartment and, where necessary, full evacuation, and should consider interim measures such as additional night staff or a fire watch.
2. Recommend actions to improve evacuation capability for residents, including night-time arrangements.
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Actions should build evacuation capability around the residents who are least able to self-evacuate:
Immediate
- Close and repair the linen-store door; repair or replace the defective flat door; remove the obstruction from the external stair and repair the handrail.
- Remove the extension lead and reposition the recliner; check for other daisy-chained leads.
- Locate or create PEEPs for the three new residents, and review all 60; include mobility, dementia, hearing/vision, medication and equipment needs.
- Brief night staff on the current evacuation plan and the location of evacuation equipment.
Short-term
- Increase night staffing or provide an on-call arrangement until competence is demonstrated; run a night drill and record timings, defects and lessons.
- Provide evacuation chairs/sheets and train staff in their use; identify refuges and protected compartments.
- Fit signage and emergency lighting on escape routes; check door hardware and self-closers.
- Consult the fire and rescue service and insurer; update the emergency plan.
Longer-term
- Introduce a rolling programme of PEEP reviews and drills, including dementia-specific scenarios.
- Consider sprinklers and enhanced detection in bedrooms; review compartmentation.
- Audit records monthly and report to the responsible person.
The reasoning is that a stay-put or horizontal-evacuation plan depends on staff being able to buy time; without PEEPs, equipment and drills, the plan is only a document.