Care home water temperature checks: legionella, sentinel taps and TMVs

Water in a care home has to be hot enough to stop legionella growing in the pipes, and cool enough at the tap or bath that it can't scald a resident who can't feel heat or move away from it. Getting both right means a written risk assessment, a few simple controls and a routine of checks that are actually recorded.

This guide gives you HSE's figures, what to check and how often, and log sheets you can copy.

The two risks

Legionella. The bacteria grow in water between about 20°C and 45°C, especially where water sits still: in dead legs, rarely used showers, warm cold-water tanks. Older people and those with weakened immune systems are at higher risk of legionnaires' disease. HSE's Approved Code of Practice L8 and its technical guidance HSG274 set out how to control it.

Scalding. Residents may have reduced sensitivity to heat, limited mobility or dementia. HSE says many scalding accidents have been fatal, mainly during bathing or showering, and that where vulnerable people are at risk during whole-body immersion, water must not exceed 44°C. Hot surfaces matter too: HSE says radiators and pipework that vulnerable people can touch should not exceed 43°C when the system is running at full output.

The two pull in opposite directions, which is why care homes store hot water hot and blend it down at the outlet with thermostatic mixing valves (TMVs).

The numbers (HSE guidance)

HSE's care-home guidance uses the 50°C distribution figure, while HSG274 gives 55°C for healthcare premises. Follow whatever your legionella risk assessment specifies. For baths and showers, HSE says TMVs should be fitted so water doesn't exceed 44°C. For washbasins, where the risk is lower, it says adequate controls on outlet temperature, such as TMVs, should be in place for people assessed as vulnerable. The 41°C shower figure you'll see quoted is an NHS requirement for NHS premises.

Law versus guidance

• The law: the Health and Safety at Work etc Act 1974, the Management of Health and Safety at Work Regulations 1999 and COSHH require you to assess and control the risk of legionella. In England, CQC's Regulations 12 and 15 require premises and equipment to be safe, suitable and properly maintained.
• The Approved Code of Practice (L8) has special legal status: if you don't follow it, you need to show you've done something equally effective.
• HSG274 and HSE's care home guidance (HSG220) are guidance, giving the temperatures and frequencies above.

What your legionella routine should include

1. A written legionella risk assessment by a competent person, reviewed regularly and whenever the system or the use of the building changes.
2. A named responsible person who manages the controls day to day.
3. A list of sentinel outlets and other monitoring points.
4. Monthly temperature checks of the sentinel outlets and stored hot water.
5. Weekly flushing of little-used outlets, including showers in empty rooms and en-suites of residents in hospital.
6. TMV checks and servicing, and shower head descaling and disinfection as your assessment requires.
7. Records of every check, with readings, who did it and what you did about anything out of range.

Log sheet 1: monthly sentinel outlet temperatures

Month: ____________ Thermometer used: ____________

Log sheet 2: weekly flushing of little-used outlets

Write the date and your initials in each box. Run outlets long enough to draw fresh water through, as your risk assessment sets out, avoiding spray where you can.

Log sheet 3: TMV and bath temperature checks

Staff should also check bath water with a thermometer before every resident gets in, and record it where your policy requires.

Mistakes to avoid

• Checking the same convenient tap every month instead of the named sentinels.
• Forgetting empty rooms. An en-suite in a room that's been empty for three weeks is exactly where legionella grows.
• Writing "OK" instead of a reading. A number shows it was measured.
• Recording a failure and nothing else. An out-of-range reading needs an action: re-test, adjust, call the contractor.
• TMVs nobody has serviced. A failed TMV can let full-temperature water through to a bath.

Wales, Scotland and Northern Ireland

Legionella control is one of the areas where the rules are the same across Great Britain. L8 and HSG274 are HSE publications and the Health and Safety at Work etc Act 1974 applies in England, Wales and Scotland, so the temperatures, frequencies and records in this guide are the same in all three.

What changes is the care regulator that checks premises safety for residents:

• Wales: Care Inspectorate Wales, under the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017. Premises fall under the "environment" theme of its inspections. See our CIW inspection checklist.
• Scotland: the Care Inspectorate, which looks at the setting under the key question "How good is our setting?" in its quality framework. See our Care Inspectorate inspection checklist.
• Northern Ireland: RQIA for the care home, while health and safety law is separate and enforced by HSENI (or the district council for residential homes). HSENI's guidance for private nursing and care homes asks for legionella records. See our RQIA inspection checklist.

How ShiftComplete helps

ShiftComplete for care turns this routine into checks on a phone or tablet:

• Each sentinel outlet and TMV set up with its own target range; readings out of range are flagged on the dashboard.
• Weekly flushing of little-used outlets as a recurring task, with photos if you want them, named and timestamped.
• Due dates for your legionella risk assessment review and other certificates, with reminders.
• Everything recorded flows into your inspection pack, grouped under CQC's five key questions. See our CQC inspection checklist and our fire drill record.

£2.49 per active staff member per month, no minimum and no contract, free for 60 days with no card needed. See it on our care homes page.