Care homes must control legionella under the Health and Safety at Work etc. Act 1974 and COSHH 2002, following ACOP L8 and HSG274 Part 2. The core frequencies are weekly flushing of little-used outlets, monthly temperature checks, quarterly showerhead cleaning, six-monthly tank temperature checks and annual tank inspection. Sampling is advised where residents are susceptible or control is not achieved. Records are kept for at least five years.
The legal duty
Care homes carry a higher legionella risk than most buildings for two reasons that compound. The residents are older and often have underlying conditions, so they are more susceptible to Legionnaires' disease. The building has many outlets, long pipe runs to en-suite bathrooms, thermostatic mixing valves that deliberately blend water into the growth range, and rooms that stand empty between residents. The control regime must be tighter than an office and the records must be complete.
The duty comes from the Health and Safety at Work etc. Act 1974 and the Control of Substances Hazardous to Health Regulations 2002, which require the duty holder to identify and assess the risk from legionella, prepare a written scheme to control it, implement and monitor the scheme, and keep records. ACOP L8 (fourth edition, 2013) is the approved code of practice. HSG274 Part 2 is the technical guidance for hot and cold water systems and is the document your water hygiene contractor should be working from. In England the Care Quality Commission expects water safety evidence under Regulation 12 (safe care and treatment) and Regulation 15 (premises and equipment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The risk assessment is the starting point. Our legionella risk assessment guide covers what it must contain and who is competent to do it. This guide covers what happens after: the monitoring frequencies, the care-home-specific controls and the records.
The monitoring schedule under HSG274 Part 2
HSG274 Part 2, Table 2.1, sets out the checks for hot and cold water systems. The frequencies below are the guidance defaults. The written scheme may tighten them where the risk assessment justifies it, and the assessment for a care home frequently does.
Legionella monitoring frequencies for hot and cold water systems in care homes
| Check | Frequency | Target or action |
|---|---|---|
| Flush little-used outlets (vacant bedrooms, spare en-suites, staff showers) | Weekly, or more often if the risk assessment requires | Run until temperature stabilises; record each flush |
| Sentinel outlet temperatures (nearest and furthest from calorifier on each loop) | Monthly | Hot reaches 50 degrees Celsius within one minute; cold at or below 20 degrees Celsius within two minutes |
| Representative outlets on rotation | Monthly, covering all outlets over a year | As above |
| Calorifier flow and return temperatures | Monthly | Flow at or above 60 degrees Celsius; return at or above 50 degrees Celsius |
| Calorifier internal inspection and drain-down for debris | Annually | Clean and disinfect if scale or sediment found |
| Point-of-use water heaters | Monthly | Outlet at or above 50 degrees Celsius |
| Thermostatic mixing valves | Annually, or per manufacturer | Service, check fail-safe, confirm blended temperature at or below 44 degrees Celsius |
| Showerheads and hoses | Quarterly, or as fouling rate dictates | Dismantle, clean, descale, disinfect |
| Cold water storage tank temperature | Six-monthly | At or below 20 degrees Celsius, checked remote from the inlet |
| Cold water storage tank internal inspection | Annually | Check lid, insect screen, debris, scale, biofilm; clean and disinfect if required |
| Expansion vessels | Six-monthly to annually per manufacturer | Flush through where design allows |
| Strainers and filters | Annually | Clean |
| Risk assessment review | Regularly, and on any trigger | See review section below |
Where a care home has continuous temperature monitoring fitted, the monthly manual checks can be reduced in line with the written scheme, but the sentinel and calorifier data still need reviewing and recording monthly.
Care-home-specific controls
Scalding versus legionella. The tension in care homes is that legionella control needs hot water at 50 degrees Celsius or above at outlets, while resident safety needs bathing water at no more than 44 degrees Celsius. HSE's information sheet HSIS6 resolves it: keep the distribution hot and fit thermostatic mixing valves as close to the outlet as possible, with Type 3 valves (TMV3, the NHS D08 specification) for whole-body immersion. The valve then becomes a legionella control point because the blended pipework downstream sits in the growth range. It must be short, it must be flushed, and the valve must be serviced annually and its fail-safe tested.
Vacant rooms. Bedrooms turn over. A room empty for two weeks has stagnant water in every outlet. The written scheme must assign responsibility for weekly flushing of vacant rooms, and the flushing log must exist and be complete. This is the single most common gap found in care home water records.
Hoists, baths and specialist equipment. Assisted baths, spa baths and hydrotherapy equipment have their own guidance under HSG274 Part 3 and, for spa pools, HSG282. They need their own section in the risk assessment.
Sampling. HSG274 Part 2 does not require routine microbiological sampling of well-managed hot and cold water systems. It does advise sampling where control measures are not consistently achieved, where there is reason to suspect the risk assessment is no longer valid, and where the population is particularly susceptible. A care home population is particularly susceptible, so many operators run a sampling programme as a management standard, commonly quarterly at rotating outlets. The frequency is a risk assessment decision, not a statutory interval, and the assessment should record the reasoning.
Action levels for legionella results in hot and cold water systems (HSG274 Part 2)
| Result (colony forming units per litre) | Required action |
|---|---|
| Not detected, or up to 100 | System under control; continue the scheme |
| More than 100, up to 1,000 | Resample; review control measures and risk assessment; if the majority of samples are positive, disinfect and review |
| More than 1,000 | Immediate review of control measures and risk assessment; disinfect the system; resample |
In a care home the operator should also take clinical advice on the exposure of residents when a result exceeds the action level, and consider whether the local health protection team should be informed.
Reviewing the risk assessment
ACOP L8 removed the old two-year default and replaced it with a duty to review regularly and whenever there is reason to suspect the assessment is no longer valid. The triggers that should force a review in a care home are:
- any alteration to the hot or cold water system, including new en-suites, new TMVs, tank replacement or a new calorifier;
- a change in occupancy, such as a wing reopening or a change in the dependency of residents;
- monitoring results outside target for two consecutive months at any outlet;
- a positive sample above the action level;
- a suspected or confirmed case of legionellosis associated with the home;
- new guidance from HSE;
- a change in the competent person or the contractor.
Absent a trigger, a documented periodic review by the responsible person, with a full reassessment by a competent assessor at an interval the assessment recommends, is what inspectors expect to see.
Records: what CQC and the enforcing authority will ask for
ACOP L8 requires that the risk assessment, written scheme, allocation of responsibilities and training records are kept while current and for at least two years after, and that monitoring, inspection, test and check records are kept for at least five years. In practice a care home should be able to produce the following within the hour:
- The current legionella risk assessment and its review history.
- The written scheme, naming the responsible person and the deputy.
- The schematic of the water system.
- Twelve months of monthly temperature logs with no gaps.
- The weekly flushing log for vacant rooms.
- TMV service records with fail-safe test results.
- Showerhead cleaning records.
- Tank inspection and cleaning reports.
- Sampling results and the actions taken on any exceedance.
- Training records for staff who take temperatures and flush outlets.
The Care Quality Commission inspects under Regulation 12 and Regulation 17 (good governance). An incomplete log is treated as a governance failure, and it is the governance failure, not the legionella count, that most often appears in inspection reports. Our care home compliance checklist shows how the water regime sits alongside fire, electrical and lift duties, and our duty holder guide explains how the responsible person role is allocated.
Procurement points
- Buy the monitoring as a defined scope. The contract should list every check in the table above with its frequency, the outlets covered, and the reporting format. A vague "monthly legionella visit" is not a scope.
- Ask who does what. In-house staff can take temperatures and flush outlets if trained. The contractor should provide training records, not just do the work.
- Require a portal or a log you own. Records must be retrievable by your team, not held by the contractor.
- Check competence. The Legionella Control Association code of conduct is the recognised standard for water treatment and hygiene service providers. Ask for the LCA registration and the individual competence of the assessor.
- Separate assessment from remediation where you can. The assessor who identifies dead legs should not be the only firm quoting to remove them.
Related reading: the managing agent compliance obligations guide if a third party runs the site for you.
Working with TICDesk
TICDesk is a UK procurement desk for testing, inspection and compliance work. Tell us the number of homes and outlets, the current state of your records and your deadline, and we introduce up to three vetted water hygiene providers, typically within 48 hours. The service is free to the client; TICDesk earns a success fee from the contractor. Visit our water hygiene desk or open a brief.
Frequently asked
How often should a care home test for legionella?
The routine regime under HSG274 Part 2 is weekly flushing of little-used outlets, monthly temperature checks at sentinel outlets and at the calorifier flow and return, quarterly cleaning and descaling of showerheads and hoses, six-monthly cold water storage tank temperature checks and an annual internal tank inspection. Microbiological sampling is not a fixed-frequency requirement, but HSG274 advises considering it where occupants are particularly susceptible, which describes a care home, and where temperature control is not being achieved.
Is legionella testing a legal requirement for care homes?
Controlling the risk is a legal requirement. The Health and Safety at Work etc. Act 1974 and the Control of Substances Hazardous to Health Regulations 2002 require the duty holder to assess and control the risk from legionella. ACOP L8 is the approved code of practice and HSG274 Part 2 the technical guidance for hot and cold water systems. The Care Quality Commission also expects evidence of water safety management under Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
What temperatures should care home water systems run at?
HSG274 Part 2 sets hot water storage at 60 degrees Celsius or above, hot water distribution reaching 50 degrees Celsius within one minute at outlets, and cold water at 20 degrees Celsius or below within two minutes. Because residents are at risk of scalding, HSE guidance HSIS6 requires water at outlets used for bathing and showering vulnerable people to be limited to 44 degrees Celsius, achieved with thermostatic mixing valves. The valves themselves need annual servicing and their fail-safe checked.
How often should the legionella risk assessment be reviewed in a care home?
ACOP L8 requires the risk assessment to be reviewed regularly and specifically whenever there is reason to suspect it is no longer valid, for example after a change to the water system, a change in the use of the building, new information about risks, a case of legionellosis, or monitoring results that show control is not being achieved. The older two-year default was removed in the 2013 edition. Many care operators still adopt a two-year review as a management standard, which is a policy choice, not a legal interval.
What happens if a legionella sample comes back positive?
HSG274 Part 2 gives action levels for hot and cold water systems. A result above 100 but not more than 1,000 colony forming units per litre requires the system to be resampled and the control measures and risk assessment reviewed. A result above 1,000 colony forming units per litre requires immediate review of the control measures and risk assessment and disinfection of the system. In a care home, the operator should also consider clinical advice given resident susceptibility.
How long must care homes keep legionella records?
ACOP L8 states that records of the risk assessment, written scheme and responsibilities should be retained throughout the period they remain current and for at least two years afterwards, and that records of monitoring, inspection, test and check results should be retained for at least five years. CQC inspectors and the enforcing authority will ask for these, and gaps in the monthly temperature log are the most common finding.
Who enforces legionella control in care homes?
Health and safety enforcement in care premises is allocated between the Health and Safety Executive and local authorities under the Health and Safety (Enforcing Authority) Regulations 1998, with residential care homes generally falling to the local authority. Separately, the Care Quality Commission regulates the quality and safety of care in England, the Care Inspectorate in Scotland, Care Inspectorate Wales in Wales and the RQIA in Northern Ireland, and all expect water safety evidence.
Sources & further reading
