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Registration Number: {{org_field_registration_no}}

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Managing Heat Waves Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} prepares for, responds to, and reviews periods of hot weather and heatwaves in a safe, person-centred and legally compliant way. The policy is designed to protect the health, safety, dignity and well-being of residents, staff, visitors and others who may be affected by hot weather within the care home.

This policy supports compliance with the Regulation and Inspection of Social Care (Wales) Act 2016 and The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, including requirements relating to safe care and support, suitable premises, staffing, medicines, health and safety, records, notifications, monitoring and improvement.

The policy also reflects Welsh Government statutory guidance for regulated services, Public Health Wales hot-weather advice for social care managers, and the need for health and social care providers in Wales to prepare for the effects of climate change and extreme weather. Older people, people living in care homes, people with long-term health conditions, people with dementia or cognitive impairment, people with reduced mobility, people who are bed bound, and people taking medicines that affect hydration, temperature regulation or kidney function may be at increased risk during hot weather.

2. Scope

This policy applies to all residents, staff, agency workers, bank staff, volunteers, contractors, visiting professionals, relatives, representatives and visitors at {{org_field_name}}. It applies before, during and after periods of hot weather, including heat-health alerts, heatwave conditions, unusually warm nights, high indoor temperatures, and any period where the Registered Manager or senior person on duty identifies a risk of heat-related harm.

This policy covers prevention, preparation, environmental controls, hydration and nutrition, resident monitoring, medicines management, staffing, emergency response, communication, record keeping, CIW notification, business continuity and post-incident review.

Where a resident has additional risks associated with hot weather, these must be reflected in the resident’s provider assessment, personal plan, risk assessments, hydration plan, nutrition plan, moving and handling plan, medication support plan and any other relevant care records.

3. Risk Factors and Health Impacts

Hot weather can cause dehydration, heat exhaustion, heatstroke, sunburn and worsening of existing physical and mental health conditions. It can also increase the risk of heart attack, stroke, breathing problems, kidney injury, falls, confusion, delirium, pressure damage, urinary tract infections and deterioration in people with dementia or frailty.

Residents may be at increased risk where they:

• are aged over 65;
• live with heart disease, breathing problems, dementia, diabetes, kidney disease, Parkinson’s disease, mobility problems, serious mental health conditions or cognitive impairment;
• are bed bound, frail, unable to communicate thirst, unable to access drinks independently, or dependent on staff for personal care;
• are already dehydrated, unwell, vomiting, experiencing diarrhoea, feverish, or recovering from infection;
• take medicines that may increase risk during hot weather, including diuretics, antihypertensives, anticholinergics, psychotropic medicines, laxatives, medicines affecting kidney function, or medicines requiring temperature-controlled storage;
• have swallowing difficulties, reduced appetite, poor fluid intake, alcohol dependency or drug dependency;
• are unable to regulate their own environment, clothing, bedding or activity levels;
• live in a room or area of the building that is difficult to keep cool.

Environmental risk factors include poor ventilation, direct sunlight through windows, high indoor temperatures, poorly shaded areas, lack of cool rooms, hot medication storage areas, inadequate access to fluids, prolonged outdoor exposure, strenuous activity, staff shortages, power failure, water supply interruption, and high air pollution levels.

The Registered Manager must ensure that residents who are at higher risk are identified before hot weather occurs and that their individual risk management measures are recorded and communicated to staff.

4. Heatwave Preparedness and Annual Planning

The Registered Manager must ensure that heatwave preparedness is reviewed before the summer period each year and whenever a heat-health alert or period of unusually hot weather is forecast.

The annual heatwave preparedness review must include:

• identifying residents at increased risk from hot weather and ensuring their personal plans and risk assessments are updated;
• checking that staff know how to recognise heat exhaustion, heatstroke, dehydration and deterioration from existing health conditions;
• checking that fans, air conditioning units, cooling equipment, thermometers and fridge thermometers are clean, safe, working, serviced where required, and PAT tested where applicable;
• checking that medicines storage areas are suitable and that medication fridges are working, monitored and maintained;
• checking that there are enough working thermometers to monitor rooms where residents spend the most time;
• identifying rooms or areas most at risk of overheating and agreeing control measures;
• identifying cooler rooms or shaded areas that can be used during hot weather;
• reviewing stocks of drinking water, oral rehydration products where clinically appropriate, hydrating foods, sun protection, lightweight bedding and other relevant supplies;
• reviewing business continuity arrangements for power failure, water supply interruption, lift failure, staff shortage, transport disruption and extreme weather emergencies;
• ensuring staff know where to find current Public Health Wales and Welsh Government advice;
• ensuring relevant information is shared with residents, families and representatives in a format they can understand.

The Responsible Individual must maintain oversight of the provider’s arrangements for preparation, governance, quality assurance and learning in relation to hot weather and heatwave risks.

5. Preventative Measures

{{org_field_name}} will take proportionate action before and during hot weather to reduce the risk of heat-related harm.

5.1 Hydration and Nutrition

Staff must ensure that residents have regular access to cool drinks throughout the day and night, unless a resident has a clinically advised fluid restriction or other specific instruction in their personal plan. Staff must encourage and support fluid intake, especially for residents who cannot independently ask for, reach, recognise or safely consume drinks.

Hydration support must include:

• offering drinks regularly and proactively, not only when requested;
• offering a range of suitable drinks according to the resident’s preferences, swallowing needs, dietary needs and clinical advice;
• offering hydrating foods such as fruit, jelly, yoghurt, ice lollies or other suitable alternatives where appropriate;
• monitoring residents for changes from their normal hydration status, including reduced urine output, dizziness, light-headedness, dry mouth, increased confusion, drowsiness, constipation, headache or fatigue;
• recording fluid intake where this is required by the personal plan, risk assessment, clinical instruction or senior staff decision;
• escalating concerns promptly to the nurse in charge, senior carer, Registered Manager, GP, NHS 111 Wales, community nurse or emergency services as appropriate.

5.2 Keeping the Building Cool

Staff must take practical steps to reduce indoor heat, including:

• checking and recording indoor temperatures in agreed areas during hot weather;
• closing curtains, blinds, shutters or other window coverings early in the morning where direct sunlight is expected;
• closing windows when the outdoor temperature is higher than the indoor temperature, where this is safe and appropriate;
• opening windows when outdoor air is cooler than indoor air, where this is safe and does not compromise resident safety, security, infection prevention or window restrictor requirements;
• using fans or air conditioning units only where they are safe, clean, working and suitable for the environment;
• ensuring fans are positioned safely and do not create trip hazards, discomfort, dehydration risk, infection control concerns or risk to residents with cognitive impairment;
• using cooler rooms or shaded areas for residents who are at higher risk;
• reducing unnecessary use of heat-producing equipment where safe to do so;
• checking that communal areas, bedrooms and medication storage areas do not become excessively hot.

5.3 Outdoor Activities and Sun Exposure

Residents must be supported to avoid direct sun exposure during the hottest part of the day, usually between 11am and 3pm. Outdoor activities, appointments, gardening, exercise and trips should be planned for cooler parts of the day, such as the morning or evening, unless there is a clear reason why this is not possible and the risk has been assessed.

When residents go outside during hot weather, staff must consider:

• shaded seating;
• suitable lightweight clothing;
• hats or other sun protection;
• sunscreen where appropriate and with the resident’s consent or best-interest decision where applicable;
• access to drinks;
• reduced exertion;
• the resident’s mobility, cognition, medication and clinical risk factors.

Residents must not be left in hot closed spaces, including stationary vehicles, conservatories, poorly ventilated rooms or areas where the temperature could rise quickly.

5.4 Medicines and Clinical Risks

Staff must remain alert to the effect of hot weather on medicines and clinical conditions. Where a resident may be at increased risk because of their medicines or health condition, staff must seek advice from the GP, pharmacist, community nurse or other relevant healthcare professional.

Medicines must be stored in line with the Medication Management and Administration Policy, manufacturer’s instructions and pharmacy guidance. Most medicines should be stored below 25°C unless the medicine has specific storage instructions. Medicines must not be stored on windowsills, in direct sunlight, in hot rooms, or in refrigerators unless refrigeration is required.

Any concern about medication storage temperatures, missed medicines, medication side effects, dehydration, reduced oral intake, acute illness, or possible need for clinical review must be escalated promptly and recorded.

6. Monitoring Residents During Heat Weather and Heatwaves

The Registered Manager, nurse in charge or senior person on duty must ensure that residents are monitored according to their level of risk during hot weather. Monitoring must be proportionate, person-centred and recorded clearly.

6.1 Environmental Monitoring

During hot weather, staff must check and record indoor temperatures in areas where residents spend significant time, including bedrooms of residents at higher risk, lounges, dining rooms, medication storage areas and any areas known to overheat.

The frequency of temperature checks must be increased where:

• a heat-health alert has been issued;
• indoor temperatures are rising;
• residents are showing signs of heat-related illness;
• the building is difficult to cool;
• there is a power failure, ventilation failure or air-conditioning failure;
• senior staff identify increased risk.

Where temperatures are concerning, staff must take action to cool the environment, move residents to a cooler area where appropriate, increase hydration support, inform the senior person on duty and record the action taken.

6.2 Resident Health Monitoring

Staff must monitor residents for signs of heat-related illness, dehydration and deterioration. Symptoms may include:

• increased thirst, dry mouth or reduced urine output;
• dizziness, faintness, weakness or headache;
• tiredness, drowsiness, agitation or increased confusion;
• muscle cramps;
• nausea or vomiting;
• heavy sweating or, in more serious cases, hot dry skin;
• fast pulse, fast breathing or shortness of breath;
• high temperature;
• collapse, seizure, loss of consciousness or symptoms suggestive of heatstroke.

Residents identified as high risk must have enhanced monitoring recorded in their care records. This may include fluid intake records, food intake records, skin integrity checks, continence monitoring, body temperature checks where clinically indicated, and increased welfare checks.

6.3 Escalation

Staff must escalate concerns immediately to the senior person on duty where a resident shows signs of dehydration, heat exhaustion, heatstroke, acute confusion, collapse, reduced consciousness, chest pain, breathing difficulty, reduced urine output, or any significant deterioration from their normal presentation.

The senior person on duty must decide whether to contact the GP, NHS 111 Wales, community nursing team, pharmacist, out-of-hours service or emergency services. Any escalation, advice received, action taken and outcome must be recorded in the resident’s care records.

7. Emergency Response Plan

All staff must treat suspected heat-related illness seriously and take immediate action.

7.1 Suspected Heat Exhaustion

Where a resident has symptoms of heat exhaustion, staff must:

• move the resident to a cooler place, such as a cool room, shaded area or air-conditioned area if available;
• remove unnecessary clothing, blankets or bedding;
• encourage cool water or a suitable rehydration drink if the resident is conscious, safe to swallow and not subject to a fluid restriction that prevents this;
• cool exposed skin using cool water, a spray, sponge, fan or cool packs wrapped in cloth placed on the neck or under the armpits;
• monitor the resident closely and inform the senior person on duty;
• record symptoms, observations, action taken and the resident’s response.

If the resident does not improve within 30 minutes, symptoms worsen, or staff are concerned, the senior person on duty must seek medical advice through NHS 111 Wales, the GP, out-of-hours service or emergency services as appropriate.

7.2 Suspected Heatstroke

Heatstroke is a medical emergency. Staff must call 999 immediately if heatstroke is suspected.

Possible signs of heatstroke include:

• very high temperature;
• hot skin that may not be sweating;
• fast heartbeat;
• fast breathing or shortness of breath;
• confusion, agitation or lack of coordination;
• seizure;
• collapse or loss of consciousness.

While waiting for emergency services, staff must:

• continue cooling measures;
• place the resident in the recovery position if they are unconscious and breathing;
• monitor airway, breathing and circulation;
• follow first aid training and emergency instructions;
• inform the Registered Manager or senior person on duty;
• inform the resident’s representative or family member as appropriate;
• record all actions taken.

7.3 Post-Emergency Actions

Following any heat-related emergency, the Registered Manager or delegated senior person must ensure that:

• the resident’s care records are updated;
• relevant professionals and family/representatives are informed where appropriate;
• a CIW notification is submitted where the incident meets notification requirements, including serious accident or injury, death, or any event which prevents or could prevent the service from continuing safely;
• safeguarding procedures are followed if neglect, avoidable harm or failure to act is suspected;
• the incident is reviewed for learning and service improvement.

8. Staff Training, Competency and Staffing Arrangements

All staff, including agency and bank staff, must receive information appropriate to their role on preventing, recognising and responding to heat-related risks. This must be included in induction, seasonal briefings, team meetings, handovers and refresher training.

Training and briefing must cover:

• residents most at risk during hot weather;
• signs and symptoms of dehydration, heat exhaustion and heatstroke;
• hydration support and fluid monitoring;
• safe use of fans, air conditioning and cooling equipment;
• checking and recording room temperatures;
• safe medicines storage during hot weather;
• when and how to escalate clinical concerns;
• emergency response, including when to contact NHS 111 Wales or call 999;
• infection prevention, moving and handling and safeguarding considerations during hot weather;
• staff health, hydration and welfare during hot weather.

The Registered Manager must consider whether additional staffing, changed deployment, additional welfare checks or altered routines are required during periods of hot weather. Staffing arrangements must continue to meet residents’ needs and support safe care and treatment.

Agency staff must be informed of current heatwave arrangements, residents at higher risk, emergency procedures, and any changes to normal routines before starting their shift.

9. Staff Health, Safety and Wellbeing

{{org_field_name}} recognises that staff may also be at risk during high temperatures. Staff must be encouraged and enabled to stay hydrated, take appropriate rest breaks, report concerns about their own health promptly, and seek support if they feel unwell.

Managers must consider the impact of hot weather on staff working in warm areas, undertaking moving and handling tasks, wearing PPE, working outdoors, preparing food, doing laundry, or completing physically demanding duties.

Where staff report symptoms of heat-related illness, the senior person on duty must take appropriate action to protect the staff member and maintain safe staffing levels. This may include rest, hydration, redeployment, medical advice, replacement staffing or emergency action.

The Registered Manager must consider Health and Safety Executive guidance on managing workplace temperature and PPE in hot weather where relevant.

10. Communication Strategy

The Registered Manager, deputy manager, nurse in charge or delegated senior person must monitor official weather forecasts, heat-health alerts, Public Health Wales advice, Welsh Government advice, local authority communications, health board communications and any relevant air pollution forecasts during periods of hot weather.

When hot weather is forecast or identified, the senior person on duty must ensure that staff are informed of:

• the expected duration and severity of the hot weather;
• residents who are at higher risk;
• any changes to hydration rounds, activities, visiting, outdoor access or staffing;
• room temperature monitoring arrangements;
• escalation arrangements and emergency procedures.

Residents must be given information and reassurance in a way they can understand. Where appropriate, families, representatives and advocates must be informed of precautions being taken, especially where a resident is at higher risk or has experienced heat-related deterioration.

Communication must be recorded where it relates to a resident’s health, care, risk, representative involvement, clinical escalation, safeguarding, complaint, concern or significant incident.

11. Compliance, Monitoring and Quality Assurance

The Registered Manager is responsible for implementing this policy on a day-to-day basis. The Responsible Individual is responsible for maintaining oversight of the effectiveness of the service’s governance, monitoring and improvement arrangements.

Heatwave management will be monitored through:

• pre-summer preparedness checks;
• environmental audits, including room temperature recording and action taken;
• hydration and nutrition audits;
• medication storage audits;
• checks of fans, air conditioning units, thermometers and cooling equipment;
• care plan and risk assessment audits for residents at increased risk;
• review of staff training and briefing records;
• review of incidents, accidents, safeguarding concerns, complaints and compliments;
• feedback from residents, staff, families, representatives and visiting professionals.

Any incident, near miss, complaint or concern linked to hot weather must be reviewed to identify learning and improvement. Findings must be used to update risk assessments, personal plans, staff briefings, environmental controls and business continuity arrangements.

CIW must be notified in line with Regulation 60 and the relevant notification schedules where a heat-related event results in, or is connected to, a notifiable incident. This includes serious accident or injury, death, an outbreak of infectious disease where relevant, an incident reported to the police, or any event which prevents or could prevent the provider from continuing to provide the service safely.

Records must be accurate, contemporaneous, stored securely and available for audit, regulatory inspection and quality assurance.

11.1 Business Continuity During Hot Weather

The Registered Manager must ensure that the service’s business continuity plan includes hot-weather and heatwave risks.

The plan must consider:

• power failure affecting fans, air conditioning, call bells, lifts, specialist beds, pressure-relieving equipment, refrigeration, medicines storage and kitchen equipment;
• water supply interruption affecting hydration, hygiene, laundry, cleaning and infection prevention;
• staff shortages caused by illness, transport disruption or caring responsibilities;
• failure of cooling equipment;
• food safety during high temperatures;
• disruption to clinical appointments, deliveries, pharmacy supplies or emergency services;
• safe evacuation or temporary relocation if areas of the home become unsafe due to heat.

Where an incident prevents, or could prevent, the safe delivery of the regulated service, the Registered Manager or Responsible Individual must consider whether CIW notification is required and must seek advice where necessary.

11.2 Mental Capacity, Consent and Best Interests

Residents must be supported to make their own decisions wherever possible, including decisions about drinks, clothing, room ventilation, use of fans, moving to cooler areas and outdoor activities.

Where a resident refuses support during hot weather, staff must assess the level of risk, offer information in a way the resident can understand, consider whether the resident has capacity to make the specific decision at the time, and record the discussion and action taken.

Where a resident lacks capacity to make a specific decision linked to heatwave risk, staff must act in accordance with the Mental Capacity Act 2005 and the resident’s best interests. Any best-interest decision must be the least restrictive option available, proportionate to the risk, and recorded clearly.

Where restrictions are considered to keep a resident safe, staff must ensure that the action is lawful, necessary, proportionate, time-limited and reviewed. Deprivation of liberty must not occur without lawful authority.

11.3 Safeguarding and Duty of Candour

Heat-related harm may raise safeguarding concerns where there is suspected neglect, acts of omission, failure to follow care plans, failure to provide fluids, failure to monitor a resident at risk, failure to escalate deterioration, unsafe staffing, unsafe premises, or avoidable harm.

Staff must report safeguarding concerns immediately in line with the Safeguarding Adults from Abuse and Improper Treatment Policy and the Wales Safeguarding Procedures.

{{org_field_name}} will act in an open and transparent way with residents, representatives, placing authorities and relevant professionals where something has gone wrong in relation to hot weather management. This includes explaining what happened, what immediate action has been taken, what further review will occur, and what learning or improvement will be implemented.

12. Related Policies

This policy should be read in conjunction with:

• CHW07 – Person-Centred Care Policy
• CHW11 – Safe Care and Treatment Policy
• CHW13 – Safeguarding Adults from Abuse and Improper Treatment Policy
• CHW42 – Communication and Engagement with Service Users and Families Policy
• CHW16 – Health and Safety at Work Policy

13. Policy Review

This policy will be reviewed at least annually and sooner where:

• legislation, Welsh Government guidance, Public Health Wales advice, CIW requirements or local safeguarding/health board guidance changes;
• there is a heat-related incident, near miss, complaint, safeguarding concern or CIW notification;
• audits identify gaps in practice;
• residents’ needs or the premises change;
• learning from staff, residents, families, representatives, commissioners or professionals indicates that improvements are required.

Changes to this policy will be communicated to relevant staff through briefings, supervision, team meetings, training, handovers and policy updates. Where changes affect residents or representatives, information will be shared in an accessible and appropriate way.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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