Legionella risk assessment for Care homes
Updated 16 August 2026
Key points
- A legionella risk assessment is required for care homes premises under the Health and Safety at Work Act 1974 and the Approved Code of Practice L8
- Typical cost: £400 to £900
- Review every 6 months, or sooner if the water system, its use, or the people using it change
- A named duty holder (usually the employer, landlord, or building operator) must arrange it and act on its findings
Care homes are one of the highest-risk premises for legionella because of the combination of vulnerable residents and complex water systems. Residents are often elderly, immunocompromised, or have underlying respiratory conditions, all of which significantly raise the probability of infection if exposure occurs. A case of Legionnaires' disease in a care home can be fatal and will almost always trigger an HSE investigation under RIDDOR.
The water system in a typical care home is larger and more varied than an office: stored hot water for multiple bathrooms, thermostatic mixing valves on every bath and shower to prevent scalding, assistive bathing equipment, and often a hydrotherapy pool or spa bath. Each of these is a potential colonisation site. The CQC expects providers to demonstrate that water safety is actively managed, and inspectors will routinely ask to see the risk assessment, the written scheme, and the most recent monitoring records.
The control scheme for a care home typically requires monthly temperature checks at sentinel outlets, quarterly TMV inspections, six-monthly descale and disinfection of shower heads, and annual sampling. The responsible person should be a named member of senior staff, not simply the water hygiene contractor, because the duty under ACOP L8 cannot be contracted out.
Is it legally required?
Care home operators are duty holders under the Health and Safety at Work Act 1974 and ACOP L8. Additional duties arise under the Health and Social Care Act 2008 through CQC registration, which requires effective management of health and safety risks. The HSE's HSG274 Part 2 gives specific guidance on domestic hot and cold water systems, and the Department of Health's HTM 04-01 sets out the NHS standard that most care homes also follow.
Who is the duty holder?
The duty holder is whoever has control of the premises or the water system. For care homes premises, this is usually the employer, owner, landlord, or managing agent. The duty cannot be contracted out: you can hire a water hygiene consultant, but the legal responsibility still sits with you.
If you are unsure who holds the duty for your premises, see: Who is responsible for a legionella risk assessment?
What the assessment should cover
ACOP L8 sets out five things a suitable and sufficient assessment must do:
- Identify and assess sources of risk across the whole water system, including stored hot and cold water, dead legs, rarely used outlets, and any equipment that generates aerosols
- Produce a written scheme for preventing or controlling the risk, with specific tasks, temperatures, and frequencies
- Implement, manage, and monitor the scheme in practice, not just on paper
- Keep records of the assessment, the scheme, monitoring results, and any remedial action taken
- Appoint a competent person (often called the "responsible person") to be accountable for the scheme
Free legionella risk assessment template
A structured Word document following the five-step approach in ACOP L8. Covers risk identification, written scheme, monitoring, and records. If it isn't written down, you can't evidence it.
Follows ACoP L8 and HSG274 Part 2. Free. No spam.
Specific water system risks to check
For care homes premises, assessors typically pay close attention to:
- Hot water storage temperatures (calorifiers must reach 60°C throughout)
- Hot water distribution temperatures (50°C within one minute at outlets)
- Cold water storage tank condition, lid seal, and temperature (below 20°C)
- Dead legs, redundant pipework, and little-used outlets
- Shower heads, flexible hoses, and thermostatic mixing valves
- Any cooling tower, evaporative condenser, or spa pool (these are notifiable to the local authority under the Notification of Cooling Towers and Evaporative Condensers Regulations 1992)
How often to review
There is no fixed legal interval, but ACOP L8 requires that the assessment is reviewed regularly and whenever there is reason to believe it may no longer be valid. For most care homes premises, that means at least every 6 months and sooner after any of the following:
- Changes to the water system (new pipework, fittings, equipment)
- Changes to the use of the building or the number of occupants
- A positive legionella test result or a case of Legionnaires' disease linked to the premises
- Prolonged periods of low occupancy or system shutdown (a risk during holidays, term breaks, or refurbishment)
- New guidance from HSE
Typical cost
A professional legionella risk assessment for care homes premises typically costs between £400 and £900, depending on the size of the building, the number of water outlets, and whether there are any cooling towers or evaporative condensers (these add significantly to the cost because of the statutory inspection regime).
Use our cost calculator for an estimate based on your specific water system.
Need a legionella risk assessment for your premises? We will be partnering with Legionella Control Association registered providers shortly.
Free legionella risk assessment template
A structured Word document following the five-step approach in ACOP L8. Covers risk identification, written scheme, monitoring, and records. If it isn't written down, you can't evidence it.
Follows ACoP L8 and HSG274 Part 2. Free. No spam.
The care home template + worked example — Pro edition, £29
A completed worked example for care homes, the editable Word and Excel documents, and the smart log book to run your monitoring from. It records, it never certifies.