Emergency/Disaster Preparedness Regulatory Requirements at a Glance for Texas Long Term Care Facilities

Emergency/Disaster Preparedness

Regulatory Requirements

at a Glance for

Texas Long Term Care Facilities

Sonia Thomas, RN, BSN, SMQT

Facility Surveyor/Liaison

Texas Department of Aging and Disability Services (DADS) Regulatory Services Division, Region 6

713-767-2218

sonia.thomas@dads.state.tx.us

2013 Healthcare Hurricane & Emergency Preparedness Summit

2

Greetings from

Mark Kendall, LBSW, SMQT

Texas Department of Aging and Disability Services, (DADS)

Regulatory Services Division Regional Director, Region 6 Phone: 713-767-2191

E-mail:

DADS Mission

• To ensure the health, safety, and welfare of

individuals in long-term care facilities in the state of Texas.*

*Not verbatim

DADS REGIONAL MAP in Texas

Region 6: Gulf Coast Counties Served

Austin, Brazoria, Colorado, Fort Bend,

Galveston, Harris, Matagorda, Montgomery, Walker, Waller, Wharton

Region 6 - Facility Totals

May 2013

• Nursing Homes 161

• Assisted Living Facility (ALF) 449

• Adult Day Care (ADC) 39

• Intermediate Care Facilities for the

Intellectually Disabled (ICF-IID) 123

• Home & Community Support 1715

Objectives

• To emphasize the importance of emergency

preparedness and response plans

• To identify the critical value of staff training

• Core Regulatory requirements of emergency

Objectives

• Safety Operations/Emergency Operations Rules

• DADS „s Role in the Disaster Response

Emergency/Disaster Preparedness

Response Plans -

WHY?

The

failure to plan

is

a plan to fail.

Emergency Preparedness Response

PLANS -

WHY

?

• Disasters can occur at any time.

(Hurricane season: June 1 - November 30.)

Common Misconceptions During

Disasters

Common Misconceptions During

Disasters

Common Misconceptions During

Disasters

WHY?

"Learning is like rowing

upstream; not to advance

is to fall back."

DADS Licensing Regulations

Nursing TAC § 19.1914(a-f)

ICF/IID TAC § 90.50(a- g)

Assisted Living TAC § 92.62(d)

Adult Daycare TAC § 98.64(a) – (f)

HCSSAs TAC § 97.256 (a – p)

Freestanding Hospice (additional) TAC § 97.403 (w)(2)(A-G)

Facilities must comply with the Texas Administrative Code (TAC) requirements for their specific program types for a written disaster

plan.

The Texas Administrative Code (TAC) are standards that are adopted and regulated by the Texas Department of Aging & Disability Services (DADS)

Top 10 Deficiencies/Violations for

Fiscal Year 2012 – DADS Region 6

Disaster/Emergency Plans were cited by DADS surveyors for the following facilities:

1. Adult Day Care – ranked #2, #4, #5

2. Assisted Living Facilities: - ranked #1, #4

#5 #9

3. Nursing Homes : Life Safety Code – ranked

#2, #3, #8, #10

4. Intermediate Care Facilities for the

Individuals with Intellectual (ICF-IID)

Top 10

Adult Day Care Violations

Fiscal Year 2012 - Region 6

•The facility failed to install a smoke detection

system in required locations in the facility. #2

•The facility failed to ensure portable fire

extinguishers were visually inspected monthly by facility staff #5

Top 10

Adult Day Care Violations

Fiscal Year 2012 - Region 6

• The facility failed to ensure manual fire alarm

system and automatic smoke detection system

were installed in accordance with NFPA 72

National Fire Alarm Code series and state fire marshal licensing requirements. #4

Top 10

Assisted Living Facilities

Care Violations

Fiscal Year 2012 - Region 6

• The facility failed to ensure the required

sprinkler system was inspected, tested and

maintained in compliance with NFPA 25. #1

• The facility failed to maintain the fire alarm

Top 10

Assisted Living Facilities

Care Violations

Fiscal Year 2012 - Region 6

• The facility failed to a written contract with

a fire alarm firm. #5

• The facility failed to conduct quarterly fire

drills on each shift and with at least one drill conducted each month. #9

TOP 10 ICF-IID

Deficiencies Region 6 - FY 2012

• The facility failed to meet applicable

requirements for sprinkler system

coverage.

• The facility failed to meet applicable Life

Safety Code requirements for the fire

TOP 10 ICF-IID

Deficiencies Region 6 - FY2012

• The facility failed to provide a working

manual fire alarm as required.

• The facility failed to provide an

acceptable primary means of escape for every sleeping room as required for fire safety.

Top 10 Life Safety Code Deficiencies for

Nursing Homes

Fiscal Year 2012 - Region 6

•The facility failed to meet requirements for air

conditioning and ventilating equipment. #3

•The facility failed to inspect and test its

generators as required by NFPA 99 #8

•The facility failed to ensure that the fire alarm

system meets the functional requirements of the Life Safety Code. #10

Top 10 Life Safety Code Deficiencies

for

Nursing Homes

Fiscal Year 2012 - Region 6

• The facility failed to ensure that the

required sprinkler systems are

maintained in reliable operating

condition and are inspected and tested periodically #2

In an Emergency, the Generator is your Life Preserver

Generator Check List

• Visual inspection of generator condition

• Generator Spare Parts must be on site

• Generator instruction manual (two sets)

Generator Check List

• Battery back-up lighting at generator

• Generator at sufficient elevation in case

of flooding

• Check of all emergency lighting for

CRITICAL CONSIDERATIONS for GENSET SYSTEMS for

DADS Life Safety Code Surveyors

CODES

•NFPA 37 Standard for the Installation and Use of Stationary -Combustion Engines and Gas Turbines 1998

•NFPA 70 National Electrical Code 1999

•NFPA 99 Standard for Health Care Facilities 1999

•NFPA 101 Code for Safety to Life from Fire in Buildings and Structures 2000 Edition

•NFPA 110 Standard for Emergency and Standby Power Systems , 1999 Edition

Rules

for

Emergency Preparedness and

Response Plans

for

Nursing Facilities

Intermediate Care Facilities for Individuals with an Intellectual Disability (ICF-IID)

HCSSAs (Home Health/Hospice) Assisted Living Facilities

Definitions

•

Emergency situation

•

Emergency Plan

•

Receiving facility

Administration

A facility must:

• Develop and implement

• Maintain a current accessible copy

EVALUATE THE PLAN

• After emergency response

• Physical changes to the facility

• At least annually;

• After information changes

Emergency Preparedness and

Safety Plans must include:

• A risk assessment

• Description of the population

• Description of the services needed by the

residents

• Section for each core function

RISK ASSESSMENT

• Disaster type

• Likelihood

• Potential Impact on facility/agency

• Potential Impact on Community

• Warning time

• Risk Priority

Sample Table for Risk Assessment

Hurricane High Critical Critical >24 hours High during

hurricane season June 1 through November 30

…

Hurricane Ike – Landfall

Houston/Galveston – 9/13/08

…

a TORNADO

Before After

Greensburg KS, on May 4, 2007

…

FIRES CAUSED BY LIGHTING

or a thunderstorm with a risk for harm to persons or property

43

…

Fires Caused by a Facility Incident

On 4/2/11, just before 3:30 pm, emergency crews were dispatched to the Blue Ridge Health Care Center in Raleigh, NC

Explosion

Failure of Heating & Cooling

Systems

…Hazardous Material, Industrial,

& Transportation Accidents

…Bomb Threat,

… Extreme snow and ice conditions for

an area

8 Core Functions of Emergency

Management – at a Glance

1. Direction and control

2. Warning

3. Communication

4. Sheltering Arrangements

5. Evacuation

6. Transportation

7. Health and medical needs

Core Function #1

Direction and Control

• Emergency preparedness coordinator

(EPC)

• Alternate EPC

• Local emergency management

Who is the Emergency Management

Coordinator (EMC)

• The Mayor and the County Judge

• They will usually designate a

coordinator.

• EMC contact information should be listed

DADS Licensing Regulations

Nursing TAC § 19.326

Assisted Living TAC § 92.62(d) ICF-IID TAC § §90.50, (d) (1) (C)

Adult Daycare TAC § 98.42(a)

HCSSAs TAC §97.256 (d) (4)(C) Free Standing Hospice TAC § 97.403 (w) ((2)D)(v)

for sheltering

The Texas The Texas Administrative Code (TAC) are standards that are adopted and regulated by the Texas Department of Aging & Disability Services (DADS

Facilities must coordinate with the

Local Emergency Management Coordinator.

Core Function #2

Warning

• How the EPC is notified

• Who the EPC will notify

• Monitoring of local news and weather

Core Function #3

Communication

• Primary/alternate mode of communication

• Current list of telephone numbers

• Residents' responsible parties

• Potential evacuation locations

• Staff

• Location of the lists

Core Function #3

Communication

• Procedures to notify

• facility staff

• receiving facility

• residents, representatives, and others

• Resident information

• Maintain communication

• Facility staff

• Receiving facility

Core Function #4

Sheltering Arrangements

• Shelter-in-place implementation

decisions

• Access to medications, records, food, water,

equipment and supplies

• Responding facility staff

• Staff family members

• Notifying DADS regional office

• Receiving facility

Mark Kendall

DADS Regional, Director, Region 6

Core Function #5

Evacuation

• Decisions to evacuate residents

• Evacuation destinations and routes

w/map

DADS Licensing Regulations

Nursing TAC § 19.1914(d) (5)(A)

ICF/IID TAC § 90.50(a)(4)

Adult Daycare TAC § 98.64 (d)(5)(D)

The Texas Administrative Code (TAC) are standards that are adopted and regulated by the Texas Department of Aging & Disability Services (DADS)

Facility plans must include evacuation routes with maps

Core Function #5

Evacuation

• Staff must accompany residents

• Ensuring total evacuation

• Accounting for residents

• Accounting for residents in other

locations

• Continuity of care

• Repatriation to area

Core Function #5

Evacuation cont‟d

• Notifying the local EMC

• Notifying DADS regional office

• Evacuating

• Return after evacuation Mark Kendall

DADS Regional, Director, Region 6

Core Function #6

Transportation

• Transporting

• Residents

• Staff

• Staff family members

• Pets

• Access to oxygen, medications, records,

food, water, equipment, and supplies needed during an evacuation.

Core Function #6

Transportation

Core Function #7

Health and Medical Needs

• Residents with special medical needs

• Identification

Core Function #8

Resource Management Procedures

• Checklists

• Medications

• Records

• Food and water

• Equipment and supplies

• Staff assignments

• Medications

• Secure

Training

• Inform/train staff of responsibilities

• Annual training on responsibilities

• Responsibilities change - re-train

Emergency Preparedness & Response

Emphasizes Training – WHY?

• Incorrect information

• Consistency w/Direction and Control

• Staff expertise levels; available staff

DADS Licensing Regulations

• Nursing § 19.1914(e) (1-3)

• ICF/IID § 90.50(a) (3)

• Assisted Living § 92.41(a)(4)(vi)

• Adult Daycare § 98.64(e) (1-3)

• HCSSAs § 97.256 (i)

• Freestanding Hospice § 97.403 (w)(2)(G)(i-v)

Regulatory Requirements for Staff Training on Emergency

Preparedness plan.

The Texas Administrative Code (TAC) are standards that are adopted and regulated by the Texas Department of Aging & Disability Services

Similarities of all Disaster Plans

CORE Requirements HCSSAs Adult Day Care ICF-IID Nursing Facility

Risk Assessment Maintain a current written accessible copy In each house/day program Central location and w/ personnel supervisor Designate a Coordinator

Fire Safety Plan Free-Standing Hospice only

Annual review + 30 days after ea.

Emergency, 30 days after changes

Annual review and when necessary

After remodeling & construction

After remodeling & construction

Alter remodeling /additions

Similarities of all Disaster Plans

CORE Requirements HCSSAs Adult Day Care ICF-IID Nursing Facility

Coordination with EMC

As required by EMC guidelines

Training _{Initial &}

periodically

Within 3 days of hire, annually

Within 5 days of r hire, annually

30 days after hire, annually

1 Unannounced Annual Drill **

Free Standing Hospice -actual or

Planned drill

Fire Safety Plan Free Standing only Hospice

Similarities of all Disaster Plans

CORE Requirements HCSSAs Adult Day Care ICF-IID Nursing Facility

Contract with the evacuation site Free-standing hospice only In each house/day program Evacuation route in plan

NO map Include a map Include a map Include a map

Quarterly Drill Free Standing hospice only Notify DADS Evac/Sheltering Free standing hospice only Number of Core Functions Free Standing Hospice only - 7 core Functions

Assisted Living Facilities (ALF)

Regulatory Requirements for

Disaster Plans

• Written disaster plan

• 8 core requirements

• Coordinated with Emergency Management

Coordinator

• Should address man made, technological and

local disasters

• Emergency/Evacuation Training on hire

Home and Communities Support Services

Agencies (HCSSAs)

HCSSAs

• Agency personnel must identify clients needing evacuation assistance & registration with 2-1-1

Regulatory Reference:

§97.256 (g) ( 1-2)

• No requirement to evacuate or transport a client during a

disaster

Free Standing Hospice

• In addition to § 97.256 (a) -(p) must comply with

regulatory reference at § 97.403 (w) (2) (A) – (G)

• 7 Core functions of emergency management

• Must evacuate or transport clients when appropriate in response to disasters

HIPPA Privacy Decision Tool for

Emergency Preparedness Planning

• Available at:

http://www.hhs.gov/ocr/privacy/hipaa/unde rstanding/special/emergency/decisiontoolintr o.html

Emergency Preparedness Rules

ICF-IID

• Must develop a plan w/core functions

• Designate Emergency Preparedness

Coordinator

• Address Training of staff & reporting fires

• Effective: 3/21/11

Regulatory reference: TAC $90.50

Emergency Preparedness Rules

Adult Day Care

• Must develop an plan w/ core functions

• Designate Emergency Preparedness

Coordinator

• Address Training of staff , fire drills &

reporting fires

• Effective: 8/1/11

Regulatory reference: TAC $98.64

Emergency Preparedness Rules

Nursing Facilities

• Must develop an plan w/ core functions of emergency management

• Designate Emergency Preparedness Coordinator

• Addresses Administrative procedures, Training of staff, and reporting fires

• Effective: 8/1/11

Regulatory reference: TAC $19.1914 Provider Letter 11-26 – issued 7/22/11

New Emergency Preparedness Rules

HCSSAs

• Must have a written preparedness & response plan w/ based on a risk assessment – identifies service

disasters

• Designate personnel that must be involved

• Agency must offer registration assistance with 2-1-1: Effective: 8/2011

New Emergency Preparedness

Rules - Free Standing Hospices

• In addition, to meeting the requirement at TAC $97.256:

• Must evacuate or transport clients when appropriate in response to disaster

• Seven (7) core functions of emergency management Regulatory reference: TAC $403 (w)(2)(A)-(G)

Provider Responsibilities

• Procedures for notifying DADS state office

by telephone, 1-800-458-9858

• within 24 hours after evacuation

•

Procedures for notifying DADS

regional office

of location of

•

Evacuation decision (

IMMEDIATELY

)

•

Return to facility after evacuation

Provider Responsibilities

• Be prepared.

• Back up plan to the back up plan.

• Follow the Local Emergency Management

Coordinator‟s (EMC) orders on evacuation and re-entry

• Be in contact with DADS, as needed.

• Update FIVES

DADS

FIVES

PROGRAM

http://fives.dads.state.tx.us

F

I

V

E

S

Registration through the 2-1-1 (STEAR)

System for

NF‟s, ALF‟s and HCSSAs

• Register – It‟s the law

• Provider Letter 09-20 – Registration

with the Texas Information and Referral

Network – 2-1-1; to ALF‟s and NF‟s

DADS Message to Providers of LTC

Facilities

Coastal facilities must evacuate inland.

Have a backup plan in case primary plans fails.

State resources are

intended for use only when primary and backup plans fail.

87

Stay up to date with

DADS Automatic E-Mail Updates/Alerts

Go to this web site: http://www.dads.state.tx.us/

DADS‟ ROLE IN DISASTER

RESPONSE

Protocol for Region 6 DADS-

Hurricane/Disaster Evacuation

Pre- Disaster

• A provider may request to exceed licensed

capacity by 20% by contacting:

• Carol Ahmed, Director of Survey Operations

• Phone: 512-438-5695

• E-mail: carol.ahmed@dads.state.tx.us

• Mark Kendall, Regional Director, Region 6

• Phone: 713-767-2291

Protocol for Region 6 DADS- Hurricane

/Disaster Evacuation

• Evacuation: Fax blast alerts will be sent to all

facilities/agency providers

• regarding the need to evacuate (NF, ALF, HH, Hospice, ICF-IID)

• Sheltering in Place: DADS staff will call all NF‟s

and ICF-IID‟s if no mandatory evacuation is called and facilities shelter in place

Protocol for Region 6 DADS-

Hurricane/Disaster Evacuation

• No Surveys or non- priority complaints

Protocol for Region 6 DADS

Hurricane /Disaster Evacuation

• Assist with Special Needs shelter activity

coordination

Region 6 Evacuation Vests

• FREE of charge

• Bright & easily

identifiable

• Water tight pouch in

front for storage

• To order contact:

281-822-4442

ALF/ADC Contact Information

DOTTY ACOSTA

Adult Day Care Program Specialist

Regulatory Services Division

(512) 438-2170

dorothea.acosta@dads.state.tx.us

CARMELA STOWERS

Specialist

Regulatory Services Division

(512) 438-4624

HCSCCA Contact Information

•

Yolanda Chavez, BSN, RN

Department of Aging and Disability Services, Regulatory Services

(512) 438-3161

ICF-IID Contact Information

Alan Garms – LMSW, AP

DADS Regulatory Services Division Program Manager , Region 6

713/767-2292 – office 713/767-2201 – fax E-mail address:

Life Safety Code

Contact Information

Cedric Peace

DADS Regulatory Services Division

Interim Program Manager , Region 6 713/767-2293 – office

E-mail address:

THANK YOU

for your attendance and