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

Transcription

1 Emergency/Disaster Preparedness Regulatory Requirements at a Glance for Texas Long Term Care Facilities 2013 Healthcare Hurricane & Emergency Preparedness Summit 6/26/2013 Sonia Thomas, RN, BSN, SMQT Facility Surveyor/Liaison Texas Department of Aging and Disability Services (DADS) Regulatory Services Division, Region sonia.thomas@dads.state.tx.us

2 Greetings from: Mark Kendall, LBSW, SMQT Texas Department of Aging and Disability Services, (DADS) Regulatory Services Division Regional Director, Region 6 Phone: mark.kendall@dads.state.tx.us 2

3 DADS Mission To ensure the health, safety, and welfare of individuals in long-term care facilities in the state of Texas.* *Not verbatim

4 DADS REGIONAL MAP in Texas Region 6: Gulf Coast Counties Served Austin, Brazoria, Colorado, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Walker, Waller, Wharton

5 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 Services Agencies (HCSSAs)

6 Objectives To emphasize the importance of emergency preparedness and response plans To identify the critical value of staff training Core Regulatory requirements of emergency disaster/plans

7 Objectives Safety Operations/Emergency Operations Rules DADS s Role in the Disaster Response Provider Liabilities/Responsibilities

8 Emergency/Disaster Preparedness Response Plans - WHY? The failure to plan is a plan to fail. Alan Lakeeein

9 Emergency Preparedness Response PLANS - WHY? Disasters can occur at any time. (Hurricane season: June 1 - November 30.) Special Needs population

10 Common Misconceptions During Disasters RE: FIRST RESPONDERS

11 Common Misconceptions During Disasters RE: HOSPITAL Drop-offs

12 Common Misconceptions During Disasters Evacuation Site

13 WHY? Because of Lessons Learned Evacuation: I-45 North, Rayford, Sawdust exit

14 "Learning is like rowing upstream; not to advance is to fall back." Chinese Proverb

15 DADS Licensing Regulations Facilities must comply with the Texas Administrative Code (TAC) requirements for their specific program types for a written disaster plan. Nursing TAC (a-f) ICF/IID TAC 90.50(a- g) Assisted Living TAC 92.62(d) Adult Daycare TAC 98.64(a) (f) HCSSAs TAC (a p) Freestanding Hospice (additional) TAC (w)(2)(a-g) The Texas Administrative Code (TAC) are standards that are adopted and regulated by the Texas Department of Aging & Disability Services (DADS)

16 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)

17 Top 10 Adult Day Care Violations Fiscal Year 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

18 Top 10 Adult Day Care Violations Fiscal Year 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

19 Top 10 Assisted Living Facilities Care Violations Fiscal Year 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 and smoke detection system. #4

20 Top 10 Assisted Living Facilities Care Violations Fiscal Year 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

21 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 safety of doors.

22 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.

23 Top 10 Life Safety Code Deficiencies for Nursing Homes Fiscal Year 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

24 Top 10 Life Safety Code Deficiencies for Nursing Homes Fiscal Year 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

25 In an Emergency, the Generator is your Life Preserver (note Fuel spill or leak)

26 Generator Check List Visual inspection of generator condition Generator Spare Parts must be on site Generator instruction manual (two sets) 24 hour fuel supply as minimum

27 Generator Check List cont d Battery back-up lighting at generator Generator at sufficient elevation in case of flooding Check of all emergency lighting for working bulbs

28 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

29 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

30 Definitions Emergency situation Emergency Plan Receiving facility Sheltering in Place

31 Administration A facility must: Develop and implement Maintain a current accessible copy Evaluate, sign and date

32 EVALUATE THE PLAN After emergency response Physical changes to the facility At least annually; After information changes Document compliance

33 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 Fire safety plan

34 RISK ASSESSMENT Disaster type Likelihood Potential Impact on facility/agency Potential Impact on Community Warning time Risk Priority

35 Sample Table for Risk Assessment DISASTER LIKELIHOOD POTENTIAL IMPACT ON FACILITY/AGENCY POTENTIAL IMPACT ON COMMUNITY WARNING TIME RISK PRIORITY Either Highly likely, Likely or Possible Either Catastrophic, Critical, Limited or negligible Either Catastrophic Critical, Limited or negligible Minimal 6-12 hours, hours, or > 24 hours Either Catastrophic, Critical, Limited or negligible Hurricane High Critical Critical >24 hours High during hurricane season June 1 through November 30

36 Hurricane Ike Landfall Houston/Galveston 9/13/08

37 a TORNADO

38 a TROPICAL STORM

39 a TORNADO Before Greensburg KS, on May 4, 2007 After

40 a FLOOD

41 FIRES

42 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 Because quality of life and quality "of care require safety from fire." 43

44

45 Source: Explosion

46 Failure of Heating & Cooling Systems

47 Hazardous Material, Industrial, & Transportation Accidents

48 Bomb Threat, Active- Shooter, or Terrorist Threat

49 Extreme snow and ice conditions for an area

50 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 8. Resource management

51 Core Function #1 Direction and Control Emergency preparedness coordinator (EPC) Alternate EPC Local emergency management coordinator (EMC)

52 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 in your emergency plan.

53 DADS Licensing Regulations Nursing TAC Assisted Living ICF-IID Adult Daycare HCSSAs Facilities must coordinate with the Local Emergency Management Coordinator. Free Standing Hospice TAC 92.62(d) TAC 90.50, (d) (1) (C) TAC 98.42(a) TAC (d) (4)(C) TAC (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 Keep a copy of each contact.

54 Core Function #2 Warning How the EPC is notified Who the EPC will notify Monitoring of local news and weather reports

55 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 1/2

56 Core Function #3 Communication cont d. Procedures to notify facility staff receiving facility residents, representatives, and others Resident information Maintain communication Facility staff Receiving facility Vehicle drivers

57 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

58 Core Function #5 Evacuation Decisions to evacuate residents Evacuation destinations and routes w/map Agreement with a receiving facility

59 DADS Licensing Regulations Facility plans must include evacuation routes with maps including destinations and routes. Nursing ICF/IID Adult Daycare TAC (d) (5)(A) TAC 90.50(a)(4) TAC (d)(5)(d) The Texas Administrative Code (TAC) are standards that are adopted and regulated by the Texas Department of Aging & Disability Services (DADS)

60 Evacuation Routes

61 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 Entering the building

62 Order of Evacuation

63 Notifying the local EMC Core Function #5 Evacuation cont d Notifying DADS regional office Evacuating Return after evacuation Mark Kendall DADS Regional, Director, Region 6

64 Transporting Residents Staff Core Function #6 Transportation Staff family members Pets Access to oxygen, medications, records, food, water, equipment, and supplies needed during an evacuation.

65 Transporting Oxygen Medications Records Food Water Equipment Supplies Core Function #6 Transportation

66 Core Function #7 Health and Medical Needs Residents with special medical needs Identification Assure needs are met

67 Core Function #8 Resource Management Procedures Checklists Medications Records Food and water Equipment and supplies Staff assignments Medications Secure Proper temperatures

68 Training Inform/train staff of responsibilities Annual training on responsibilities Responsibilities change - re-train Annual drills.

69 Emergency Preparedness & Response Emphasizes Training WHY? Incorrect information Consistency w/direction and Control Staff expertise levels; available staff Unexpected Contingencies

70 DADS Licensing Regulations Regulatory Requirements for Staff Training on Emergency Preparedness plan. Nursing (e) (1-3) ICF/IID 90.50(a) (3) Assisted Living 92.41(a)(4)(vi) Adult Daycare 98.64(e) (1-3) HCSSAs (i) Freestanding Hospice (w)(2)(g)(i-v) The Texas Administrative Code (TAC) are standards that are adopted and regulated by the Texas Department of Aging & Disability Services (DADS)

71 Similarities of all Disaster Plans CORE Requirements HCSSAs Adult Day Care ICF-IID Nursing Facility Risk Assessment Maintain a current written accessible copy Designate a Coordinator In each house/day program Central location and w/ personnel supervisor 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

72 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 Registration with 211 Assistance with NO NO

73 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 8 core functions 8 core functions 8 core functions

74 Assisted Living Facilities (ALF) Regulatory Requirements for Written disaster plan 8 core requirements Disaster Plans Coordinated with Emergency Management Coordinator Should address man made, technological and local disasters Emergency/Evacuation Training on hire Regulatory Reference: TAC (d)

75 Home and Communities Support Services Agencies (HCSSAs) HCSSAs Agency personnel must identify clients needing evacuation assistance & registration with Regulatory Reference: (g) ( 1-2) No requirement to evacuate or transport a client during a disaster Free Standing Hospice In addition to (a) - (p) must comply with regulatory reference at (w) (2) (A) (G) 7 Core functions of emergency management Must evacuate or transport clients when appropriate in response to disasters

76 HIPPA Privacy Decision Tool for Emergency Preparedness Planning Available at: rstanding/special/emergency/decisiontoolintr o.html This tool is for advance planning purposes.

77 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 Provider Letter issued 3/21/2011

78 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 Provider Letter issued 7/22/11

79 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 $ Provider Letter issued 7/22/11

80 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 Regulatory reference: TAC $97.256

81 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 Letter issued 8/24/11

82 Provider Responsibilities Procedures for notifying DADS state office by telephone, within 24 hours after evacuation Procedures for notifying DADS regional office of location of Evacuation decision (IMMEDIATELY) Return to facility after evacuation - (IMMEDIATELY)

83 Be prepared. Provider Responsibilities 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 FIVES

84 DADS FIVES PROGRAM Facility Information Vacancy & Evacuation Status

85 Registration through the (STEAR) System for NF s, ALF s and HCSSAs Register It s the law Provider Letter Registration with the Texas Information and Referral Network 2-1-1; to ALF s and NF s HCSSAs : Assist with registration

86 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 Updates/Alerts Go to this web site: Select tab labeled subscribe and follow the instructions. 87

88 DADS ROLE IN DISASTER RESPONSE

89 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: carol.ahmed@dads.state.tx.us Mark Kendall, Regional Director, Region 6 Phone: mark.kendall@dads.state.tx.us

90 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

91 Protocol for Region 6 DADS- Hurricane/Disaster Evacuation No Surveys or non- priority complaints Only Priority One status investigations

92 Protocol for Region 6 DADS Hurricane /Disaster Evacuation Assist with Special Needs shelter activity coordination Post Disaster

93 Region 6 Evacuation Vests FREE of charge Bright & easily identifiable Water tight pouch in front for storage To order contact: Roxie.ward@setrac.org

94 ALF/ADC Contact Information DOTTY ACOSTA DADS Assisted Living and Adult Day Care Program Specialist Regulatory Services Division CARMELA STOWERS DADS Assisted Living and Adult Day Care Program Specialist Regulatory Services Division (512) (512)

95 HCSCCA Contact Information Yolanda Chavez, BSN, RN HCSSA Program Specialist Policy, Rules and Curriculum Development Unit Department of Aging and Disability Services, Regulatory Services (512)

96 ICF-IID Contact Information Alan Garms LMSW, AP DADS Regulatory Services Division Program Manager, Region 6 713/ office 713/ fax address: alan.garms@dads.state.tx.us

97 Cedric Peace Life Safety Code Contact Information DADS Regulatory Services Division Interim Program Manager, Region 6 713/ office address: cedric.peace@dads.state.tx.us

98 THANK YOU for your attendance and participation.