Day 5: Emergency Preparedness & Safety

Course Overview: Emergency Preparedness & Safety

Welcome, future leaders in assisted living! I\’m Ayo AkinOni, and I\’m thrilled to guide you through this vital course on Emergency Preparedness & Safety. In our journey together, we\’ll transform potential anxieties into empowering confidence. This isn\’t just about ticking boxes for compliance; it\’s about building a robust shield of safety around the precious lives entrusted to our care. It\’s about ensuring peace of mind for residents, their families, and our dedicated staff. Let\’s embrace preparedness not as a burden, but as a profound commitment to excellence and compassion.

Learning Objectives

By the end of this course, you will be able to:

• Understand the core components of an Assisted Living Emergency Preparedness Packet.
• Develop, implement, and review an effective Emergency and Disaster Plan tailored to your facility.
• Master the requirements for resident evacuation, sheltering in-place, and accurate tracking during emergencies.
• Comprehend and apply Maryland\’s COMAR 10.07.14.47 regulations regarding fire safety, drills, and emergency electrical power.
• Cultivate a proactive mindset towards safety, fostering a culture of readiness within your assisted living program.

COMAR Regulatory Framework: 10.07.14.47 – Emergency Preparedness

Our foundation for this course is firmly rooted in the Code of Maryland Regulations (COMAR) 10.07.14.47, which specifically addresses Emergency Preparedness for Assisted Living Programs. This regulation outlines the comprehensive requirements designed to ensure the safety and well-being of residents and staff during various emergency situations. We will delve into each critical aspect, ensuring you have a clear understanding of your responsibilities and how to meet them effectively.

COMAR 10.07.14.47 – Emergency Preparedness

A. The facility shall comply with:

(1) All applicable local fire and building codes; and

(2) The National Fire Protection Association (NFPA) 101 Life Safety Code, including Chapter 24 of NFPA 101 if the facility is a one or two family dwelling as defined by NFPA 101.

B. Fire Extinguishers. An assisted living program shall:

(1) Ensure that fire extinguishers are:

(a) Located on each floor and adjacent to, or in, special hazard areas, such as:

(i) Furnace rooms;

(ii) Boiler rooms;

(iii) Kitchens; or

(iv) Laundries;

(b) Of standard and approved types;

(c) Installed and maintained to be conveniently available for use at all times; and

(d) Serviced annually, as evidenced by documentation maintained on-site, by an individual or company licensed by the Maryland State Fire Marshall; and

(2) Initially and at least annually instruct staff in the use of fire extinguishers.

C. Emergency and Disaster Plan.

(1) The assisted living program shall develop an Assisted Living Emergency Preparedness Packet in compliance with the requirements of §C(2)-(11) of this regulation, which shall be readily available to all staff.

(2) The assisted living program shall develop an emergency and disaster plan that includes procedures that shall be followed before, during, and after an emergency or disaster, including:

(a) Evacuation, transportation, or sheltering in-place of residents;

(b) Notification of families and staff regarding the action that will be taken concerning the safety and well-being of the residents;

(c) Staff coverage, organization, and assignment of responsibilities for ongoing sheltering in-place or evacuation, including identification of staff members available to report to work or remain for extended periods; and

(d) The continuity of services, including:

(i) Operations, planning, financial, and logistical arrangements;

(ii) Procuring essential goods, equipment, and services to sustain operations for at least 72 hours;

(iii) Relocation to alternate facilities or other locations; and

(iv) Reasonable efforts to continue care.

(3) The assisted living program shall have a tracking system to locate and identify residents in the event of displacement, an emergency, or a disaster that includes at a minimum the:

(a) Resident\’s name;

(b) Date and time that the resident was sent to the initial alternative facility or location;

(c) Name of the initial alternative facility or location where the resident was sent; and

(d) Contact person and phone number for the facility where the resident was sent.

(4) When the assisted living program relocates residents, the assisted living program shall send a brief medical fact sheet with each resident that includes at a minimum the resident\’s:

(a) Name;

(b) Medical condition or diagnosis;

(c) Medications;

(d) Allergies;

(e) Special diets or dietary restrictions; and

(f) Family or legal representative contact information.

(5) The brief medical fact sheet for each resident described in §C(4) of this regulation shall be:

(a) Updated upon the occurrence of change in any of the required information;

(b) Reviewed at least monthly; and

(c) Maintained in a central location readily accessible and available to accompany residents in case of an emergency evacuation.

(6) The assisted living program shall review the emergency and disaster plan at least annually and update the plan as necessary.

(7) The assisted living program shall:

(a) Identify a facility, facilities, or an alternate location or locations that have agreed to house the licensee\’s residents during an emergency evacuation; and

(b) Document an agreement with each facility or location.

(8) The assisted living program shall:

(a) Identify a source or sources of transportation that have agreed to safely transport residents during an emergency evacuation; and

(b) Document an agreement with each transportation source.

(9) Upon request, an assisted living program shall provide a copy of the facility\’s emergency and disaster plan to the local emergency management organization for the purpose of coordinating local emergency planning. The assisted living program shall provide the emergency and disaster plan in a format that is mutually agreeable to the local emergency management organization.

(10) The assisted living program shall identify an emergency and disaster planning liaison for the facility and shall provide the liaison\’s contact information to the local emergency management organization.

(11) The assisted living program shall prepare an executive summary of its evacuation procedures to provide to a resident, family member, or legal representative upon request. The executive summary shall, at a minimum:

(a) List means of potential transportation to be used in the event of evacuation;

(b) List potential alternative facilities or locations to be used in the event of evacuation;

(c) Describe means of communication with family members and legal representatives;

(d) Describe the role of the resident, family member, or legal representative in the event of an emergency situation; and

(e) Notify families that the information provided may change depending upon the nature or scope of the emergency or disaster.

D. Evacuation Plans. The facility shall:

(1) Conspicuously post individual floor plans with designated evacuation routes on each floor; and

(2) Ensure that all staff have access to the entire emergency preparedness plan.

E. Orientation and Drills.

(1) The assisted living program shall:

(a) Orient staff to the emergency and disaster plan and to their individual responsibilities within 24 hours of the commencement of job duties; and

(b) Document completion of the orientation in the staff member\’s personnel file through the signature of the employee.

(2) Fire Drills.

(a) The assisted living program shall conduct fire drills at least quarterly on all shifts.

(b) Documentation and Retention. The assisted living program shall document and maintain on file for a minimum of 2 years the:

(i) Completion date and time of each drill;

(ii) Names and signatures of staff who participated in the drill;

(iii) Fire scenario used in the drill;

(iv) Steps taken by staff during the drill;

(v) Successful and non-successful actions taken by staff during the drill; and

(vi) Opportunities for improvement identified as a result of the drill.

(3) Semiannual Disaster Drill.

(a) The assisted living program shall conduct a semiannual emergency and disaster drill on all shifts during which it practices evacuating residents or sheltering in-place so that each is practiced at least one time a year.

(b) The drills may be conducted via a table-top exercise if the program can demonstrate that moving residents will be harmful to the residents.

(c) The assisted living program shall document and keep on file for a minimum of 2 years the:

(i) Completion date and time of each disaster drill or training session;

(ii) Names and signature of staff who participated in the drill or training;

(iii) Type of disaster utilized for the drill or training;

(iv) Type of drill or training undertaken;

(v) Steps taken or discussed by staff during the drill or training;

(vi) Successful and non-successful actions taken or discussed by staff during the drill or training; and

(vii) Opportunities for improvement as identified as a result of the drill.

(4) The assisted living program shall cooperate with the local emergency management agency in emergency planning, training, and drills and in the event of an actual emergency.

F. Emergency Electrical Power Generator.

(1) Generator Required. By October 1, 2009, an assisted living program with 50 or more residents shall have an emergency electrical power generator on the premises, unless the program meets the requirements of §F(7) of this regulation.

(2) Generator Specifications. The power source shall be a generating set and prime mover located on the program\’s premises with automatic transfer. The emergency generator shall:

(a) Be activated immediately when normal electrical service fails to operate;

(b) Come to full speed and load acceptance within 10 seconds; and

(c) Have the capability of 48 hours of operation of the systems listed in §F(5) of this regulation from fuel stored on-site.

(3) Test of Emergency Power System.

(a) The program shall test the emergency power system once each month.

(b) During testing of the emergency power system, the generator shall be exercised for a minimum of 30 minutes under normal emergency facility connected load.

(c) Results of the test shall be recorded in a permanent log book that is maintained for that purpose.

(d) The assisted living program shall monitor the fuel level of the emergency generator after each test.

(4) The emergency power system shall provide lighting in the following areas of the facility:

(a) Areas of egress and protection as required by the State Fire Prevention Code and Life Safety Code 101 as adopted by the State Fire Prevention Commission;

(b) Nurses\’ station;

(c) Medication distribution station or unit dose storage;

(d) An area for emergency telephone use;

(e) Boiler or mechanical room;

(f) Kitchen;

(g) Emergency generator location and switch gear location;

(h) Elevator, if operable on emergency power;

(i) Areas where life support equipment is used;

(j) If applicable, common areas or areas of refuge; and

(k) If applicable, toilet rooms of common areas or areas of refuge.

(5) Emergency electrical power shall be provided for the following:

(a) Nurses\’ call system;

(b) At least one telephone in order to make and receive calls;

(c) Fire pump;

(d) Well pump;

(e) Sewerage pump and sump pump;

(f) If required for evacuation purposes, an elevator;

(g) If necessary, heating equipment needed to maintain a minimum temperature of 70°F (24°C) in all common areas or areas of refuge;

(h) Life support equipment; and

(i) Nonflammable medical gas systems.

(6) Common Areas or Areas of Refuge. If the emergency power system does not provide heat to all resident rooms and toilet rooms, the program shall provide common areas or areas of refuge for all residents. The areas shall meet the following requirements:

(a) The common area or areas of refuge shall maintain a minimum temperature of 70°F (24°C);

(b) Heated toilet rooms shall be provided adjacent to the common areas or areas of refuge; and

(c) The program facility shall provide to the Department a written plan that defines the:

(i) Specified common areas or areas of refuge;

(ii) Paths of egress from the common areas or areas of refuge; and

(iii) Provision for light, heat, food service, and washing and toileting of residents.

(7) Applicability of Emergency Power Requirements.

(a) An assisted living program shall be exempt from the requirements of this section if the program can safely transfer residents through an enclosed corridor to a building that is equipped with an electrical power generator that satisfies the requirements of §E of this regulation.

(b) An assisted living program may request a waiver from the requirements of this section in accordance with the procedures outlined in COMAR 10.07.14.09 on a year-to-year basis. The program shall demonstrate in the waiver request financial hardship that would create an undue financial burden on the facility and will require the facility to cease operation of the assisted living program.

(c) When the Department grants a waiver to an assisted living program for the requirements of this section, the assisted living program shall:

(i) Disclose in writing to all residents, their families, and legal representatives that the program does not have an emergency electrical power generator and that, in the event of a power outage, residents may need to be relocated; and

(ii) Provide a copy of the waiver to all residents, their families, and legal representatives.

Core Content Modules

Module 1: Fire Safety and Evacuation Plans

Fire safety is paramount in any assisted living environment. Compliance begins with understanding and adhering to both local fire and building codes, as well as the National Fire Protection Association (NFPA) 101 Life Safety Code. This includes specific considerations for facilities that are one or two family dwellings, as outlined in Chapter 24 of NFPA 101.

Beyond codes, the proper placement and maintenance of fire extinguishers are critical. They must be:

• Strategically Located: On each floor and near high-risk areas like furnace rooms, boiler rooms, kitchens, and laundries.
• Approved Types: Of standard and approved types to ensure effectiveness.
• Readily Available: Installed and maintained for convenient access at all times.
• Annually Serviced: Documented annual servicing by a Maryland State Fire Marshall licensed individual or company.

Crucially, all staff must receive initial and annual instruction on the proper use of fire extinguishers. Furthermore, clear evacuation plans are essential. Individual floor plans with designated evacuation routes must be conspicuously posted on each floor, and all staff must have access to the entire emergency preparedness plan to ensure a coordinated and effective response.

Module 2: The Emergency and Disaster Plan

A comprehensive Emergency and Disaster Plan is the cornerstone of resident safety. This plan, encapsulated in an Assisted Living Emergency Preparedness Packet, must be readily available to all staff. It details procedures to be followed before, during, and after an emergency or disaster, covering critical aspects such as:

• Evacuation, Transportation, or Sheltering in-Place: Clear guidelines for moving residents to safety or keeping them secure within the facility.
• Family and Staff Notification: Protocols for informing families and staff about actions taken for resident safety.
• Staff Coverage and Responsibilities: Defined roles and responsibilities for staff during extended periods of sheltering or evacuation, including identifying available personnel.
• Continuity of Services: Strategies for maintaining essential operations, including financial and logistical arrangements, procuring goods for at least 72 hours, relocating to alternate facilities, and continuing care.

An effective tracking system is vital for locating and identifying residents during displacement. This system must include the resident\’s name, date and time of transfer, the name of the alternative facility, and contact information for that facility. When residents are relocated, a brief medical fact sheet must accompany them, detailing their name, medical condition, medications, allergies, special diets, and family contact information. This sheet must be updated with any changes, reviewed monthly, and kept readily accessible for emergencies.

The Emergency and Disaster Plan must be reviewed and updated annually. Assisted living programs are required to identify and document agreements with alternate facilities for housing residents and transportation sources for safe relocation. Collaboration with the local emergency management organization is also mandated, including providing a copy of the plan and identifying a planning liaison. Finally, an executive summary of evacuation procedures must be available to residents and families upon request, outlining transportation, alternative locations, communication methods, and the roles of residents and families during an emergency.

Module 3: Staff Orientation and Drills

Even the most meticulously crafted plan is only as effective as the team implementing it. Therefore, thorough staff orientation and regular drills are non-negotiable. New staff members must be oriented to the emergency and disaster plan and their individual responsibilities within 24 hours of commencing job duties. This orientation must be documented in their personnel file with the employee\’s signature.

Fire drills are to be conducted at least quarterly on all shifts. Detailed documentation is required for a minimum of 2 years, including the date, time, participating staff, fire scenario, steps taken, successful and unsuccessful actions, and identified opportunities for improvement.

In addition to fire drills, a semiannual emergency and disaster drill must be conducted on all shifts, practicing either evacuation or sheltering in-place, ensuring each is practiced at least once a year. These drills can include table-top exercises if moving residents poses a harm. Similar to fire drills, comprehensive documentation for a minimum of 2 years is required, detailing the drill\’s specifics, participants, type of disaster, actions taken, and areas for improvement. Active cooperation with the local emergency management agency in planning, training, and drills is also essential.

Module 4: Emergency Electrical Power

For assisted living programs with 50 or more residents, an emergency electrical power generator is a critical requirement, unless specific exemptions apply. This generator must be located on the premises with automatic transfer, activating immediately upon normal electrical service failure, reaching full speed and load acceptance within 10 seconds, and capable of 48 hours of operation for essential systems from on-site fuel.

Regular testing is mandatory: the emergency power system must be tested monthly, exercising the generator for a minimum of 30 minutes under normal emergency facility connected load. Results must be recorded in a permanent log book, and fuel levels monitored after each test.

Emergency electrical power must provide lighting in crucial areas such as egress routes, nurses\’ stations, medication areas, emergency telephone areas, boiler/mechanical rooms, kitchens, generator locations, elevators (if operable), life support areas, and common areas/refuge areas. It must also power essential systems like the nurses\’ call system, at least one telephone, fire pump, well pump, sewerage/sump pumps, elevators (if needed for evacuation), heating equipment to maintain 70°F (24°C) in common areas, life support equipment, and nonflammable medical gas systems.

If the emergency power system does not heat all resident rooms, common areas or areas of refuge must be provided, maintaining 70°F (24°C) with adjacent heated toilet rooms. A written plan defining these areas, egress paths, and provisions for light, heat, food service, and toileting must be submitted to the Department.

Exemptions apply if residents can be safely transferred to a building with a compliant generator. Programs can also request a waiver due to financial hardship, but must then disclose the lack of a generator and potential relocation needs to residents and families, providing them with a copy of the waiver.

Practical Application: Real-World Scenarios

Let\’s bring these regulations to life with a couple of scenarios:

Scenario 1: The Winter Storm and Prolonged Power Outage

Imagine a severe winter storm hits, causing a widespread and prolonged power outage. Your facility, with 60 residents, is now relying on its emergency generator. How do you ensure continuous care and safety?

• Activation: The generator kicks in automatically, providing power to essential lighting and systems.
• Sheltering in-Place: With the storm raging, evacuation is not an immediate option. Your Emergency and Disaster Plan guides staff on sheltering residents in-place.
• Communication: Staff use the emergency telephone system to communicate with families, providing updates and reassurance.
• Comfort and Care: Common areas are maintained at 70°F, and staff ensure residents have access to food, water, and necessary medications, utilizing the brief medical fact sheets for each resident.
• Tracking: The resident tracking system is ready, should any internal movement or eventual relocation become necessary.

Scenario 2: Localized Fire and Immediate Evacuation

Consider a small, localized fire in the laundry room. The fire alarm sounds, requiring immediate evacuation of that wing.

• Rapid Response: Staff, trained in fire extinguisher use, attempt to contain the fire if safe to do so, while others initiate evacuation procedures.
• Evacuation Routes: Residents are guided along clearly marked evacuation routes, as per the posted floor plans.
• Resident Tracking: As residents move to a safe assembly point, the tracking system is updated to account for everyone.
• Coordination: The designated emergency planning liaison communicates with local emergency services, providing crucial information about the facility and residents.
• Family Notification: Families are promptly notified about the incident and the actions taken to ensure their loved ones\’ safety.

These scenarios highlight the critical importance of not just having a plan, but regularly practicing it and ensuring all staff are well-versed in their roles. Preparedness is a continuous journey, not a destination.

Summary & Encouragement

As we conclude this essential course, I want to reiterate that emergency preparedness is more than a regulatory requirement; it is a profound act of care and responsibility. By mastering these principles and diligently implementing them, you are not just managing a facility; you are cultivating a sanctuary of safety and peace for your residents. Remember, every drill, every plan, every moment of training builds a stronger, more resilient community. You have the power to create an environment where everyone feels secure, knowing that you are prepared for anything. Keep leading with confidence, compassion, and unwavering dedication. You are making a remarkable difference!

Ayo AkinOni, MPH
Founder and CEO, Balanced Care Academy