Emergency preparedness and Safety Standards | AZ

Emergency preparedness and Safety Standards

When operating an Assisted Living Facility, it is imperative to operate by the rule of the 5 ‘P’s; Proper Preparation Prevents Poor Performance. This could be no truer than when discussing emergency preparedness plan and the safety standards of a community. Make sure you and your team are completely aware of the following Emergency Preparedness regulations provided by the Arizona Bureau of Residential Facilities Licensing:

R9-10-818. Emergency and Safety Standards

1. A manager shall ensure that:
2. A disaster plan is developed, documented, maintained in a location accessible to caregivers and assistant caregivers, and, if necessary, implemented that includes:
3. When, how, and where residents will be relocated;
4. How a resident’s medical record will be available to individuals providing services to the resident during a disaster;
5. A plan to ensure each resident’s medication will be available to administer to the resident during a disaster; and
6. A plan for obtaining food and water for individuals present in the assisted living facility or the assisted living facility’s relocation site during a disaster;
7. The disaster plan required in subsection (A)(1) is reviewed at least once every 12 months;
8. Documentation of the disaster plan review required in subsection (A)(2) includes:
9. The date and time of the disaster plan review;
10. The name of each employee or volunteer participating in the disaster plan review;
11. A critique of the disaster plan review; and
12. If applicable, recommendations for improvement;
13. A disaster drill for employees is conducted on each shift at least once every three months and documented;
14. An evacuation drill for employees and residents:
15. Is conducted at least once every six months; and
16. Includes all individuals on the premises except for:
17. A resident whose medical record contains documentation that evacuation from the assisted living facility would cause harm to the resident, and
18. Sufficient caregivers to ensure the health and safety of residents not evacuated according to subsection (A)(5)(b)(i);
19. Documentation of each evacuation drill is created, is maintained for at least 12 months after the date of the evacuation drill, and includes:
20. The date and time of the evacuation drill;
21. The amount of time taken for employees and residents to evacuate the assisted living facility;
22. If applicable:
23. An identification of residents needing assistance for evacuation, and
24. An identification of residents who were not evacuated;
25. Any problems encountered in conducting the evacuation drill; and
26. Recommendations for improvement, if applicable; and
27. An evacuation path is conspicuously posted in each hallway of each floor of the assisted living facility.
28. A manager shall ensure that:
29. A resident receives orientation to the exits from the assisted living facility and the route to be used when evacuating the assisted living facility within 24 hours after the resident’s acceptance by the assisted living facility, and
30. The resident’s orientation is documented.
31. A manager shall ensure that a first-aid kit is maintained in the assisted living facility in a location accessible to caregivers and assistant caregivers.
32. When a resident has an accident, emergency, or injury that results in the resident needing medical services, a manager shall ensure that a caregiver or an assistant caregiver:
33. Immediately notifies the resident’s emergency contact and primary care provider; and
34. Documents the following:
35. The date and time of the accident, emergency, or injury;
36. A description of the accident, emergency, or injury;
37. The names of individuals who observed the accident, emergency, or injury;
38. The actions taken by the caregiver or assistant caregiver;
39. The individuals notified by the caregiver or assistant caregiver; and
40. Any action taken to prevent the accident, emergency, or injury from occurring in the future.
41. A manager of an assisted living center shall ensure that:
42. Unless the assisted living center has documentation of having received an exception from the Department before October 1, 2013, in the areas of the assisted living center providing personal care services or directed care services:
43. A fire alarm system is installed according to the National Fire Protection Association 72: National Fire Alarm and Signaling Code, incorporated by reference in R9-10-104.01, and is in working order; and
44. A sprinkler system is installed according to the National Fire Protection Association 13: Standard for the Installation of Sprinkler Systems, incorporated by reference in R9-10-104.01, and is in working order;
45. For the areas of the assisted living center providing only supervisory care services:
46. A fire alarm system and a sprinkler system meeting the requirements in subsection (E)(1) are installed and in working order, or
47. The assisted living center complies with the requirements in subsection (F);
48. A fire inspection is conducted by a local fire department or the State Fire Marshal before initial licensing and according to the time-frame established by the local fire department or the State Fire Marshal;
49. Any repairs or corrections stated on the fire inspection report are made; and
50. Documentation of a current fire inspection is maintained.
51. A manager of an assisted living home shall ensure that:
52. A fire extinguisher that is labeled as rated at least 2A-10-BC by the Underwriters Laboratories is mounted and maintained in the assisted living home;
53. A disposable fire extinguisher is replaced when its indicator reaches the red zone;
54. A rechargeable fire extinguisher:
55. Is serviced at least once every 12 months, and
56. Has a tag attached to the fire extinguisher that specifies the date of the last servicing and the identification of the person who serviced the fire extinguisher;
57. Except as provided in subsection (G):
58. A smoke detector is:
59. Installed in each bedroom, hallway that adjoins a bedroom, storage room, laundry room, attached garage, and room or hallway adjacent to the kitchen, and other places recommended by the manufacturer;
60. Either battery operated or, if hard-wired into the electrical system of the assisted living home, has a back-up battery;

iii. In working order; and

1. Tested at least once a month; and
2. Documentation of the test required in subsection (F)(4)(a)(iv) is maintained for at least 12 months after the date of the test;
3. An appliance, light, or other device with a frayed or spliced electrical cord is not used at the assisted living home; and
4. An electrical cord, including an extension cord, is not run under a rug or carpeting, over a nail, or from one room to another at the assisted living home.
5. A manager of an assisted living home may use a fire alarm system and a sprinkler system to ensure the safety of residents if the fire alarm system and sprinkler system:
6. Are installed and in working order, and
7. Meet the requirements in subsection (E)(1).

Top Takeaways:

• A disaster plan is developed, documented, maintained in a location accessible to caregivers and assistant caregivers, and, if necessary, implemented that includes: A-D

2. The disaster plan required in subsection (A)(1) is reviewed at least once every 12 months;

Having an up to date disaster plan that encompasses the elements required in subsection a-d is key to an effective disaster response. Your team should be aware of the disaster plan and the how they will respond to each potential disaster. The plan must be reviewed and updated every 12 months and submitted to BRFL.

• A disaster drill for employees is conducted on each shift at least once every three months and documented;

5. An evacuation drill for employees and residents:
6. Is conducted at least once every six months; and
7. Includes all individuals on the premises except for:
8. A resident whose medical record contains documentation that evacuation from the assisted living facility would cause harm to the resident, and
9. Sufficient caregivers to ensure the health and safety of residents not evacuated according to subsection (A)(5)(b)(i);

After a surveyor preforms an inspection of your employee trainings and finds no evidence of emergency trainings, they will absolutely cite you for a deficiency. They have heard time and time again, “we did the trainings! We just forgot to do a sign in sheet.” No excuses! Make sure you have a system in place for who conducts these trainings and is responsible for the training documentation.