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 for disasters. Make sure you are completely aware of the following Emergency
Preparedness regulation provided by the Maryland Office of Health Care Quality:
.46 Emergency Preparedness.
A. The facility shall comply with:
(1) All applicable local fire and building codes; and
(2) The Life Safety Code, NFPA 101, 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
(b) Of the standard and approved types; and
(c) Installed and maintained to be conveniently available for use at all times; 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 emergency and disaster plan that includes procedures that shall
be followed before, during, and after an emergency or disaster, including:
(a) Evacuation, transportation, or shelter-in-place of residents;
(b) Notification of families and staff regarding the action that will be taken concerning the safety and wellbeing of the residents;(c) Staff coverage, organization, and assignment of responsibilities for ongoing shelter-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.
(2) The licensee 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) Time that the resident was sent to the initial alternative facility or location; and
(c) Name of the initial alternative facility or location where the resident was sent.
(3) When the assisted living program relocates residents, the program shall send a brief medical fact sheet with
each resident that includes at a minimum the residents:
(b) Medical condition or diagnosis;
(e) Special diets or dietary restrictions; and
(f) Family or legal representative contact information.
(4) The brief medical fact sheet for each resident described in §C(3) of this regulation shall be:
(a) Updated upon the occurrence of a 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
(5) The licensee shall review the emergency and disaster plan at least annually and update the plan as
(6) The licensee shall:(a) Identify a facility, facilities, or 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.
(7) The licensee 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.
(8) Upon request, a licensee 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 licensee shall
provide the emergency and disaster plan in a format that is mutually agreeable to the local emergency management
(9) The licensee 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.
(10) The licensee 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
(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 conspicuously post individual floor plans with designated evacuation
routes on each floor.
E. Orientation and Drills.
(1) The licensee 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
(2) Fire Drills.
(a) The assisted living program shall conduct fire drills at least quarterly on all shifts.(b) Documentation. The assisted living program shall:
(i) Document completion of each drill;
(ii) Have all staff who participated in the drill sign the document; and
(iii) Maintain the documentation on file for a minimum of 2 years.
(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 tabletop exercise if the program can demonstrate that moving residents will be harmful to the residents.
(c) Documentation. The assisted living program shall:
(i) Document completion of each disaster drill or training session;
(ii) Have all staff who participated in the drill or training sign the document;
(iii) Document any opportunities for improvement as identified as a result of the drill; and
(iv) Keep the documentation on file for a minimum of 2 years.
(4) The licensee 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
(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
(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 licensee 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) Drug distribution station or unit dose storage;
(d) An area for emergency telephone use;
(e) Boiler or mechanical room;
(g) Emergency generator location and switchgear 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) Within 36 months of the effective date of this chapter, existing programs with 50 or more beds shall
complete the installation and acceptance of a working system as required in this regulation.
(b) An assisted living program shall be exempt from the requirements of §F of this regulation 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.
(c) An assisted living program may request a waiver from the requirements of §F of the regulation in
accordance with the procedures outlined in COMAR 10.07.14.08 on a year-to-year basis. The program shall
demonstrate in the waiver request financial hardship that would adversely affect the program’s viability.
(d) When the Department grants a waiver to an assisted living program for the requirements of §F of this
regulation, the assisted living program shall:
(i) Disclose in writing to current and prospective residents that the program does not have an emergency
(ii) Develop a plan to follow in the event of a loss of electrical power.
The biggest takeaway here is ensuring your staff is fully aware and equipped to deal with a disaster by training them frequently (document this and keep in staff file) on your emergency preparedness plan. It should also be suggested to have updated photos, relocation status as well as a contact number for all
residents in case of the need to evacuate the community due to a disaster