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TITLE 26HEALTH AND HUMAN SERVICES
PART 1HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 553LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
SUBCHAPTER CSTANDARDS FOR LICENSURE
RULE §553.44Emergency Preparedness and Response

(a) Definitions. The following words and terms, when used in this section, have the following meanings, unless the context clearly indicates otherwise.

  (1) Designated emergency contact--A person that a resident, or a resident's legally authorized representative, identifies in writing for the facility to contact in the event of a disaster or emergency.

  (2) Disaster or emergency--An impending, emerging, or current situation that:

    (A) interferes with normal activities of a facility and its residents;

    (B) may:

      (i) cause injury or death to a resident or staff member of the facility; or

      (ii) cause damage to facility property;

    (C) requires the facility to respond immediately to mitigate or avoid the injury, death, damage, or interference; and

    (D) except as it relates to an epidemic or pandemic, or to the extent it is incident to another disaster or emergency, does not include a situation that arises from the medical condition of a resident, such as cardiac arrest, obstructed airway, or cerebrovascular accident.

  (3) Emergency Management Coordinator (EMC)--The person who is appointed by the local mayor or county judge to plan, coordinate, and implement public health emergency preparedness planning and response within the local jurisdiction.

  (4) Emergency Preparedness Coordinator (EPC)--The facility staff person with the responsibility and authority to direct, control, and manage the facility's response to a disaster or emergency.

  (5) Evacuation Summary--A current summary of the facility's emergency preparedness and response plan that includes:

    (A) the name, address, and contact information for each receiving facility or pre-arranged evacuation destination identified by the facility under subsection (g)(3)(B) of this section;

    (B) the procedure for safely transporting residents and any other individuals evacuating a facility;

    (C) the name or title, and contact information, of the facility staff member to contact for evacuation information;

    (D) the facility's primary mode of communication to be used during a disaster or emergency and the facility's supplemental or alternate mode of communication;

    (E) the facility's procedure for notifying persons referenced in subsection (g)(5) of this section as soon as practicable about facility actions affecting residents during a disaster or emergency, including an impending or actual evacuation, and for maintaining ongoing communication with them for the duration of the disaster, emergency, or evacuation;

    (F) a statement about training that is available to a resident, the resident's legally authorized representative, and each designated emergency contact for the resident, on procedures under the facility's plan that involve or impact each of them, respectively; and

    (G) the facility's procedures for when a resident evacuates with a person other than a facility staff member.

  (6) Plan--A facility's emergency preparedness and response plan.

  (7) Receiving facility--A separate licensed assisted living facility:

    (A) from which a facility has documented acknowledgement, from an identified authorized representative, as described in subsection (i)(2)(C) of this section; and

    (B) to which the facility has arranged in advance of a disaster or emergency to evacuate some or all of a facility's residents, on a temporary basis due to a disaster or emergency, if, at the time of evacuation:

      (i) the receiving facility can safely receive and accommodate the residents; and

      (ii) the receiving facility has any necessary licensure or emergency authorization required to do so.

  (8) Risk assessment--The process of evaluating, documenting, and examining potential disasters or emergencies that pose the highest risk to a facility, and their foreseeable impacts, based on the facility's geographical location, structural conditions, resident needs and characteristics, and other influencing factors, in order to develop an effective emergency preparedness and response plan.

(b) A facility must conduct and document a risk assessment that meets the definition in subsection (a)(8) of this section for potential internal and external emergencies or disasters relevant to the facility's operations and location, and that pose the highest risk to a facility, such as:

  (1) a fire or explosion;

  (2) a power, telecommunication, or water outage; contamination of a water source; or significant interruption in the normal supply of any essential, such as food or water;

  (3) a wildfire;

  (4) a hazardous materials accident;

  (5) an active or threatened terrorist or shooter, a detonated bomb or bomb threat, or a suspicious object or substance;

  (6) a flood or a mudslide;

  (7) a hurricane or other severe weather conditions;

  (8) an epidemic or pandemic;

  (9) a cyber attack; and

  (10) a loss of all or a portion of the facility.

(c) A facility must develop and maintain a written emergency preparedness and response plan based on its risk assessment under subsection (b) of this section and that is adequate to protect facility residents and staff in a disaster or emergency.

  (1) The plan must address the eight core functions of emergency management, which are:

    (A) Direction and Control;

    (B) Warning;

    (C) Communication;

    (D) Sheltering arrangements;

    (E) Evacuation;

    (F) Transportation;

    (G) Health and medical needs; and

    (H) Resource management.

  (2) The facility must prepare for a disaster or emergency based on its plan and follow each plan procedure and requirement, including contingency procedures, at the time it is called for in the event of a disaster or emergency. In addition to meeting the other requirements of this section, the emergency preparedness plan must:

    (A) document the contact information for the EMC for the area, as identified by the office of the local mayor or county judge;

    (B) include a process that ensures communication with the EMC, both as a preparedness measure and in anticipation of and during a developing and occurring disaster or emergency; and

    (C) include the location of a current list of the facility's resident population, which must be maintained as required under subsection (g)(3) of this section, that identifies:

      (i) residents with Alzheimer's disease or related disorders;

      (ii) residents who have an evacuation waiver approved under §553.41(f)(2) of this subchapter; and

      (iii) residents with mobility limitations or other special needs who may need specialized assistance, either at the facility or in case of evacuation.

  (3) A facility must notify the EMC of the facility's emergency preparedness and response plan, take actions to coordinate its planning and emergency response with the EMC, and document communications with the EMC regarding plan coordination.

(d) A facility must:

  (1) maintain a current printed copy of the plan in a central location that is accessible to all staff, residents, and residents' legally authorized representatives at all times;

  (2) at least annually and after an event described in subparagraphs (A)-(D) of this paragraph, review the plan, its evacuation summary, if any, and the contact lists described in subsection (g)(3) of this section, and update each:

    (A) to reflect changes in information, including when an evacuation waiver is approved under §553.41(f)(2) of this subchapter;

    (B) within 30 days or as soon as practicable following a disaster or emergency if a shortcoming is manifested or identified during the facility's response;

    (C) within 30 days after a drill, if, based on the drill, a shortcoming in the plan is identified; and

    (D) within 30 days after a change in a facility policy or HHSC rule that would impact the plan;

  (3) document reviews and updates conducted under paragraph (2) of this subsection, including the date of each review and dated documentation of changes made to the plan based on a review;

  (4) provide residents and the residents' legally authorized representative with a written copy of the plan or an evacuation summary, as defined in subsection (a)(5) of this section, upon admission, on request, and when the facility makes a significant change to a copy of the plan or evacuation summary it has provided to a resident or a resident's legally authorized representative;

  (5) provide the information described in subsection (a)(5)(A) of this section to a resident or legally authorized agent who does not receive an evacuation summary under paragraph (4) of this subsection and requests that information;

  (6) notify each resident, next of kin, or legally authorized representative, in writing, how to register for evacuation assistance with the Texas Information and Referral Network (2-1-1 Texas); and

  (7) register as a provider with 2-1-1 Texas to assist the state in identifying persons who may need assistance in a disaster or emergency. In doing so, the facility is not required to identify or register individual residents for evacuation assistance.

(e) Core Function One: Direction and Control. A facility's plan must contain a section for direction and control that:

  (1) designates the EPC, who is the facility staff person with the responsibility and authority to direct, control, and manage the facility's response to a disaster or emergency;

  (2) designates an alternate EPC, who is the facility staff person with the responsibility and authority to act as the EPC if the EPC is unable to serve in that capacity; and

  (3) assigns responsibilities to staff members by designated function or position and describes the facility's system for ensuring that each staff member clearly understands the staff member's own role and how to execute it, in the event of a disaster or emergency.

(f) Core Function Two: Warning. A facility's plan must contain a section for warning that:

  (1) describes applicable procedures, methods, and responsibility for the facility and for the EMC and other outside organizations, based on facility coordination with them, to notify the EPC or alternate EPC, as applicable, of a disaster or emergency;

  (2) identifies whom, including during off hours, weekends, and holidays, the EPC or alternate EPC, as applicable, will notify of a disaster or emergency, and the methods and procedures for notification;

  (3) describes a procedure for keeping all persons present in the facility informed of the facility's present plan for responding to a potential or current disaster or emergency that is impacting or threatening the area where the facility is located; and

  (4) addresses applicable procedures, methods, and responsibility for monitoring local news and weather reports regarding a disaster or potential disaster or emergency, taking into consideration factors such as:

    (A) location-specific natural disasters;

    (B) whether a disaster is likely to be addressed or forecast in the reports; and

    (C) the conditions, natural or otherwise, under which designated staff become responsible for monitoring news and weather reports for a disaster or emergency.

(g) Core Function Three: Communication. A facility's plan must contain a section for communication that:

  (1) identifies the facility's primary mode of communication to be used during a disaster or emergency and the facility's supplemental or alternate mode of communication, and procedures for communication if telecommunication is affected by a disaster or emergency;

  (2) includes instructions on when to call 911;

  (3) includes the location of a list of each of the following, with current contact information for each, where it is easily accessible to staff at all times:

    (A) the legally authorized representative and designated emergency contacts for each resident;

    (B) each primary and alternate receiving facility or pre-arranged evacuation destination; the list for which must be kept with the written acknowledgement for each, as described and required in subsection (i)(2)(C) of this section;

    (C) home and community support services agencies and independent health care professionals that deliver health care services to residents in the facility;

    (D) personal contact information for facility staff; and

    (E) the facility's resident population, which must identify residents who may need specialized assistance at the facility or in case of evacuation, as described in subsection (c)(2)(C)(ii) or (iii) of this section;

  (4) provides a method for the facility to communicate information to the public about its status during a disaster or emergency; and

Cont'd...

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