| (5) describes the facility's procedure for notifying
at least the following persons, as applicable and as soon as practicable,
about facility actions affecting residents during an emergency, including
an impending or actual evacuation, and for maintaining ongoing communication
for the duration of the emergency or evacuation:
(A) all facility staff members, including off-duty
staff;
(B) each facility resident;
(C) any legally authorized representative of a resident;
(D) each resident's designated emergency contacts;
(E) each home and community support services agency
or independent health care professional that delivers health care
services to a facility resident;
(F) each receiving facility or evacuation destination
to be utilized, if there is an impending or actual evacuation, which,
if utilized at the time of evacuation, must be utilized in accordance
with the pre-arranged acknowledged procedures described in subsection
(i)(2)(C) of this section, where applicable, and must verify with
the applicable destination that it is available, ready, and legally
authorized at the time to receive the evacuated residents and can
safely do so;
(G) the driver of a vehicle transporting residents
or staff, medication, records, food, water, equipment, or supplies
during an evacuation, and the employer of a driver who is not a facility
staff person, and
(H) the EMC.
(h) Core Function Four: Sheltering Arrangements. A
facility's plan must contain a section for sheltering arrangements
that:
(1) describes the procedure for making and implementing
a decision to remain in the facility during a disaster or emergency,
that includes:
(A) the arrangements, staff responsibilities, and procedures
for accessing and obtaining medication, records, equipment and supplies,
water and food, including food to accommodate an individual who has
a medical need for a special diet;
(B) facility arrangements and procedures for providing,
in areas used by residents during a disaster or emergency, power and
ambient temperatures that are safe under the circumstances, but which
may not be less than 68 degrees Fahrenheit or more than 82 degrees
Fahrenheit; and
(C) if necessary, sheltering facility staff or emergency
staff involved in responding to an emergency and, as necessary and
appropriate, their family members; and
(2) includes a procedure for notifying HHSC Regulatory
Services regional office for the area in which the facility is located
and, in accordance with subsection (g)(5)(H) of this section, the
EMC, immediately after the EPC or alternate EPC, as applicable, makes
a decision to remain in the facility during a disaster or emergency.
(i) Core Function Five: Evacuation.
(1) A facility has the discretion to determine when
an evacuation is necessary for the health and safety of residents
and staff. However, a facility must evacuate if the county judge of
the county in which the facility is located, the mayor of the municipality
in which the facility is located mandates it by an evacuation order
issued independently or concurrently with the governor.
(2) A facility's plan must contain a section for evacuation
that:
(A) identifies evacuation destinations and routes,
including at least each pre-arranged evacuation destination and receiving
facility described in subparagraph (C) of this paragraph, and includes
a map that shows each identified destination and route;
(B) describes the procedure for making and implementing
a decision to evacuate some or all residents to one or more receiving
facilities or pre-arranged evacuation destinations, with contingency
procedures, and a plan for any pets or service animals that reside
in the facility;
(C) includes the location of a current documented acknowledgment
with an identified authorized representative of at least one receiving
facility or pre-arranged evacuation destination, and at least one
alternate. The documented acknowledgment must include acknowledgement
by the receiving facility or pre-arranged evacuation destination of:
(i) arrangements for the receiving facility or pre-arranged
destination to receive an evacuating facility's residents; and
(ii) the process for the facility to notify each applicable
receiving facility or pre-arranged destination of the facility's plan
to evacuate and to verify with the applicable destination that it
is available, ready, and not legally restricted at the time from receiving
the evacuated residents, and can do so safely;
(D) includes the procedure and the staff responsible
for:
(i) notifying HHSC Regulatory Services regional office
for the area in which the facility is located and, in accordance with
subsection (g)(5)(H) of this section, the EMC, immediately after the
EPC or alternate EPC, as applicable, makes a decision to evacuate,
or as soon as feasible thereafter, if it is not safe to do so at the
time of decision;
(ii) ensuring that sufficient facility staff with qualifications
necessary to meet resident needs accompany evacuating residents to
the receiving facility, pre-arranged evacuation destination, or other
destination to which the facility evacuates, and remain with the residents,
providing any necessary care, for the duration of the residents' stay
in the receiving facility or other destination to which the facility
evacuates;
(iii) ensuring that residents and facility staff present
in the building have been evacuated;
(iv) accounting for and tracking the location of residents,
facility staff, and transport vehicles involved in the facility evacuation,
both during and after the facility evacuation, through the time the
residents and facility staff return to the evacuated facility;
(v) accounting for residents absent from the facility
at the time of the evacuation and residents who evacuate on their
own or with a third party, and notifying them that the facility has
been evacuated;
(vi) overseeing the release of resident information
to authorized persons in an emergency to promote continuity of a resident's
care;
(vii) contacting the EMC to find out if it is safe
to return to the geographical area after an evacuation;
(viii) making or obtaining, as appropriate, a comprehensive
determination whether and when it is safe to re-enter and occupy the
facility after an evacuation;
(ix) returning evacuated residents to the facility
and notifying persons listed in subsection (g)(5) of this section
who were not involved in the return of the residents; and
(x) notifying the HHSC Regulatory Services regional
office for the area in which the facility is located immediately after
each instance when some or all residents have returned to the facility
after an evacuation.
(j) Core Function Six: Transportation. A facility's
plan must contain a section for transportation that:
(1) identifies current arrangements for access to a
sufficient number of vehicles to safely evacuate all residents;
(2) identifies facility staff designated during an
evacuation to drive a vehicle owned, leased, or rented by the facility;
notification procedures to ensure designated staff's availability
at the time of an evacuation; and methods for maintaining communication
with vehicles, staff, and drivers transporting facility residents
or staff during evacuation, in accordance with subsection (g)(5)(A)
and (G) of this section;
(3) includes procedures for safely transporting residents,
facility staff, and any other individuals evacuating a facility; and
(4) includes procedures for the safe and secure transport
of, and staff's timely access to, the following resident items needed
during an evacuation: oxygen, medications, records, food, water, equipment,
and supplies.
(k) Core Function Seven: Health and Medical Needs.
A facility's plan must contain a section for health and medical needs
that:
(1) identifies special services that residents use,
such as dialysis, oxygen, or hospice services;
(2) identifies procedures to enable each resident,
notwithstanding an emergency, to continue to receive from the appropriate
provider the services identified under paragraph (1) of this subsection;
and
(3) identifies procedures for the facility to notify
home and community support services agencies and independent health
care professionals that deliver services to residents in the facility
of an evacuation in accordance with subsection (g)(5)(E) of this section.
(l) Core Function Eight: Resource Management. A facility's
plan must contain a section for resource management that:
(1) identifies a plan for identifying, obtaining, transporting,
and storing medications, records, food, water, equipment, and supplies
needed for both residents and evacuating staff during an emergency;
(2) identifies facility staff, by position or function,
who are assigned to access or obtain the items under paragraph (1)
of this subsection and other necessary resources, and to ensure their
delivery to the facility, as needed, or their transport in the event
of an evacuation;
(3) describes the procedure to ensure medications are
secure and maintained at the proper temperature throughout an emergency;
and
(4) describes procedures and safeguards to protect
the confidentiality, security, and integrity of resident records throughout
an emergency and any evacuation of residents.
(m) Receiving Facility. To act as a receiving facility,
as defined in paragraph (a)(7) of this section, a facility's plan
must include procedures for accommodating a temporary emergency placement
of one or more residents from another assisted living facility, only
in an emergency and only if:
(1) the facility does not exceed its licensed capacity,
unless pre-approved in writing by HHSC, and the excess is not more
than 10 percent of the facility's licensed capacity;
(2) the facility ensures that the temporary emergency
placement of one or more residents evacuated from another assisted
living facility does not compromise the health or safety of any evacuated
or facility resident, facility staff, or any other individual;
(3) the facility is able to meet the needs of all evacuated
residents and any other persons it receives on a temporary emergency
basis, in accordance with §553.18(h) of this chapter, while continuing
to meet the needs of its own residents, and of any of its own staff
or other individuals it is sheltering at the facility during an emergency,
in accordance with its plan under subsection (h) of this section;
(4) the facility maintains a log of each additional
individual being housed in the facility that includes the individual's
name, address, and the date of arrival and departure.
(5) the receiving facility ensures that each temporarily
placed resident has at arrival, or as soon after arrival as practicable
and no later than necessary to protect the health of the resident,
each of the following necessary to the resident's continuity of care:
(A) necessary physician orders for care;
(B) medications;
(C) a service plan;
(D) existing advance directives; and
(E) contact information for each legally authorized
representative and designated emergency contact of an evacuated resident,
and a record of any notifications that have already occurred.
(n) Emergency preparedness and response plan training.
The facility must:
(1) provide staff training on the emergency preparedness
plan at least annually;
(2) train a facility staff member on the staff member's
responsibilities under the plan:
(A) prior to the staff member assuming job responsibilities;
and
(B) when a staff member's responsibilities under the
plan change;
(3) conduct at least one unannounced annual drill with
facility staff for severe weather or another emergency identified
by the facility as likely to occur, based on the results of the risk
assessment required by subsection (b) of this section;
(4) offer training, and document, for each, the provision
or refusal of such training, to each resident, legally authorized
representative, if any, and each designated emergency contact, on
procedures under the facility's plan that involve or impact each of
them, respectively; and
(5) document the facility's compliance with each paragraph
of this subsection at the time it is completed.
(o) Self-reported incidents related to a disaster or
emergency.
(1) A facility must report a fire to HHSC as follows:
(A) by calling 1-800-458-9858 immediately after the
fire or as soon as practicable during the course of an extended fire;
and
(B) by submitting a completed HHSC form titled "Fire
Report for Long Term Care Facilities" within 15 calendar days after
the fire.
(2) A facility must report to HHSC a death or serious
injury of a resident, or threat to resident health or safety, resulting
from an emergency or disaster as follows:
(A) by calling 1-800-458-9858 immediately after the
incident, or, if the incident is of extended duration, as soon as
practicable after the injury, death, or threat to the resident; and
(B) by conducting an investigation of the emergency
and resulting resident injury, death, or threat, and submitting a
completed HHSC Form 3613-A titled "SNF, NF, ICF/IID, ALF, DAHS and
PPECC Provider Investigation Report with Cover Sheet." The facility
must submit the completed form within five working days after making
the telephone report required by paragraph (2)(A) of this subsection.
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