Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This rule establishes the additional
standards for those assisted living facilities which provide services to
residents with a physical, cognitive, or other impairment that prevents the
individual from safely evacuating the facility with minimal
assistance.
AGENCY NOTE: All rules relating to long-term care
facilities licensed by the department are followed by a Roman Numeral notation
which refers to the class (either Class I, II or III) of standard as designated
in section 198.085.1, RSMo.
(1) This rule contains the additional
standards for those assisted living facilities licensed pursuant to sections
198.005
and
198.073,
RSMo (CCS HCS SCS SB 616, 93rd General Assembly, Second Regular Session (2006))
and complying with sections 198.073.4 and
198.073.6,
RSMo (CCS HCS SCS SB 616, 93rd General Assembly, Second Regular Session (2006))
and
19
CSR 30-86.047 that choose to admit or continue to care
for any individual having a physical, cognitive or other impairment that
prevents the individual from safely evacuating the facility with minimal
assistance.
(2) Definitions. For
the purposes of this rule, the following definitions shall apply:
(A) Area of refuge-A space located in or
immediately adjacent to a path of travel leading to an exit that is protected
from the effects of fire, either by means of separation from other spaces in
the same building or its location, permitting a delay in evacuation. An area of
refuge may be temporarily used as a staging area that provides some relative
safety to its occupants while potential emergencies are assessed, decisions are
made, and evacuation has begun;
(B)
Evacuating the facility-The act of the resident going from one (1) smoke
section to another within the facility, going to an area of refuge within the
facility, or going out of the facility;
(C) Individualized evacuation plan-A plan to
remove the resident from the facility, to an area of refuge within the facility
or from one (1) smoke section to another within the facility. The plan is
specific to the resident's needs and abilities based on the current community
based assessment;
(D) Minimal
assistance-
1. Is the criterion which
determines whether or not staff must develop and include an individualized
evacuation plan as part of the resident's service plan;
2. Minimal assistance may be the verbal
intervention that staff must provide for a resident to initiate evacuating the
facility;
3. Minimal assistance may
be the physical intervention that staff must provide, such as turning a
resident in the correct direction, for a resident to initiate evacuating the
facility;
4. A resident needing
minimal assistance is one who is able to prepare to leave and then evacuate the
facility within five (5) minutes of being alerted of the need to evacuate and
requires no more than one (1) physical intervention and no more than three (3)
verbal interventions of staff to complete evacuation from the
facility;
5. The following actions
required of staff are considered to be more than minimal assistance:
A. Assistance to traverse down stairways
;
B. Assistance to open a door;
and
C. Assistance to propel a
wheelchair;
(E) Resident, only for the purpose of this
rule, means any individual having a physical, cognitive or other impairment
that prevents the individual from safely evacuating the facility with minimal
assistance who is admitted to or continues to be cared for in the facility
under the provisions of this rule; and
(F) Smoke section-A fire-rated separation of
one (1) section of the building from the rest of the building.
(3) General Requirements. I/II
(A) If the facility admits or retains any
individual needing more than minimal assistance due to having a physical,
cognitive or other impairment that prevents the individual from safely
evacuating the facility, the facility shall:
1. Meet the fire safety requirements of
19
CSR 30-86.022(16); I/II
2. Take necessary measures to provide
residents with the opportunity to explore the facility and, if appropriate, its
grounds; II
3. Use a personal
electronic monitoring device for any resident whose physician recommends the
use of such device; II
4. Have
sufficient staff present and awake twenty-four (24) hours a day to assist in
the evacuation of all residents; I/II
5. Include an individualized evacuation plan
in the resident's individual service plan; II
6. At a minimum the evacuation plan shall
include the following components:
A. The
responsibilities of specific staff positions in an emergency specific to the
individual; II
B. The fire
protection interventions needed to ensure the safety of the resident; and
II
C. The plan shall evaluate the
resident for his or her location within the facility and the proximity to exits
and areas of refuge. The plan shall evaluate the resident, as applicable, for
his or her risk of resistance, mobility, the need for additional staff support,
consciousness, response to instructions, response to alarms, and fire drills;
II
7. The resident's
evacuation plan shall be amended or revised based on the ongoing assessment of
the needs of the resident; II
8.
Those employees with specific responsibilities shall be instructed and informed
regarding their duties and responsibilities under the resident's evacuation
plan at least every six (6) months and upon any significant change in the plan;
II
9. A copy of the resident's
evacuation plan shall be readily available to all staff; and II
10. Comply with all requirements of this
rule. I/II
(4) Staffing Requirements.
(A) The facility shall have an adequate
number and type of personnel for the proper care of residents and upkeep of the
facility. At a minimum, the staffing pattern for fire safety and care of
residents shall be one (1) staff person for every fifteen (15) residents or
major fraction of fifteen (15) during the day shift, one (1) person for every
fifteen (15) residents or major fraction of fifteen (15) during the evening
shift, and one (1) person for every twenty (20) residents or major fraction of
twenty (20) during the night shift. I/II
|
Time
|
Personnel
|
Residents
|
| 7 a.m. to 3 p.m. (Day)* |
1 |
3-15 |
| 3 p.m. to 9 p.m. (Evening)* |
1 |
3-15 |
| 9 p.m. to 7 a.m. (Night)* |
1 |
3-20 |
*If the shift hours vary from those indicated, the hours of
the shifts shall show on the work schedules of the facility and shall not be
less than six (6) hours. III
(B) The required staff shall be in the
facility awake, dressed, and prepared to assist residents in case of emergency.
I/II
(C) The administrator shall
count toward staffing when physically present at the facility. II
(D) These staffing requirements are
applicable only when the facility actually has in residence one (1) or more
residents who require more than minimal assistance in evacuating the facility.
II
(E) At a minimum there shall be
a licensed nurse employed by the facility to work at least the following hours
per week:
3-30 Residents-8 hours
31-60 Residents-16 hours
61-90 Residents-24 hours
91 or more Residents-40 hours. II
(F) The licensed nurse shall be available to
assess residents for pain and significant and acute changes in condition. The
nurse's duties shall include, but shall not be limited to, review of residents'
records, medications, and special diets or other orders, review of each
resident's adjustment to the facility, and observation of each individual
resident's general physical, psychosocial, and mental status. The nurse shall
inform the administrator of any problems noted and these shall be brought to
the attention of the resident's physician and legally authorized representative
or designee. II/III
*Original authority: 198.073, RSMo 1979, amended 1984,
1992, 1999, 2006, 2007 and 198.076, RSMo 1979, amended 1984,
2007.
