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State of California—Health and Human Services Agency
California Department of Public Health

AFL 06-22
July 24, 2006

Skilled Nursing Facilities (SNF)
Congregate Living Health Facilities (CLHF)
Intermediate Care Facilities (ICF)
Intermediate Care Facilities/Developmentally Disabled (ICF/DD)
Intermediate Care Facilities/Developmentally Disabled-Habilatative (ICF/DD-H)
Intermediate Care Facilities/Developmentally Disabled-Nursing (ICF/DD-N)
Intermediate Care Facilities/Developmentally Disabled-Continuous Nursing  (ICF/DD-CN)

Requirements for Implementation of External Disaster Plans for Department of Health Services, Licensing and Certification Long Term Care Facilities

The hot summer months are bringing with them extreme temperatures throughout California. The California Department of Health Services (CDHS), Licensing and Certification (L&C) is issuing this letter to remind providers of their responsibilities to residents, clients, patients, and to CDHS when it becomes necessary for facilities to implement their internal and external disaster plans. We have also included an  attachment describing the existing requirements for the main elements needed for facilities’ internal and external disaster plans. In addition, attached is a memo addressing hot weather advisories and Centers for Disease Control and Prevention (CDCP) guidelines for responding to power outages, and a poster providing emergency
after-hours contact information for CDHS L&C.

The California Code of Regulations Title 22 (22 CCR) requires all long term care provider types to, “Accept and retain only those patients for whom it can provide adequate care.” When a facility experiences a power outage during a time of extreme heat, residents, clients, and patients may be maintained in the facility only while it is safe to do so. When the facility recognizes that there is an imminent threat to the continued provision of safe care at the facility, the facility’s external disaster plan must be implemented and followed for orderly evacuation or transfer of all residents, clients, and patients. In addition, facilities must have contingency plans in place to deal with either the loss of air conditioning or, in the case when no air conditioning is available, to take measures to ensure patients and residents are kept as cool as possible. Portable fans and other temporary cooling devices should be used when indicated. Facilities are also required to ensure that residents’ conditions are assessed and reassessed as necessary for their health and safety.

The requirements for back up power vary by licensee category. All SNFs, ICFs, and ICF/DD-CN facilities must have generators and back-up sources for emergency utilities. In addition, any facility to which patients are admitted with life support equipment are required to have generators. ICF/DD-Ns and ICF/DD-Hs utilize alternative back up power such as additional battery packs, battery-operated lights, alternative heating such as oil heaters, and camping stoves and barbeques for cooking.

All long term care facilities are also required by 22 CCR to report all unusual occurrences to the CDHS L&C program. An “unusual occurrence” is defined as any occurrence that threatens the welfare, safety, or health of patients, personnel, or visitors. Power outages that may impact the health and safety of residents, clients, and patients are required to be reported to CDHS L&C within 24 hours by telephone and later confirmed in writing. After business hours, the CDHS L&C duty officer may be paged at any time at (916) 328-3605. If your facility is not certain about the need to report a power outage, telephone the duty officer for assistance.

While 22 CCR allows 24 hours for the reporting of unusual occurrences, notifying L&C as early as possible during these heat-related unusual occurrences can enable District Office staff to offer you assistance in coordinating with other agencies from whom you might obtain needed help.

We greatly appreciate your commitment to keeping our most fragile citizens safe during times of emergency.


Original signed by Kathleen Billingsley

Kathleen Billingsley, RN
Deputy Director


CDC - What You Need to Know When the Power Goes Out Unexpectedly (PDF)
Essential Plan Elements for External Disaster Plans in California Long Term Care Facilities

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