Healthcare facilities are required by state and federal regulations to have written emergency and disaster preparedness plans and to adequately train staff in those procedures. The California Department of Public Health (CDPH) has been increasing their focus on these requirements for healthcare facilities and issuing subsequent deficiencies for facilities’ failure to adequately prepare for emergencies.
In 2014, 20% of the California skilled nursing facilities surveyed received a deficiency for F-518: Training Staff in Emergency Preparedness, which is up from 17% over the past three years. CDPH issued a deficiency in nearly 10% of surveys in 2014 for failing to have an adequate written emergency plan (F-517).
What is disconcerting for healthcare facilities is that various CDPH district offices cite these deficiencies at vastly different rates. In the Redwood Coast district office, F-518: Training Staff in Emergency Procedures, was cited as the 4th most frequently-cited F-Tag at 48% of surveys. And F-517: Written Emergency Plan was in 11th place at 26% of the surveys in their district.
Perhaps this has something to do with their location covering counties such as Napa, Sonoma, Marin, and Solano, and the occurrence of a 6.0 earthquake in Napa in August 2014. Compare this to the Bakersfield district office where neither made it to the top 20 cited deficiencies for 2014. The Santa Ana office (Orange County) cited F-518 at 76% of their surveys in their #2 spot in 2014. Maybe the results of the Napa earthquake made them look harder at preparedness in southern California.
Many healthcare facilities in Napa County were affected by the earthquake in August 2014. It did test the preparedness of one skilled nursing facility and taught some valuable lessons. Their emergency food was stored in a storeroom with an entrance door that swings inward. During the earthquake, boxes fell off of the shelves and onto the floor, where they blocked the door from opening inward. Staff had to take the door off the hinges to enter the storeroom and access the emergency food supply. Lesson learned — ensure the door to your food storage room opens outward.
In the foothills of the Sierra Nevada during the “49er” fire in May 2009, another skilled nursing facility learned a lesson involving emergency food storage when the wild fire came very close to the facility. The emergency food was stored in an outside storage shed; the fire got close enough to heat the shed, heating canned goods which caused them to explode, splattering food all over the interior of the shed. Lesson learned — store your emergency food inside the building for easier access and safekeeping from the elements.
During this emergency, CDPH surveyors actually showed up to determine if residents were safe, if the facility was following its emergency preparedness plan, and if the destruction of the emergency food was a potential for harm for the residents. The facility still had power and water, so the staff was able to safely prepare their regular menu and serve resident meals without interruption. Knowing that the CDPH was on premises and would be scrutinizing their staff training and emergency preparedness plan did make the facility step up their game; the next survey showed no deficiencies in F-517 or F-518.
By knowing the trends in surveys conducted by their CDPH district offices, California healthcare facilities can be better prepared for survey. The same thinking is applicable in other states.
If you have noticed survey trends in your state, please share your findings in the comment section below.