adult care facilities

Adult Care Facilities 1

Running head: Adult Care Facilities

Adult Care Facilities

Jeffrey M. Stewart

Clark County Fire District 3

Brush Prairie, Washington

September 2009


Certification Statement

I hereby certify that this paper constitutes my own product, that where the language of others is

set forth, quotation marks so indicate, and that appropriate credit is given where I have used the

language, ideas, expressions, or writings of another.

Signed:____________________________________________


Abstract

The problem is Clark County Fire District 3 (CCFD 3) has numerous adult care facilities

located within the Fire District with no understanding of County, State, or Federal regulations.

The purpose of this research was to determine how many and what type of adult care

facilities exist within the CCFD 3, the locations, and the regulations governing them. The

descriptive research utilized three research questions that evaluated the number and locations of

adult care facilities within CCFD 3, the regulations associated with adult care facilities, and

policies of other Fire Districts. The procedures used to conduct the research included a

comprehensive adult care facility location plan, telephone interviews, a nine question telephone

survey, and detailed website research.

The results revealed numerous adult family homes located in CCFD 3 as well as adjacent

agencies with no notification from governing agencies. The recommendations include increasing

adult care facility awareness and safety through development of a notification plan and pre-

incident planning for CCFD 3 personnel. Additional recommendations include County and State

involvement in requiring adult care facility owners to notify Fire Districts of facilities located in

their emergency response jurisdiction.


Table of Contents Certification Statement ....................................................................................................... 2

Abstract ............................................................................................................................ 3

Table of Contents .............................................................................................................. 4

Introduction ...................................................................................................................... 5

Background and Significance .............................................................................................. 6

Literature Review .............................................................................................................. 7

Procedures ...................................................................................................................... 10

Results ............................................................................................................................ 11

Discussion ...................................................................................................................... 26

Recommendations............................................................................................................ 28

References ...................................................................................................................... 30

Appendix A..................................................................................................................... 35

Appendix B ..................................................................................................................... 36

Appendix C ..................................................................................................................... 38


Adult Care Facilities

Introduction

This research has been conducted to assist Clark County Fire District 3 (CCFD 3) in

answering the question, why are we not being properly notified of adult family homes located in

CCFD 3? Nationally, adult care facilities are referred to as adult care homes, adult care facilities,

assisted living facilities, nursing homes, and retirement centers. The facilities are called various

names but all have inherent dangers to patients, staff, and firefighters under fire conditions. The

research revealed the facilities located in CCFD 3 are called adult family homes per the

Washington State Department of Social and Health Services. Since 2003, CCFD 3 personnel

have responded to emergencies in adult family homes 228 times. One hundred percent of the 228

responses were medical emergencies to 14 different adult family homes. CCFD 3 has not

responded to one of the 14 facilities for fire related emergencies but the risk of a catastrophic

loss of life is prevalent.

The problem is CCFD 3 has numerous adult care facilities located within the Fire District

with no understanding of County, State, or Federal regulations. CCFD 3 provides 24 hour

emergency medical and fire suppression service to a rural population of approximately 20,000 in

an 83 square mile area operating out of four stations. The emergency response is provided with

career and volunteer personnel. At times the staffing level falls to two personnel per apparatus.

The purpose of this research was to determine what type of adult care facilities exist

within CCFD 3, the locations, and the regulations governing them.

The questions used for this descriptive research were:

1. What County and State regulations govern adult care facilities?

2. What Federal regulations govern adult care facilities?


3. How many and what type of adult care facilities are located in CCFD 3?

4. What policies exist in other fire districts regarding adult care facilities?

Background and Significance

Clark County Fire District 3 (CCFD 3), established in 1947, provides fire protection and

emergency medical services to an area of 83 square miles with an approximate population of

20,000. In 2008, the District responded to 1058 alarms out of four fire stations with a staff of 21

career personnel and 40 volunteers. The District is comprised mainly of rural residential.

Additional features include an elevation range of 300 feet to over 1600 feet, heavily forested

areas, lakes, a river, a railway system, State Route Highways, public and private parks, schools,

private airports, churches, farms, small businesses, and high dollar residential neighborhoods.

In the early existence of the District, the landscape was mostly farm land in the lower

elevations and forest land in the higher elevations. Today, the farm lands are turning into multi-

family residential neighborhoods and the forest lands have turned into view lots for mini-

mansions. Many of the mini-mansions have been turned into adult care facilities. These facilities

are tucked away in areas that are not seen unless called to an emergency. This raises great

concern for the occupants of the facilities and for the responding firefighters.

These facilities house occupants who are mentally or medically ill and are unable to walk

or assist themselves out of a building under fire conditions. Firefighters arriving to an adult care

facility under fire conditions have to make a quick calculated decision to either rescue the

occupants by removing them from the hazard or remove the hazard by leaving the occupants in

place and attacking to the fire. This type of scenario requires numerous personnel and apparatus

to orchestrate. It has the potential to tax CCFD 3 resources and mutual-aid resources.


Currently CCFD 3 is not notified when adult care facilities are located in CCFD 3.

District personnel become familiar with some of the facility locations when responding to

medical emergencies. There are only four pre-incident surveys and plans that have been

conducted on known adult care facilities in the District. Having pre-incident plans would assist

firefighters in knowing the number of occupants, the size and layout of the facility, and any

hazards that may be present.

The research project was completed in accordance with the National Fire Academy’s

Executive Fire Officer Program (EFOP) requirements. The research relates to the second United

States Fire Administrations (USFA) Operational Goal which is to improve local planning and

preparedness. In addition, the project relates to the issue of promoting community and fire

personnel risk reduction, which was a topic of the Executive Leadership course for which this

Applied Research Project (ARP) was written.

Literature Review

The purpose of this literature review was to research and examine new information to

address the issue of adult care facilities located in Clark County Fire District 3 (CCFD 3). There

proved to be an adequate amount of information in the Learning Resource Center of the National

Fire Academy. There was no applied research material found on this issue. The findings of this

research were derived from journals and Internet web sites.

Most communities have residences that care for the elderly. They may be nursing homes

or assisted-living facilities. These types of occupancies will present problems for firefighters

should a fire occur (Smith, 2002, p.16). As previously noted, the specific adult care facilities

located in CCFD 3 are classified as adult family homes. These types of facilities have occupants

that are both ambulatory and non-ambulatory. The ambulatory occupants typically require an


assisted living type of care. The non-ambulatory occupants are often bedridden or lack mobility.

Evacuation of residents in assisted-living facilities under fire conditions may require the hands

on removal by staff and firefighters. Smith (2002) goes on to say, since assisted-living facilities

have a reduced number of staff in comparison to nursing homes, a greater response of firefighters

for evacuation will be required (p. 18).

Jaslow, et al. (2005, p. 134) found that according to the US Centers for Disease Control

and Prevention, approximately 1.5 million Americans live in a group setting such as a nursing

home or assisted living facility. More than 90% of these people are more than 65 years of age,

and approximately 35% are more than 85 years of age. Of adults over the age of 85 years, nearly

25% of people live in group-living facilities. Fire in group facilities pose greater-than-normal

risks for several reasons including, high resident-to-staff ratios, bedridden residents, and older

construction. During the four-year period of 1999-2002, an estimated average of 3,680 structure

fires in nursing homes and residential board and care facilities were reported to U.S. fire

departments per year. These fires resulted in an annual average of 11 civilian deaths and 172

civilian injuries (Ahrens, 2005, p.13). Kennedy and Alexander (2008) wrote that according to the

National Fire Protection Association (NFPA), once a person reaches age 65, the risk of being

killed or injured by fire doubles in comparison with the general population.

Healthcare occupancies present emergency responders with a unique set of tactical

problems. Many of their occupants are immobile, partially incapacitated, or in an altered state of

consciousness due to sleep, illness, or medication. They spend 24 hours a day, seven days a

week, in areas containing a high-potential fuel load of combustibles and oxygen, while other

hazardous areas, such as kitchens, laundries, and storage areas also exist (Klaene & Sanders,

2004, p. 22). Klaene and Sanders go on to say the best tactical option for ensuring the occupants’


fire safety is extinguishment. If sufficient staff is available, the staff should move patients to

areas of refuge while firefighters immediately begin to extinguish the blaze (p. 22). There are

additional fire risks incurred by those choosing to live in a group living facility. Fluctuations in

staffing may leave a high resident to staff ratio during the nights.

Fires in nursing homes and assisted living facilities will tax every fire department. The

type of construction used in group living facilities may contribute to fire risk, since many

buildings are designed with large, open, meeting places that facilitate the passage of smoke and

toxic gases through several stories. The ability to have a sufficient number of firefighters at the

incident scene can mean the difference between life and death. The labor intensiveness of these

assignments will necessitate the rotation of personnel due to the firefighting demands and the

exertion necessary to move a large number of occupants (Smith, 2002, p. 18). Firefighters and

the health-care facility staff must work together to save the lives of the patients who depend on

them. The most effective way to do this is to create a pre-incident plan and train together to

implement it during an emergency (Klaene & Sanders, 2004, p.22).

It was very obvious while gathering literature information for this research project that

adult care facilities are a national problem for the fire service. It was identified numerous times

in the literature review that adult care facilities can be named or classified several different ways

while having several different meanings. Regardless of the facility type, they all have inherent

risks and problems to the occupants and fire service personnel. An adult care facility under fire

conditions presents a huge challenge for firefighters attempting to ensure all occupants are out of

the facility while engaged in fire suppression efforts. Notification of adult care facility locations,

indentifying the type of facilities, and pre-incident planning can reduce the challenges presented

by these types of incidents.


Procedures The descriptive research method was used for this Applied Research Paper in an effort to

determine the number and type of adult care facilities in Clark County Fire District 3 (CCFD 3).

In addition, it was the desire of the author to determine what current County, State and Federal

regulations govern adult care facilities. It was also the desire of the author to determine if other

fire agencies in Clark County were faced with the same adult care facility issues as CCFD 3.

In order to determine the actual number and type of adult care facilities located in CCFD

3, the author used the District’s “Firehouse” data management system to gather addresses of

adult care facilities in which CCFD 3 had responded to on emergency alarms. The author used

the Washington Department of Social and Health Services website to cross reference the

addresses found in District’s data management system. Once the actual number and location of

facilities were confirmed, the author physically drove to each facility. The adult care facilities

were identified and inventoried based on the location, number of residence located at the facility,

and the construction type of the building. A copy of the inventory can be found in Appendix C.

Several phone interviews were used to ascertain the needed information in determining

what County, State, and Federal regulations govern adult care facilities. The first interview was

conducted with Clark County Fire Marshal Jon Dunaway on June 5, 2009. Fire Marshal

Dunaway assisted with identifying the County regulations for adult care facilities. Washington

State Fire Marshal Ken Morss was called on June 6, 2009. Fire Marshal Morss identified key

Washington Administrative Codes (WAC) and Revised Codes of Washington (RCW) that were

pertinent to State regulation of adult care facilities. Once the WAC’s and RCW’s were

researched, the author contacted Washington State Department of Social and Human Services

(WSDSHS) Field Supervisor Casey Zimmer on July 7, 2009 for assistance in clarifying some of


the information found in the WAC’s and RCW’s. WSDSHS Nursing Supervisor Linda Ronco

was contacted via e-mail on July 21, 2009. Supervisor Ronco assisted the author with

indentifying the Federal regulations governing adult care facilities.

A telephone survey was conducted in June of 2009 with three Fire Districts and two Fire

Departments from Clark County, Washington. The survey was primarily directed toward the

number and type of adult care facilities located in each agency. The survey consisted of nine

questions focusing on adult care facilities and ways CCFD 3 could use the information gathered.

The author interviewed one chief officer in the rank of battalion chief or above from each

agency. The telephone survey is located in Appendix A. The results, agencies, and contact

personnel can be found in Appendix B.

The procedures used to gather information for the results of this applied research project

were limited to CCFD 3, fire service agencies within Clark County, Washington, and

Washington State. As the literature review indicated, adult care facilities are a national problem

for the entire fire service. The scope of this problem is so big the author limited the research to

local issues. Also, once the author determined the adult care facilities located in CCFD 3 were

classified as adult family homes, the research was limited to adult family homes.

Results

The first research question sought to identify what County and State regulations govern

adult care facilities. To answer the first part of the question the author chose to contact the Clark

County Fire Marshal’s office. Fire Marshal Jon Dunaway was contacted via the telephone June

5, 2009. Fire Marshal Dunaway was informed of the author’s research desires and the requests

for detailed information. Fire Marshal Dunaway clarified the different types of adult care

facilities and the role the Fire Marshal’s office takes in each one. He advised the adult care


facilities in Clark County were boarding houses, nursing homes, hospitals, and adult family

homes. It was identified that the type of facilities located in Clark County Fire District 3 (CCFD

3) were private homes typically used to care for the elderly. The homes were limited to six

patient beds or less with a health care provider on site at all times. Due to the overwhelming

research needed for all adult care facilities, the author chose to keep the research centered on the

adult family homes.

It was also indentified after Fire Marshal Dunaway clarified the different types of adult

care facilities located in Clark County that the facilities located in CCFD 3 were called adult

family homes and were regulated by the Washington State Department of Social and Health

Services (WSDSHS). Fire Marshal Dunaway advised the only service the Clark County Fire

Marshal’s Office (CCFMO) provides with adult family homes is to confirm there is adequate

water available for fire suppression and the homes have adequate space provided for emergency

fire apparatus access. The CCFMO does not perform actual fire inspections of the buildings.

The second part of question one sought to identify what State regulations govern adult

care facilities. The author researched the Washington State Patrol website to seek information on

personnel to contact who could assist in answering question one. The website indentified 10

Washington State Deputy Fire Marshal’s who were located throughout the State to provide fire

and life safety inspections and education to nursing homes, boarding homes, group homes,

children centers, schools, and hospitals. Deputy Fire Marshal Ken Morss was indicated as the

Regional Deputy Fire Marshal for CCFD 3.

The author contacted Fire Marshal Morss via the telephone on June 6, 2009 and

requested information on adult care facilities. Fire Marshal Morss advised that the size and type

of adult care facilities located in CCFD 3 were called adult family homes and were regulated by


the WSDSHS. He informed the author of numerous Washington Administrative Codes (WAC)

and Revised Codes of Washington (RCW) that the WSDSHS are required to follow. When the

author informed him the intent of this research was to determine why fire departments are not

being notified when adult care facilities open businesses in their fire protection area, Fire

Marshal Morss replied, “It looks like we need to ruffle some feathers to get that changed.”

The author investigated the WAC’s and RCW’s provided by Deputy Fire Marshal Morss

via each department’s website. Two RCW’s were found pertaining to adult family homes and

were investigated by the author. The first RCW investigated was a directive to the WSDSHS

field agents who are authorized to conduct inspections of adult family homes. RCW 70.128.090,

Inspections – Generally, indicated that during inspections of an adult family home, the

department shall have access and authority to examine areas and articles in the home used to

provide care or support to residents, including resident records, accounts, and the physical

premises, including the buildings, grounds, and equipment. The second section read, whenever

an inspection is conducted, the department shall prepare a written report that summarizes all

information obtained during the inspection, and if the home is in violation of this chapter, serve a

copy of the inspection report upon the provider at the same time as a notice of violation. Lastly,

the third section states, the provider shall develop corrective measures for any violations found

by the department’s inspection.

The second RCW researched was RCW 70.128.130, Adult family homes – Requirements.

Adult family homes shall be maintained internally and externally in good repair and condition.

Adult family homes shall be maintained in a clean and sanitary manner, including proper sewage

disposal, food handling, and hygiene practices. Adult family homes shall develop a fire drill plan

for emergency evacuation of residents, shall have smoke detectors in each bedroom where a


resident is located, shall have fire extinguishers on each floor of the home, and shall not keep

nonambulatory patients above the first floor of the home. Adult family homes shall establish

health care procedures for the care of residents including medication administration and

emergency medical care. Adult family home providers shall either reside at the family home or

employ or otherwise contract with a qualified resident manager to reside at the adult family

home. Lastly, an adult family home provider must ensure that staff are competent and receive

necessary training to perform assigned tasks. Staff must satisfactorily complete department-

approved staff orientation, basic training, and continuing education as specified by the

department by rule

The author researched numerous WAC’s that pertain to adult family homes. The WAC’s

were divided into four categories of compliance, fire safety, fire drill and evacuation, emergency

and disaster planning, and inspections. The adult family home must be in compliance of all four

categories during the initial inspection by WADSHS prior to an approval of operation.

WADSHS may conduct unannounced periodic inspections and are required to conduct

inspections upon receipt of a complaint.

The first fire safety WAC researched was WAC 388-76-10805, Automatic smoke

detectors. The adult family home must ensure approved automatic smoke detectors are installed,

at a minimum, in every bedroom used by the resident. The detector must be in proximity to the

area where the resident or adult family home staff sleeps and on every level of a multilevel

home. The detectors shall be installed in a manner that the fire warning is heard in all parts of the

home upon activation of a single detector and kept in good working condition at all times.

The second fire safety WAC was WAC 388-76-10810, Fire Extinguishers. The adult

family home must have an approved five pound 2A:10B-C rated fire extinguisher on each floor


of the home. The home must ensure the fire extinguishers are installed according to manufacturer

recommendations, inspected, and serviced annually. The fire extinguishers must be in proper

working order and readily available for use at all times. If required by the local fire authority, the

home must provide different fire extinguishers in place of the fire extinguishers required in this

section. WAC 388-76-10825, Space heaters and stoves, accompanied the previous WAC. The

adult family home must ensure the oil, gas, kerosene, and electric space heaters are not used in a

home except during a power outage and the portable heater is the only safe source of heat. Stoves

and heaters must not block residents, staff or household members from escaping.

The next WAC addressed was WAC 388-76-10815, Notice required – Compliance with

building code and fire protection. Before a resident is admitted, the adult family home must

disclose in writing in a language understood by the prospective resident whether or not resident

bedrooms comply with the current building code including evacuation standards and if the home

is located outside a public fire district, the source, and plan for on-site fire protection. Lastly,

WAC 388-76-10820, Resident evacuation capabilities and location of resident bedrooms, is

piggybacked with the previous WAC. The adult family home must ensure each resident who has

an evacuation capability of Level 2 or Level 3, as defined in WAC 388-76-10870, has a bedroom

located on grade level and exiting the building does not require the use of stairs, elevators, or

lifts. The home must install alternative emergency evacuation protection equipment when

serving hearing or visually impaired residents.

The second category of WAC’s researched was fire drill and evacuations. WAC 388-76-

10870, Resident evacuation capability levels – Identification required, was referenced in the

previous WAC. The adult family home must ensure that each resident preliminary care plan and


negotiated care plan contains the resident’s ability to evacuate the home according to the

following levels:

1. Level 1 – resident is able to get out of the home safely and independently without

mobility aids or any assistance from another individual.

2. Level 2 – resident is physically and mentally capable of traversing a normal pathway

to safety with mobility aids, but unable to ascend or descend stairs without the

physical assistance of another individual.

3. Level 3 – resident is unable to walk or traverse a normal pathway to safety without

the physical assistance of another individual.

The following are individual WAC’s specifically written to the evacuation process of

residents and staff. WAC 388-76-10860, Fire drill and procedures for emergency evacuation –

Required. The adult family home must have a drill plan and procedure for the emergency

evacuation of all residents from the adult family home and not admit or keep residents the

provider or entity representative cannot safely evacuate from the adult family home. WAC 388-

76-10865, Emergency evacuation from adult family home. The adult family home must be able

to evacuate all people living in the home to a safe location outside the home in five minutes or

less. WAC 388-76-10880, Emergency evacuation adult home floor plan. The adult family home

must ensure each resident with an evacuation capability of Level 2 or Level 3 has a bedroom on

a ground-level floor which has at least two means of exiting the bedroom. Exiting the bedroom

must not require the use of stairs, elevators, or a platform lift.

The next set of WAC’s consists of the requirements for emergency evacuation floor

plans. WAC 388-76-10885, Elements of emergency evacuation floor plan. The adult family

home must ensure the emergency evacuation floor plan has an accurate floor plan of the home,


including rooms, hallways, exits (such as doorways and windows) to the outside of the home.

The plan must have emergency evacuation routes showing the paths to take to exit the home and

the location for the residents to meet outside the home. WAC 388-76-10890, Posting the

emergency evacuation floor plan – Required. The adult family home must display an emergency

evacuation floor plan on each floor of the home in a visible location in common areas normally

used by the residents, staff, and visitors. WAC 388-76-10895, Emergency evacuation drills –

Frequency and participation. The adult family home must ensure emergency evacuation drills

occur at least every two months and all residents take part in at least one emergency evacuation

drill each calendar year involving full evacuation from the home to a safe location.

The last set of WAC’s for the category of drills and evacuations are for documentation of

emergency evacuation drills and notification. WAC 388-76-10900, Documentation of emergency

evacuation drills – Required. The adult family home must document in writing the emergency

evacuation drills which must include the names of each resident and staff involved in the drill.

The documentation must also include the name of the person conducting the drill, the date and

time of the drill, and the length of time it took to evacuate all residents. WAC 388-76-10905,

Emergency evacuation – Notification of department required. The adult family home must

immediately call the department’s (WSDSHS) complaint toll free complaint telephone number

of any fire or emergency evacuation from the home.

The third category of WAC’s researched was emergency and disaster planning in adult

family homes. WAC 388-76-10830, Emergency and disaster plan – Required. The adult family

home must have written emergency and disaster plan and procedures to meet the needs of each

resident during emergencies and disasters. WAC 388-76-10835, Elements of an emergency and

disaster plan. The adult family home must ensure the emergency and disaster plan includes plans


for responding to natural and man-made emergencies and disasters that reasonably occur at

home. The plan must address actions to be taken by staff and residents when an emergency or

disaster strikes or the fire drill plan for evacuation of the home. WAC 388-76-10855, Emergency

and disaster plan training – Required. The adult family home must ensure all staff are trained on

the emergency and disaster plan and procedures when they begin work in the home and residents

review the emergency and disaster plan and procedures at least annually.

The remainder of WAC”S researched in category three refer to supplies needed in the

event of a disaster. WAC 388-76-1040, Emergency food supply. The adult family home must

have an on-site emergency food supply that can be stored with other food in the home and will

last for a minimum of seventy-two hours for each resident and each household member. The

food must meet the dietary needs of each resident, including any specific dietary restrictions any

resident may have. WAC 388-76-10845, Emergency drinking water supply. The adult family

home must have an on-site emergency supply of drinking water that will last for a minimum of

seventy-two hours for each resident and each household member. There must be at least three

gallons of water for each resident and household member. The water must be stored in a food

grade of glass container and is chemically treated or replaced every six months. WAC 388-76-

10850, Emergency medical supplies. The adult family home must have emergency medical

supplies that include first-aid supplies and a first-aid manual.

The fourth and final category of WAC’s researched for adult family homes was

inspections. WAC 388-76-10910, Inspections – Complaint investigations – Monitoring visits –

General. The department (WSDSHS) must conduct unannounced inspections, complaint

investigations, and monitoring visits to determine if the adult family home is in compliance.

WAC 388-76-10915, department staff access – Willful interference prohibited. The adult family


home must ensure department staff has access to the home, residents, and former residents.

Records of residents, former residents, facility staff, and relevant staff records must be available.

The home and staff must not willfully interfere or fail to corporate with department staff in the

performance of official duties. WAC 388-76-10920, Inspection and investigation reports –

Provided by department. The department will mail or hand deliver the department’s report to the

provider or entity representative within ten working days of completion of the inspection or

within ten calendar days of the completion of inspection if the home does not have deficiencies.

WAC 388-76-10925, Disclosure of inspection and complaint investigation reports. Upon

request, the department must provide the public with copies, subject to applicable disclosure and

confidentiality requirements of inspection and complaint investigation reports as soon as they are

completed. The report must identify the home’s plan of correction, if a copy is available at the

time of request and any written decision by the department to take an enforcement action.

The final WAC reviewed in reference to inspections was the adult family home’s plan of

correction. WAC 388-76-10930, Plan of correction (POC) – Required.

1. The adult family home must comply with all applicable licensing laws and

regulations at all times.

2. When the department (WSDSHS) finds the adult family home out of compliance with

any licensing law or regulation, the department will send an inspection report with an

attestation of correction statement for each cited deficiency.

3. The adult family home must complete an attestation of correction for any inspection

report as the department requires.

4. For the purposes of this section an “attestation of correction statement” means a

statement, developed by the department and signed by the home, that the home has or


will correct each cited deficiency and will maintain correction of each cited

deficiency.

5. The home must be able to show to the department, upon request, that, for each

deficiency cited, the home has a plan of correction and maintaining correction,

corrected or is correcting each deficiency, and has maintained or is maintaining

compliance.

6. On each attestation of correction, the home must give a date, approved by the

department, showing when the cited deficiency has been or will be corrected. The

home must by signature and date show that the home has or will correct each

deficiency.

7. The home must return the inspection report, with completed attestation of correction

statements, to the department within ten calendar days of receiving the report.

Once the WAC and RCW requirements for adult family homes were researched, the

author attempted to contact the local WADSHS office via the telephone to determine the type of

background, training, and certifications the WADSHS field agents have to enable them to

conduct the previously stated RCW and WAC regulated inspections. On July 7, 2009 the author

attempted to call the local WADSHS office numerous times without success. The author then

drove to the local WADSHS office to make face to face contact. The author made contact with

Sandra Brewer who advised there were no field agents available in the office and then gave the

author a phone number to contact Field Supervisor Casey Zimmer at the WADSHS headquarters

in Olympia, Washington.

The author contacted Casey Zimmer on July 8, 2009 via the telephone. Casey advised the

field agents are trained inspectors who perform initial inspections of newly licensed adult family


homes per WAC and RCW requirements. The field agents also perform unannounced annual

inspections, complaint follow-up inspections, and after death inspections in adult family homes.

The field agents training consisted of general knowledge of WAC and RCW requirements of

adult family homes and a flow chart of how to perform inspections. The field agents have no

official training in fire inspection or suppression procedures. Casey also advised that contacting

local fire departments was not part of the certification check off. She went on to say if all of the

field agents were required to check in with local fire departments across the State, she would

make it part of the inspection process.

Research question two of this applied research project sought to identify the current

Federal regulations that govern adult care facilities. The author requested information from

Casey Zimmer on any Federal regulations pertaining to adult care facilities. Casey advised there

were no Federal regulations governing adult family homes. She also advised the only regulations

known were Federal Medicare and Medicaid regulations that govern nursing homes, boarding

homes, and hospital compliance. She gave the author contact information for the WADSHS

Nursing Home Supervisor, Linda Ronco.

The author contacted Linda Ronco via e-mail July 21, 2009. Linda replied the same day

with detailed information on 42 Code of Federal Regulations (CFR) Part 483. Linda confirmed

the Federal regulations only pertain to Medicare and Medicaid compliance. The author

researched the CFR via the internet to find wording that indicated, skilled nursing facilities

(SNF) and nursing facilities (NF) are required to be in compliance with the requirements of 42

CFR Part 483, to receive payment under the Medicare or Medicaid programs. The regulation

went on to say in order to certify a SNF or NF, a state surveyor completes at least a life safety


code survey or a standard survey. The surveys indicated in the CFR were inline with surveys

outlined in the previous Washington Administrative Codes.

The National Fire Protection Association (NFPA) was researched to identify if standards

exist for adult family home style of care providers. The author found the NFPA 101, Life Safety

Code, 2009 Edition. NFPA 101 Code addresses construction, protection, and occupancy features

necessary to minimize danger to life from the effects of fire, including smoke, heat, and toxic

gases created during a fire. The Code establishes minimum criteria for the design of egress in

facilities so as to allow for prompt escape of occupants from buildings or, where desirable, into

safe areas within buildings. The Code also addresses protective features and systems, building

services, operating features, and maintenance activities. The Code does not address fire

prevention or building construction features that are normally a function of fire prevention codes

and building codes (National Fire Protection Association [NFPA] 101, 2009).

The Code identified requirements for residential board and care occupancies used for

lodging and boarding of four or more residents, not related by blood or marriage to the owners or

operators, for the purpose of providing personal care services (NFPA 101, 2009). The Code

further identified requirements for new and existing residential board and care occupancies.

Small facilities were identified as four or more but no more than 16 residents. The requirements

consisted of primary and secondary means of escape, evacuation capabilities, construction type,

and fire protection systems. The Code was inline with the requirements found in the Washington

Administrative Codes. No other adult care facility Federal regulations were found by the author.

Research question three sought to identify how many and what type of adult care

facilities are located in CCFD 3. The author initiated the research to this question by conducting

a report of all applicable records pertaining to adult care facilities within the District’s data


management system. “Firehouse” is the data management system used to document all of the fire

and emergency medical alarms in CCFD 3. The author found that CCFD 3 had responded to

adult care facilities 228 times in a five year period. Of the 228 responses, all of them were for

emergency medical response to14 different locations within CCFD 3. The names, addresses,

phone numbers, and construction type can be found in Appendix C.

While researching the information for question two of this research project, the author

found a link on the WADSHS webpage to find adult family homes located in Washington State.

The webpage required a zip code and then posted all of the adult family homes located in that

area. There are two zip codes located in CCFD 3. The author entered both zip codes and found

the same 14 adult family homes posted on the webpage that were found in the District’s data

management system. There were no additional adult family homes or adult care facilities found

in CCFD 3.

To confirm the existence, location, and construction type of the 14 adult family homes

found, the author drove to each location on June 6, 2009. The author drove 67 miles to make

contact at each home to confirm the home was still operating as an adult family home. All 14

homes were fully functional and operating. It took the author three hours and 16 minutes of drive

time and contact time to confirm the 14 locations. The author confirmed the only type of adult

care facilities located in CCFD 3 was the adult family home.

Research question four sought to identify what policies exist in other fire districts

regarding adult care facilities. The research tool used was a nine question phone survey. Three

fire districts and two fire departments in Clark County, Washington with known adult care

facilities were called on June 12, 2009. The telephone survey can be found in Appendix A and

the results can be found in Appendix B.


Survey question one was, “Do you have adult care facilities in your Fire District/Fire

Department?” The fire districts and fire departments surveyed consisted of urban, suburban, and

rural agencies. This question was asked to identify if adult care facilities were prominent

throughout Clark County. All of the agencies surveyed indicated they do have adult care

facilities within their service areas.

Survey question two was, “Approximately how many?” The intent of this question was to

determine how CCFD 3 ranked in the number of total adult care facilities. East County Fire and

Rescue (ECF&R) indicated they have three. Clark County Fire District 6 (CCFD 6) indicated

they have approximately 12. Vancouver Fire Department topped all of the agencies surveyed

indicating they have hundreds, small and large commercial. Clark County Fire and Rescue

(CCF&R) advised they had approximately 15. Camas Fire Department (CFD) indicated they

have two assisted living facilities with numerous beds and four smaller facilities. The number of

adult care facilities located in CCFD 3 fell in the middle of the agencies surveyed.

Survey question three was, “Are you notified when new adult care facilities are

established in your Fire District?” The question was asked to determine if CCFD 3 was the only

agency not being notified. ECF&R and CCFD 6 are both county agencies and advised they are

not notified. VFD is a city agency who advised they are not notified if it’s a small facility and are

notified if it’s a large facility. CCF&R advised they are notified if it’s in the city limits. CFD gets

the information from their city fire marshal.

Survey question four was, “If so, who notifies you?” This question was asked to indentify

if there was consistency in the agencies being notified. ECF&R and CCFD 6 are both not

notified. VFD advised that city planning notifies the city deputy fire marshal who in turn notifies

the fire department. CCF&R indicated that the owner of a health care facility would have to get a


business license through city hall. The information is forwarded from city hall to the fire

department. CFD advised the State of Washington notifies the fire department when a new

commercial facility is built.

Survey question five asked, “Does your organization conduct pre-incident surveys of

these facilities?” CCFD 3 conducts pre-fire surveys of known adult care facilities. This question

was asked to identify if all surveyed agencies conduct pre-incident surveys. ECF&R and CFD

both indicated they do not conduct pre-incident surveys. CCFD 6 and CCF&R both indicated

they do conduct pre-incident surveys. VFD advised they do if it’s a large facility and do not if

it’s a small facility.

Survey question six was, “What does your organization do with the information obtained

from the pre-incident surveys?” CCFD 3 places all pre-incident surveys in binders which are

placed on each apparatus. The intent of this question was to identify other means of processing

and storing the data. ECF&R and CFD indicated they do not conduct pre-incident surveys.

CCFD 6 advised the information is placed in mobile pre-planning “Firehouse” software and used

in the apparatus mobile data computers for on-scene reference. VFD places the information in a

response guide book and also in the mobile data computers on all apparatus. CCF&R places the

information in a pre-fire manual.

Survey question seven asked, “Approximately how many residents are housed at the

facilities?” CCFD 6 and CCF&R indicated it was unknown how many residents are housed at the

facilities. ECF&R has three to four at each facility. VFD can have one resident to many hundreds

in the facilities located their response are. CFD advised it depends on the size of the facility.

Some have six beds while others have 83 beds.


Survey question eight was, “Does your organization have written policies on adult care

facilities?” The intent of this question was to indentify if polices exist in other agencies that

CCFD 3 could use as a reference. All of the agencies except CCFD 6 indicated they have no

policies for adult care facilities. CCFD 6 has a patient lifting policy but no fire response policy.

Lastly, question nine of the phone survey gave each agency an opportunity to offer

additional comments. ECF&R would like to be notified when new facilities enter their fire

protection area. Chief Johnson of CCFD 6 wishes his district would be notified when a new

facility pops up in his area. Chief Senchyna with VFD indicated the facilities are a disaster

waiting to happen. He has been to a fatal fire in a six bed facility. Two to three people died in

that fire. CCF&R had no comment while CFD felt this is a real issue.

Discussion

The study results appeared right on track with the literature obtained while researching

the adult care facility issue. The first obvious issue was the inconsistency in terminology for

adult care facilities. The author chose the title of this research paper to encompass all adult care

institutions until the research identified the type of institutions located in Clark County Fire

District 3 (CCFD 3) are classified as adult family homes. Nursing homes are not located in

CCFD 3 but were found to be a more medically focused institution for occupants who are unable

to care for themselves. Assisted living facilities seemed to encompass a variety of institutions.

“There is no universal definition of an assisted living facility. However, it is generally accepted

that a range of services are offered to the resident in order to maximize their independence while

enabling them to complete their activities of daily living (Jaslow, et al. 2005, p. 137).” As was

found in the results section, the facilities located in CCFD 3 are called adult family homes per

the Washington State Department of Social and Health Services. The results section also


indicated adult family homes have ambulatory and non-ambulatory occupants which could make

them a cross between a nursing home and an assisted living facility.

The inspection process found in the results section identified the Washington State

Department of Social and Health Services (WADSHS) conduct a minimal inspection. They

inspect smoke detectors, access, and evacuation procedures. The inspectors do not have a

background in fire suppression. CCFD 3 does not conduct fire inspections but rather pre-incident

surveys. The surveys provide personnel with pertinent information when responding to fire

incidents. To date CCFD 3 has not responded to a fire situation in an adult family home but as

they continue to move into the Fire District the potential for a fire grows. Lack of participation in

fire drills and unfamiliarity with the building fire plan are personal actions that directly may

increase the chances of death or injury in an actual fire event (Jaslow, et al. 2005, p. 137). It is

vital that CCFD 3 work with the adult family homes to ensure the pre-incident surveys are

current and relationships remain positive.

The implications for CCFD 3 may be positive or negative depending on the outcome of

this research project. The positive implications are for CCFD 3 to take this research and apply it

by getting District personnel out in the community conducting pre-incident surveys of adult

family homes listed in Appendix C. This process will allow personnel to familiarize themselves

with construction types, facility size, and any hazards that may be present. While conducting pre-

incident surveys of commercial occupancies, the owners will often times ask questions and get

engaged with personnel. This type of positive encounter will likely create a positive experience

for the adult family home owner, District personnel, and the patients of the homes resulting in a

positive working relationship for future medical and fire responses.

The negative implications may come as a result of not being prepared in the event of a


fire in an adult family home. It was indentified earlier in this research paper that CCFD 3

responds frequently to adult family homes for medical emergencies only. CCFD 3 personnel

must be trained and ready to respond to a fire in an adult family home knowing that rescue of up

to six occupants in addition to the care providers is likely. If personnel are not prepared, the

likelihood of an injury or death of an occupant or firefighter is compounded.

Recommendations

In response to the results of this research, three primary recommendations can be elicited.

The recommendations being addressed are for Clark County Fire District 3 (CCFD 3) to provide

prompt and skillful emergency response while providing safety for District members when

responding to emergencies in adult family homes.

The first recommendation based on the research findings is for CCFD 3 to conduct pre-

incident surveys on all of the adult family homes found in Appendix C. This will enable CCFD 3

to pre-plan for appropriate rescue and fire suppression strategies in the event of a fire or rescue

emergency. In conjunction with conducting pre-incident surveys of known adult family homes,

CCFD 3 will need to monitor the Washington State Department of Social and Health Services

website for new postings of adult care homes located in CCFD 3 and take appropriate actions to

educate District personnel of new locations, size, and the number of occupants.

The second recommendation is for CCFD 3 to take an active role with the Clark County

Fire Chiefs Association and the Clark County Fire Marshal in lobbying for increased County

Government involvement in requiring new adult family home owners to notify the local fire

departments of the locations, size, and number of occupants. It should not be up to each

individual emergency services agency to seek out the information. Therefore, the Clark County


Commissioners, Clark County Community Development, and the Clark County Fire Marshal’s

Office should be involved in the development of a County wide policy for all agencies to follow.

Lastly, it is recommended that CCFD 3 lobby with the Washington State Fire Marshal’s

Office to encourage a change at the Legislative level of Washington State for the revision of an

existing or development of a new Washington Administrative Code that encompasses all adult

care facility owners and requires them to contact the local fire agency having jurisdiction of the

location, number of occupants, and the size of the facility. This minor task may save the lives of

innocent patients housed at these facilities and also the lives of the firefighters attempting to

rescue them during fire suppression operations.


References Ahrens, M. (2005, Summer). Fire and the Aging Population. Fire Protection Engineering, 27,

10-14.

Jaslow, D. S., Ufberg, J., Yoon, R., McQueen, C., Zecher, D., & Jakubowski, G. (2005,

March/April). Fire Safety Knowledge and Practices Among Residents of an Assisted Living Facility. Prehospital and Disaster Medicine, 20, 134-138.

Kennedy, M., & Alexander A. D. (2008, January). Fire Operations at Senior Living Facilities.

Fire Engineering, 161, 99-104. Klaene, B. & Sanders, R. (2004, January/February). Hospitals, nursing homes need pre-incident

plans. NFPA Journal, 98, 22. National Fire Protection Association. (2009). NFPA 101, Life Safety Code, 2009 edition. Quincy,

MA: National Fire Protection Association.

Revised Code of Washington. (2001). RCW 70.128.090, Inspections – Generally. Retrieved June

18, 2009 from http://apps.leg.wa.gov.RCW/default.aspx?cite=70.128.090

Revised Code of Washington. (2001). RCW 70.128.130, Adult family home - Requirements.

Retrieved June 18, 2009 from http://apps.leg.wa.gov.RCW/default.aspx?cite=70.128.130 Smith, J. P. (2002, August). Fires In Nursing Homes And Assisted-Living Facilities. Firehouse,

27, 16-20. Smith, J. P. (2002, October). Fires In Nursing Homes And Assisted-Living Facilities: Incident

Consideration. Firehouse, 27, 14-18. Washington Administrative Code. (2008). WAC 388-76-10805, Automatic smoke detectors.

Retrieved June 18, 2009 from http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76- 10805


Washington Administrative Code. (2008). WAC 388-76-10810, Fire extinguishers. Retrieved

June 18, 2009 from http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10810 Washington Administrative Code. (2008). WAC 388-76-10815, Notice required – Compliance

with building code and fire protection. Retrieved June 18, 2009 from http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10815

Washington Administrative Code. (2008). WAC 388-76-10820, Resident evacuation capabilities

and location of resident bedrooms. Retrieved June 18, 2009 from http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10820

Washington Administrative Code. (2008). WAC 388-76-10825, Space heaters and stoves.


Washington Administrative Code. (2008). WAC 388-76-10830, Emergency and disaster plan –

Required. Retrieved June 18, 2009 from

http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10830 Washington Administrative Code. (2008). WAC 388-76-10835, Elements of an emergency and

disaster plan. Retrieved June 18, 2009 from http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10835

Washington Administrative Code. (2008). WAC 388-76-10840, Emergency food supply.


Washington Administrative Code. (2008). WAC 388-76-10845, Emergency drinking water

supply. Retrieved June 18, 2009 from http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10845


Washington Administrative Code. (2008). WAC 388-76-10850, Emergency medical supplies..


Washington Administrative Code. (2008). WAC 388-76-10855, Emergency and disaster plan

training – Required. Retrieved June 18, 2009 from http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10855

Washington Administrative Code. (2008). WAC 388-76-10860, Fire drill plan and procedures

for emergency evacuation – Required. Retrieved June 18, 2009 from http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10860

Washington Administrative Code. (2008). WAC 388-76-10865, Emergency evacuation from

adult family home. Retrieved June 18, 2009 from http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10865

Washington Administrative Code. (2008). WAC 388-76-10870, Resident evacuation capability

levels – Identification required. Retrieved June 18, 2009 from http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10870

Washington Administrative Code. (2008). WAC 388-76-10880, Emergency evacuation adult

family home floor plan. Retrieved June 18, 2009 from http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10880

Washington Administrative Code. (2008). WAC 388-76-10885, Elements of emergency

evacuation floor plan. Retrieved June 18, 2009 from http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10885

Washington Administrative Code. (2008). WAC 388-76-10890, Posting the emergency

evacuation floor plan – required. Retrieved June 18, 2009 from


http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10890 Washington Administrative Code. (2008). WAC 388-76-10895, Emergency evacuation drills –

Frequency and participation. Retrieved June 18, 2009 from http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10895

Washington Administrative Code. (2008). WAC 388-76-10900, Documentation of emergency

evacuation drills – Required. Retrieved June 18, 2009 from http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10900

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Notification of department required. Retrieved June 18, 2009 from http://apps.leg.wa.gov/WAC/default.aspx?cite=388-76-10905

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Appendix A

Adult Care Facilities Phone Survey

Phone Survey Questions: 1. Do you have adult care facilities in your Fire District? 2. Approximately how many? 3. Are you notified when new adult care facilities are established in your Fire District? 4. If so, who notifies you? 5. Does your organization conduct pre-incident surveys of these facilities? 6. What does your organization do with the information obtained from the pre-incident surveys? 7. Approximately how many residents are housed at the facilities? 8. Does your organization have written policies on adult care facilities? 9. Additional comments?


Appendix B

Phone Survey Results

East County Fire & Rescue 600 NE 267 Ave. Camas, WA 98607 (360)834-5454 Contact: Assistant Chief Dean Thornberry Question 1 – Yes Question 2 – Three Question 3 – No Question 4 – N/A Question 5 – No Question 6 – N/A Question 7 – Three to four at each facility. Question 8 – No Question 9 – Would like to be notified when new facilities enter their fire protection area. Clark County Fire District 6 8800 NE Hazel Dell Ave. Vancouver, WA 98665 (360)576-1195 Contact: Battalion Chief Brian Johnson Question 1 – Yes Question 2 – Approximately 12. Question 3 – No Question 4 – No Question 5 – Yes Question 6 – The information is placed in mobile pre-planning FIREHOUSE software and then used in the apparatus mobile data computers for on-scene reference. Question 7 – Unknown Question 8 – Yes; A patient lifting policy exist. No fire response policies. Question 9 – Chief Johnson wishes his department would be notified when a new facility pops up in his area. Vancouver Fire Department 7110 NE 63 St. Vancouver, WA 98661 (360)892-8291 Contact: Battalion Chief Mike Senchyna Question 1 – Yes Question 2 – Hundreds; small and large commercial. Question 3 – No if it’s a small facility and yes if it’s a large facility. Question 4 – City planning notifies the Cities Deputy Fire Marshal, who in turn notifies the fire department.


Question 5 – Yes if it’s a large facility and no if it’s a small facility. Question 6 – The information is placed in a response guide book and also the mobile data computer on all apparatus. Question 7 – One to many hundreds. Question 8 – No Question 9 – These facilities are a disaster waiting to happen. Chief Senchyna has been to a fatal fire in a six bed facility. Two to three people died in that fire. Clark County Fire and Rescue 911 N. 65 Ave. Ridgefield, WA 98642 (360)887-4609 Contact: Assistant Chief Dan Yager Question 1 – Yes Question 2 – Approximately 15. Question 3 – Yes if it’s in the city limits. Question 4 – The owner of a health care facility would have to get a business license through city hall. That information is forwarded to the fire department. Question 5 – Yes Question 6 – The information is placed in a pre-fire manual. Question 7 – Unknown Question 8 – No Question 9 – No Camas Fire Department 616 NE 4 Ave. Camas, WA 98607 (360)834-8854 Contact: Battalion Chief Mark Ervin Question 1 – Yes Question 2 – Two assisted living with numerous beds and four smaller facilities. Question 3 – Yes by their City Fire Marshal Question 4 – The State of Washington notifies the fire department when a new commercial facility is built. Question 5 – No Question 6 – N/A Question 7 – It depends on the size of the facility. Some have six beds while others have 83 beds. Question 8 – No Question 9 – This is a real issue.


Appendix C

Adult Care Facility Location Project Name Max # of Residence Construction Type Advanced Care Center 6 Two Story 14604 NE 129 ST 3231 sq. ft. Main Floor Brush Prairie, WA 2173 sq. ft. Second Floor 98606 360-597-3615 Blueberry Hills AFH 6 Single Story 20613 NE 176 AVE 1787 sq. ft. Main Floor Battle Ground, WA 98604 360-667-0300 Bright Care 6 Two Story 14604 NE 129 ST 3149 sq. ft. Main Floor Brush Prairie, WA 1010 sq. ft. Second Floor 98606 360-891-0070 Canyon Creek Adult Family Home 6 Single Story 22918 NE 169 ST 3741 sq. ft. Main Floor Brush Prairie, WA 98606 360-896-0471 Country Care 6 Single Story 17413 NE 167 AVE 2396 sq. ft. Main Floor Brush Prairie, WA 98606 360-891-6991 Craciun AFH 6 Two Story 16504 NE 142 AVE 1822 sq. ft. Main Floor Brush Prairie, WA 1064 sq. ft. Second Floor 360-944-9167 Pavel’s AFH 6 Two Story 17904 NE 119 ST 3785 sq. ft. Main Floor Brush Prairie, WA 1112 sq. ft. Second Floor 98606 360-896-0273


Quality Adult Family Home 6 Two Story 11501 NE 192 AVE 3378 sq. ft. Main Floor Brush Prairie, WA 1836 sq. ft. Second Floor 98606 360-944-5134 Randall Woods 6 Single Story 28706 NE 197 AVE 3874 sq. ft. Main Floor Battle Ground, WA 98604 360-687-4888 Rock Creek Manor INC 6 Single Story 15700 NE 295 CIR 1944 sq. ft. Main Floor Battle Ground, WA 98604 360-667-0187 Vickis Foster Home 6 Two Story 18716 NE Davis RD 2692 sq. ft. Main Floor Brush Prairie, WA 744 sq. ft. Basement 98606 360-892-7162 Welcome Home NW INC 6 Single Story 19315 NE 214 ST 2183 sq. ft. Main Floor Battle Ground, WA 98604 360-687-9000 Wisteria Gardens INC 6 Two Story 14101 NE 144 ST 2063 sq. ft. Main Floor Brush Prairie, WA 994 sq. ft. Second Floor 98606 360-891-4433 5 Star Adult Family Home, LLC 6 Three Story 12820 NE 151 ST 1900 sq. ft. Main Floor Brush Prairie, WA 2478 sq. ft. Second Floor 98606 2009 sq. ft. Basement 360-254-5111

adult care facilities

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