1. (1) The provider must train all program staff in staff safety procedures prior to beginning their first regular shift. All residents must be trained in resident safety procedures during their first 24 hours of residency.

2. (2) Emergency Procedures:

   1. (a) An emergency evacuation procedure must be developed, posted, and rehearsed with the residents residing in the home occupants. The emergency evacuation procedure must include training on when and how to safely evacuate the home, where to meet after the evacuation, who to contact, how to get assistance with evacuating if needed, and instructions for how to respond specifically to a smoke alarm, carbon monoxide alarm, or other emergency devices or notifications.

   2. (b) A record must be maintained of evacuation drills. Evacuation drills must be scheduled at different times of the day, on different days of the week, with exit routes being varied, and with different locations designated as the origin of the fire for drill purposes:

      1. (A) Evacuation drills must be held at least once a every 90 calendar days, with at least one drill per year conducted between the hours of 10:00 P.M. and 6:00 A.M;
      2. (B) Evacuation drill records must include the date and time of the drill, the time for full evacuation and for each individual to evacuate, the location designated as the origin of the fire for drill purposes, the full names of all residents and staff present, comments on the drill results and any difficulties experienced, the names of residents requiring assistance for evacuation and the type of evacuation assistance provided by staff to individuals as specified in each individual's safety plan, and the signature of the staff person conducting the drill.;
      3. (C)  Evacuation drill records will also document safety checks of fire extinguishers, emergency lights, smoke and carbon monoxide alarms, protection equipment, egress paths, secondary egress points and furnace filters (to be changed per manufacturer instructions), number of staff present; and
      4. (D) Evacuation drill records must be maintained for a minimum of three years.
   3. (c) The residential care plan must document that within 24 hours of arrival, each new resident has received an orientation to basic safety and has been shown how to respond to a fire alarm and how to exit from the AFH in an emergency;
   4. (d) The provider must demonstrate the ability to evacuate all residents from the facility to a point of safety exterior to and away from the structure, with access to a public way, within three minutes. If there are problems in demonstrating this evacuation time, the Division may apply conditions to the license that include, but may not be limited to, reduction of residents under care, additional staffing, or increased fire protection.
3. (3) The provider must provide to the Division, maintain as current, and post a floor plan on each floor containing room sizes, location of each resident’s sleeping room,  resident manager or provider's sleeping room, the location of any ramps, any designated smoking areas, the location of all exits on each level of the residential setting including emergency exits such as windows, smoke and carbon monoxide alarms , fire extinguishers,  escape routes and point of safety, and a list of major fire hazards associated with the normal use and occupancy of the premises.  A copy of this drawing must be submitted with the application and updated to reflect any change;
4. (4) There must be at least one plug-in rechargeable flashlight available for emergency lighting in a readily accessible area on each floor including a basement.

5. (5) Evacuation capability categories are based upon the ability of the residents and staff to evacuate the facility or relocate  to the point of safety:

   1. (a) Documentation of a resident’s ability to safely evacuate from the facility, and the level of assistance needed to safely evacuate the home, must be maintained in the resident’s personal care plan;

   2. (b) The provider must assess the resident's ability to evacuate the home in response to an alarm or simulated emergency:

      1. (A) Prior to an individual's entry to the home; and
      2. (B) Annually, or when there is a change in a resident’s support needs that would likely impact a resident’s emergency evacuation abilities, whichever occurs more frequently.
   3. (c) Resident’s experiencing difficulty with evacuating in a timely manner must be provided assistance from staff and offered environmental and other accommodations, as practical. Under these circumstances, the provider must consider increasing staff levels, changing staff assignments, offering to change the resident’s room assignment, arranging for special equipment, and taking other actions that may assist the resident. The provider must document all actions and interventions attempted;
   4. (d) Resident who regularly decline to participate in evacuation drills will be evaluated for their evacuation capability to determine whether or not they need special assistance to evacuate.
   5. (e) Resident who cannot evacuate the home safely within three minutes must be assisted with transferring to another program with an evacuation capability designation consistent with the resident’s documented evacuation capability;
   6. (f) Only ambulatory residents capable of self-preservation must be housed on a second floor or in a basement. Lifts or elevators must not be used as a substitute for a resident’s capability to ambulate stairs.

   7. (g)The provider must develop a written individual fire safety and evacuation plan for residents who are unable to evacuate the residence within the required evacuation time or who decline to participate in fire drills on more than two occasions that includes the following:

      1. (A) Documentation of the risk to the resident's medical and physical condition, and behavioral status;
      2. (B) Identification of how the resident evacuates his or her residence, including level of support needed;
      3. (C) The routes to be used to evacuate the resident to a point of safety;
      4. (D) Identification of assistive devices required for evacuation;
      5. (E) The frequency the plan is to be practiced and reviewed by the resident and staff;
      6. (F) The alternative practices;
      7. (G) Approval of the plan by the resident or resident's legal representative (as applicable), case manager, and the provider, licensee, or resident manager; and
      8. (H) A plan to encourage future participation.
   8. (h) The residential setting must maintain documentation of the practice and review of the individual fire evacuation safety plan by the individual and the staff.
6. (6) All stairways, halls, doorways, passageways, and exits from rooms and from the home must be unobstructed.
7. (7) At least one 2A-10BC rated fire extinguisher must be in a visible and readily accessible location within 75 feet of travel distance in the AFH, on each floor, including basements, and must be maintained in accordance with Section 906 of the Oregon Fire Code.

8. (8) Fire extinguishers must:

   1. (a) Be serviced annually and tagged by a qualified company or technician. New extinguishers manufactured within the last 12 months are exempted from this requirement.
   2. (b) Be located in conspicuous locations along normal paths of travel where they will have ready access and be immediately available for use;
   3. (c) Not be obscured from view. In rooms or areas in which visual obstruction cannot be completely avoided, signage must be provided to indicate the locations of extinguishers;
   4. (d) Be installed on the hangers or brackets supplied.  Hangers or brackets must be securely anchored to the mounting surface in accordance with the manufacturer’s installation instructions;
   5. (e) Be installed so that the tops are not more than 3.5 feet above the floor;
   6. (f) Be installed so that the bottoms are not less than 4 inches above the floor; and
   7. (g) Not be locked.

9. (9) Approved smoke detector systems or smoke alarms, and carbon monoxide alarms must be UL- approved, and installed according to Oregon Residential Specialty Code, Oregon Fire Code requirements, and manufacturer’s instructions. These alarms must be inspected and tested at least monthly, and during each evacuation drill. The provider must provide approved signal devices for resident’s with disabilities who do not respond to the standard auditory alarms. If a resident is deaf or hard of hearing, smoke alarm(s) consistent with the resident’s support needs must be provided. All of these devices must be inspected and maintained in accordance with the requirements of the State Fire Marshal or local agency having jurisdiction. Ceiling placement of smoke alarms or detectors is recommended. Alarms must be installed in each bedroom, adjacent hallways, common living areas, basements and in multilevel homes, at the top of each stairway or attic spaces accessible by an interior stairway. Carbon monoxide alarms must be installed and maintained in all areas with a fuel-burning appliance or carbon monoxide source, including attached garages, and in each bedroom or within 15 feet (4572 mm) outside each bedroom door. Bedrooms on separate floor levels in a structure consisting of two or more stories must have separate carbon monoxide alarms serving each story. Alarms must be equipped with a device that warns of low battery when battery operated. All smoke detectors and alarms must be maintained in functional condition;

   1. (a) An AFH licensed on or after March 1, 2025 must have permanent, hard-wired, interconnected smoke alarms and carbon monoxide alarms with battery back-up.

   2. (b) Alarms must be replaced when any of the following occur:

      1. (A) The end-of-life signal is activated;
      2. (B) The manufacturer’s replacement date is reached; or
      3. (C) The alarm(s) fail to respond to operability tests.

10. (10) Special hazards:

    1. (a) Flammable and combustible liquids and hazardous materials must  be safely and properly stored in original, properly labeled containers or safety containers, and secured to prevent tampering by residents and vandals.

       1. (A) Flammables and combustibles must not be stored in unvented rooms or spaces, or closets.
       2. (B) Propane tanks must not be stored in the home interior
       3. (C) Measures, including locking materials and incendiary devices, must be implemented, as appropriate, to address individually-identified safety risks related to fire, flammables, and combustibles.
    2. (b) Oxygen and other gas cylinders in service or in storage must be adequately secured in accordance with the Oregon Fire Code to prevent the cylinders from falling or being knocked over. No smoking signs must be visibly posted on all doors leading to oxygen use and storage areas. In accordance with the Oregon Fire Code, oxygen cylinders must not be used or stored in rooms where wood stoves, fireplaces, or open flames are located.

    3. (c) Generators and generator fuel may not be stored or operated in the home interior.

       1. (A) A gasoline or propane generator may be stored in a garage when not in use.
       2. (B) Liquid propane gas must not be stored in an attached garage or enclosed storage space. Enclosed structures used for the storage of liquid propane gas may not share a wall or direct openings to the home.
    4. (d) Firearms stored on the premises of an AFH must be stored in a locked cabinet. The firearms cabinet must be located in an area of the home that is not readily accessible to clients, and all ammunition must be stored in a separate, locked location;
    5. (e) Smoking regulations shall be adopted to allow smoking only in safe designated areas away from the building. Ashtrays of noncombustible material and safe design must be provided in areas where smoking is permitted; and
    6. (f) Cleaning supplies, poisons, and insecticides must be properly stored in original, properly labeled containers in a safe area away from food, preparation and storage of food, dining areas, and medications.
11. (11) Sprinkler systems, if used, must be installed in compliance with the Oregon Structural Specialty Code and Oregon Fire Code and maintained in accordance with rules adopted by the State Fire Marshal.
12. (12) First aid supplies must be readily accessible to staff. All supplies must be properly labeled.
13. (13) Portable heaters must be listed, labeled, and approved per Oregon Fire Code and must be plugged directly into an approved outlet without the use of an extension cord, power strip or expander device. Heaters must be equipped with tip-over, shut-off capacity.
14. (14)  Safety Plans must be developed and implemented to identify and prevent the occurrence of hazards. A safety plan will be developed identifying common hazards in the facility and that describes how staff should respond when specific hazards are identified. A safety record will be kept documenting the actions taken by staff to mitigate hazards when safety risks are identified. The safety plan should identify both environmental hazards and actions or behaviors of staff, residents, or guests that create an unsafe situation in the home. Potential situations that could cause health or safety risks in the home may include, the identification of dangerous substances or items; broken, chipped, or sharp objects, exposed electrical wiring or unprotected electrical outlets; the overuse of extension cords or other special plug-in adapters; slippery floors or stairs, damaged decks or walkways, exposed heating devices, broken glass, unsafe smoking areas, unsafe ashtrays and ash disposal, and other potential fire hazards. The safety plan must also document monthly safety checks of fire extinguishers, emergency flashlights, smoke and carbon monoxide alarms, egress paths, secondary egress points and furnace filters. Monthly documentation of these checks must be maintained for a minimum of three years. Furnace filters must be changed per manufacturer instructions.
15. (15) When hazards are identified concerning residents, the provider will determine if an incident report should be written or if behavior support plans need to be developed and included in the resident’s residential care plan. The Safety record should include a description of the identified concerns, and how staff resolved the concern and whether additional action may be needed.

16. (16) The provider must develop and implement a written Emergency Preparedness plan. The plan must include when emergency services will be contacted and describe procedures for staff to follow during such emergencies and disasters as fires, missing persons, accidents, earthquakes, floods, and tsunamis. The program must be immediately available to the program administrator and program staff. The plan must include diagrams of evacuation routes, and these must be posted. The plan must specify where staff and residents will reside if the setting becomes uninhabitable. Shelter plans should not depend on the availability of public shelters that may or may not be available at the time of an emergency. The program must update the plan and must include:

    1. (a) Emergency instructions for employees;
    2. (b) The telephone numbers of the local fire department, police department, the poison control center, the local public health office, the administrator, the administrator's designee, and other persons to be contacted in emergencies; and
    3. (c) Instructions for the evacuation of residents and staff.
    4. (d) Resources for sheltering in place.
    5. (e) Alternative resources for utility outages.
    6. (f) Procedures for notifying public health when significant health risks are present, including but not limited to communicable and noncommunicable diseases and conditions, pest infestations, and other environmental hazards as described in OAR 333.

17. (17) An Emergency Evacuation and Fire Safety Procedure shall be developed, posted, and practiced with all occupants. The procedure must:

    1. (a) Meet standards consistent with Oregon Fire Code; and
    2. (b) Be readily available at all times within the AFH in a prominent location with other postings and the license.

18. (18) An Emergency Evacuation and Fire Safety Procedure must include the following:

    1. (a) Emergency egress and escape routes, including assembly point for occupants following egress;
    2. (b) Procedures for assisting individuals who require support to use means of egress;
    3. (c) Procedures for accounting for occupants of the home after evacuation has been completed;
    4. (d) Preferred and any alternative means for notifying occupants of a fire or emergency;
    5. (e) Preferred and any alternative means of reporting fires and other emergencies to the fire department or designated emergency response organization;
    6. (f) Identification and assignment of personnel who can be contacted for further information or explanation of duties under the plan;
    7. (g) A description of the emergency voice/alarm communication system alert tone and preprogrammed voice messages, where applicable.
19. (19) All staff must be trained in safety procedures including emergency evacuation procedures, and proper use of portable fire extinguishers prior to providing care.
20. (20) All staff must review their duties and responsibilities under the fire safety evacuation plan no less than every three months. Such review must be documented and maintained in the provider records.

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 443.705 - 443.825

History

BHS 5-2025, amend filed 02/28/2025, effective 03/01/2025
MHS 9-2017, f. 6-29-17, cert. ef. 7-1-17
MHS 3-2017(Temp), f. 3-3-17, cert. ef. 3-4-17 thru 8-30-17
MHS 14-2016(Temp), f. 9-6-16, cert. ef. 9-7-16 thru 3-3-17
MHD 3-2005, f. & cert. ef. 4-1-05