CMS Memo S&C 14-46-LSC: Categorical Waiver for Power Strips Use in Patient Care Areas

Memo Summary:

  • Categorical Waiver:  CMS has determined that the 2000 edition of the National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) contains provisions on the use of power strips in health care facilities that may result in unreasonable hardship for providers or suppliers.  Further, an adequate alternative level of protection may be achieved by compliance with the 2012 edition of the LSC, which has extended allowances on the use of power strips in patient care areas.


  • CMS is permitting a categorical waiver to allow for the use of power strips in existing and new health care facility patient care areas, if the provider/supplier is in compliance with all applicable 2012 LSC power strip requirements and with all other 2000 LSC electrical system and equipment provisions.


  •  Resident rooms in long-term care or other residential care facilities that do not use line-operated electrical appliances for diagnostic, therapeutic, or monitoring purposes are not subject to the more restrictive NFPA 99 requirements regarding the use of power strips in patient care areas/rooms.  Resident rooms using line-operated patient-care-related electrical equipment in the patient care vicinity must comply with the NFPA 99 power strip requirement and may elect to utilize this categorical waiver.


  • Individual waiver applications are not required:  Providers and suppliers are expected to have written documentation that they have elected to use the waiver.  A provider or supplier must notify the LSC survey team at the entrance conference that it has elected the use the waiver permitted under this guidance and that it meets the applicable waiver requirements. The survey team will review the information and confirm the facility meets the conditions for the waiver.

Please see the complete memo here or visit

New Generations Quarterly Newsletter – Spring 2014

The Section for Long-Term Care Regulation has published New Generations – Volume 12, Issue 2, Spring 2014.

A complimentary color copy will be distributed via regular mail to each licensed home in Missouri. The spring issue is now available on the Department’s website, along with an archive of previous issues.  Please visit

CMS Proposes Adoption of Updated Life Safety Code

To view this complete announcement from CMS, please visit

The Centers for Medicare & Medicaid Services (CMS) has announced a proposed rule on the adoption of updated life safety code (LSC) that CMS would use in its ongoing work to ensure the health and safety of all patients, family, and staff in every provider and supplier setting.  The updated code contains new provisions that are vital to the health and safety of all patients and staff.

A key priority of CMS is to ensure that patients and staff continue to experience the highest degree of safety possible, including fire safety.  CMS intends to adopt the National Fire Protection Association’s (NFPA) 2012 editions of the (LSC) and the Health Care Facilities Code (HCFC).  This would reduce burden on health care providers, as the 2012 edition of the LSC also is aligned with the international building codes and would make compliance across codes much simpler for Medicare and Medicaid-participating facilities.


To view the proposed rule you may visit  PDF format is available for download in the right-hand column or click here.

View CMS Memo S&C: 14-21-LSC issued April 18, 2014 here:

Safety Reminders: Holiday Decorations

It is that time of year when people are decorating their homes and businesses with festive décor and anticipating upcoming holiday celebrations.  Residents and staff in your care home also look forward to festivities and enjoy holiday decorations.  It is important for residents, staff and visitors to carry on traditions and to feel a sense of joy and peace we all want this time of year.

The Section for Long-Term Care Regulation (SLCR) wants to help you and your residents have a safe holiday season by sending out the following safety tips, references and regulatory reminders.

Fires or other accidents are not something anyone wants! 

Safe decorations include:

  • Artificial Christmas trees, and decorations that are non-combustible or flame retardant.
  • UL approved decorative lighting (use in supervised areas and turn off when not in use).
  • UL approved outdoor lighting.
  • Holiday decorations, including evergreen wreaths, ornaments, photos, etc. can be used on resident’s doors, and in hallways, as long as they do not exceed 3 ½” in depth and they are not blocking the entrances or exits.*

*Any combustible decorations hung from doors or walls in corridors may be used with a waiver.  Non-rated combustible decorations cannot exceed 20% of the wall space in an exit egress corridor.

SLCR published an article regarding holiday decorating in the winter 2011 edition of the quarterly newsletter.  Please visit

Although the 2000 Edition National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) is the official reference, the 2012 Edition contains some less restrictive requirements.  Please refer to the CMS memo regarding waivers here: CMS Memo S&C 13-58-LSC 2000 Edition National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) Waivers, or visit the CMS website at

Prohibited decorations include displays, hangings, and other decorations that block exits, visibility of exits, or fire protection appliances.  Never hang decorations from fire sprinkler heads or pipes.

NFPA 101, Section  Combustible decorations shall be prohibited in any health care occupancy unless they are flame retardant.

NFPA 101, Section  Means of egress shall be continuously maintained free of all obstructions or impediments to full instant use in the case of fire or other emergency.

NFPA 101, Section  No furnishings, decorations, or other objects shall obstruct exits, access thereto, egress therefrom, or visibility thereof.


Please note, some county or city local ordinances may also require compliance with more restrictive standards, including the International Fire Code (IFC).


  • F323:  Electrical Safety – Any electrical device, whether or not it needs to be plugged into an electric outlet, can become hazardous to the residents through improper use or improper maintenance.  Electrical equipment such as electrical cords can become tripping hazards.  Halogen lamps or heat lamps can cause burns or fires if not properly installed away from combustibles in the resident environment.  The Life Safety Code prohibits the use of portable electrical space heaters in resident areas.



  • Can candles be used in nursing homes under supervision, in sprinklered facilities?

CMS Memo S&C-07-07:  Nursing Home Culture Change Regulatory Compliance Questions and Answers

Answer: Regarding the request to use candles in sprinklered facilities under staff supervision, National Fire Protection Association data shows candles to be the number one cause of fires in dwellings.  Candles cannot be used in resident rooms, but may be used in other locations where they are placed in a substantial candle holder and supervised at all times while they are lighted.  Lighted candles are not to be handled by residents due to the risk of fire and burns.

This holiday season, consider using battery-operated flameless candles.  They look and smell real!  Learn more about candle fire safety from the U.S. Fire Administration at

If you have any questions regarding the Life Safety Code, please contact SLCR at 573-526-8524.  We wish you a wonderful and safe holiday season.

Change Your Clock – Change Your Batteries!

When you change your clocks, do not forget to replace your smoke alarm and CO detector batteries.  Daylight Saving Time ends on Sunday, November 3, 2013.  For more safety tips, visit the U.S. Consumer Product Safety Commission (CPSC) at

View the news release here:


August 9, 2013:  Resident Safety Culture Success Stories

Learn about the National TeamSTEPPS program and Just Culture.  For more information, please visit Primaris at or Click Here to Reserve your Webinar seat now.

August 20, 2013:  Summary of CMS Updates for Antipsychotic Medication Use for People with Dementia

Tracy Niekamp, Missouri Department of Health and Senior Services, will provide a summary of the recently updated guidelines survey teams will use to investigate and determine compliance regarding antipsychotic medication use for people with dementia.  Valuable resources and insights will be shared regarding compliance and quality care.  For more information, please visit Primaris at or Click Here to Reserve your Webinar seat now.

Long-Term Care Emergency Preparedness Report 2012/2013

The Section for Long-Term Care Regulation (SLCR) conducted the fifth annual Emergency Preparedness Survey of all licensed long-term care homes in Missouri.  SLCR received 538 completed surveys and would like to thank the homes that responded.  For the first time, SLCR also conducted an Emergency Generator Survey that asked specific questions regarding a home’s electrical generator capacity.  819 long-term care homes completed this survey.  SLCR welcomes any questions concerning the surveys or emergency preparedness planning at 573-522-1333.  The new report is available on our website, please visit

MC5 Regional Meetings – July 2013

East – July 12, 2013:  Is our Iceberg Melting too?  An Expedition Toward Consistent Assignment

Brentwood Community Center, Room 104, 2505 S. Brentwood Blvd., Brentwood.  RSVP to Ruthie, or 314-801-0446.

Southwest – July 16, 2013:  Food and Dining – Dining with Friends

Council of Churches, 627 N. Glenstone, Springfield.  RSVP to

Northwest – July 17, 2013:  Life Safety Code and Culture Change

East Hills Library, 502 N. Woodbine Rd., St. Joseph.  RSVP to Karen Fletchall,, 660-564-3304, or Freda Miller,, 660-822-6209.

Route 71 – July 19, 2013:  Interact III

Community Center, 200 N. Ash, Nevada.  RSVP to

West – July 24, 2013:  Staff Turnover and Open Forum with DHSS

St. Mary’s Manor, 111 Mock Ave., Blue Springs.  RSVP to Kathy Vogt or Leslie Carter at 816-228-5655.

Please visit the Missouri Coalition Celebrating Care Continuum Change (MC5) website for details!

CMS Life Safety Code Reminders

  • Fire extinguishers should not be mounted over five feet from the floor to the top of the extinguisher

 Fire extinguishers having a gross weight not exceeding 40 pounds shall be installed so that the top of the fire extinguisher is not more than 5 feet above the floor.  Fire extinguishers having a gross weight greater than 40 pounds shall be so installed that the top of the fire extinguisher is not more than 3 ½ feet above the floor.  In no case shall the clearance between the bottom of the fire extinguisher and the floor be less than 4 inches.  1998 NFPA 10, 1-6.10.

  • A facility which allows smoking needs to have a metal container with a self-closing cover provided in the area.  A smokers urn, only meets the requirement of an ashtray of safe design.  Providers are under the impression that if these urns are metal that they meet the requirement of the container with a self-closing cover

Metal self-closing containers for disposing of cigarette butts and ashes from ashtrays, and ashtrays of noncombustible material and safe design, shall be provided in all areas where smoking is permitted as required in NFPA 101, 18/19.7.4.

  • Facilities need to have a zone evacuation plan in their fire emergency procedures

The administration of every health care occupancy shall have, in effect and available to all supervisory personnel, written copies of a plan for the protection of all persons in the event of a fire, for their evacuation to areas of refuge, and for their evacuation from the building when necessary.  All employees shall be periodically instructed and kept informed with respect to their duties under the plan.  A copy of the plan shall be readily available at all times in the telephone operator’s position or at the security center.  The provisions of through shall apply.  2000 NFPA 101, 18/

A written health care occupancy fire safety plan shall provide for the following:  1) Use of alarms 2) Transmission of alarm to the fire department 3) Response to alarms 4) Isolation of fire 5) Evacuation of immediate area 6) Evacuation of smoke compartment 7) Preparation of floors and building for evacuation, 8 Extinguishment of fire.  2000 NFPA 101, 18/

CMS website:

National Fire Protection Association (NFPA) website:

Nursing Home Leadership Assistance

In cooperation with the Missouri Department of Health and Senior Services, the MU Sinclair School of Nursing at the University of Missouri offers a Nursing Home Leadership Coaching Service to assist nursing home administrators and key operational leaders to meet the leadership challenges of the long-term care industry.  The services offered focus on helping nursing home administrators deal effectively with the complex management issues they face each day in their business and personnel operations.  The coaching is tailored to meet individual administrator needs within the context of each person’s unique operational situations, as well as within the variety of corporate and business models in Missouri.  Designed as a voluntary service, the Nursing Home Leadership Coach assists with such issues as Operational Improvement, Corporate Compliance, Budget Analysis, Regulations, Process Improvement Leadership Skills, Staff Retention, Contract Review, Survey Readiness, Staff Training, Quality of Life, and Culture Change.  The Coaching Service works collaboratively with our existing QIPMO program.  Dave Walker, LNHA, functions as the NHA Coach.  Nursing home administrators interested in consulting with Mr. Walker should contact Jessica Mueller, Project Coordinator at the MU Sinclair School of Nursing at (573) 882-0241 or by e-mail at  Please visit:

  •  Nursing Home Survey Manual:  Resource Available!

Dave Walker, MU NHA Coach, has created a Long-Term Care Survey Manual for use by nursing home staff.  The purpose of the manual is to provide guidance on how to comply with State and Federal regulations.  The manual offers numerous forms and policies for nursing homes to consider using in order to prepare for their annual survey visit.  The manual is available at, and may be downloaded by section or in its entirety.

2012 Annual Long-Term Care Provider Meetings

Sponsored by the Missouri Department of Health & Senior Services, Section for Long-Term Care Regulation (SLCR).

Topics Include:

    SLCR Updates / Rule Changes  Regulatory Update Provider Meetings 2012

    CPR and Elopement Issues  CPR and Elopement Provider Meetings 2012

    2012 Life Safety Code  Life Safety Code Update Provider Meetings 2012

    New Dining Practice Standards New Dining Practice Standards Provider Meetings 2012

    Update from the Missouri Coalition Celebrating Care Continuum Change (MC5)

Please view the flyer and agenda here:   2012 ANNUAL PROVIDER MEETINGS

National Scald Prevention Campaign

The Missouri Division of Fire Safety in conjunction with the National Scald Prevention Steering Committee

The Division of Fire Safety has made the Scald Prevention Brochure available for distribution.  Fire Safety Inspectors will also distribute the brochure when they conduct facility inspections.  The brochure is printed in both English and in Spanish.  Please visit the website for more information: