Residential Care Homes and Nursing Homes Regulations 2000
RESIDENTIAL CARE HOMES AND NURSING HOMES
REGULATIONS 2000 – REVOKED BY 2001
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REVOKED BY 2001
BR 79 / 2000
RESIDENTIAL CARE HOMES AND NURSING HOMES ACT 1999
1999:28
RESIDENTIAL CARE HOMES AND NURSING HOMES
REGULATIONS 2000
The Minister of Health, in exercise of the power conferred on him
under section 23 of the Residential Care Homes and Nursing Homes Act
1999, makes the following Regulations:
Citation and commencement
1 These Regulations may be cited as the Residential Care Homes
and Nursing Homes Regulations 2000 and shall come into operation on
the 1st day of December 2000.
Interpretation
2 In these Regulations—
“the Act” means the Residential Care Homes and Nursing Homes
Act 1999;
“administrator” means the person who has responsibility for the
day to day administration of a home;
“”nurse” means a person who is registered as a general or
specialist nurse under the Nursing Act 1987;
“nursing associate” means a person who is registered as a
nursing associate under the Nursing Act 1997;
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“operator” in relation to a home, means the person to whom a
certificate of registration has been issued under the Act;
“physician” means a person who is registered as a medical
practitioner under the Medical Practitioners Act 1950;
“registered dietician” means a person who is registered as a
dietician under the Professions Supplementary to Medicine
Act 1973.
Duty of operator to comply with Regulations
3 It shall be the duty of an operator to observe the requirements of
these Regulations and to ensure that a home in respect of which he is
the operator, complies with the requirements of these Regulations.
Application for registration
4 An application for the registration of a home shall be made in
such form as the Chief Medical Officer may require.
Staffing
Administrators
5 (1) An operator of a home shall designate a person to be the
administrator of the home, and shall notify the Chief Medical Officer of
the administrator’s name.
(2) A person shall not be qualified to be designated
administrator of a home unless such person—
(a) is at least twenty-one years of age;
(b) is of good character;
(c) has been certified by a physician to be in good physical
and mental health and free from communicable
diseases;
(d) has not less than three years current experience working
with senior citizens; and
(e) has adequate experience in management or has received
adequate training in management.
Deputy administrators
6 (1) An operator shall also designate a person to be the deputy
administrator of a home, who shall act in the absence of the
administrator, and shall notify the Chief Medical Officer of the deputy
administrator’s name.
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(2) A person shall not be qualified to be designated as a deputy
administrator of a home unless such person—
(a) is at least twenty-one years of age;
(b) is of good character;
(c) is certified by a physician to be in good physical and
mental health and free from communicable diseases;
(d) has not less than one year’s current experience working
with senior citizens; and
(e) has adequate experience in management or has received
adequate training in management.
Medical consultant
7 An operator shall retain the services of a physician to advise on
medical matters and review the home’s programme of health care.
Nursing staff
8 (1) The operator of a residential care home shall employ on a
full time basis a nurse or a nursing associate to be supervisor of care.
(2) The operator of a nursing home shall―
(a) employ on a full time basis a nurse to be director of
nursing services;
(b) ensure that there shall be a nurse on duty at the home
for not less than eight hours a day and a nurse on call
for the rest of the time in each day.
Other staff
9 An operator shall ensure that every other employee who provides
direct care to the residents in a home possess the following
qualifications―
(a) is at least eighteen years of age;
(b) is of good character;
(c) is certified by a physician, not more than thirty days prior to
employment, to be in good physical and mental health, and
free from communicable diseases;
(d) has received adequate training in basic first aid anti-choking
and cardiopulmonary resuscitation; and
(e) has successfully completed a geriatric training course at the
Bermuda College or has successfully completed an
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equivalent course at some other institution recognised by the
Chief Medical Officer.
Staffing ratio
10 (1) In a home where all residents are ambulatory and oriented
as to time and place, the operator shall ensure that at all times the ratio
of staff to residents shall be at least one staff member to every ten
residents.
(2) The Chief Medical Officer may, where in all the
circumstances of a particular home and having regard to the interest
and needs of the residents, he considers it appropriate so to do, impose
additional staffing requirements on a home.
(3) In determining the staff ratio account shall not be taken of―
(a) part-time staff, or
(b) other staff not directly involved in the provision of care to
the residents.
Facilities
Dietary Requirements
11 (1) An operator, in determining the dietary requirements of
residents in a home, shall take into account their nutritional, emotional,
religious, cultural and therapeutic needs.
(2) In particular, the operator shall―
(a) provide daily at least three meals that are nutritious and
suited to the special needs of residents;
(b) ensure that at all times there shall be available for
emergency purposes at least two weeks’ supply of food.
Sterilisation of utensils
12 (1) An operator shall ensure that a home shall be provided with
such equipment as will ensure that all multi-use utensils and equipment
used in the preparation, cooking and serving of food or drink can be
thoroughly washed in hot water at temperatures of at least one hundred
and ten degrees Fahrenheit.
(2) All such utensils and equipment shall be so washed after
each use.
Food service personnel
13 An operator shall employ in the home an adequate number of
food service personnel who are trained in safe food-handling practices.
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Dietitian
14 An operator shall employ in a home a registered dietitian who
shall be responsible for planning and approving appropriate diets for the
residents of the home.
Hygiene and comfort standards
15 An operator shall ensure that a home shall be kept weatherproof,
dry, free of pests, adequately heated, ventilated and lighted, in a state of
good repair and sanitation and in general safe, clean and comfortable for
residents, to the satisfaction of the Chief Medical Officer.
Housekeeping and laundry services
16 (1) An operator shall ensure that a home shall, on each floor
and in each area where residents are accommodated, be equipped with
one or more locked and vented closets fitted with a sink, shelves, and
sufficient space for the purpose of storing housekeeping and cleaning
utensils and supplies.
(2) An adequate supply of clean linen shall be provided to each
resident whenever necessary and at least once per week.
(3) All laundry shall be handled in such a way as to minimize
contamination, and in particular―
(a) personal laundry of residents and personnel shall be
collected, transported, sorted, washed, and dried in a
sanitary manner, separate from bed linen; and
(b) where feasible, arrangements shall be made so that
residents who wish to do so shall have a safe and
convenient place to wash and dry small amounts of
personal laundry.
(4) Soiled linen shall be collected in such a manner as to avoid
the contamination of the environment; and the following procedures
shall apply―
(a) soiled linen shall be taken to a designated dirty laundry
storage area in closed hampers or bags;
(b) soiled linen shall not be taken through a food storage or
food preparation area;
(c) soiled linen shall be kept separate from clean linen at all
times;
(d) separate and specific carts shall be used for the pick-up
of soiled linen and the distribution of clean linen; and
(e) soiled linen shall be kept in identifiable bags.
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(5) Every laundry worker shall wear a distinctive uniform while
doing laundry work, and shall not wear this uniform at any other time or
while performing any other duty.
Resident activities
17 (1) An operator shall, so far as practicable, ensure that there is
a programme of activities and recreational opportunities available to
residents in a home.
(2) An operator shall designate a staff member to be responsible
for managing activities and supervising volunteers.
(3) Staff who provide recreational activities shall have such
qualification and experience as the Chief Medical Officers considers
appropriate.
Records
Medical records
18 (1) The operator of a residential care home shall record and
keep current the following records in respect of each resident―
(a) the name, address and telephone number of his
physician and dentist;
(b) the name, address and telephone number of his next of
kin or other person who may be contacted in case of an
emergency;
(c) pre-admission evaluation of his condition and
subsequent re-evaluation and all orders and
recommendations for care;
(d) all symptoms and other indications of illness or injury
brought to the attention of the staff by him or from other
sources, including the date, time and action taken
regarding each such illness or injury.
(2) The operator of a nursing home shall record and keep
current the following records in respect of each resident―
(a) the name, address and telephone number of his
physician and dentist;
(b) the name address and telephone number of his next of
kin or other person who may be contacted in case of an
emergency;
(c) his functional status on admission;
(d) his admission history and physical examination;
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(e) his existing medical condition;
(f) his treatment and medication;
(g) physicians’ progress notes on him;
(h) nurses’ notes on him;
(i) special examinations and reports on him;
(j) reports and recommendations from physicians, social
workers or other health care professionals regarding his
care and treatment;
(k) his date and time of discharge;
(l) his final diagnosis;
(m) his condition on discharge;
(n) date and time of his death.
(3) An operator shall preserve medical records for a period of not
less than six years from the date of discharge or death of the resident to
whom they relate; and shall make such records available for inspection
by the Chief Medical Officer.
Other resident records
19 An operator shall record and keep current, the following records
in respect of each resident which shall be made available for inspection
by the Chief Medical Officer―
(a) the resident’s name;
(b) the resident’s age and sex;
(c) the resident’s social security number;
(d) the date the resident was admitted;
(e) the date the resident was discharged or the date of the
resident’s death;
(f) the name, address, and telephone number of the resident’s
personal physician;
(g) the name, address, and telephone number of the resident’s
next of kin or sponsor, if any;
(h) the resident’s religious affiliation, if any, and the name and
telephone number of the resident’s clergyman.
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Administrative records
20 An operator shall maintain records of the following matters
which shall be made available for inspection by the Chief Medical
Officer―
(a) a report book in which emergencies and other unusual
occurrences involving residents are recorded by the person
on duty at the time of the occurrence;
(b) contingency plans and procedures;
(c) a list of current charges and fees for services; and
(d) staff schedules.
Annual statistical records
21 (1) An operator shall compile annual statistical records of the
following matters―
(a) the total number of persons admitted to the home; and
(b) the total number of persons discharged from the home.
(2) An operator shall provide the Chief Medical Officer with a
copy of such record not later than 30 January in every year.
Quarterly record of occupancy levels
22 An operator shall keep a record of quarterly changes in a home’s
occupancy level and shall provide the Chief Medical Officer with a copy of
such record as soon as practicable after the end of the quarter to which
it relates.
Personnel records
23 An operator shall keep the following records in respect of each
person employed in the home―
(a) his name and address;
(b) his sex;
(c) his social insurance number;
(d) his current professional license or registration number, if
any; and
(e) particulars of his education, training, experience and places
of previous employment.
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Premises
Environmental requirements
24 (1) A home shall be located in an area which is free from
noxious and hazardous smoke and fumes.
(2) Where possible, a home shall be located away from known
sources of loud and irritating noises.
(3) A home shall be located away from hazardous surroundings
including cliffs and bodies of water, except where suitable safety
structures such as walls, fences and gates have been erected to provide
for the safety of the residents.
Structural requirements
25 (1) A home on more than one level shall provide for the use of
residents elevator access to other levels with resident facilities.
(2) All windows in a home shall be capable of being opened.
(3) All windows sills in rooms occupied by residents shall be no
higher than three feet above the floor.
Lighting
26 (1) A home and its lighting system shall be designed, equipped
and maintained to avoid high brightness, highly reflective surfaces and
glare.
(2) An operator shall provide such additional lighting as may be
required by residents with visual impairment.
(3) Incandescent fixtures shall be equipped with at least sixty
watt light bulbs.
(4) Night lights shall be provided in bathrooms, hallways and
resident’s bedrooms.
(5) Outside entrances shall be well-lit at all times when they are
likely to be in use.
Water supply
27 (1) An operator shall ensure that there shall be no cross-
connection between the potable water supply and other sources of water
through which a safe supply might become contaminated.
(2) An adequate supply of hot water for the use of residents
shall be provided at all times.
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(3) The temperature of hot water at fixtures, used by the
residents shall not exceed one hundred and ten degrees Fahrenheit.
(4) A separate supply of hot water shall be provided for dish
washing.
Heat and ventilation
28 (1) Heating and cooling systems shall be so located as to
prevent drafts to residents.
(2) Every home shall be well ventilated through the use of
windows, forced air or both.
(3) All cooking units shall be hooded and vented.
(4) Air filters shall be provided in all recirculating air systems
and a record shall be kept of all maintenance, which shall include proper
cleaning.
Architectural requirements
29 (1) A home shall be so equipped, furnished and maintained as
to provide a comfortable, congenial, home-like setting for residents while
providing the staff with a reasonable functional working environment.
(2) In particular a home shall have the following amenities―
(a) a adequate community space comprising at least twenty-
five square feet of space for each resident for social and
recreational purposes, including a living room, a
recreation room, and a dining room;
(b) adequate working space for staff, and areas exclusive
and appropriate to their personal needs including a staff
room, toilets and shower facilities;
(c) a secure outdoor area for use by residents, staff and
visitors which shall be accessible from the ground floor
level of the home without the use of ramps or steps.
Bedrooms
30 (1) Bedrooms shall be designed and equipped for the comfort
and privacy of residents.
(2) Each bedroom shall have at least one window, and egress to
a hallway.
(3) No bedroom shall be occupied by more than three residents.
(4) In the case of―
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(a) a single occupancy room, the minimum usable floor
place shall be one hundred and twenty square feet; and
(b) a multi-occupancy room, the minimum usable floor
space for each occupant shall be ninety square feet,
exclusive of closets, toilet rooms, wardrobes and vestibules.
(5) In the case of a single room or a double room, the minimum
room dimensions, excluding toilets and closets, shall be ten feet by
twelve feet.
(6) In the case of a multi-occupancy room, the minimum room
dimension, excluding toilets and closets, shall be twelve feet by twelve
feet.
(7) A resident’s bedroom shall be equipped with―
(a) a bed appropriate to the residents physical condition;
(b) a bedside table or cabinet with lockable storage space;
(c) individual reading lamp with at least a sixty watt bulb;
(d) a comfortable armchair; and
(e) suitable sufficient storage space for each resident’s
personal clothing and personal effects.
(8) There shall be at least three feet of space between beds and
between beds and a heating source or window.
(9) In the case of a multi-occupancy room, there shall be
provided to every resident who requests it, a flame-resistant washable
bedside curtain or portable screen that completely conceals the bed to
ensure privacy.
(10) In a home in which residents are given keys to their
bedrooms, staff shall have access to duplicate keys for use in emergency
situations and for regularly scheduled routine housekeeping.
Bathing and toilet facilities
31 (1) There shall be at least one wash-basin and one toilet for
every four residents.
(2) There shall be at least one bathtub for every six residents;
the tub shall be so designed as to accommodate a bath hoist.
(3) At least one bathroom shall be accessible to residents in
wheelchairs.
(4) The minimum dimensions of any room containing only a
toilet shall be three feet by six feet.
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(5) Grab bars shall be installed in all toilets and bathrooms.
(6) All toilets and bathrooms shall be equipped with sturdily
mounted handrails to provide adequate assistance to residents.
(7) Door fittings on toilets and bathrooms shall be of the type
that operates from both the inside and outside.
(8) Doors to which residents have access shall be at least three
feet wide.
(9) Staff shall not use toilets and bathrooms reserved for
residents.
(10) In a home registered for more than twenty residents, toilets
facilities and wash basins shall be provided near the community space.
(11) The doors of toilets and bathrooms shall not open directly
into any dining room, kitchen, pantry, food preparation room or storage
room.
(12) Every wash-basin, shower unit and bathtub used by
residents shall be equipped with a make of faucet that is simple to
understand and easy to use.
(13) No spring-loaded or pressure-operated faucet shall be used
on a wash-basin, shower or bathtub that is intended for use by a
resident.
Safety
Exits
32 (1) An operator shall ensure that a home shall be provided with
a sufficient number of exits to permit the prompt escape or evacuation of
occupants in the event of a fire or other emergency.
(2) There shall be at least two exits from every home, which
shall be so located as to minimize any risk of both exits being blocked by
fire, smoke or fumes simultaneously.
(3) All exit and other doors used as means of escape shall be
provided with pushbars or similar fittings which do not require the use of
keys or special tools to operate; and no locks or fastenings shall be
installed which may prevent free escape from a home or a patient’s room.
(4) All exit doors shall open in line of exit travel.
(5) All exit ways shall remain clear and unobstructed and a
minimum width of forty-four inches shall be maintained at all times.
(6) No exit doors shall open directly to a flight of stairs or a
landing that is less than the width of the door.
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Exit sign
33 (1) Every exit from a home shall be clearly visible and marked
with exit signs.
(2) Directional exit signs, where necessary, shall be provided to
indicate the direction of travel to reach such exit.
Emergency lighting
34 (1) In every home, emergency lighting shall be provided and
maintained for all exits, exit ways and community spaces.
Fire alarm system
35 In every home, adequate fire detection and alarm system shall be
provided and maintained.
Fire separation
36 (1) In every home, all vertical openings between floors shall be
so enclosed and protected as to afford reasonable safety to the occupants
while using exits and to prevent the spread of fire, smoke or fumes from
floor to floor.
(2) In every home, all exits and exit ways shall be adequately
protected as to afford reasonable safety to the occupants using such
exits or exit ways and to prevent the spread of fire, smoke or fumes.
Fire extinguishing equipment
37 Every home shall be provided with adequate fire extinguishing
equipment clearly marked and so located as to be immediately
accessible.
Fire Procedure Rules
38 (1) An operator shall publish in a conspicuous place in a home
rules prescribing the action to be taken in the event of fire (“Fire
Procedure Rules”) and shall ensure that all employees are aware of the
action to be taken by them in accordance with such rules in the event of
a fire.
(2) Fire Procedure Rules shall include the following matters―
(a) action to be taken on discovery of fire;
(b) evacuation plan;
(c) extinguishment of fire.
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Duty to take precautions to prevent fires
39 An operator shall take all reasonable precautions to prevent
explosion or the spread of fire or smoke in a home, and shall ensure that
exits and equipment, which are provided for the protection of the
premises and its occupants from fire, are maintained in efficient
condition and are readily available for use in the event of a fire.
Instruction of employees in fire safety measures
40 Every operator shall ensure that every employee in the home is
adequately instructed in precautions to be taken to prevent fire,
explosion or spread of fire and smoke in a home and of the action to be
taken by in accordance with the Fire Procedures Rules.
Log book
41 An operator shall keep a log book in the home in which shall be
recorded every fire drill, fire training session, test of fire alarm system
and any outbreak of fire and each such entry shall be signed by the
person conducting the drill, training session or testing of the fire alarm
system or, in the case of an outbreak of fire, by the person in charge of
the home at the time of the outbreak.
Duty of employees to report fire
42 It shall be the duty of every person employed at a home to report
immediately any outbreak or suspected outbreak of fire, by notifying the
Fire Service.
General safety and egress requirements
43 (1) Floors and stairways in a home shall have non-skid finishes
and coverings.
(2) Handrails shall be installed on every stairway and ramp.
(3) Protective guards shall be placed around and over all
heating devices.
(4) First aid supplies shall be provided in a place accessible to
all staff responsible for the health and well-being of residents.
Contingency plan
44 (1) A home shall have a written contingency plan for the proper
and timely care of residents and casualties arising from internal or
external disasters.
(2) The plan shall provide for the following matters―
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(a) procedures for the orderly evacuation of all residents
and employees from the premises due to any real or
perceived threat;
(b) the assignment of personnel to specific tasks and
responsibilities;
(c) instructions relating to the use of alarm systems and
signals;
(d) information concerning methods of fire containment;
(e) information concerning the location of fire fighting and
other emergency equipment;
(f) procedures for notification of appropriate emergency
services and authorities;
(g) evacuation routes;
(h) a plan of the interior of the building and the adjacent
exterior driveways and roads;
(i) information on evacuation to shelters; and
(j) arrangements made for admission of injured to the
hospital.
(3) Copies of the contingency plan shall be placed in
conspicuous locations within the home and a copy shall be provided o
the Chief Medical Officer.
(4) Evacuation drills shall be held at least once every six
months.
(5) All staff at a home shall be required to familiarize themselves
with the contingency plan.
(6) An operator shall provide for the continued operation of a
home in the event of a disaster and shall make provision for―
(a) an emergency electrical power supply to ensure
continuation of water supply, minimum lighting,
refrigeration and the operation of cooking appliances;
(b) availability of essential supplies including fuel, food,
medical and supportive materials;
(c) the maintenance of communication outside the home.
(7) An operator shall draw up and have prepared a plan of
action to be followed in the event of a labour dispute or action including
slow-down, walk-out, mass resignation or, strike.
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Offences
45 Every operator who fails to comply with any duty imposed on
him by regulation 3 commits and offence and is liable on summary
conviction to a fine of $10,000.
Dated this 19th day of October 2000
Minister of Health
