902 KAR 20:046.
Facility specifications; nursing homes.
RELATES TO: KRS
216B.010-216B.130, 216B.990(1), (2)
STATUTORY AUTHORITY:
KRS 216B.042, 216B.105
NECESSITY, FUNCTION,
AND CONFORMITY: KRS 216B.042 and 216B.105 mandate that the Kentucky Cabinet for
Human Resources regulate health facilities and health services. This
administrative regulation provides licensure requirements for structural
specifications for the alteration and maintenance of existing nursing home
facilities.
Section 1.
Definitions. (1) "Board" means the Commission for Health Economics
Control in Kentucky.
(2)
"License" means an authorization issued by the board for the purpose
of operating a nursing home facility.
(3) "Licensure
Agency" means the Division for Licensing and Regulation in the Office of
the Inspector General, Cabinet for Human Resources.
Section 2.
Preparation and Approval of Plans and Specifications. (1) Before alterations
are begun to existing buildings or any change in existing nursing home
facilities, the licensee or applicant shall submit plans to the licensure
agency for approval.
(2) All
architectural, mechanical and electrical drawings shall bear either the seal of
an architect registered in the Commonwealth of Kentucky or the seal of a
professional engineer registered in the Commonwealth of Kentucky, or both.
(3) Drawings shall
not exceed thirty-six (36) inches by forty-six (46) inches when trimmed.
(4) All such plans
and specifications must be approved by the licensure agency prior to
commencement of alteration of existing buildings.
(5) Plans and
specifications in specific detail as required by the Kentucky Building Code
shall be submitted together with architectural and/or engineering stamps as
required by KRS Chapters 322 and 323, to the Department of Housing, Buildings
and Construction for determining compliance with the Kentucky Building Code.
All such plans and specifications must be approved by the Department of
Housing, Buildings and Construction and appropriate local building permits
shall be obtained prior to commencement of any alteration.
Section 3.
Submission of Plans and Specifications. (1) First stage, schematic plans.
(a) Single line
drawings of each floor shall show the relationship of the various departments
or services to each other and the room arrangement in each department. The name
of each room shall be noted. Drawings shall include typical patient room
layouts (scaled one-fourth (1/4) inch to one (1) foot) with dimensions noted.
The proposed roads and walks, service and entrance courts, parking and
orientation shall be shown in a plot plan.
(b) If the project
is an addition or is otherwise related to existing buildings on the site, the
plans shall show the facilities and general arrangements of those buildings.
(2) Second stage, preliminary
plans. Preliminary sketch plans shall include the following:
(a) Architectural:
plans of basement and floors.
(b) Outline
specifications.
1. General
description of the alteration, including interior finishes, types and locations
of acoustical material, and special floor covering;
2. Description of
the air-conditioning, heating, and ventilation systems and their controls, duct
and piping systems; and dietary, laundry, sterilizing, and other special
equipment;
3. General
description of electrical service including voltage, number of feeders, and
whether feeders are overhead or underground.
(3) Third stage.
Contract documents.
(a) Working
drawings. Working drawings shall be complete and adequate for bid, contract,
and construction purposes. Drawings shall be prepared for each of the following
branches of the work: architectural, structural, mechanical, and electrical.
They shall include the following:
1. Architectural
drawings.
a. Approach plan
showing all new topography, newly established levels and grades, existing
structures on the site (if any), new building structures, roadways, walks, and
parking areas;
b. Plan of each
basement, floor and roof;
c. Elevations of
each facade;
d. Sections through
building;
e. Required scale
and full-size details;
f. Schedule of
doors, windows, and room finishes;
g. Layout of typical
and special rooms indicating all fixed equipment and major items of movable
equipment. Equipment not included in contract shall be so indicated;
h. Conveying
systems. Details of construction, machine and control space necessary, size and
type of equipment, and utility requirements for the following: dumbwaiters -
electric, hand, hydraulic; elevators - freight, passenger, patient; loading
dock devices; pneumatic tube systems.
2. Structural
drawings.
a. Plans for
foundations, floors, roofs, and all intermediate levels with sizes, sections,
and the relative location of the various structural members;
b. Dimensions of
special openings;
c. Details of all
special connections, assemblies, and expansion joints.
3. Mechanical
drawings.
a. Heating, steam
piping, and air-conditioning systems. Radiators and steam heated equipment,
such as sterilizers, warmers, and steam tables; heating and steam mains and
branches with pipe sizes; sizes, types, and capacities of boilers, furnaces,
hot water heater with stokers; oil burners, or gas burners; pumps, tanks,
boiler breeching, and piping and boiler room accessories; air-conditioning
systems with required equipment, water and refrigerant piping, and ducts;
supply and exhaust ventilation systems with heating/cooling connections and
piping; air quantities for all room supply and exhaust ventilating duct
openings.
b. Plumbing,
drainage, and standpipe systems. Size and elevation of: street sewer, house
sewer, house drains, street water main, and water service into the building;
location and size of soil, waste, and water service with connections to house
drains, clean-outs, fixtures, and equipment; size and location of hot, cold and
circulating branches, and risers from the service entrance, and tanks; riser
diagram of all plumbing stacks with vents, water risers, and fixture
connections; gas, oxygen, and vacuum systems; standpipe and sprinkler systems
where required; all fixtures and equipment that require water and drain
connections.
4. Electrical
drawings.
a. Electrical
service entrance with switches and feeders to the public service feeders,
characteristics of the light and power current, transformers and their
connections if located in the building;
b. Location of main
switchboard, power panels, light panels, and equipment. Diagram of feeders and
conduits with schedule of feeder breakers or switches;
c. Light outlets,
receptacles, switches, power outlets, and circuits;
d. Telephone layout
showing service entrance, telephone switchboard, strip boxes, telephone
outlets, and branch conduits;
e. Nurses' call
systems with outlets for beds, duty stations, door signal light, annunciators,
and wiring diagrams;
f. Emergency
electrical system with outlets, transfer switch, sources of supply, feeders,
and circuits;
g. All other
electrically operated systems and equipment.
(b) Specifications.
Specifications shall supplement the drawings to fully describe types, sizes,
capacities, workmanship, finishes and other characteristics of all materials
and equipment and shall include:
1. Cover or title
sheet;
2. Index;
3. Sections
describing materials and workmanship in detail for each class of work;
4. Access to the
work. Representatives of the appropriate state agencies shall have access at
all reasonable times to the work wherever it is in preparation or progress, and
the contractor shall provide proper facilities for such access and inspection.
Section 4.
Compliance with Building Codes, Ordinances and Administrative Regulations. (1)
This section be administered independently from other sections of this
administrative regulation.
(2) General. Nothing
stated herein shall relieve the sponsor from compliance with building codes,
ordinances, and administrative regulations which are enforced by city, county,
or state jurisdictions.
(3) The following
requirements shall apply where applicable and as adopted by the respective
agency authority:
(a) Requirements for
safety pursuant to 815 KAR 10:020, as amended;
(b) Requirements for
plumbing pursuant to 815 KAR 20:010 to 20:190, as amended;
(c) Requirements for
air contaminants for incinerators pursuant to 401 KAR 59:020 and 401 KAR
61:010;
(d) Requirements for
elevators pursuant to 815 KAR 4:010; and
(e) Requirements for
making buildings and facilities accessible to and usable by the physically
handicapped, pursuant to KRS 198B.260 and administrative regulations
promulgated thereunder.
(4) Prior to
occupancy, facility must have final approval from appropriate agencies.
(5) All facilities
shall be currently approved by the Fire Marshal's Office in accordance with the
Life Safety Code before relicensure is granted by the licensure agency.
Section 5. Facility
Requirements and Special Conditions. (1) Independent facilities with a capacity
of fifty (50) beds or less present special problems. The sizes of the various
departments will depend upon the requirements of the facilities. Some functions
allotted separate spaces or rooms in these general standards may be combined
provided that the resulting plan will not compromise the standards of safety
and of medical and nursing practices and the social needs of patients. In other
respects, the general standards set forth herein, including the area
requirements, shall apply.
(2) Facilities shall
be available to the public, staff, and patients who may be physically
handicapped with special attention given to ramps, drinking fountain height,
mirrors, etc.
(3) The number of
beds in a nursing unit shall not exceed sixty (60) unless additional services
are provided, as deemed necessary by the state agency. At least two (2) rooms
per nursing unit shall be designed for single person occupancy (one (1) bed)
and shall have private toilet rooms with bath. At least sixty (60) percent of
the beds shall be located in rooms designed for one (1) or two (2) beds.
Section 6. Nursing
Unit. (1) Patient rooms. Each patient room shall meet the following
requirements:
(a) Maximum room
capacity: four (4) patients;
(b) Patient rooms
shall be designed to permit no more than two (2) beds side by side parallel to
the window wall. Not less than a four (4) foot space shall be provided between
beds, and at least a three (3) foot space between the side of a bed and the
nearest wall, fixed cabinet, or heating/cooling element. A minimum of four (4)
feet is required between foot of bed and opposite wall, or foot of opposite bed
in multibed rooms;
(c) Window. All
patient rooms must have windows opening to the outside. Sill shall not be
higher than three (3) feet above the floor and shall be above grade. Window
area to be at least eight (8) percent of patient room floor area;
(d) Lavatory. In
single and two (2) bed rooms with private toilet room, the lavatory may be
located in the toilet room. Where two (2) patient rooms share a common toilet,
a lavatory shall be provided in each patient room;
(e) Wardrobe or
closet for each patient. Minimum clear dimensions: one (1) foot deep by one (1)
foot and eight (8) inches wide with full length hanging space clothes rod and
shelf;
(f) Cubicle
curtains, or equivalent built-in devices for complete privacy for each patient
in each multibed room and in tub, shower and toilet rooms;
(g) No patient room
shall be located more than 120 feet from the nurses' station, the clean
workroom, and the soiled workroom. No room shall be used as a patient room
where the access is through another patient's room.
(2) Patient toilet
rooms.
(a) A toilet room
shall be directly accessible from each patient room and from each central
bathing area without going through the general corridor. One (1) toilet room
may serve two (2) patient rooms but not more than four (4) beds. The minimum
dimensions of any room containing only a toilet shall be three (3) feet by five
(5) feet;
(b) Toilets must be
easily usable by wheelchair patients. Grab bars shall be provided at all
toilets;
(c) At least one (1)
toilet for each sex shall be provided for training purposes and access by
wheelchairs. It shall be accessible from the nursing corridor, may be part of
the bathing area and shall have a minimum size, of five (5) feet by six (6)
feet;
(d) Doors to toilet
rooms shall have a minimum width of two (2) feet and ten (10) inches to admit a
wheelchair.
(3) Service areas in
each nursing unit. The size of each service area will depend on the number and
types of beds within the unit and shall include:
(a) Nurses' station
for nurses' charting, doctors' charting, communications, and storage for
supplies and nurses' personal effects;
(b) Staff lounge
area. The area shall have personal storage space and a toilet room for staff;
(c) Visitors toilet
room. The facility shall provide a toilet room for visitors. The staff toilet
room may serve as the visitors toilet room if marked and accessible;
(d) Clean workroom
for storage and assembly of supplies for nursing procedures containing work
counter, sink, and small sterilizer;
(e) Soiled workroom
containing clinical sink, work counter with two (2) compartment sink, waste
receptacles, and soiled linen receptacles;
(f) Medicine room
adjacent to nurses' station with sink, refrigerator, locked storage, and
facilities for preparation and dispensing of medication. (May be designated
area within clean workroom if a self-contained cabinet is provided.) The
controlled substances locker must be under double lock and wired to warning
light at nurses' station;
(g) Clean linen
storage with enclosed storage space (may be a designated area within the clean
workroom);
(h) Nourishment
station with storage space, sink, hot plate and refrigerator for serving
between-meal nourishments (may serve more than one (1) nursing unit on the same
floor);
(i) Equipment
storage room for storage of IV stands, inhalators, air mattresses, walkers, and
similar bulky equipment;
(j) Patient baths.
One (1) shower stall or one (1) bathtub required for each fifteen (15) beds not
individually served. There shall be at least one (1) free standing bathtub in
each bathroom. Grab bars or patient lift with a safety device shall be provided
at all bathing fixtures. Each bathtub or shower enclosure in central bathing
facilities shall provide space for the private use of bathing fixture, for
dressing, and for a wheelchair and attendant. Showers in central bathing
facilities shall not be less than four (4) feet square, without curbs, and
designed to permit use from a wheelchair. Soap dishes in showers and bathrooms
shall be recessed;
(k) Stretcher and
wheelchair parking area or alcove;
(l) Janitor's closet
for storage of housekeeping supplies and equipment. Floor receptor or service
sink;
(m) Bedpan washing
facilities. Bedpan washing attachments are recommended for each patient room
toilet. It will be acceptable, however, to have separate bedpan washing closets
in each nursing unit, provided that they are so located that bedpans need not
be carried through lobbies, dining and recreation areas, or day rooms.
(4) Special purposes
room(s) for consultation, examination and treatment, and therapeutic and
nursing procedures. (May serve more than one (1) nursing unit on the same
floor.) These rooms shall include a lavatory, storage space, and space for a
treatment table and have a minimum floor area of nine (9) feet by eleven (11)
feet.
(5) Patients'
dining, TV viewing and recreation areas.
(a) The total areas
set aside for these purposes shall be not less than thirty (30) square feet per
bed for the first fifty (50) beds and twenty (20) square feet per bed for all
beds in excess of fifty (50). Additional space shall be provided for
outpatients if they participate in a day care program.
(b) Storage shall be
provided for recreational equipment and supplies (e.g., wall cabinet and
closets).
Section 7. Therapy
Units. (1) If the facility has a physical therapy unit the following shall be
provided (depending on the program):
(a) Office (may also
serve for occupational therapy office);
(b) Exercise and
treatment areas with sink or lavatory and cubicle curtains around treatment
areas;
(c) Hydrotherapy
areas with cubicle curtains around treatment areas;
(d) Storage for supplies
and equipment; and
(e) Toilet rooms
located for convenient access by physical therapy patients (may also serve
occupational therapy patients).
(2) If the facility
has an occupational therapy unit it shall include:
(a) Office space
(may be shared with physical therapy office);
(b) Therapy area
with sink or lavatory;
(c) Storage for
supplies and equipment;
(d) Toilet room (Not
required if other toilet facilities are convenient).
(3) Personal care
room with space for shampoo sink and barber chair (not required in facility of
less than twenty-five (25) beds).
Section 8. Dietary
Department. If a commercial service will be used or meals will be provided by
an adjacent hospital, dietary areas and equipment shall be designed to
accommodate the requirements for sanitary storage, processing, and handling,
otherwise the following shall be provided:
(1) Food preparation
center with a lavatory but no mirror;
(2) Food serving
facilities to accommodate patients and staff;
(3) Dishwashing room
with commercial-type dishwashing equipment and a lavatory;
(4) Pot-washing
facilities;
(5) Refrigerated
storage to accommodate three (3) day supply;
(6) Dry storage to
accommodate three (3) day supply;
(7) Cart cleaning
facilities;
(8) Cart storage
area;
(9) Waste disposal
facilities;
(10) Can-washing
facilities;
(11) Staff dining
facilities;
(12) Patient dining
facilities;
(13) Dietician's
office (may be omitted in facilities with less than 100 beds if desk space is
provided in kitchen);
(14) Janitor's closet
with storage for housekeeping supplies and equipment, floor receptor or service
sink; and
(15) Toilet room
which is conveniently accessible to dietary staff with a two (2) door
separation from food preparation area or dining area.
Section 9. Administration
Department. The facility shall have adequate administrative, public, and staff
facilities (e.g., offices, lobby, toilet facilities) to accommodate the needs
of the public, patients, and staff without interfering with the provision of
medical care services.
Section 10. Laundry.
The following shall be included:
(1) Soiled linen
room;
(2) Clean linen and
mending room;
(3) Linen cart
storage;
(4) Lavatories
accessible from soiled, clean, and processing rooms;
(5) Laundry
processing room with commercial type equipment sufficient to take care of seven
(7) days' needs within the workweek;
(6) Janitor's closet
with storage for housekeeping supplies and equipment, floor receptor or service
sink; and
(7) Storage for
laundry supplies. (Subsections (5), (6), and (7) of this section need not be
provided if laundry is processed outside the facility.)
Section 11. Storage
and Service Areas. (1) Central storage room(s) with at least ten (10) square
feet per bed for first fifty (50) beds; and five (5) square feet per bed for
all beds over fifty (50), to be concentrated in one (1) area.
(2) Locker rooms
with toilets, and lavatories for staff and volunteers and rest space for
females.
(3) Engineering
service and equipment areas. The following shall be provided:
(a) Boiler room;
(b) Engineers'
office (may be omitted in facilities of less than 100 beds);
(c) Mechanical and
electrical equipment room(s) (can be combined with boiler room);
(d) Maintenance
shop(s). At least one (1) room shall be provided (can be combined with boiler
room in nursing homes of less than fifty (50) beds);
(e) Storage room for
building maintenance supplies and paint storage;
(f) Storage room for
housekeeping equipment (need not be provided if space is available in janitor's
closets or elsewhere);
(g) Toilet and
shower rooms (may be omitted in nursing homes of less than 100 beds);
(h) Incinerator
space. If the facility has an incinerator, it shall be in a separate room, in a
designated area within the boiler room, or outdoors;
(i) Refuse room for
holding trash prior to disposal located convenient to service entrance; and
(j) Yard equipment
storage room for yard maintenance equipment and supplies.
Section 12. Details
and Finishes. The facility shall be designed for maximum safety for the
occupants to minimize the incidence of accidents. Hazards such as sharp corners
shall be avoided. All details and finishes shall meet the following
requirements:
(1) Details.
(a) Doors to patient
toilet rooms and other rooms needing access for wheelchairs shall have a
minimum width of two (2) feet and ten (10) inches.
(b) Such items as
drinking fountains, telephone booths and vending machines shall be located so
that they do not project into the required width of exit corridors.
(c) Handrails shall
be provided on both sides of corridors used by patients in facilities with a
clear distance of one and one-half (1 1/2) inches between handrail and wall.
(d) All doors to
patient-room toilet rooms and patient-room bathrooms shall swing outward or shall
be equipped with hardware which will permit access in any emergency.
(e) All doors
opening onto corridors shall be swing-type except elevator doors. Alcoves and
similar spaces which generally do not require doors are excluded from this
requirement.
(f) Thresholds and
expansion joint covers, if used, shall be flush with the floor.
(g) Grab bars and
accessories in patient toilet, shower, and bathrooms shall have sufficient
strength and anchorage to sustain a load of 250 pounds for five (5) minutes.
(h) Lavatories
intended for use by patients shall be installed to permit wheelchairs to slide
under.
(i) The location and
arrangement of lavatories and sinks with blade handles intended for
hand-washing purposes shall provide sixteen (16) inches clearance each side of
center line of fixture.
(j) Mirrors shall be
arranged for convenient use by patients in wheelchairs as well as by patients
in standing position.
(k) Towel dispensers
shall be provided at all lavatories and sinks used for hand-washing.
(l) If linen and
refuse chutes are used, they shall be designed as follows:
1. Minimum diameter
of gravity-type chutes shall be two (2) feet;
2. Chutes shall
extend at least four (4) feet above the roof and shall be covered by a metal
skylight glazed with thin plain glass or plastic.
(m) Ceiling heights.
1. The boiler room
ceiling shall not be less than two (2) feet six (6) inches above the main
boiler header and connecting piping with nine (9) feet headroom under piping
for maintenance and access;
2. Corridors,
storage rooms, patients' toilet room, and other minor rooms shall not be less
than seven (7) feet and six (6) inches;
3. Ceilings in all
other rooms shall not be less than eight (8) feet.
(n) Boiler room,
food preparation centers, and laundries shall be insulated and ventilated to
prevent any floor surface above from exceeding a temperature of eighty-five
(85) degrees Fahrenheit.
(o) Noise reduction
criteria. Provision shall be made to minimize sound transmission in:
1. Corridors in
patient areas;
2. Nurses' stations;
3. Utility rooms;
4. Floor pantries;
and
5. Lobbies and
recreation areas.
(p) Special
attention shall be given to sound transmission from boiler rooms, mechanical
rooms, and kitchen, to patient bedroom areas.
(2) Finishes.
(a) Floors generally
shall be easily cleanable and shall have the wear resistance appropriate for
the location involved. Floors in kitchen and related spaces shall be waterproof
and grease-proof. In all areas where floors are subject to wetting, they shall
have a nonslip finish. Carpeting is not permitted in the following areas:
kitchen, dishwashing room, soiled utility room, janitor's closet, soiled linen
rooms, storage room, bathrooms, public toilet rooms, patient toilet rooms,
hydrotherapy rooms, treatment rooms, and any other room where the floor is
subject to repeated wetting or soiling.
(b) Adjacent
dissimilar floor materials shall be flush with each other to provide an
unbroken surface.
(c) Walls generally
shall be washable, and in the immediate area of plumbing fixtures, the finish
shall be moisture-proof. Wall bases in dietary areas shall be free of spaces
that can harbor insects.
(d) Ceilings
generally shall be washable or easily cleanable. This requirement does not
apply to boiler rooms, mechanical and building equipment rooms, shops and
similar spaces.
Section 13.
Elevators. All facilities where either patient beds or inpatient facilities
such as diagnostic, recreation, patient dining or therapy rooms are located on
other than the first floor, shall have electric or electrohydraulic elevators
as follows:
(1) Number of
elevators. All facilities with patient beds or residential facilities located
on any floor other than the first floor shall have at least one (1)
hospital-type elevator and such additional elevators as determined by the
licensure agency from a study of the facility plan and the estimated vertical
transportation requirements.
(2) Cars and
platforms. Elevator cars and platforms shall be constructed of noncombustible
material, except that fire-retardant-treated material may be used if all
exterior surfaces of the cars are covered with metal. Cars of hospital-type
elevators shall have inside dimensions that will accommodate a patient's bed
and attendants and shall be at least five (5) feet wide by seven (7) feet and
six (6) inches deep. Car doors shall have a clear opening of not less than
three (3) feet and eight (8) inches. Cars of all other required elevators shall
have a clear opening of not less than three (3) feet.
(3) Leveling. Elevators
shall have automatic leveling of the two (2) way automatic maintaining type
with accuracy within plus or minus one-half (1/2) inch.
Section 14.
Foundations. Foundations shall rest on natural solid ground if a satisfactory
soil is available at reasonable depths. Proper soil bearing values shall be
established in accordance with recognized standards. If solid ground is not
encountered at practical depths, the structure shall be supported on driven
piles or drilled piers designed to support the intended load without detrimental
settlement.
Section 15.
Mechanical Requirements. (1) General. Prior to completion of the contract and
final acceptance of the facility, the architect and/or engineer shall obtain
certification from the contractor that all mechanical systems have been tested
and that the installation and performance of these systems conform to the
requirements of the plans and specifications.
(2) Steam and hot
water systems.
(a) Boilers. If
boilers are used, a minimum of two (2) must be provided. The combined capacity
of the boilers, based upon the published Steel Boiler Institute of Boiler and
Radiator Manufacture's net rating, must be able to supply 150 percent of the
normal requirements of all systems and equipment.
(b) Covering. Boiler
and smoke breeching, all steam supply piping and high pressure steam return
piping, and hot water space heating supply and return piping shall be
insulated.
(3) Temperatures and
ventilating systems.
(a) Temperatures. A
minimum temperature of seventy-two (72) degrees Fahrenheit shall be provided
for in all occupied areas in winter conditions. A maximum temperature of
eighty-five (85) degrees Fahrenheit shall be provided for in occupied areas in
summer conditions.
(b) Ventilation
system details. All air-supply and air-exhaust systems shall be mechanically
operated. All fans serving exhaust systems shall be located at the discharge
end of the system. The ventilation rates shown in Section 17, Table 1 of this
administrative regulation, shall be considered as minimum acceptable rates and
shall not be construed as precluding the use of higher ventilation rates if
they are required to meet design conditions.
1. Outdoor
ventilation air-intakes, other than for individual room units, shall be located
as far away as practicable but not less than twenty-five (25) feet from the
exhausts from any ventilating system or combustion equipment. The bottom of
outdoor intakes serving central air systems shall be located as high as
possible but not less than eight (8) feet above the ground level or, if
installed through the roof, three (3) feet above roof level.
2. The ventilation
systems shall be designed and balanced to provide the general pressure
relationship to adjacent areas shown in Section 17, Table 1 of this
administrative regulation.
3. Room supply air
inlets, recirculation, and exhaust air outlets installed in nonsensitive areas
shall be located not less than three (3) inches above the floor.
4. Corridors shall
not be used to supply air to or exhaust air from any room, except that exhaust
air from corridors may be used to ventilate bathrooms, toilet rooms, or
janitor's closets opening directly into corridors.
5. Filters. Central
systems shall be provided with filters rated at eighty (80) percent efficiency
based upon the National Bureau of Standards Dust Spot Method with Atmospheric
Dust.
6. A manometer shall
be installed across each filter bed serving central air systems.
7. The air from
dining areas may be used to ventilate the food preparation areas only after it
has been passed through a filter with eighty (80) percent efficiency.
8. Boiler rooms
shall be provided with sufficient outdoor air to maintain combustion rates of
equipment and required temperatures in the facility.
(4) Plumbing and
other piping systems.
(a) Lavatories and
sinks required in patient care areas shall have the water supply spout mounted
so that its discharge point is a minimum distance of five (5) inches above the
rim of the fixture. All fixtures used by medical and nursing staff, and all lavatories
used by patients and food handlers shall be trimmed with valves which can be
operated without the use of hands. Where blade handles are used for this
purpose, they shall be at a distance from the center line of the sink to be
operational.
(b) Clinical sinks
shall have an integral trap in which the upper portion of a visible trap seal
provides a water surface.
(5) Water supply
system.
(a) Systems shall be
designed to supply water to the fixtures and equipment on the upper floors at a
minimum pressure of fifteen (15) pounds per square inch during maximum demand
periods.
(b) Each water
service main, branch main, riser and branch to a group of fixtures shall be
valved. Stop valves shall be provided at each fixture.
(c) Hot, cold and
chilled water piping and waste piping on which condensation may occur shall be
insulated. Insulation of cold and chilled water lines shall include an exterior
vapor barrier.
(d) Backflow
preventers (vacuum breakers) shall be installed on hose bibbs and on all
fixtures to which hoses or tubing can be attached such as janitor's sinks and
bedpan flushing attachments.
(e) Flush valves
installed on plumbing fixtures shall be of a quiet operating type, equipped
with silencers.
(f) Bedpan flushing
devices shall be provided.
(g) Hot water
distribution systems shall be arranged to provide hot water at each fixture at
all times.
(h) Plumbing
fixtures which require hot water and which are intended for patient use shall
be supplied with water which is controlled to provide a maximum water
temperature of 110 degrees Fahrenheit at the fixture.
(i) Piping over food
preparation centers, food serving facilities, food storage areas, and other
critical areas shall be kept to a minimum and shall not be exposed. Special
precautions shall be taken to protect these areas from possible leakage of, or
condensation from, necessary overhead piping systems.
(6) Hot water
heaters and tanks.
(a) The hot water
heating equipment shall have sufficient capacity to supply the water at the
temperature and amounts indicated below:
Use
Clinical
Dietary
Laundry
Gal/hr/bed
6
1/2
4
4
1/2
Temp. F.
100-110
180*
140-180**
*Temperature may be
reduced to 140 if chloritizer is used.
**If the temperature used
is below 180 the facility shall utilize detergents and other additives to
insure that the linens will be adequately cleaned.
(b) Storage tank(s)
shall be provided and shall be fabricated of corrosion-resistant metal, or have
noncorrosive lining.
(7) Plumbing
approval. Prior to final approval of the plans and specifications by the
licensure agency, the plumbing plans and specifications must be approved by the
Division of Plumbing, Department of Housing, Buildings and Construction.
Section 16.
Electrical Requirements. (1) Electrical requirements of the Kentucky Building
Code shall apply where applicable.
(2) The wiring in
each facility shall be inspected by a certified electrical inspector and a
certificate of approval shall be issued to the facility, prior to occupancy.
However, the wiring in existing buildings shall be approved by a certified
electrical inspector only when the building has not been previously so approved
for health care occupancy or where the State Fire Marshal finds that a
hazardous condition exists.
(3) Switchboard and
power panels. All breakers and switches shall be indexed.
(4) Lighting.
(a) All spaces
occupied by people, machinery, and equipment within buildings, and the
approaches thereto, and parking lots shall have electric lighting.
(b) Patients'
bedrooms shall have general lighting and night lighting. A reading light shall
be provided for each patient. A fixed receptacle type night light mounted
approximately sixteen (16) inches above the floor, shall be provided in each
patient room. Patients' reading lights and other fixed lights not switched at
the door shall have switch controls convenient for use at the luminaire. All
switches for control of light in patient areas shall be of the quiet operating
type.
(c) Lighting levels
for the facility shall comply with the requirements of Section 17, Table 2 of
this administrative regulation.
(5) Receptacles.
Convenience outlets.
(a) Bedroom. Each
patient bedroom shall have duplex receptacles on each side of the head of each
bed (for parallel adjacent beds, only one (1) receptacle is required between
the beds), receptacles for luminairies, television and motorized beds, if used,
and one (1) receptacle on another wall.
(b) Corridors.
Duplex receptacles for general use shall be installed approximately fifty (50)
feet apart in all corridors and within twenty-five (25) feet of ends of
corridors.
(6) Nurses' calling
system. A nurses' calling station shall be installed at each patient bed and in
each patient toilet, bath, and shower room. The nurses' call in toilet, bath,
or shower rooms shall be an emergency call. All calls shall register at the
nurses' station and shall actuate a visible signal in the corridor at the
patients' door, in the clean workroom, soiled workroom, and nourishment station
of the nursing unit. Nurses' call systems which provide two (2) way voice
communication shall be equipped with an indicating light at each calling
station which lights and remains lighted as long as the voice circuit is
operative.
(7) Emergency
electric service.
(a) General. To
provide electricity during an interruption of the normal electric supply that
could affect the nursing care, treatment, or safety of the occupants, an
emergency source of electricity shall be provided and connected to certain
circuits for lighting and power.
(b) Sources. The
source of this emergency electric service shall be as follows:
1. An emergency
generating set, when the normal service is supplied by one (1) or more central
station transmission lines;
2. An emergency
generating set or a central station transmission line, when the normal electric
supply is generated on the premises.
(c) Emergency
generating set.
1. The required
emergency generating set, including the prime mover and generator, shall be
located on the premises and shall be reserved exclusively for supplying the
emergency electric system. The emergency generator set shall be sufficient
kilowatt capacity to supply all electrical connections itemized in paragraph
(d) of this subsection.
2. In facilities
constructed prior to the effective date of this administrative regulation which
are supplied by at least two (2) dedicated and separate utility service
feeders, an emergency generating set is not required.
(d) Emergency
electrical connections. Emergency electric service shall be provided to
circuits as follows:
1. Lighting.
a. Exitways and all
necessary ways of approach thereto, including exit signs and exit direction
signs, exterior of exits, exit doorways, stairways, and corridors;
b. Dining and
recreation rooms;
c. Nursing station
and medication preparation area;
d. Generator set
location, switch-gear location, and boiler room;
e. Elevator; and
f. Night lights in
patient rooms.
2. Equipment.
Essential to life safety and for protection of important or vital materials:
a. Nurses' calling
system;
b. Alarm system
including fire alarm actuated at manual stations, water flow alarm devices of
sprinkler system if electrically operated, fire detecting and smoke detecting
systems, paging or speaker systems if intended for issuing instructions during
emergency conditions, and alarms required for nonflammable medical gas systems,
if installed;
c. Fire pump, if
installed;
d. Sewerage or sump
lift pump, if installed;
e. At least one (1)
duplex receptacle in each patient room;
f. One (1) elevator,
where elevators are used for vertical transportation of patients. Provide
manual switch-over to operate other elevators;
g. Equipment such as
burners and pumps necessary for operation of one (1) or more boilers and their
necessary auxiliaries and controls, required for heating and sterilization; and
h. Equipment
necessary for maintaining telephone service.
3. Heating. Where
electricity is the only source of power normally used for space heating, the
emergency service shall provide for heating of patient rooms. Emergency heating
of patient rooms will not be required in areas where the facility is supplied
by at least two (2) utility service feeders, each supplied by separate
generating sources or a network distribution system fed by two (2) or more
generators, with the facility feeders so routed, connected, and protected that
a fault any place between the generators and the facility will not likely cause
an interruption of more than one (1) of the facility service feeders.
(e) Details. The
emergency system shall be so controlled that after interruption of the normal
electric power supply, the generator is brought to full voltage and frequency
and connected within ten (10) seconds through one (1) or more primary automatic
transfer switches to all emergency lighting, all alarms, nurses' call,
equipment necessary for maintaining telephone service, and receptacles in
patient corridors. All other lighting and equipment required to be connected to
the emergency system shall either be connected through the above described
primary automatic transfer switching or shall be subsequently connected through
other automatic or manual transfer switching. Receptacles connected to the
emergency system shall be distinctively marked for identification. Storage
battery powered lights shall not be used as a substitute for the requirement of
a generator. Where fuel is normally stored on the site, the storage capacity
shall be sufficient for twenty-four (24) hour operation of required emergency
electric services. Where fuel is normally piped underground to the site from a
utility distribution system, storage facilities on the site will not be
required.
Section 17. Table 1
- Pressure Relationships and Ventilation of Certain Nursing Home Areas. Table 2
- Lighting Levels for Nursing Homes.
TABLE
1.
PRESSURE
RELATIONSHIPS AND VENTILATION OF CERTAIN NURSING HOME AREAS
Area
Designation
Pressure
Relationship
to
Adjacent Areas
All
Supply
Air
From
Outdoors
Minimum
Air
Changes
of
Outdoor
Air Per Hour
Minimum
Total Air Changes Per Hour
All
Air Exhausted Directly to Outdoors
Patient room
O
--
1
4
--
Patient room corridor
O
--
2
4
--
Treatment room
O
Yes
2
6
Yes
Physical and
hydrotherapy; if applicable
N
--
2
6
--
Dining and recreation
areas
O
--
2
4
--
Soiled workroom
N
--
2
4
Yes
Clean workroom
P
Yes
2
4
--
Toilet room
N
--
--
10
Yes
Bedpan room; if applicable
N
--
--
10
Yes
Bathroom
N
--
--
10
Yes
Janitor's closet
N
--
--
10
Yes
Linen and trash chute
rooms
N
--
--
10
Yes
Food preparation center
O
Yes
2
10
Yes
Dishwashing area
N
--
--
10
Yes
Dietary dry storage
O
--
--
2
Yes
Laundry, general
O
Yes
2
10
--
Soiled linen sorting and
storage
N
--
--
10
Yes
Clean linen storage
P
--
2
2
Yes
P = Positive N = Negative
O = Equal -- = Optional
TABLE
2.
LIGHTING
LEVELS FOR NURSING HOMES FACILITIES
Area
Foot-candles*
Administrative and lobby
areas, day
50
Administrative and lobby
areas, night
20
Barber and beautician
areas; if applicable
50
Corridors and interior
ramps
20
Corridor night lighting
3
Dining area and kitchen
30
Doorways
10
Exit stairways and
landings
5
Janitor's closet
15
Nurses' station,
general, day
50
Nurses' station,
general, night
20
Nurses' desk, for charts
and records
70
Nurses' medicine cabinet
100
Patient care unit (or
room), general
10
Patient care room,
reading
30
Recreation area (floor
level)
50
Stairways other than
exits
30
Toilet and bathing
facilities
30
Utility room, general
20
Utility room, work
counter
50
*Minimum on task at
anytime.
(8 Ky.R. 391; eff.
1-6-82; Am. 16 Ky.R. 972; eff. 1-12-90.)
