902 KAR 20:046. Facility specifications; nursing homes

Link to law: http://www.lrc.ky.gov/kar/902/020/046.htm
Published: 2015

      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.)
Read Entire Law on www.lrc.ky.gov