RELATES TO: KRS 216B.010-216B.130,
216B.990(1),
(2)
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
216B.042 and
216B.105
mandate that the Kentucky Cabinet for Human Resources regulates health
facilities and health services. This administrative regulation provides
licensure requirements for structural specifications for the construction,
alteration and maintenance of nursing facilities.
Section 1. Definitions.
(1) "Board" means the Commission for Health
Economics Control in Kentucky.
(2)
"License" means an authorization issued by the cabinet for the purpose of
operating a nursing facility.
(3)
"Licensure agency" means the Division for Licensing and Regulation in the
Office of the Inspector General, Cabinet for Human Resources.
Section 2. Applicability.
(1) Nursing homes, skilled or intermediate
care facilities that were found to be in compliance on their last annual
licensure survey will be considered to be in compliance with this licensure
administrative regulation, except for the requirements of Section 17(7)(d)3 of
this administrative regulation, or any alterations.
(2) Applications for certificate of need
submitted prior to December 1, 1990 may choose to build to either these
specifications or to the specifications in the licensure category requested on
their certificate of need application.
Section 3. Preparation and Approval of Plans
and Specifications for New Construction or Facility Alterations.
(1) Before construction is begun for the
erection of new buildings or alterations to existing buildings or any change in
existing nursing 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)
by forty-six (46) inches when trimmed.
(4) All such plans and specifications must be
approved by the licensure agency prior to commencement of construction of new
buildings or 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 4. 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 construction or
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)
(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-condition
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. Electric 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 5. Compliance
with Building Codes, Ordinances and Regulations.
(1) This section may 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
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;
(c) Requirements for air contaminants for
incinerators pursuant to 401 KRS 59:020 and
401 KAR
61:010;
(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 6. 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 licensure 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 7.
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 clean 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 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;
(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;
(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 one (1) nursing unit on same floor);
(i) Equipment storage room for storage of IV
stands, inhalators, air mattresses, walkers, and similar bulky equipment (may
serve more than one (1) nursing unit on same floor);
(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) freestanding 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 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. Separate
bedpan washing closets in each nursing unit which are located so that bedpans
need not be carried through lobbies, dining and recreation areas or day rooms
are recommended. It will be acceptable, however, to have bedpan washing
attachments for each patient room toilet.
(4) Patient's 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 8. 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 patient (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).
(4) If the
facility has more than 120 beds, it shall provide the following:
(a) Office space for a social
worker;
(b) Toilet room (not
required if other toilet facilities are convenient).
Section 9. 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 and a lavatory;
(4) Potwashing 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) Janitor's closet with storage for
housekeeping supplies and equipment, floor receptor or service sink;
and
(14) Toilet room which is
conveniently accessible to dietary staff with a two (2) door separation from
food preparation area or dining area.
Section 10. 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 11. 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 12. Storage and Service Areas.
(1) Central storage room(s) with at least ten
(10) square bed for first fifty (50) beds; and five (5) square feet per bed for
eleven (11) beds over fifty (50), to be concentrated in one (1) area.
(2) Adequate secure storage space must be
provided for staff and volunteer's personal belongings.
(3) Engineering service and equipment areas.
The following shall be provided:
(a) Boiler
room;
(b) Mechanical and electrical
equipment room(s) (can be combined with boiler room);
(c) Adequate storage for building maintenance
and engineering supplies;
(d)
Storage room for housekeeping equipment (need not be provided if space is
available in janitor's closets or elsewhere);
(e) 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;
(f) Yard
equipment storage room for yard maintenance equipment and supplies.
Section 13. 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 clean
distance of one-half (1/2) inch 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
handwashing.
(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
14. 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 15. 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 16. 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 Manufacturer'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-one (71) degrees Fahrenheit,
shall be provided for in all occupied areas in winter conditions. A maximum
temperature of eighty-one (81) 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.
a. Central systems that serve patient
care areas shall be provided with filters rated at eighty (80) percent
efficiency based upon the National Bureau of Standards Dust Spot Method with
Atmospheric Dust.
b. Central
systems that serve only areas other than patient care areas shall be provided
with filters rated at twenty-five (25) percent efficiency based upon the
National Bureau of Standards Dust Spot Method with Atmospheric Dust.
6. 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) Bedpan flushing devices shall be
provided.
(f) Hot water
distribution systems shall be arranged to provide hot water at each fixture at
all times.
(g) 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.
(h) 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) A
hot water system which supplies fixtures utilized by patients shall be equipped
with an antiscald mixing valve.
(c)
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 17. 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
luminaries 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 communications 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 located on the headwall 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. Emergency
heating.
a. By September 1, 1992 an emergency
heating system for the patient rooms, or the corridors of the facility designed
at 150 percent efficiency, shall be required; or
b. Emergency heating of patient rooms or
corridors shall 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; or
c. For a facility existing prior to
the effective date of this administrative regulation, an acceptable transfer
agreement with another facility which meets the requirements of clause a. or b.
of this sub-paragraph or is supplied by a separate generating source or network
distribution system which is so routed, connected, and protected that a fault
any place between the generator and the transferring facility would not affect
the receiving facility. This receiving facility shall be within a reasonable
distance and provide adequate space to assure an orderly transfer. The transfer
agreement shall specify how the resident will be cared for at the receiving
facility.
(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
18. Table 1 - Pressure Relationships and Ventilation of Certain
Nursing Facility Areas. Table 2 - Lighting Levels for Nursing Facilities.
TABLE 1 PRESSURE RELATIONSHIPS AND
VENTILATION OF CERTAIN NURSING FACILITY AREAS
|
Area Designation
|
Pressure Relationship to Adjacent Areas
|
Minimum Air Changes of Outdoor Air per Hour
|
Minimum Total Air Changes Per Hour
|
All Air Exhausted to Outdoors
|
Patient room
|
O
|
1
|
4
|
--
|
Patient room corridor
|
O
|
2
|
4
|
--
|
Treatment room
|
O
|
1
|
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
|
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
|
2
|
10
|
Yes
|
Dishwashing area
|
N
|
--
|
10
|
Yes
|
Dietary dry storage
|
O
|
--
|
2
|
--
|
Laundry, general
|
O
|
2
|
10
|
Yes
|
Soiled linen sorting and storage
|
N
|
--
|
10
|
Yes
|
Clean linen storage
|
P
|
2
|
2
|
--
|
P = Positive
N = Negative
O = Equal
-- = Optional
|
Table 2 Lighting Levels for Nursing
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.
|