216 R.I. Code R. § 216-RICR-40-10-1.19 - Physical Plant

1.19.1 New Construction, Addition or Modification

A. All new construction, alterations, extensions or modifications of an existing nursing facility, as defined in the "Rules and Regulations for Determination of Need for New Health Care Equipment and New Institutional Health Services," shall be subject to the following provisions:

1. R.I. Gen. Laws Chapter 23-15 (Certificate of Need).

2. R.I. Gen. Laws Chapter 23-1 (Department of Health).

3. Part 50-10-1 of this Title, Rhode Island Food Code

4. FGI "Guidelines for Design and Construction of Residential Health, Care and Support Facilities, 2018 edition.

5. R.I. Gen. Laws Chapter 23-28.1 (Fire Safety Code - General Provisions)

6. 250-RICR-150-10-6, Rules Establishing Minimum Standards Relating to Location, Design, Construction and Maintenance of Onsite Wastewater Treatment Systems

7. ICC A117.1-2009

8. R.I. Gen. Laws Chapter 23-27.3 (State Building Code)

9. Americans with Disabilities Act

10. In addition, any other applicable State and local laws, codes and Regulations shall apply. Where there is a difference between codes, the code having the higher standard shall apply.

B. All plans for new construction or the renovation, alteration, extension, modification or conversion of an existing nursing facility that may affect compliance with §§ 1.19.4, 1.19.6, 1.19.7, 1.19.8, 1.19.9, and 1.19.15 of this Part, and "Guidelines for Design and Construction of Residential Health, Care and Support Facilities, 2018 edition, shall be reviewed by a Rhode Island licensed architect. Said architect shall certify that the plans conform to the construction requirements of §§ 1.19.4, 1.19.6, 1.19.7, 1.19.8, 1.19.9, and 1.19.15 of this Part, and "Guidelines for Design and Construction of Hospital and Health Care Facilities," 2010 Edition, prior to construction. The nursing facility shall maintain a copy of the plans reviewed and the architect's signed certification, for review by the licensing agency upon request.

1. In the event of non-conformance for which the nursing facility seeks a variance, the general procedures outlined in § 1.20.2 of this Part shall be followed. Variance requests shall include a written description of the entire project, details of the non-conformance for which the variance is sought and alternate provisions made, as well as detailing the basis upon which the request is made. The Department may request additional information while evaluating variance requests.

2. In the event where plans are designed to meet resident-directed operation models per §§ 1.40 and 1.41 of this Part, and are non-compliant to the required construction requirements, the nursing facility may request a variance and the Department shall consider such alternative models in evaluation of the request.

3. If variances are granted, a licensed architect shall certify that the plans conform to all construction requirements of §§ 1.19.4, 1.19.6, 1.19.7, 1.19.8, 1.19.9 and 1.19.15 of this Part, and "Guidelines for Design and Construction Residential Health, Care and Support Facilities," 2018edition, except those for which variances were granted, prior to construction. The nursing facility shall maintain a copy of the plans reviewed, the variance(s) granted and the architect's signed certification, for review by the Department upon request.

C. Upon completion of construction, the nursing facility shall provide written notification to the Department describing the project, and a copy of the architect's certification. The nursing facility shall obtain authorization from the Department prior to occupying/re-occupying the area. At the discretion of the Department, an on-site visit may be required.

1.19.2 General Provisions - Physical Environment

A. Each nursing facility shall be constructed, equipped and maintained to protect the health and safety of residents, personnel and the public. All equipment and furnishings shall be maintained in good condition, properly functioning and replaced when necessary.

B. All steps, stairs and corridors shall be suitably lighted, both day and night. Stairs used by residents shall have banisters, handrails or other types of support. All stair treads shall be well maintained to prevent hazards.

C. All rooms utilized by residents shall have proper ventilation and shall have outside openings with satisfactory screens. Shades or Venetian blinds and draperies shall be provided for each window.

D. Grounds surrounding the nursing facility shall be accessible to and usable by residents and shall be maintained in an orderly and well-kept manner.

1.19.3 Fire and Safety

A. Each nursing facility shall meet the provisions of R.I. Gen. Laws Chapter 23-28.1 (Fire Safety Code - General Provisions).

B. Each nursing facility shall establish a monitoring program for the internal enforcement of all applicable fire and safety laws and Regulations. Such a program shall include written procedures for the implementation of said Rules and Regulations and logs shall be maintained.

1.19.4 Emergency Power

A. An emergency electrical system shall be provided and installed in accordance with the applicable requirements as specified in the NFPA 99, 2012 Edition. The source of supply shall be an on-site fuel-fired generator.

1. Such emergency power system shall supply power adequate at least for:

a. Lighting all means of egress;

b. Equipment to maintain fire detection, alarm and extinguishing systems;

c. Life support systems, where applicable or of high probability of need to ensure an emergency response to health and safety; and

d. Continuation of normal health and safety operations of the nursing facility until normal operations resume or implementation of the 's EOP plan and safe evacuation of all residents.

2. The nursing facility is responsible for ensuring appropriate testing and preventive maintenance of the generator in accordance with the NFPA 99, 2012 Edition and NFPA 110, 2010 Edition, including:

a. Generator is maintained and serviced in accordance with its manufacturer's requirements;

b. Generator is inspected weekly and exercised (tested) under routine operational load for thirty (30) minutes each month.

c. In addition to its own internal resources, each nursing facility shall also have agreements with contracted service providers for emergency services, should the generator fail during testing or unscheduled use.

d. The nursing facility will maintain documentation of all testing and preventive maintenance of the generator system, and

e. The nursing facility will notify the licensing agency when the system is or is expected to be off-line for more than eight (8) hours for maintenance or when there is a significant failure of the equipment during testing or unscheduled use, or an inability of the equipment to provide for fifty (50) per cent of the operational load at any time of its operation.

B. A nursing facility without a generator upon promulgation of this Part must submit a written plan to the licensing agency within thirty (30) days detailing a time line to acquire, install, test, and place on-line a generator as required by § 1.19.4(A) of this Part no later than six (6) months after the effective date of this Part, or any extended time line acceptable to the Department.

1. Prior to the installation and availability of a generator as outlined in § 1.19.4(A) of this Part, the nursing facility shall provide an emergency source of electrical power necessary to protect the health and safety of residents in the event the normal electrical supply is interrupted.

C. In the event of a catastrophic failure or inability of a nursing facility's emergency electrical system to protect the health and safety of residents, the nursing facility may be subject to a civil money penalty of up to ten thousand dollars ($10,000.00) if the incident or injuries are determined to be resulting from the nursing facility's failure to routinely test and/or maintain the nursing facility's emergency electrical system.

1.19.5 Nursing Facility Requirements for the Physically Handicapped

A. Each nursing facility shall be accessible to, and functional for, residents, personnel and the public. All necessary accommodations shall be made to meet the needs of persons with mobility disabilities, or sight, hearing and coordination or perception disabilities in accordance with ICC A117.1-2009

B. Blind, non-ambulatory, physically handicapped or residents with mobility disabilities which limit self-preservation capability shall not be housed above the street level floor unless the nursing facility is equipped with an elevator and meets other requirements of ICC A117.1-2009. Further, the nursing facility must meet one (1) of the following as defined in NFPA Standard 220:

1. Is of fire resistive construction, one (1) hour protected non-combustible construction; or

2. Is fully sprinklered one (1) hour protected ordinary construction; or

3. Is fully sprinklered one (1) hour protected wood frame construction.

1.19.6 Residential Area

A. Each residential area, as defined this Part, shall have at least the following:

1. A nurses' area or office of sufficient space for the materials and work of nursing services, with adjacent hand washing facilities for all staff;

2. Storage and preparation area(s) for drugs and biologicals;

3. Storage rooms for walkers, wheelchairs and other equipment;

4. Appropriate clean and soiled utility space; and

5. A telephone or a cell phone with outside line.

B. In addition, each residential area shall be equipped with a communication system which, as a minimum, shall be:

1. Electrically activated;

2. Operated from the bedside of each occupant and from all areas used by occupants, including multipurpose rooms, toilet and bathing facilities;

3. Capable of alerting the responsible person or persons on duty twenty-four (24) hours a day, wherever their station may be; and

4. Capable of providing for calls both internal and external to the nursing facility.

1.19.7 Resident Rooms and Toilet Facilities

A. Resident rooms shall be designed and equipped for adequate nursing care, the individual resident's comfort and privacy with no more than two (2) beds per room, and amenable to resident-directed furnishings and personal property. At least five percent (5%) of the total beds (per unit or per nursing facility) shall be located in single-bed rooms, each with a private bathing facility and toilet.

1. Single bedrooms shall be no less than one hundred (100) square feet in area and no less than eight feet (8') wide exclusive of toilet rooms, closets, lockers, wardrobes, alcoves or vestibules. In new construction, single bedrooms shall be no less than one hundred and twenty (120) square feet in area.

2. Multi-bedrooms shall be no less than one hundred and sixty (160) square feet in area and no less than ten feet (10') wide, exclusive of toilet rooms, closets, lockers, wardrobes, alcoves or vestibules. In new construction, multi-bedrooms shall be no less than two hundred (200) square feet in area.

B. Each room shall have a window which can be easily opened. The window sill shall not be higher than three feet zero inches (3'0") above the floor and shall be above grade level.

C. The size of each window shall be no less than two feet six inches (2'6") wide by four feet five inches (4'5") high, double hung or an approved equivalent.

D. Each room shall have direct access to a corridor and outside exposure with the window at or above grade level.

E. Lavatories and bathing areas to be used by the handicapped shall be equipped with grab-bars for the safety of the residents and shall meet the requirements of "Guidelines for Design and Construction of Residential Health, Care and Support Facilities, 2018 edition.

F. All facilities constructed after March 20, 1977 shall have as a minimum, connecting toilet rooms between residents' rooms in accordance with the requirements of § 1.19.1 of this Part.

G. In all facilities constructed after August 1, 2001, patient toilet rooms shall be equipped with facilities for cleaning bedpans.

1. However, in facilities constructed prior to March 20, 1977, there shall be no less than one (1) toilet per eight (8) beds or fraction thereof on each floor where resident rooms are located.

H. Separate lavatory and toilet facilities shall be provided for employees and the general public commensurate with the needs of the facility.

I. A minimum of one (1) bathtub or shower shall be provided for every twelve (12) residents, not otherwise served by bathing facilities in resident rooms. At least one (1) bathtub shall be provided in each residential area.

J. Each bathtub or shower shall be in an individual room or enclosure which provides space for the private use of the bathing fixture, for drying and dressing and for a wheelchair and an attendant.

K. Complete privacy shall be provided to each resident in semi-private rooms by the use of overhead type fire resistive screens and/or cubicle fire resistive curtains suspended by inset overhead tracks in accordance with R.I. Gen. Laws Chapter 23-28.1 (Fire Safety Code - General Provisions).

L. When overhead type screens and/or cubicle curtains are not provided, each semi-private room shall be equipped with a fire resistive portable screen.

M. Each resident must be provided with a bed of proper size and height for the convenience of the resident, with a clean, comfortable mattress, bedside stand, comfortable chair, dresser and individual closet space for clothing with clothes racks and shelves accessible to residents in each room, and a reading lamp equipped with bulb of adequate candlepower.

N. Bedding including bedspread, shall be seasonally appropriate.

O. In all situations where physical configuration is not comfortable to adequate nursing care, comfort or privacy in the application of the above standards, the licensing agency shall be the ultimate authority in determining standards to be applied.

1.19.8 Special Care Unit

A. A resident room shall be designated for isolation purposes. Such room shall be properly identified with precautionary signs, shall have outside ventilation, private toilet and hand washing facilities, and shall conform to other requirements established for the control of infection in accordance with § 1.16.2 of this Part.

1.19.9 Dining amp; Resident Activities Rooms

A. The facility shall provide one or more clean, orderly, appropriately furnished and easily accessible room(s) of adequate size designed for resident dining and resident activities.

1. These areas shall be appropriately lighted and ventilated with non-smoking areas identified.

2. If a multipurpose room is used, there must be sufficient space to accommodate dining and resident activities and prevent interference with each other.

3. The total area set aside for these purposes shall be not less than thirty (30) square feet per bed for the first one hundred (100) beds and twenty-seven (27) square feet per bed for all beds in excess of one hundred (100).

4. Storage shall be provided for recreational equipment and supplies.

1.19.10 Plumbing

A. All plumbing shall be installed in such a manner as to prevent back siphonage or cross connections between potable and non-potable water supplies in accordance with R.I. Gen. Laws Chapter 23-27.3 (State Building Code).

B. Fixtures from which grease is discharged may be served by a line in which a grease trap is installed in accordance with standards of R.I. Gen. Laws Chapter 23-27.3 (State Building Code). The grease trap shall be cleaned sufficiently often to sustain efficient operation.

1.19.11 Waste Disposal

A. Medical Waste: Medical waste, as defined in 250-RICR-140-15-1, Medical Waste Regulations, shall be managed in accordance with the provisions of the aforementioned Regulations.

B. Other Waste: Wastes which are not classified as infectious waste, hazardous wastes or which are not otherwise regulated by law or Rule may be disposed in dumpsters or load packers provided the following precautions are maintained:

1. Dumpsters shall be tightly covered, leak proof, inaccessible to rodents and animals, and placed on concrete slabs preferably graded to a drain. Water supply shall be available within easy accessibility for washing down of the area. In addition, the pick-up schedule shall be maintained with more frequent pick-ups when required. The dumping site of waste materials must be at a waste disposal facility approved by the Rhode Island Department of Environmental Management or a waste disposal facility located outside Rhode Island which has been approved by the appropriate regulatory agency.

2. Load packers must conform to the same restrictions required for dumpsters and in addition, load packers shall be:

a. High enough off the ground to facilitate the cleaning of the underneath areas of the stationary equipment; and

b. The loading section shall be constructed and maintained to prevent rubbish from blowing from said area site.

3. Recyclable waste: Containers for recyclable waste, including paper and cardboard, shall be tightly covered, leak proof, inaccessible to rodents and animals, and placed on concrete slabs preferably graded to a drain. In addition, the pick-up schedule shall be maintained with more frequent pick-ups when required.

1.19.12 Water Supply

A. Water shall be distributed to conveniently located taps and fixtures throughout the building and shall be adequate in volume and pressure for all purposes including firefighting.

1. In resident areas, hot water temperatures shall not be less than one hundred degrees Fahrenheit (100 ºF) nor exceed one hundred and eighteen degrees Fahrenheit (118 ºF). Thermometers [accuracy of which can be plus or minus two degrees Fahrenheit (±2 ºF)] shall be provided in each residential area to check water temperature periodically on that unit and at each site where residents are immersed or showered.

2. Thermostatic or pressure balanced mixing valves are required at each site or fixture used for immersion or showering of residents. Thermometers and tactical (skin sense) method shall be used to verify the appropriateness of the water temperature prior to each use.

3. In addition to temperature regulating devices controlling the generation of domestic hot water, hot water supply(ies) to resident care areas shall be regulated by anti-scalding, water tempering or mixing valves (approved by the director or his or her designee) in order to maintain the temperature standards of § 1.19.12(A)(1) of this Part.

1.19.13 Waste Disposal Systems

A. Any new nursing facility shall be connected to a public sanitary sewer if available, or otherwise shall be subject to the requirements of 250-RICR-150-10-6, Rules Establishing Minimum Standards Relating to Location, Design, Construction and Maintenance of Onsite Wastewater Treatment Systems.

1.19.14 Maintenance

A. All essential mechanical, electrical and resident care equipment shall be maintained in safe operating condition and logs or records shall be maintained of periodic inspections.

1.19.15 Other Provisions

A. Nursing facilities shall make provisions to ensure that the following are maintained:

1. Lighting levels in all areas to ensure an adequate and comfortable work environment for both the employees and for residents in accordance with acceptable community standards for workplace safety and lighting standards for the elderly;

2. Limitation of sounds at comfort levels;

3. Comfortable temperature levels for the residents in all parts of resident occupied areas with a centralized heating system to maintain a minimum of seventy degrees Fahrenheit (70° F) during the coldest periods;

4. Adequate ventilation through windows or by mechanical means; and

5. Corridors equipped with firmly secured handrails on each side.

6. Heat relief: Pursuant to R.I. Gen. Laws § 23-17.5-27, any nursing facility which does not provide air conditioning in every patient room shall provide an air conditioned room or rooms in a residential section(s) of the nursing facility to provide relief to patients when the outdoor temperature exceeds eighty degrees Fahrenheit (80° F).

Notes

216 R.I. Code R. § 216-RICR-40-10-1.19

Amended effective 7/3/2022
Amended effective 8/25/2022
Amended effective 10/2/2023, exp. 1/30/2024(Emergency)
Amended effective 3/7/2024