No. 35460 (Amendment): Rule R432-5. Nursing Facility Construction

(Amendment)

DAR File No.: 35460
Filed: 11/18/2011 04:15:53 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

In Section R432-5-4, deletes a requirement that is moved to Section R432-5-7. In Section R432-5-5, coordinates with renumbering of another rule. Coordinate with updated federal requirements. In Section R432-5-6, referenced standard is two editions out of date and is out of print. In Section R432-5-7, clarifications and minor modifications to reflect current practices. In Section R432-5-12, coordinated with updated federal requirements, eliminates duplicate requirements, and miscellaneous changes requested by interested parties. In Section R432-5-14, eliminates requirements that are covered elsewhere. In Section R432-5-16, coordinates with reformatted edition of an updated referenced standard. These changes have been vetted in two meetings with providers and interested parties and have been approved by the Health Facilities Committee.

Summary of the rule or change:

In Section R432-5-4, this is a nonsubstantive change. It is relocation of a requirement within the rule to Section R432-5-7. In Section R432-5-5, coordinates with federal requirements by changing reference from the Americans with Disabilities Act Accessibility Guidelines (ADAAG) to the new federal standard titled Americans with Disabilities Act and Architectural Barriers Act Accessibility Guidelines (ADA/ABA-AG). In Section R432-5-6, updates the adopted reference from the 2001 Guidelines for Design and Construction of Hospital and HealthCare Facilities to the 2010 edition of the Guidelines for Design and Construction of Health Care Facilities. In Section R432-5-7, clarifies and makes revisions to requirements for windows, showers, door locks, and ventilation rates. In Section R432-5-12, changes reference from the Americans with Disabilities Act Accessibility Guidelines (ADAAG) to the new federal standard titled Americans with Disabilities Act and Architectural Barriers Act Accessibility Guidelines (ADA/ABA-AG). Adds requirements for handrail graspability and contrasting color. Removes acoustical requirements that are now covered in the adopted referenced standard. In Section R432-5-14, removes mechanical requirements that are covered elsewhere or no longer needed. In Section R432-5-16, coordinates with reformatted numbers in the new edition of the referenced standard.

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 21

This rule or change incorporates by reference the following material:

• Updates Guidelines for Design and Construction of Health Care Facilities, published by ASHE (American Society of Healthcare Engineering), 2010 edition

Anticipated cost or savings to:

the state budget:

The cost of purchasing the new referenced standard and the cost of printing and distribution of the revised rule is covered in Rule R432-4, General Construction, which is being amended concurrent with this rule. State expenses are expected to be completed within the usual course of business and existing budgets. The cost of the referenced standards is $168. (DAR NOTE: The proposed amendment to Rule R432-4 is under DAR No. 35459 in this issue, December 15, 2011, of the Bulletin.)

local governments:

The rule change has no impact on local government because these standards are enforced at the state level.

small businesses:

Small business nursing care providers that build new buildings or remodel existing facilities and the architects and engineers that design the buildings will have the cost of purchasing the new standards. The cost of the new standards is $168. Assuming 5 small businesses purchase copies of the updated standards the aggregate cost to small business is $840.

persons other than small businesses, businesses, or local governmental entities:

Nursing care providers that build new buildings or remodel existing facilities will have the cost of purchasing the new referenced standards. The cost of the new referenced standards is $168. Assuming 5 nursing care providers purchase copies of the updated standards the aggregate cost to business is $840.

Compliance costs for affected persons:

The cost to nursing facilities constructing or remodeling buildings and architects and engineers designing them for the purchase of the new referenced standards is $168. The rule change will not increase compliance costs for providers.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule has been extensively discussed with the regulated businesses and they appear to concur that updating the rule to adopt updated federal accessibility standards and the 2010 edition of the Guidelines for Design and Construction of Health Care Facilities is appropriate. Public comment received will be carefully evaluated for any unforeseen fiscal impact.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Family Health and Preparedness, Licensing
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Joel Hoffman at the above address, by phone at 801-538-6279, by FAX at 801-538-6024, or by Internet E-mail at [e-mail]
• Andrew Baxter at the above address, by phone at 801-538-6140, by FAX at 801-538-6325, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

01/17/2012

This rule may become effective on:

01/24/2012

Authorized by:

David Patton, Executive Director

RULE TEXT

R432. Health, Family Health and Preparedness, Licensing.

R432-5. Nursing Facility Construction.

R432-5-1. Legal Authority.

This rule is promulgated pursuant to Title 26, Chapter 21.

 

R432-5-2. Purpose.

The purpose of this rule is to promote the health and welfare through the establishment and enforcement of construction standards. The intent is to provide residential like environments and encourage social interaction of residents.

 

R432-5-3. Definitions.

(1) "Special Care Unit" means a physical area within a licensed facility designated for the housing and treatment of residents diagnosed with a specifically defined disease or medical condition.

(2) "Room or Office" when used in this rule describes a specific, separate, enclosed space for the service. When room or office is not used, multiple services may be accommodated in one enclosed space.

 

R432-5-4. Description of Service.

(1) A nursing unit shall consist of resident rooms, resident care spaces, and services spaces.

(2) Each nursing unit shall contain at least four resident beds.

(3) Rooms and spaces composing a nursing unit shall be contiguous.

(4) A nursing care facility operated in conjunction with a general hospital or other licensed health care facility shall comply with all provisions of this section. Dietary, storage, pharmacy, maintenance, laundry, housekeeping, medical records, and laboratory functions may be shared by two or more facilities.

(5) Special care units shall comply with all provisions of R432-5.

[ (6) Windows, in rooms intended for 24-hour occupancy, shall be operable.

]

R432-5-5. General Design Requirements.

R432-4-1 through R432-4-23, and R432-4-24[(3)](8) apply with the following modifications.

(1) Fixtures in all public and resident toilet and bathrooms shall comply with Americans with Disabilities Act and Architectural Barriers Act Accessibility Guidelines, [(ADAAG) 28 CFR 36, Appendix A, (July 1993)](ADA/ABA-AG). These rooms shall be wheelchair accessible with wheelchair turning space within the room.

(2) Lavatories, counters, and door clearances within resident rooms shall be wheelchair accessible.

 

R432-5-6. General Construction Requirements.

(1) Nursing facilities shall be constructed in accordance with the Guidelines for Design and Construction of [Hospital and] Health Care Facilities (Guidelines), [Section 8 and Appendix A, 2001]Sections 4.1 and 4.2, 2010 edition which is adopted and incorporated by reference.

(2) Where a modification is cited, the modification supersedes conflicting requirements of the Guidelines.

 

R432-5-7. Nursing Unit.

(1) When more than one nursing unit shares spaces and service areas, as permitted in this rule, the shared spaces and service areas shall be contiguous to each nursing unit served.

(2) Facility service areas shall be accessible from common areas without compromising resident privacy.

(3) Each nursing unit shall have a maximum number of 60 beds.

(4) At least two single-bed rooms, each with private toilet room containing a toilet, lavatory, and bathing facility shall be provided for each nursing unit.

(a) In addition to the lavatory in the toilet room, in new construction and remodeling, a lavatory or handwashing sink shall be provided in the resident room.

(b) Ventilation shall be [in accordance with Table 6]continuous with not less than two outside air changes per hour with all air exhausted to the outside.

(5) Each resident sleeping room shall have a window in accordance with R432-4-23(5). Windows in resident rooms intended for sleeping shall be operable.

(6) Each resident closet shall be a minimum of 22 inches deep by 36 inches wide with a shelf to store clothing and a clothes rod positioned to accommodate full length garments.

(7) A nurse call system is not required in facilities which care for persons with mental retardation or developmental disabilities. With prior approval of the Department, a nursing facility may modify the system to alleviate hazards to residents.

(8) Handwashing facilities shall be located near the nursing station and the drug distribution station.

(9) A staff toilet room may also serve as a public toilet room if it is located in the nursing unit.

(10) A clean workroom or clean holding room with a minimum area of 80 square feet shall provide for preparing resident care items.

(a) The clean work room shall contain a counter, handwashing facilities and storage facilities.

(b) The work counter and handwashing facilities may be omitted in rooms used only for storage and holding, as part of a larger system for distribution of clean and sterile supply materials.

(11) If a medical cart is used it shall be under visual control of staff.

(a) Double locked storage shall be provided for controlled drugs.

(b) Provisions shall be made for receiving, assembling, and storage of drugs and other pharmacy products.

(12) If a closed cart is used for clean linen storage, it shall be stored in a room with a self closing door. Storage in an alcove in a corridor is prohibited.

(13) Ice intended for human consumption shall be dispensed by self dispensing ice makers. Bin type storage units are prohibited.

[ (14) Gurney showers for residents may be provided at the option of the facility.

] [(a)](14) One bathtub and shower shall be provided on each nursing floor in addition to bath fixtures in resident toilet rooms.

[(b)](a) At least one shower on each floor shall be at least four feet square without curbs designed for use by a resident using a wheelchair. A gurney shower may be provided at the option of the facility and shall satisfy this requirement.

[(c)](b) Each resident bathtub and shower shall be in a separate room or enclosure large enough to ensure privacy and to allow staff to assist with bathing, drying, and dressing.

(15) At least one toilet room shall be provided on each floor containing a nursing unit to be used for resident toilet training.

(a) The room shall contain a toilet and lavatory with wheelchair turning space within the room.

[(b)](16) A toilet room with direct access from the bathing area shall be provided at each central bathing area if a toilet is not otherwise provided in the bathing area. The toilet training facility may serve this function if there is direct access from the bathing area.

[(c)](17) Doors to toilet rooms shall [have a minimum width of 34 inches to admit a wheelchair. The doors shall]be equipped with hospital privacy locks or other hardware that protects resident privacy and permit s access from the outside without the use of keys or tools in case of an emergency.

[(d)](18) A handwashing fixture shall be provided in each toilet room.

[(16)](19) An equipment storage room with a minimum area of 120 square feet for portable equipment shall be provided.

 

R432-5-8. Resident Support Areas.

(1) Occupational therapy service areas may be counted in the calculation of support space.

(2) Physical Therapy, personal care room, and public waiting lobbies shall not be included in the calculation of support space.

(3) There shall be resident living areas equipped with tables, reading lamps, and comfortable chairs designed to be usable by all residents.

(4) There shall be a general purpose room with a minimum area of 100 square feet equipped with a table and comfortable chairs.

(5) A minimum area of ten square feet per bed shall be provided for outdoor recreation. This space shall be provided in addition to the setbacks on street frontages required by local zoning ordinances.

(6) Examination and Treatment rooms.

(a) An examination and treatment room shall be provided except when all resident rooms are single bed rooms.

(b) An examination and treatment room may be shared by multiple nursing units.

(c) When provided, the room shall have a minimum floor area of 100 square feet, excluding space for vestibules, toilet, closets, and work counters, whether fixed or moveable.

(d) The room shall contain a lavatory equipped for handwashing, work counter, storage facilities, and a desk, counter, or shelf space for writing.

(7) In addition to facility general storage areas, at least five square feet per bed shall be provided for resident storage.

 

R432-5-9. Rehabilitation Therapy.

(1) A separate storage room for clean and soiled linen shall be provided contiguous to the rehabilitation therapy area.

(2) Storage for rehabilitation therapy supplies and equipment shall be provided.

 

R432-5-10. General Services.

(1) Linen services shall comply with R432-4-24[(3)](8).

(2) There shall be one housekeeping room for each nursing unit.

(3) Yard equipment and supply storage areas shall be located so that equipment may be moved directly to the exterior without passing through building rooms or corridors.

 

R432-5-11. Waste Storage and Disposal.

Facilities and equipment shall be provided for the sanitary storage and treatment or disposal of all categories of waste, including hazardous and infectious wastes if applicable, using techniques defined by the Utah Department of Environmental Quality, and the local health department having jurisdiction.

 

R432-5-12. Details and Finishes.

(1) Grab bars shall be installed in all toilet rooms in accordance with the [ADAAG]ADA/ABA-AG.

(2) Corridor and hallway handrails shall comply with [ADAAG]ADA/ABA-AG. The top of the rail shall be 34 inches above the floor, except for areas serving children and other special care areas. Corridor handrails shall have a graspable profile with finger wrap recesses not less than 5/8" deep. Handrails shall have color that contrasts to the wall.

(3) Cubicle curtains and draperies shall be affixed to permanently mounted tracks or rods. Portable curtains or visual barriers are not permitted.

(4) Signs shall be provided as follows:

(a) general and circulation direction signs in corridors;

(b) identification at each door; and

(c) emergency directional signs;

(d) all signs in corridors shall comply with [ADAAG]ADA/ABA-AG.

[ (5) Partitions, floor and ceiling construction in resident areas shall comply with the noise reduction criteria of Table 1 for sound control.

 

TABLE 1

Sound Transmission Limitations
in Long-Term Care Facilities

  
  
Airborne Sound Transmissions
  
Transmissions Class (STC) (a)

  Class (IIC) (b)                      Partitions      Floors
  
(Residents')
  
room to resident's room                   35           40
  
Public space to
  
(residents) room (b)                      40           40
  
Service areas to
  
(residents') room (c)                     45           45
  

  
  (a)  Sound transmissions (STC) shall be determined by tests
  
in accordance with Standard E90 and ASTM Standard E413.  Where
  
partitions do not extend to the structure above, the designer
  
shall consider sound transmissions through ceilings and
  
composite STC performance.
  
  (b)  Public space includes lobbies, dining rooms, recreation
  
rooms, treatment rooms, and similar space.
  
  (c)  Service areas include kitchens, elevators, elevator
  
machine rooms, laundry rooms, garages, maintenance rooms,
  
boilers and mechanical equipment rooms and similar spaces of
  
high noise.  Mechanical equipment located on the same floor or
  
above patient's rooms, offices, nurses' stations, and similarly
  
occupied space shall be effectively isolated from the floor.

]

R432-5-13. Elevators.

At least one elevator serving all levels shall accommodate a gurney with attendant and have minimum inside cab dimensions of 5'8" wide by 8'5" deep and a minimum clear door width of 3'8".

 

R432-5-14. Mechanical Standards.

(1) Mechanical tests shall be conducted prior to final Department construction inspection.

(2) Written test results shall be retained in facility maintenance files and available for Department review.

(3) Air Conditioning, Heating, and Ventilating Systems shall include:

(a) A heating system capable of maintaining a temperature of 80 degrees Fahrenheit in areas occupied by residents.

(b) A cooling system capable of maintaining a temperature of 72 degrees Fahrenheit in areas occupied by residents.

[ (c) Evaporative coolers may only be used in kitchen hood systems that provide 100% outside air.

(d) Isolation rooms may be ventilated by reheat induction units in which only the primary air supplied from a central system passes through the reheat unit. No air shall be recirculated into the building system.

(e) Supply and return systems must be within a duct. Common returns using corridor or attic spaces as return plenums are prohibited.

(f) Filtration shall be provided when mechanically circulated outside air is used.

(g) Hoods.

(i) All hoods over cooking ranges shall be equipped with grease filters, fire extinguishing systems, and heat activated fan controls.

(ii) Cleanout openings shall be provided every 20 feet in horizontal sections of duct systems serving the hoods.

(h) Gravity exhaust may be used, where conditions permit, for boiler rooms, central storage, and other nonresident areas.

] (4) Plumbing and other Piping Systems shall include:

(a) Handwashing facilities that are arranged to provide sufficient clearance for single lever operating handles.

[ (b) Dishwashers, disposal and appliances that are National Sanitation Foundation (NSF) approved and have the NSF seal affixed.

] [(c)](b) Kitchen grease traps that are located and arranged to permit access without the need to enter food preparation or storage areas.

[(d)](c) Hot water provided in patient tubs, showers, whirlpools, and handwashing facilities that is regulated by thermostatically controlled automatic mixing valves. These valves may be installed on the recirculating system or on individual inlets to appliances.

 

R432-5-15. Electric Standards.

(1) Operators shall maintain written certification to the Department verifying that systems and grounding comply with NFPA 99 and NFPA 70.

(2) Approaches to buildings and all spaces within buildings occupied by people, machinery, or equipment shall have fixtures for lighting in accordance with the requirements of the Illuminating Engineering Society of North America (IESNA). Parking lots shall have fixtures for lighting to provide light levels as recommended in IES Recommended Practice RP-20-1998, Lighting for parking facilities by the Illuminating Engineering Society of North America.

(3) Automatic emergency lighting shall be provided in accordance with NFPA 99 and NFPA 101.

(4) Each examination and work table shall have access to a minimum of two duplex outlets.

(5) Receptacles and receptacle cover plates on the emergency system shall be red.

(6) An on-site emergency generator shall be provided in all nursing care facilities except small ICF/MR health care facilities of 16 beds or less.

(a) In addition to requirements of NFPA 70, Section 517-40, the following equipment shall be connected to the critical branch of the essential electrical system.

(i) heating equipment necessary to provide heated space sufficient to house all residents under emergency conditions,

(ii) duplex convenience outlets in the emergency heated area at the ratio of one duplex outlet for each ten residents,

(iii) nurse call system,

(iv) one duplex receptacle in each resident bedroom.

(b) Fuel storage shall permit continuous operation of the services required to be connected to the emergency generator for 48 hours.

(c) Skilled nursing facilities that accept residents that are dependant on ventilators or other electrically operated life support equipment shall be equipped with Type I essential electrical systems that meet the requirements of NFPA 99 and NFPA 70, Section 517-30.

 

R432-5-16. Exclusions to the Guidelines.

The following sections of the Guidelines do not apply:

[ (1) Parking, Section 8.1.F.

(2) Program of Functions, Section 8.1.G.

(3) Clean workroom, Subsection 8.2.C.5.

] [(4)](1) Linen Services, section [8.11]4.2-5.2.

[(5)](2) Clusters , paragraph 4.2-2.2.1.3(2)(a), and [Staffing Considerations, section A8.2.A.]Household models, paragraph 4.2-2.1.3(2)(b). [The cluster]These design concept s [has]have proven beneficial in numerous cases, but [is]are optional. However, the Department encourages new construction projects to consider [this]these concept s.

 

R432-5-17. Penalties.

The Department may assess a civil money penalty of up to $10,000 and deny approval for patient utilization of new or remodeled areas if a health care provider does not submit architectural drawings to the Bureau of Licensing. The Department may assess a civil money penalty of up to $10,000 if the licensee fails to follow Department-approved architectural plans. The Department may assess a civil money penalty of up to $1,000 per day for each day a new or renovated area is occupied prior to licensing agency approval.

 

KEY: health care facilities

Date of Enactment or Last Substantive Amendment: [February 4, 2010]2012

Notice of Continuation: December 24, 2008

Authorizing, and Implemented or Interpreted Law: 26-21-5; 26-21-16

 

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