No. 35467 (Amendment): Rule R432-12. Small Health Care Facility (Four to Sixteen Beds) Construction Rule

(Amendment)

DAR File No.: 35467
Filed: 11/18/2011 04:18:44 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

In Section R432-12-3, eliminate requirements of more acute care facilities. In Section R432-12-4, eliminates requirements that are duplicated from Rule R432-200, coordinates with the State Construction Code, State Fire Code, and the revised federal standards. In Section R432-12-7, coordinates with revised federal standards. In Section R432-12-14, coordinates with revised federal standards. In Section R432-12-23, clarification of how light levels are to be measured. Section 24: Coordinates with federal requirements and clarifies when facilities need emergency electrical generators. 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 R432-12-3, eliminates the reference to Section R432-4-23 which is requirements appropriate higher acuity care facilities. This will allow more residential character to small health care facilities. In Section R432-12-4, eliminates a portion of Table 1 which attempted to summarize the levels of care that are defined in another rule. Coordinates the fire sprinkler requirements of level IV facilities with the State Construction Code and changes the title of the federal accessibility standard to match the revised federal title. In Section R432-12-7, changes the title of the referenced federal accessibility standard to match the revised federal title. In Section R432-12-14, changes the title of the referenced federal accessibility standard to match the revised federal title. In Section R432-12-23, clarifies how light levels are to be measured and requires that corridor lighting be adjustable so that lighting may be reduced at night. In Section R432-12-24, clarifies when emergency electrical generators are required.

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 printing and distribution of the revised rule is covered in Rule R432-4, General Construction, which is being amended concurrent with this rule. No other costs are expected. (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 Health Care Facilities that construct new buildings or remodel existing buildings will no longer need to meet the requirements of Section R432-4-23 which contains requirements appropriate for higher acuity type patients. The residential character and details in lieu of institutional character is estimated to save approximately $1.50 per square foot. The typical 6,000 square foot small health care facility would save $9,000. There are currently 10 licensed small health care facilities in Utah. The bureau sees about one small health care project every other year for an annual aggregate savings of $4,500.

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

Some Small Health Care Facilities are owned by large corporations even though the facility itself is limited to a maximum of 16 residents by definition. Small Health Care Facilities that construct new buildings or remodel existing buildings will no longer need to meet the requirements of Section R432-4-23 which contains requirements appropriate for higher acuity type patients. The residential character and details in lieu of institutional character is estimated to save approximately $1.50 per square foot. The typical 6,000 square foot small health care facility would save $9,000. There are currently10 licensed small health care facilities in Utah and the bureau sees about one small health care project every other year for an annual aggregate savings of $4,500.

Compliance costs for affected persons:

Small Health Care Facilities that construct new buildings or remodel existing buildings will save approximately $1.50 per square foot. The typical 6,000 square foot small health care facility would save $9,000. Rule changes will not increase compliance costs to 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.

R432-12. Small Health Care Facility (Four to Sixteen Beds) Construction Rule.

R432-12-1. Legal Authority.

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

 

R432-12-2. Purpose.

This rule defines construction standards for small health care facilities which are categorized as Level I, Level II, Level III, or Level IV according to the resident's ability or capability to exit a building unassisted in an emergency.

 

R432-12-3. General Design Requirements.

Refer to R432-4-1 through R432-4-[23]22.

 

R432-12-4. General Construction Requirements.

(1) Table 1 identifies the levels of care and construction requirements which apply.

 

TABLE 1
[LEVELS OF CARE AND ]CONSTRUCTION REQUIREMENTS SUMMARY

               LEVEL I     LEVEL II     LEVEL III    LEVEL IV



No. residents  1[ plus]-16      4-16         4-16         [6]4-16



[Types of       SNF ICF     ICF/MR       ICF/MR       ICF/MR

Facilities     ICF/MR      Home for     Correction   Mental

               (17 plus)   Aging        Home         Health

               Mental      Social       Mental       Facility

               Health      Rehab.       Health       Home for

               Facility    Health       Facility     Aging

               (17 plus)   Care                      Social

                           Nursing                   Rehab.

                           Mental

                           Health

                           Facility



Staff          24          24           24           24

Availability   hours/      hours/       hours/       hours/

or Coverage    day         day          day          day



Licensed       16-24       0-16         0-16         0-16

Nursing

Hours



Type of

Service



medical

nursing        yes         yes          yes          yes



dietary        yes         yes          yes          yes



social svc     yes         yes          as required  as required



phy therapy    yes         as required  as required  as required



rec therapy    yes         as required  as required  as required



other therapy  yes         as required  as required  as required]



Resident       No, they    No, they     Yes, they    Yes, they

Capable        are non     are non      are          are

of Self        ambulatory  ambulatory   ambulatory   ambulatory

Preservation   non-mobile  non-mobile   mobile       mobile

Unassisted



Resident       restricted, restricted,  restricted,  not

Exit Ability   physical    physical     chemical     restricted

in an          or mental   or mental    or physical

Emergency      disability  disability   restraints

               and

               medical

               condition



Accessible     100%        10% or       10%          10%         

Rooms                      100% if

                           Physical

                           Rehab.

Construction

Requirements

code or        NFPA 101    NFPA 101     NFPA 101     Utah Fire

regulation                                           Prevention

                                                     Board

                                                     Rules

                                                     R710-3;

                                                     IBC

                                                     R-4 occupancy



fire rating    1 hour      1 hour       1 hour       No

of const                                             requirement



sprinkler      yes         yes          yes         [consider res.]Only if bldg.

                                                    [Mobility]larger than 4,500 SF



smoke          yes         yes          yes          yes

detector



manual         yes         yes          yes          yes

fire

alarm



above 3        yes         yes          yes          no

systems

interconnected



corridor        8 feet      6 feet       5 feet      As required

                                                     by IBC



resident       44 inch     44 inch      36 inch      36 inch

room door

width



nurse call     yes         yes          optional     yes

system

 

(2) General Requirements.

(a) Level I facilities shall meet the Nursing Facility Construction standards in R432-5.

(b) Level II and III facilities shall meet the construction and design requirements identified in this section, unless specifically exempted.

(c) Level IV facilities shall meet the Assisted Living Facility Type I Construction standards in R432-6.

(d) Level I, II, III and IV facilities shall comply with the Americans with Disabilities Act and Architectural Barriers Act Accessibility Guidelines (ADA/ABA-AG).

(e) Level I, II and III facilities shall conform to the life safety code requirements of NFPA 101, Chapter 18[ as specified in Sections 12.1.3], which is adopted and incorporated by reference.

(f) Level IV facilities shall conform to the fire safety provisions of R432-710-3.

 

R432-12-7. Toilet and Bathing Facilities.

Toilet rooms and bathrooms shall be mechanically exhausted, conveniently located, and accessible to, and usable by all persons accepted for care.

(1) There shall be one toilet and washbasin on each floor for each four occupants, including staff and live-in family. A facility licensed for eight beds or more shall have distinct and separate toilet and bathing facilities for live-in family and staff.

(2) There shall be at least one bathtub or shower for each six residents.

(a) In a multi-story building there shall be at least one bathtub or shower on each floor that has resident bedrooms.

(b) Each resident shall have access to at least one bathtub and one shower.

(c) There shall be at least one shower or bathtub which opens from a corridor designed for use by resident using a wheelchair with room for staff assistance that meets [ADAAG]ADA/ABA-AG standards.

(3) Each central shared bathroom shall have a toilet and washbasin.

(4) Toilet and bathing facilities may not open directly into food preparation areas.

(5) There shall be adequate provision for privacy and safety, including grab bars, in accordance with [ADAAG]ADA/ABA-AG, at each toilet, tub, and shower used by residents.

(6) All toilets, showers, and tub facilities shall have walls of impermeable, cleanable, and easily sanitized surfaces.

 

R432-12-14. Grab Bars and Handrails.

(1) Grab bars shall meet the requirements of [ADAAG]ADA/ABA-AG.

(2) In Level I and II facilities, there shall be handrails on both sides of all corridors normally used by residents. Handrail profiles shall be graspable in accordance with NFPA 101 Chapter 7, which is adopted and incorporated by reference and the Americans with Disabilities Act and Architectural Barriers Act Accessibility Guidelines.

(3) Ends shall be returned to the wall or otherwise arranged to minimize potential for injury.

 

R432-12-20. Ventilation.

(1) All rooms and areas in the facility shall have provision for positive ventilation.

(a) While natural window ventilation for nonsensitive areas and resident rooms may be utilized where weather permits, mechanical ventilation shall be provided for interior areas and during periods of temperature extremes.

(b) Fans serving exhaust systems shall be located at the discharge end and shall be conveniently accessible for service.

(2) Fresh air intakes shall be located as far as possible from exhaust outlets of ventilating systems, combustion equipment stacks, plumbing vents, or from areas which may collect vehicular exhaust or other noxious fumes.

(3) Furnace rooms shall be provided with sufficient outdoor air to maintain equipment combustion rates and to limit work station temperatures to an Effective Temperature of 90 degrees F (32.5 degrees C). When the ambient outside air temperature is higher than 90 degrees F, then the maximum temperature may be 97 degrees F (36 degrees C).

(4) Exhaust hoods in food-preparation centers shall comply with R392, the Utah Department of Health Food Service Sanitation Regulations. All hoods over cooking ranges shall be equipped with grease filters.

(5) Non-resident as well as resident areas where specific requirements are not given shall be ventilated in accordance with ASHRAE Standard 62-[1981]2004, "Ventilation for Acceptable Indoor Air Quality Including Requirements for Outside Air."

(6) Air from areas with odor problems, including toilet rooms, baths, soiled linen storage and housekeeping rooms, shall be exhausted to the outside and not recirculated.

(7) In Level II facilities, fans and dampers shall be interconnected so that activation of dampers will automatically shut down all but exhaust fans.

(8) Supply and return systems shall be in duct. Common returns using corridors or attic spaces as plenums are prohibited.

 

R432-12-23. Electrical Systems.

(1) All electrical materials shall be tested and approved by Underwriters Laboratory.

(2) The electrical installations, including alarm and nurse call system, if required, shall be tested to demonstrate that equipment installation and operation is as intended and appropriate. A written record of performance tests of special electrical systems and equipment shall show compliance with applicable codes.

(3) Switchboards and Power Panels.

(a) The main switchboard shall be located in an area separate from plumbing and mechanical equipment and be accessible only to authorized persons.

(b) The switchboards shall be convenient for use, readily accessible for maintenance, clear of traffic lanes, and located in a dry, ventilated space.

(c) Overload protection devices shall operate properly in the ambient room temperatures, except for existing Level IV facilities.

(d) Panelboards serving normal lighting and appliance circuits shall be located on the same floor as the circuits they serve.

(4) Lighting. All spaces within buildings that house people, machinery, equipment, or approaches to buildings shall have fixtures for lighting. (See Table 4.)

(a) Resident rooms shall have general and night lighting.

(i) A reading light shall be provided for each resident.

(ii) Flexible light arms, if used, shall be mechanically controlled to prevent the bulb from coming in contact with bed linen.

(iii) At least one night light fixture shall be controlled at the entrance to each resident room.

(iv) All controls for lighting in resident areas shall operate quietly.

(b) Parking lots shall have fixtures for lighting to provide light at levels recommended in the[ the] Illuminating Engineering Society of North America (IESN) Lighting for Parking Facilities (RP-20-1998 ).

(c) Lighting levels shown in Table 4 shall be used as minimum standards and do not preclude the use of higher levels that may be needed to insure the health and safety of the specific facility population served. Values in Table 4 are minimum maintained average illuminance measured at the task plane. Corridor lighting shall be adjustable so that light levels may be reduced at night and still provide a maximum brightness ratio of 1:10.

 

TABLE 4
SMALL HEALTH CARE FACILITIES LIGHTING STANDARDS

                                 MINIMUM FOOT-CANDLES



     Physical Plant Area         Level        Level IV

                                 I, II, III   Facilities

                                 Facilities

     Corridors

       Day                          20           15

       Night                        10           10

     Exits                          20           20

     Stairways                      20           20

     Nursing Station

       General                      30           30

       Charting                     75           75

       Med. Prep.                   75           75

     Pt./Res. Room

       General                      10           10

       Reading/Mattress Level       30           30

       Toilet area                  30           30

     Lounge

       General                      10           10

       Reading                      30           30

     Recreation                     30           30

     Dining                         30           30

     Laundry                        30           30



[     Based on lighting guidelines published in "Lighting for

Hospitals and Health Care Facilities", Illuminating Engineering

Society of North America, 1995 edition.]

 

(5) Each resident room shall have duplex grounding type receptacles as follows:

(a) one located on each side of the head of each bed;

(b) one for television, if used; and

(c) one on each other wall.

(6) Receptacles may be omitted from exterior walls where construction would make installation impractical.

(7) Duplex grounded receptacles for general use shall be installed in all corridors.

 

R432-12-24. Emergency Power System.

(1) Facilities that provide skilled nursing care or care for persons who require electrically operated life-support systems, [or when required by Table 1,]shall be equipped with an emergency power system.

(2) The following services shall be connected to the emergency generator :

(a) Life Safety Branch as defined in NFPA 70, section 517-32,

(b) critical branch as defined in NFPA 70, section 517-33 and

(c) Equipment systems defined [its]in NFPA 70, section 517-34 .[ of the National Electric Code NFPA 70, which is adopted and incorporated by reference.]

(3) Power need not be provided to all building heating and ventilation equipment if it is provided to a common area sufficient in size to accommodate temporary beds on a short-term emergency basis.

(4) Automatic transfer switches shall transfer essential electrical loading to the circuits described above within 10 seconds of any interruption of normal power.

(5) The emergency generator shall be fueled with a storable fuel source such as diesel fuel, gasoline, or propane. At least 48 hours of fuel shall be available.

(6) All other facilities shall make provision for essential emergency lighting and heating during an emergency to meet the needs of residents. All emergency heating devices shall be approved by the local Fire Marshal.

 

KEY: health care facilities

Date of Enactment or Last Substantive Amendment: [January 5, 2010]2012

Notice of Continuation: November 24, 2009

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

 

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