Ala. Admin. Code r. 420-5-10-.18
Current through Register Vol. 43, No. 02, November 27, 2024
Section 420-5-10-.18 - Physical Plant(1) Location. (a) The nursing facility site shall provide space to accommodate staff and visitor parking, service access, emergency access, outdoor resident activity space and other areas required to provide for the care and proper operation of the facility.(b) The location and construction of all nursing facilities shall comply with local zoning, building, and fire ordinances. Evidence to this effect, signed by local fire, building, and zoning officials shall be furnished to the Alabama Department of Public Health.(c) Nursing facilities shall be located on streets or roads which are kept passable at all times. Facilities constructed after the effective date of these rules shall be located on paved roads.(2) Submission of Plans and Specifications. (a) When construction is contemplated, either for new buildings, conversions, additions, or alterations to existing buildings coming within the scope of these rules, plans and specifications shall be submitted for review and approval to the Alabama Department of Public Health, in accordance with Alabama Administrative Code Rule 420-5-22, "Submission of Plans and Specifications for Health Care Facilities."(b) Minor alterations and remodeling which do not affect the structural integrity of the building, which does not change functional operation, which does not affect fire safety, and which does not add beds over those for which the facility is licensed, need not be submitted for approval. Documentation shall be maintained for interior wall covering finishes.(c) The renovation area of an existing nursing facility shall comply with the current requirements for new construction to the extent possible.(3) Inspections. The Alabama Department of Public Health and its authorized representative shall have access to the site for inspection.(4) General Requirements - The provisions of this section shall apply to all nursing facilities. (a) Codes. 1. Nursing facilities in existence at the time of current code adoption shall comply with the code requirements for an existing building.2. New nursing facilities, additions or alterations shall comply with the currently adopted code requirement for a new building.(b) Renovations within an existing facility shall comply with the applicable codes and requirements for new work.(c) The building shall be structurally sound, free from leaks and excessive moisture, in good repair, and painted at sufficient intervals inside and out.(d) The interior and exterior of the building shall be kept clean and orderly.(e) Maintain an effective pest control program so that the facility is free of pests and rodents.(f) There shall be a minimum of twenty feet of clear space measured perpendicularly between a resident bedroom window and any structure outside the window. A peripheral view of the exterior shall be provided from newly constructed bedrooms.(g) All water is to be obtained from a public water supply. If it is impossible to connect to a public water system, the private water system shall be approved by the Alabama Department of Public Health or its appropriate designated agency. 1. Water under pressure of not less than 15 lbs. per square inch is piped within the building to all sinks, toilets, lavatories, tubs and other fixtures requiring water.2. An adequate supply of hot water for resident and service uses is available at all times. Temperature of hot water used by residents is automatically regulated by tempering valves and shall not exceed 110 degrees Fahrenheit.3. In the laundry, provision shall be made to increase the water temperature to 160 degrees Fahrenheit unless manufacturer documentation can be provided for the chemical being used at a lower temperature.4. There shall be procedures established to ensure that water can be provided for all essential services in the event of loss of the normal water supply.(h) All liquid and human waste, including floor wash water and liquid waste from refrigerators, is disposed of through trapped drains into a public sanitary sewer system in localities where such system is available. In localities where a public sanitary sewer system is not available, liquid and human waste shall be disposed of through trapped drains and in a manner approved by the Alabama Department of Public Health or its appropriate designated agency. 1. Plumbing is so sized, installed and maintained to carry adequate quantities of water to required locations throughout the facility, to prevent contamination of the water supply, and to properly convey sewage and liquid wastes from the establishment to the sewerage or sewage disposal system, in such a manner and so that it does not constitute a source of contamination or create an unsanitary condition or nuisance.2. Solid, non-infectious wastes are kept in leak proof, non-absorbent containers which shall be kept covered with tight fitting lids, and are disposed of in a manner approved by the Alabama Department of Public Health or its appropriate designated agency.3. Solid wastes which are potentially infectious shall be burned on the premises in an incinerator approved by the Alabama Department of Public Health or disposed of in a manner approved by the Alabama Department of Public Health or its appropriate designated agency.(i) Lighting shall meet the following requirements: 1. Lighting in nursing facilities shall meet the requirement as in the Illuminating Engineers Society (IES) Lighting Handbook Application volume.2. Night lights shall be provided in bedrooms, hallways, toilet rooms and bathrooms. Glowing toggle switches are acceptable in toilet rooms and bathrooms.(j) Screens shall be provided for all operable windows.(k) All floors shall be smooth and free from cracks and finished so that they can be easily cleaned.(l) Walls and ceilings shall be of sound construction and maintained in good repair.(m) Each room occupied by residents shall have a ceiling height of eight feet or more (does not include furred area).(n) Doors. 1. Hardware on all toilet and bathroom doors shall be operable from outside the room.2. Bedroom doors shall not be equipped with hardware that will permit a resident to lock himself within the room.3. Bedroom doors shall open into the bedroom.4. To avoid danger of a resident falling and blocking the swing of a door, all doors to residents' central baths and toilets shall swing out or be double-acting and equipped with an emergency stop release.(o) Panic hardware shall be installed on each required exit door, as well as doors to and from exit stairs.(p) All differences in floor levels within the building shall be accomplished by steps of not less than three, six-inch risers or ramps. Either shall be equipped with handrails on both sides. (See Ramps.)(q) The nursing facility shall be well ventilated at all times. 1. Resident bedrooms shall be ventilated in such a manner as to supply fresh air and to prevent accumulation of objectionable odors.2. All service areas shall be ventilated as permitted by codes.(r) All facilities shall have access to public fire hydrant protection, or the equivalent approved by the local fire department or State Fire Marshal.(s) Handrails shall be installed on both sides of all corridors normally used by residents except for areas between doors of 24 inches or less.(t) A corridor smoke detection system shall be provided and consist of listed devices connected to the facility's fire alarm system. When the nursing facility is not totally sprinkled, smoke detectors shall be installed in living/recreation rooms, barber/beauty shops, examination rooms and hazardous areas.(u) When heat detectors are installed in any area, they shall be listed self-restoring type, and electrically connected to the fire alarm system.(v) Nurse Call System. 1. Existing nursing facilities shall have an electrical nurse call system at the side of each bed which will provide an initial audible signal and a visual signal on an annunciator panel at the nurses' station until deactivated. (Nursing facilities licensed after the effective date of theses rules, both audible and visual signals must function until deactivated in the resident room.)2. Nursing facilities licensed after December 26, 1988, shall have an electrical nurse call station at each bed and a light over the door to the bedrooms on the corridor.3. An electrical nurse call system shall be provided in each resident toilet and bathroom and in additions to existing buildings and in remodeling after the effective date of these rules. This signal shall be distinct from the regular nurse call signal and turned off only at the emergency calling station.4. On new call systems, additional visible signals shall be installed at corridor intersections or in main corridor area where rooms are recessed if patient room call lights are not visible from the nurses' station area.(w) Trash chutes are prohibited in nursing facilities.(x) Elevators. 1. New facilities with residents on one or more floors above the first floor shall be equipped with at least one automatic elevator of a size sufficient to carry a resident on a stretcher.2. If an elevator is not installed in the existing nursing facility due to exits on each floor, each floor shall have a dining room, living room, and sunroom.3. Annual inspections shall be made of elevators by qualified inspection service personnel and inspection documents maintained in the facility.(y) Sufficient general storage space shall be provided for the storage of equipment, supplies, etc., to prevent the need for storage in hallways or other non-storage areas of the facility and be adequately ventilated.(z) Facilities for Physically Handicapped. 1. Necessary accommodations shall be made to meet the needs of persons with semi-ambulatory disabilities, sight and hearing disabilities, disabilities of coordination, as well as other disabilities in accordance with the American National Standard Institute (ANSI), A117.1 - 1992, American National Standard for Buildings and Facilities - Providing Accessibility and Usability for Physically Handicapped People.2. In nursing facilities existing prior to these rules, provisions shall be made to accommodate the handicapped.(aa) Ramps and inclines, where installed, shall not exceed a rise of one foot in twelve feet of run, shall be finished with a non-slip surface and provided with handrails on both sides.(bb) Open fire escapes are permitted in institutions licensed prior to October 9, 1957, provided such fire escapes meet the following requirements: 1. Must be of non-combustible material.2. Must have a railing or guard at least four feet high on each unenclosed side.3. Wall openings adjacent to fire escapes are protected with fire resistive doors and protected windows.4. Doors leading to fire escapes shall open in the direction of exit and be provided with panic hardware.(cc) Emergency Power. 1. Nursing facilities and additions to nursing facilities constructed after October 20, 1967, shall have an emergency generator.2. Nursing facilities and additions to nursing facilities constructed prior to October 20, 1967, may have an automatic battery-powered system which will provide the emergency power required for at least 1 1\2 hours. An emergency generator shall be provided if life support equipment systems are used.3. As a minimum, emergency power shall be provided to the following: (i) Corridor Illumination.(ii) Exit and Directional Signs.(iii) Stair Illumination.(iv) Nurse's Station Illumination.(v) Medicine Preparation Rooms/Medicine Cart Storage Room.(vi) Recreational Areas such as living rooms, dining rooms, day rooms, and chapels - in facilities built and renovated after December 28, 1988.(vii) Electrical Equipment Room, Generator Room and Boiler Room - in facilities built and renovated after December 28, 1988. Electricity may be switch controlled in these rooms.(viii) An Exterior Light at Each Exit.(ix) Fire/Smoke Alarm System.(x) Sprinkler pump system, if provided, and sprinkler riser room lighting.(xi) Telephone and paging system.(xii) Nurse call system and(xiii) Refrigerator for storage of drugs, if provided.(dd) Mechanical, electrical, plumbing, heating, air conditioning, and water systems shall be installed to meet the requirements of local codes and ordinances and the applicable regulations of the State Board of Health at the time of construction.(ee) All essential mechanical, electrical and resident care equipment shall be maintained in safe operating condition. The facility shall establish a written preventive maintenance program to ensure that all equipment is operative.(ff) The use of portable heaters of any kind is prohibited except during emergency situations caused by severe weather that disables the normal heating system.(gg) When life support systems are used, emergency electrical service shall comply with NFPA 99 and shall be provided by an emergency electrical generator located on the premises.(hh) Fire alarm systems shall be tested monthly by an alarm initiating device to verify proper functioning of the alarm system. Documentation of the testing shall be maintained, noting the proper functioning of notification devices, releasing of door holders and locks, operation of smoke dampers, and air handling unit shutdown.(5) New Construction Requirements. (a) The provisions of this section, in addition to the provisions of Chapter 420-5-10-.18(4), (6) & (7), shall apply to all new nursing facilities or additions or renovations to nursing facilities initially licensed after the effective date of these rules or to any existing nursing facility which meets or can readily be improved to meet these requirements.(b) Facilities initially licensed, as well as additions or alterations to existing facilities, constructed after the effective date of these rules shall be classified as Health Care Occupancy, and shall comply, at the time of plan approval, with codes and standards adopted by the State Board of Health. See Alabama Administrative Code, Rule 420-5-22, for listing of adopted codes and standards.(c) Doors. 1. All doors in line of exit travel shall be hinged and shall swing in the line of travel.2. All exit doors serving residents including doors to stairs shall be as a minimum 44 inches wide.3. Doors to toilets used by residents in additions or new facilities shall be at least 34 inches wide.4. Where rated doors are required by code, a permanent label from an independent testing laboratory shall be attached to the door.(d) Corridors in resident areas shall be at least eight feet wide, except as permitted by code.(e) Exit passageways other than corridors in resident areas shall not be less than four feet wide.(f) Corridors and passageways shall be unobstructed and shall not lead through any room or space used for a purpose that may obstruct free passage.(g) Handrails shall be installed on both sides of all corridors normally used by residents except between doors in spaces 24 inches or less. 1. The handrails shall have a circular grip, a clearance of 1 1\2 inch from the wall and be mounted 30-34 inches from the floor to the top of the rail.2. Handrails shall return to the wall at all terminations.3. Handrails may be omitted where service corridors are not part of a required exit from resident areas, the corridor is not a path of circulation from one resident area to another and cross corridor doors are installed. These doors shall separate resident corridors from service corridors and shall normally remain closed.(h) Each tub or shower shall be in an individual room or enclosure with space for the private use of the bathing fixture, for drying and dressing. A separate toilet shall be available for each central bathing area without requiring entry into the general corridor.(i) If a facility chooses to admit or retain residents requiring life support equipment, essential electrical distribution systems shall conform to a Type II System as required in NFPA 99. As a minimum, life support systems shall be provided in 10% of the bedrooms and receptacles every 50 feet on alternating walls in the corridor.(6) Rooms, Spaces and Equipment - New and Existing Facilities. (a) Nursing Unit. A nursing unit consists of the number of beds served from one nurses' station and includes all of the necessary support areas required to provide care to the residents. 1. Each nursing unit shall have: (iii) Medicine preparation room.(iv) Soiled utility room or soiled holding room.(v) Clean linen storage room.(vi) Wheelchair and stretcher storage areas.(vii) Janitor's closet with mop sink or floor receptor and storage shelving.2. On a nursing unit, no residents' bedroom door shall be more than 150 feet from the nurses' station.(b) Bedrooms. 1. All bedrooms shall have window(s) with the windowsills not more than three feet above the floor. Windows shall not be below grade.2. The window area shall not be less than one-tenth of the floor area.3. Residents' bedrooms shall be located so as to minimize the entrance of odors, noise and other nuisances.4. Residents' bedrooms shall be directly accessible from the main corridor of the nursing unit. Existing resident bedrooms may be accessible from any public space other than the dining room. In no case shall a resident's bedroom be used for access to another resident's room.5. The capacity of any new room shall not exceed two residents, and the capacity of existing rooms shall not exceed four residents.6. The minimum floor area of bedrooms, exclusive of toilets, closets, wardrobes, alcoves, or vestibules in facilities and additions to existing facilities constructed after October 20, 1967, shall be as follows: Private Room 100 Square Feet
Multi-Resident Room 80 Square Feet Per Resident
7. There shall be sufficient space to permit nursing procedures to be performed and to permit the placing of beds at least three feet apart, and three feet from the wall at the foot of the bed. Sides of beds shall maintain a minimum clearance of 12 inches from electrical outlets in walls, unless electrical outlet and plug protection is maintained.(c) Provisions for privacy. Each multi-resident room shall have permanently installed cubicle curtain tracks to permit enclosing each bed with curtains to allow for the privacy of each resident without obstructing the passage of other residents either to the corridor, closet, or to the toilet/lavatory adjacent to the resident room.(d) Accommodations for Residents. The minimum accommodations for residents shall include the following: 1. Residents shall be provided with a standard or adjustable bed.2. Chair and bedside table.3. Storage space for clothing, toilet articles and personal belongings.4. Bedside electrical call system for summoning aid.5. Waste paper receptacle.6. A headwall bed light must be mounted so that it is operable by the resident from the bed.7. Nursing facilities or additions to nursing facilities constructed after November 16, 1988, shall provide hand washing lavatory in each bedroom. It may be omitted from bedroom when a lavatory is provided in an adjoining toilet or bathroom.(e) Isolation Room. 1. Isolation rooms shall be provided at the rate of not less than one private bedroom per 50 beds or major fraction thereof for the isolation of residents suffering from infectious diseases as defined by the Centers for Disease Control (CDC). The bedroom shall meet all of the requirements for bedrooms as previously stated in these regulations. Isolation bedrooms may be used to provide for the special care of residents who develop acute illnesses, have personality problems, or residents in terminal phases of illness. If central heating/cooling is provided, the air from the room shall be exhausted directly to the outside.2. Isolation rooms in nursing facilities shall have a lavatory within the room or within a private toilet.(f) Nurses' Station. The nurses' station for each nursing unit shall include as a minimum the following: 1. Annunciator board for receiving residents' calls.3. Storage space for current residents' charts.4. Working space and accommodations for recording and charting purposes by facility staff.5. Medicine preparation room. The room at each nurses' station shall have, as a minimum, 80 square feet of floor space with an additional square foot for each bed in excess of 50 beds per unit. This requirement pertains to any construction or renovation after November 16, 1988. If medication carts are utilized, sufficient storage space for the carts and over-the-counter stock medications must be provided in lieu of a medication preparation room.(g) Utility Rooms. In new nursing facilities and in additions to existing nursing facilities after December 26, 1988, a separate clean and soiled utility room shall be provided for each nursing unit. 1. The clean utility room shall contain as a minimum: (i) Wall and base cabinets.(iv) Paper towel dispenser.2. The soiled utility room shall contain as a minimum: (i) Paper towel and soap dispensers.(iii) Cabinets for storage of poisonous substances; i.e., cleaning supplies, urine test products, etc.(v) Large single compartment counter or freestanding service sink for chemical sterilization of bedpans, urinals and commode pails.(vi) Wall mounted or counter top hand washing lavatory, separate from the service sink.(vii) Soiled linen hamper(s).(viii) Clinical sink or equivalent flushing-rim fixture unless toilet with bedpan lug and bedpan washer are provided in adjoining toilets to all bedrooms in the nursing unit.3. In nursing facilities constructed prior to December 26, 1988, each nursing unit shall have at least a clean/soiled utility room, but it is recommended that a separate clean and soiled utility room be provided.(h) Toilet and Bathing Facilities. 1. For all resident bedrooms, which do not have adjoining toilet and bath facilities, plumbing fixtures shall be provided within the nursing unit, according to the following ratio: Bathtubs or Showers 1 per 25 Beds
Lavatories 1 per 6 Beds
Toilets (water closets) 1 per 6 Beds
2. Non-skid mats, or equivalent and grab bars shall be provided at tubs and showers. Grab handles on soap dishes are not acceptable for grab bars.3. Grab bars shall be provided at each water closet.(i) Nourishment Room. 1. Nursing units in facilities and additions to facilities constructed after August 23, 1996, shall have a nourishment room containing a work counter, refrigerator, storage cabinet, and a sink for serving nourishments between meals. Ice for residents' consumption shall be provided by icemaker units. The nourishment room shall include space for trays and dishes used in non-scheduled meal service.2. Existing facilities shall provide a nourishment room in accordance with the above paragraph when the nursing unit is remodeled or expanded.3. Nourishment room shall be separated from corridor by wall and door.(j) Dining/Recreation/Sitting. In new nursing facilities or additions to nursing facilities, there shall be resident dining, and recreation/sitting areas in accordance with the following: 1. The total area set aside for these purposes shall be at least 20 square feet per bed for new facilities and for expanded facilities. (i) Dining Room. The dining room shall be capable of seating 50% of the bed capacity.(ii) Recreation/sitting area. These areas shall not include exterior porches and lobby/waiting room.2. As a minimum, facility shall include two separate recreation/sitting areas and a dining area.3. Each nursing unit shall contain at least one recreation/sitting area.4. A minimum of at least one porch and/or glass enclosed sun parlor shall be provided for the use of residents.(k) Physical Therapy. Physical therapy areas, if provided, shall be in a specifically designated area and shall include equipment and areas as needed to meet specific resident requirements and shall also include storage space for linens, supplies, and equipment, a counter top or wall hung handwash lavatory and a service sink in a counter or freestanding.(l) Laundry. 1. The existing laundry room, or storage and counting area shall be located so that soiled linens are not carried through the food service area.2. Laundries built, renovated, or added to after August 23, 1996, shall provide the following rooms and shall comply with the additional requirements: (i) Adequate holding, and sorting room for control and distribution of soiled linen. Discharge from soiled linen chutes may be received within this room or in a separate room (soiled linen room).(ii) The laundry shall be vented so that odors do not enter the nursing facility. Air shall not be recirculated into a heating or cooling system serving other areas of the nursing facility.(iii) Corridors shall not be used to store or hold soiled linen or clean linen carts at any time of the day. Adequate space shall be provided in the soiled linen room and laundry processing room to prevent this.(m) Beauty/Barber Shop. Nursing facilities or additions to nursing facilities licensed after November 16, 1988, shall have space and equipment for resident hair care and grooming. The room shall open to a corridor.(n) Administration. The administrative department and services shall be located in a specifically designated area and shall include the following: 1. Administrator's office.3. Public lobby or waiting room.5. For facilities constructed after August 23, 1996, or when existing lobbies are renovated, handicapped public toilets accessible from the lobby/waiting room shall be provided.(o) Support Offices. Nursing facilities or additions to nursing facilities constructed after August 23, 1996, shall provide office space for all support staff.(p) Nursing facilities and additions to nursing facilities constructed after August 23, 1996, shall provide adequate closet or locker storage space for staff's work related personal items.(q) Maintenance. Each facility shall provide facilities/room(s) to accommodate routine maintenance appropriate to the needs.(7) Dietary (applies to all facilities). (a) Food service facilities shall be located in a designated area and shall include the following rooms and spaces: food production, food service, food storage, dishwashing, dining room, dietary manager's office, water heating equipment, and janitor closet (mops, brooms, mop sink) in all facilities built after August 23, 1996.(b) The dietetic service area shall be of such size and dimensions as to permit orderly and sanitary handling and processing of food. Avoid overcrowding and congestion of operations.(c) Hand washing facilities. Hand washing facilities shall be provided in all food production and serving areas. Sinks shall be equipped with a soap dispenser and adequate supply of soap, disposable towels, and hot and cold running water. The use of a common towel is prohibited. Hands must not be washed in sinks where food is prepared.(d) Refrigeration. Where separate refrigeration can be provided, temperatures for storing perishable foods are: 32 to 38 degrees Fahrenheit for meats, 40 degrees Fahrenheit for dairy products, 45 to 50 degrees Fahrenheit for fruits and vegetables. If it is impractical to provide separate refrigeration, the temperature shall be maintained at 38 to 40 degrees Fahrenheit at all times. Frozen food shall be maintained at 0 degrees Fahrenheit or below.(e) Dish and Utensils Washing, Disinfection and Storage. Facilities shall comply with current requirements of the Rules of Alabama State Board of Health for Food Establishment Sanitation, Alabama Administrative Code Chapter 420-3-22-.15 "Equipment and Utensil Cleaning and Sanitation," and Chapter 420-3-22-.16, "Equipment and Utensil Storage."(8) Sprinkler Systems. Provisions of AAC Chapter 420-5-10-.18 notwithstanding: (a) By January 1, 2006, all totally unsprinklered nursing facilities, and nursing facilities in multi-story buildings with sections of a nursing facility unsprinklered, shall be protected throughout by a fire sprinkler system. By July 1, 2005, completed sprinkler plans for these systems shall be submitted to Public Health for review and approval. Where means of egress passes through building areas outside of a nursing facility, those areas shall be separated from the nursing facility by a 2-hour rated wall or shall be protected by a fire sprinkler system.(b) By September 1, 2006, all nursing facilities in one-story buildings with unsprinklered building areas shall be protected throughout by a fire sprinkler system. By March 1, 2006, completed sprinkler plans for these systems shall be submitted to Public Health for review and approval. Where means of egress passes through building areas outside of a nursing facility, those areas shall be separated from the nursing facility by a 2-hour rated wall or shall be protected by a fire sprinkler system.(c) By February 1, 2007, all remaining nursing facilities (those having isolated unsprinklered rooms) shall be protected throughout by a fire sprinkler system. By August 1, 2006, completed sprinkler plans for these systems shall be submitted to Public Health for review and approval. Where means of egress passes through building areas outside of a nursing facility, those areas shall be separated from the nursing facility by a 2-hour rated wall or shall be protected by a fire sprinkler system. Author: Victor Hunt
Ala. Admin. Code r. 420-5-10-.18
Repealed and Replaced: Filed July 19, 1996; effective August 23, 1996. Amended: Filed November 18, 1999; effective December 23, 1999. Amended: Filed June 18, 2002; effective July 23, 2002. Amended: Filed September 18, 2003; effective October 23, 2003. Amended: Filed June 23, 2004; effective July 28, 2004. History: Chapter 420-5-10 "Nursing Homes" (Rules 420-5-10-.01 through 420-5-10-.11 filed September 1, 1982. Rule 420-05-10-.05. Amended: Filed November 19, 1987. Rule 420-5-10-.07. Amended: Filed November 19, 1987. Entire Chapter repealed and new chapter adopted in lieu thereof: Filed November 21, 1988. Entire Chapter repealed and new chapter adopted in lieu thereof: Filed July 19, 1996.
Statutory Authority:Code of Ala. 1975, §§ 22-21-20, etseq.