216-40-10 R.I. Code R. § 11.7

Current through June 12, 2024

Section 216-RICR-40-10-11.7 - Physical Plant

11.7.1New Construction, Addition or Modification

A. All new construction, alterations, extensions or modifications of an existing facility, as defined in rules and regulations pursuant to R.I. Gen. Laws Chapter 23-15, 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. Rhode Island Food Code (Part 50-10-1 of this Title);

4. Guidelines for Design and Construction of Hospital and Health Care Facilities incorporated above at § 11.2(A) of this Part;

5. R.I. Gen. Laws Chapter 23-28.1 (State Fire Code);

6. Rhode Island Department of Environmental Management Rules and Regulations Establishing Minimum Standards Relating to Location, Design, Construction and Maintenance of Individual Sewage Disposal Systems (Sewage regulations);

7. The American National Standard - Specifications for Making Buildings and Facilities Accessible to and Usable by, the Physically Handicapped incorporated above at § 11.2(E) of this Part;

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

9. The Americans with Disabilities Act incorporated above at § 11.2(F) of this Part.

B. 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.

C. All plans for new construction or the renovation, alteration, extension, modification, or conversion of an existing facility that may affect compliance with §§11.7.4, 11.7.6, 11.7.7, 11.7.8, 11.7.9, and 11.7.14 of this Part, and "Guidelines for Design and Construction of Hospital and Health Care Facilities" incorporated above at § 11.2(A) of this Part shall be reviewed by a Rhode Island licensed architect. Said architect shall certify that the plans conform to the construction requirements of §§11.7.4, 11.7.6, 11.7.7, 11.7.8, 11.7.9, and 11.7.14 of this Part, and "Guidelines for Design and Construction of Hospital and Health Care Facilities" incorporated above at § 11.2(A) of this Part, prior to construction. The facility shall maintain a copy of the plans reviewed and the architect's signed certification, for review by the Department upon request.

1. In the event of non-conformance for which the facility seeks a variance, the general procedures outlined in §11.8.1 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 details explaining the basis upon which the request is made. The Department may request additional information while evaluating variance requests.

2. If variances are granted, a licensed architect shall certify that the plans conform to all construction requirements of §§11.7.4, 11.7.6, 11.7.7, 11.7.8, 11.7.9, and 11.7.14 of this Part, and "Guidelines for Design and Construction of Hospital and Health Care Facilities" incorporated above at § 11.2(A) of this Part, except those for which variances were granted, prior to construction. The 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.

D. Upon completion of construction, the facility shall provide written notification to the Department describing the project, and a copy of the architect's certification. The 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.

11.7.2General Provisions - Physical Environment

A. Each facility shall be constructed, equipped, and maintained to protect the health and safety of patients, 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 patients shall have banisters, handrails, or other types of support. All stair treads shall be well maintained to prevent hazards.

C. All rooms utilized by patients 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 facility shall be accessible to and usable by patients/families and shall be maintained in an orderly and well-kept manner.

11.7.3Fire Safety

A. Each facility shall meet the provisions of R.I. Gen. Laws Chapter 23-28.1.

B. Each 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.

11.7.4Emergency Power

A. The facility shall provide an emergency source of electrical power necessary to protect the health and safety of patients in the event the normal electrical supply is interrupted.

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

a. Lighting all means of egress;

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

c. Life support systems, where applicable.

2. Where life support systems are used, emergency electrical service shall be provided by an emergency generator located on the premises.

11.7.5Facility Requirements for the Physically Handicapped

A. Each facility shall be accessible to, and functional for, patients, 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 "The Americans with Disabilities Act" incorporated above at § 11.2(F) of this Part.

B. Blind, non-ambulatory, or physically handicapped patients or patients with mobility disabilities that limit self-preservation capability shall not be housed above the street-level floor unless the facility is equipped with an elevator and meets other requirements of R.I. Gen. Laws Chapter 23-28.1. Further, the facility must meet one of the following as defined in the National Fire Protection Association Standards No. 220:

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

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

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

11.7.6Residential area

A. Each residential area, as defined in §11.3.24 of this Part, shall have at least the following:

1. Staff areas with adjacent hand-washing facility;

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

3. Appropriate clean and soiled utility space; and

4. A telephone with an outside line.

B. In addition, each residential area shall be equipped with a communication system which, at 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; and

3. Capable of alerting the responsible person or persons on duty twenty-four (24) hours a day, regardless of the location of the person on duty.

11.7.7Patient Rooms and Toilet Facilities

A. Patient rooms shall be designed with a personalized, homelike environment, and equipped for adequate nursing care, comfort, and privacy of patients with no more than one (1) bed per room.

B. Bedrooms shall be no less than one hundred (100) square feet in area and no less than eight (8) feet wide exclusive of toilet rooms, closets, lockers, wardrobes, alcoves or vestibules. In new construction, single bedrooms shall be constructed in accordance with the American Institute of Architects Academy of Architecture for Health guidelines of "Guidelines for Design and Construction of Hospital and Health Care Facilities" incorporated above at § 11.2(A) of this Part.

C. Each room shall have a window that can be easily opened. The windowsill shall not be higher than three feet (3'0") above the floor and shall be above grade level.

D. 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.

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

F. Lavatories and bathing areas to be used by the handicapped shall be equipped with grab-bars for the safety of the patients and shall meet the requirements of "Guidelines for Design and Construction of Hospital and Health Care Facilities" incorporated above at § 11.2(A) of this Part.

G. All facilities constructed after March 20, 1977 shall have at, a minimum, connecting toilet rooms between patients' rooms in accordance with the requirements of §11.7.1 of this Part. In addition, 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 patient rooms are located.

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

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

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

K. 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.

L. Complete privacy shall be provided to each patient 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.

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

M. Each patient shall be provided with a bed of proper size and height for the convenience and comfort of the patient, box spring and clean, comfortable mattress, bedside stand, straight-back chair, comfortable chair, dresser, and individual closet space for clothing with clothes racks and shelves accessible to patients in each room, and a reading lamp equipped with bulb of adequate candlepower.

1. Bedding including bedspread, shall be seasonally appropriate.

11.7.8Special Care Unit

A patient 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 §11.6.3 of this Part.

11.7.9Dining and Patient Activity Rooms

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

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 to prevent interference with each other.

11.7.10Plumbing

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.

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. The grease trap shall be cleaned sufficiently often to sustain efficient operation.

11.7.11Water 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 patient areas, hot water temperatures shall not be less than one hundred (100) degrees Fahrenheit nor exceed one hundred ten (110) degrees Fahrenheit (plus or minus two degrees). Thermometers (accuracy of which can be plus or minus two degrees) shall be provided in each residential area to check water temperature periodically on that unit and at each site where patients are immersed or showered.

2. Thermostatic or pressure balanced mixing valves are required at each site or fixture used for immersion or showering of patients. 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 supplies to patient care areas shall be regulated by anti-scalding, water tempering or mixing valves (approved by the Director or his/her designee) in order to maintain the temperature standards of §11.7.11(A)(1) of this Part.

11.7.12Waste Disposal Systems

Any new facility shall be connected to a public sanitary sewer, if available, or otherwise shall be subject to the requirements of Rhode Island Department of Environmental Management Rules Establishing Minimum Standards Relating to Location, Design, Construction and Maintenance of Onsite Wastewater Treatment Systems.

11.7.13Maintenance

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

11.7.14Other Provisions

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

1. Adequate and comfortable lighting levels in all areas in accordance with "Guidelines for Design and Construction of Hospital and Health Care Facilities" incorporated above at § 11.2(A) of this Part;

2. Limitation of sounds at comfort levels;

3. Comfortable temperature levels for the patients in all parts of patient occupied areas with a centralized heating system to maintain a minimum of seventy (70) degrees Fahrenheit 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: any hospice inpatient facility that does not provide air conditioning in every patient room shall provide an air-conditioned room or rooms in a residential section(s) of the facility to provide relief to patients when the outdoor temperature exceeds eighty (80) degrees Fahrenheit.

11.7.15Waste Disposal

A. Medical waste:

1. Medical waste as defined in the Rhode Island Department of Environmental Management Medical Waste Regulations, 250-RICR- 140-15-1, shall be managed in accordance with the provisions of the aforementioned regulations.

B. Other Waste:

1. Wastes which are not classified as infectious wastes, 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:

a. 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 in sanitary landfills approved by the Rhode Island Department of Environmental Management.

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

(1) High enough off the ground to facilitate the cleaning of the underneath areas of the stationary equipment; and

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

c. 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 pickups when required.

216 R.I. Code R. § 216-RICR-40-10-11.7

Amended effective 3/21/2023