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State Regulations Pertaining to Physical Environment

Note: This document is arranged alphabetically by State. To move easily from State to State, click the “Bookmark” tab on the Acrobat navigation column to the left of the PDF document. This will open a Table of Contents for the document. The relevant federal regulations are at the end of the PDF.

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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. 一 Nursing facilities in existence at the time of current code adoption shall comply with the code requirements for an existing building. 一 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.

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(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. 一 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. 一 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. 一 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. 一 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. 一 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. 一 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. 一 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. 一 Hardware on all toilet and bathroom doors shall be operable from outside the room. 一 Bedroom doors shall not be equipped with hardware that will permit a resident to lock himself within the room. 一 Bedroom doors shall open into the bedroom. 一 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.

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(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. 一 Resident bedrooms shall be ventilated in such a manner as to supply fresh air and to prevent accumulation of objectionable odors. 一 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 effecitve 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. 一 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. 一 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. 一 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. 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. In nursing facilities existing prior to these rules, provisions shall be made to accommodate the handicapped.

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(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 1½ 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

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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. 一 All doors in line of exit travel shall be hinged and shall swing in the line of travel. 一 All exit doors serving residents including doors to stairs shall be as a minimum 44 inches wide. 一 Doors to toilets used by residents in additions or new facilities shall be at least 34 inches wide. 一 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. 一 The handrails shall have a circular grip, a clearance of 1½ inch from the wall and be mounted 30-34 inches from the floor to the top of the rail. 一 Handrails shall return to the wall at all terminations. 一 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. 一 1. Each nursing unit shall have: 一 (i) Nurses station. 一 (ii) Clean utility room. 一 (iii) Medicine preparation room. 一 (iv) Soiled utility room or soiled holding room. 一 (v) Clean linen storage room. 一 (vi) Wheelchair and stretcher storage areas. 一 (vii) Janitor’s closet with mop sink or floor receptor and storage shelving. 一 (viii) Nourishment room. 一 (ix) Staff restroom. 一 2. On a nursing unit, no residents’ bedroom door shall be more than 150 feet from the nurses’ station.

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(b) Bedrooms. 一 1. All bedrooms shall have window(s) with the windowsills not more than three feet above the floor. Windows shall not be below grade. 一 2. The window area shall not be less than one-tenth of the floor area. 一 3. Residents' bedrooms shall be located so as to minimize the entrance of odors, noise and other nuisances. 一 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. 一 5. The capacity of any new room shall not exceed two residents, and the capacity of existing rooms shall not exceed four residents. 一 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 一 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: 一 Residents shall be provided with a standard or adjustable bed. 一 Chair and bedside table. 一 Storage space for clothing, toilet articles and personal belongings. 一 Bedside electrical call system for summoning aid. 一 Waste paper receptacle. 一 A headwall bed light must be mounted so that it is operable by the resident from the bed. 一 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. 一 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. 一 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: 一 Annunciator board for receiving residents’ calls. 一 Cabinet space. 一 Storage space for current residents’ charts. 一 Working space and accommodations for recording and charting purposes by facility staff.

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一 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. 一 1. The clean utility room shall contain as a minimum: 一 (i) Wall and base cabinets. 一 (ii) Counter space. 一 (iii) Counter top sink. 一 (iv) Paper towel dispenser. 一 (v) Soap dispenser. 一 2. The soiled utility room shall contain as a minimum: 一 (i) Paper towel and soap dispensers. 一 (ii) Shelves. 一 (iii) Cabinets for storage of poisonous substances; i.e., cleaning supplies, urine test products, etc. 一 (iv) Counter top. 一 (v) Large single compartment counter or freestanding service sink for chemical sterilization of bedpans, urinals and commode pails. 一 (vi) Wall mounted or counter top hand washing lavatory, separate from the service sink. 一 (vii) Soiled linen hamper(s). 一 (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. 一 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. 一 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 一 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. 一 3. Grab bars shall be provided at each water closet. (i) Nourishment Room. 一 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. 一 Existing facilities shall provide a nourishment room in accordance with the above paragraph when the nursing unit is remodeled or expanded. 一 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: 一 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. 一 (i) Dining Room. The dining room shall be capable of seating 50% of the bed capacity.

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一 (ii) Recreation/sitting area. These areas shall not include exterior porches and lobby/waiting room. 一 As a minimum, facility shall include two separate recreation/sitting areas and a dining area. 一 Each nursing unit shall contain at least one recreation/sitting area. 一 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. 一 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. 一 2. Laundries built, renovated, or added to after August 23, 1996, shall provide the following rooms and shall comply with the additional requirements: 一 (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). 一 (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. 一 (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: 一 Administrator's office. 一 Business office. 一 Public lobby or waiting room. 一 Public toilets. 一 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,

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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 Statutory Authority: Code of Alabama, 1975, 22-21-20, et seq. History: Original rules filed: July 19, 1996; effective August 23, 1996. Amended: Filed November 19, 1999; effective December 24, 1999. Amended: Filed June 18, 2002; effective July 23, 2002. Amended: Filed September 18, 2003; effective October 23, 2003.

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7 AAC 12.740. Laundry service (a) Each facility, with the exception of home health agencies, frontier extended stay clinics, and intermediate care facilities for the mentally retarded, must provide a laundry service. (b) A facility must develop and implement written procedures for handling, processing, storage, and transportation of linen in a manner that will prevent the spread of infection and will assure the maintenance of clean linen. (c) If a facility operates its own laundry, it must be (1) located so that steam, odors, lint, and objectionable noises do not reach patient or personnel areas; (2) well-lighted, ventilated, and adequate in size for the needs of the facility; (3) maintained in a sanitary manner and in good repair;

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(4) separate from any storage area; and (5) organized so that clean and soiled functions are physically separated. (d) A facility must have laundry equipment that provides hot water at a temperature of 160 degrees Fahrenheit unless the facility uses an alternative disinfectant measure, including ozonized water, bleach, or a bleach byproduct, at a lower temperature recommended by the product manufacturer. If the facility uses an alternative disinfectant measure, the facility must develop a written policy and procedure for use of the product and must maintain documentation of the manufacturer's minimum recommended water temperature. (e) Hand-washing and toilet facilities for laundry personnel must be provided at a location convenient to the laundry. (f) Separate covered carts must be used for transporting soiled and clean linen. The carts must be clearly labeled and equipped with washable covers that are laundered or suitably cleaned daily. (g) If laundry service is provided by an outside laundry service establishment, the facility must choose an establishment that meets the requirements of this section. History: Eff. 11/19/83, Register 88; am 12/3/2006, Register 180; am 9/30/2007, Register 183 Authority: AS 18.05.040 AS 47.32.010 AS 47.32.030 7 AAC 12.750. Housekeeping service (a) Each facility, with the exception of home health agencies and intermediate care facilities for the mentally retarded, must provide a housekeeping service. (b) A facility must have routine cleaning procedures for furniture, floors, walls, ceilings, supply and exhaust grills, and lighting fixtures. (c) A facility must have written procedures for cleaning all areas of the facility, including cleaning of a patient unit following discharge of a patient. (d) Housekeeping personnel must wear clean cap, mask, and gown when cleaning a surgical or delivery suite. (e) A facility must maintain sufficient housekeeping cleaning supplies and equipment. Separate equipment must be provided, as applicable, for operating rooms, delivery rooms, the nursery, and the dietary area. Housekeeping equipment and cleaning supplies, other than those in bulk, must be stored in designated housekeeping supply rooms. A detergent germicide must be used for all cleaning and dusting purposes. Mop heads must be removable and must be changed at least daily. (f) Each facility must provide a sufficient housekeeping service to maintain the interior of the facility in a safe, clean, orderly and attractive manner and free from offensive odors. History: Eff. 11/19/83, Register 88; am 5/4/97, Register 142; am 12/3/2006, (I) solaria, waiting rooms, and similar areas which are not permanently set aside, equipped, and staffed exclusively for inpatient bed care; and (J) unfinished space, which does not include an area which is finished except for movable equipment. (f) Bed space under construction on or after November 19, 1983 must contain, (1) for each patient, fixed available oxygen, suction, a bedlight, and a closet; (2) for every two patients, a lavatory with fixtures and adjacent toilet; and (3) for each bed in a multiple-bed room, cubicle curtain tracks. (g) Facilities in existence before January 1, 1995, will be allowed a variance of 10 square feet from the standards for square footage of patient rooms required by Guidelines for Design and Construction of Hospital and Health Care Facilities, adopted by reference in (b)(1) of this section. (h) Except as provided in 7 AAC 12.150(h) , the department may waive compliance with, or grant a variance from, a requirement in this section if the commissioner determines that an equivalent alternative is provided and the safety and well-being of patients is assured. If a facility wishes to obtain a waiver or variance, its governing body must apply in writing to the commissioner and must include in the application

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(1) the justification for the waiver; (2) an explanation of the reasons why the particular requirement cannot be satisfied; (3) a description of the equivalent alternative proposed; and (4) if the application for waiver involves fire safety or other municipal or state requirements, evidence that it has been reviewed by the appropriate municipal or state authorities. History: Eff. 11/19/83, Register 88; am 12/31/94, Register 132; am 5/4/97, Register 142; am 9/1/2000, Register 155; am 12/17/2005, Register 176; am 6/23/2006, Register 178; am 12/3/2006, Register 180 Authority: AS 47.32.010 AS 47.32.030 Editor's note: A copy of Guidelines for Design and Construction of Hospital and Health Care Facilities, adopted by reference in 7 AAC 12.900(b) (1), may be obtained from the American Institute of Architects Press, 1735 New York Avenue, Washington, D.C. 20006. To order a prepaid copy, call (202) 626-7541 or (800) 2423837, press 4. For an order using a purchase order or that must be billed, call (800) 365-2724. The International Building Code and the International Mechanical Code referred to in 7 AAC12.900(b) (5) and (b)(6), respectively, may be obtained from the International Conference of Building Officials, 5360 Workman Mill Rd., Whittier, California 90601-2298; telephone: (800) 284-4406; (562) 699-0541. Register 180 The National Fire Protection Association (NFPA) standards adopted by reference in 7 AAC12.900(c) may be obtained from the National Fire Protection Association, 1 Batterymarch Park, Quincy, Massachusetts 02169-7471; telephone: (800) 344-3555.

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R9-10-914. Physical Plant Standards An administrator shall ensure that: 1. A nursing care institution complies with: a. The physical plant health and safety codes and standards incorporated by reference in A.A.C. R9-1-412 applicable at the time of licensure; and b. The requirements for Existing Health Care Occupancies in National Fire Protection Association 101, Life Safety Code, incorporated by reference in A.A.C. R9-1-412; 2. Architectural plans and specifications for construction, a modification, or a change in resident beds or licensed capacity are submitted to the Department for approval according to the requirements in 9 A.A.C. 10, Article 1; 3. Construction, a modification, or a change in resident beds or licensed capacity complies with the requirements of this Article and the physical plant codes and standards incorporated by reference in A.A.C. R9-1-412 in effect at the time the construction, modification, or change in resident beds or licensed capacity and is approved by the Department; 4. A resident room has a window to the outside with window coverings for controlling light and visual privacy, and the location of the window permits a resident to see outside from a sitting position; 5. A nursing care institution has no more than two beds in a resident room unless: a. The nursing care institution was operating before October 31, 1982, and b. The resident room has not undergone a modification as defined in 9 A.A.C. 10, Article 1; 6. A resident room or a suite of rooms is accessible without passing through another resident's room;

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7. A resident room or a suite of rooms does not open into any area where food is prepared, served, or stored; 8. A resident room that has more than one bed has a curtain or similar type of separation between the beds for privacy; 9. A resident room has a closet with clothing racks and shelves accessible to the resident; 10. A resident has a separate bed, a nurse call system and furniture to meet the resident's needs; 11. If the nursing care institution has a semipublic swimming pool on the premises for the use of residents: a. The pool is enclosed by at least a five-foot-high wall, fence, or other barrier as measured on the exterior side of the wall, fence, or barrier; b. An opening in the wall, fence, or barrier does not exceed four inches in diameter; c. A wire mesh or chain link fence has a maximum mesh size of 1 3/4 inches as measured horizontally; d. The self-closing, self-latching gates are locked when the pool is not in use; e. The pool has safety rules conspicuously posted; f. A resident is supervised at all times when using the pool; and g. The pool conforms to state and local laws and rules for design, construction, and operation of semipublic swimming pools. Historical Note Adopted effective October 20, 1982 (Supp. 82-5). Section repealed, new Section adopted effective February 17, 1995 (Supp. 95-1). Section repealed; new Section made by final rulemaking at 9 A.A.R. 338, effective March 16, 2003 (Supp. 03-1). R9-10-915. Environmental and Equipment Standards An administrator shall ensure that: 1. A nursing care institution's premises and equipment are: a. Cleaned according to policies and procedures or manufacturer's instructions to prevent, minimize, and control illness or infection; and b. Free from a condition or situation that may cause a resident or an individual to suffer physical injury; 2. A pest control program is used to control insects and rodents; 3. Tobacco smoking is permitted only in designated ventilated areas; 4. Biohazardous and hazardous wastes are identified, stored, used, and disposed of according to A.A.C. R18-13-1401; 5. There is space and equipment to meet the needs of the residents for: a. Individual and group activities; b. Community dining; and c. Any special therapies such as physical, occupational, or speech therapy; 6. There is lighting for tasks performed by a resident or a staff member; 7. The temperature in the nursing care institution is no less than 71° F or more than 84° F; 8. A nursing care institution is ventilated by windows or mechanical ventilation, or a combination of both; 9. The corridors are equipped with handrails on each side that are firmly attached to the walls and are not in need of repair; 10. Equipment used to provide direct care is: a. Maintained in working order; b. Tested and calibrated, if applicable, at least once every 12 months or according to the manufacturer's recommendations; and c. Used according to the manufacturer's recommendations; and 11. Documentation of each equipment test, calibration, and repair is:

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a. Maintained on the nursing care institution's premises for one year from the date of the testing, calibration, or repair; and b. Provided to the Department for review within two hours from the Department's request.

Historical Note Adopted effective October 20, 1982 (Supp. 82-5). Section repealed, new Section adopted effective February 17, 1995 (Supp. 95-1). Section repealed; new Section made by final rulemaking at 9 A.A.R. 338, effective March 16, 2003 (Supp. 03-1). R9-10-916. Safety Standards A. An administrator shall ensure that: 1. A disaster plan is developed, documented, and implemented that includes: a. Procedures for protecting the health and safety of residents and other individuals; b. Assigned responsibilities for each staff member; c. Instructions for the evacuation, transport, or transfer of residents, d. Maintenance of medical records, and e. Arrangements to provide any other nursing care institution services to meet the resident's needs; 2. If applicable, a sign is placed at the entrance to a room or area indicating that oxygen is in use; 3. A plan exists for back-up power and water supply; 4. A fire drill is performed on each shift at least once every three months; 5. A disaster drill is performed at least once every six months; 6. Documentation of a fire drill required in subsection (A)(4) and a disaster drill required in subsection (A)(5) includes: a. The date and time of the drill; b. The names of each staff member participating in the drill; c. A critique of the drill; and d. Recommendations for improvement, if applicable; 7. Documentation of a fire drill or a disaster drill is maintained by the nursing care institution for 18 months from the date of the drill and provided to the Department for review within two hours of the Department's request. B. A fire safety inspection is conducted in the nursing care institution every 12 months by the fire authority having jurisdiction. C. Documentation of the fire safety inspection is provided to the Department for review within two hours of the Department's request.

Historical Note Adopted effective October 20, 1982 (Supp. 82-5). Section repealed, new Section adopted effective February 17, 1995 (Supp. 95-1). Section repealed; new Section made by final rulemaking at 9 A.A.R. 338, effective March 16, 2003 (Supp. 03-1).

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400 PHYSICAL ENVIRONMENT 401 GENERAL STANDARDS FOR EXISTING STRUCTURES 402 GENERAL Every institution must be maintained, managed, and equipped to provide adequate care, safety, and treatment of each resident. 403 FACILITY GROUNDS AND PARKING ● All homes shall be provided with dust free drives and parking lots. ● Parking areas shall be provided in a ratio of one (1) individual parking space for each five (5) licensed beds.

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404 DOORS ● All exterior doors shall be effectively weather stripped ● Doors shall swing into rooms except closet, toilet, and exit doors. ● The doors to all rooms, toilets, baths, and closets shall be legibly marked with names or numbers, as appropriate to identify the area. ● Exit doors shall not be locked in such a way that a key is necessary to open the door from the inside of the building. A latch or other fastening device on the door shall be provided with a knob, handle, panic bar or other simple type of releasing device, which is part of the door handle hardware, of which the method of operation is obvious even in darkness. 405 STANDARD PATIENT ROOMS, BATH, AND TOILET FACILITIES 405.1 Standard patient rooms shall not have more than five (5) beds. 405.2 Single standard patient rooms shall measure at least one-hundred (100) square feet. Multi-patient rooms shall provide a minimum of seventy-two (72) square feet per bed. Patient beds shall be located in rooms and placed at least three (3) feet apart in all directions and so located as to avoid contamination (respiratory droplets), drafts, excessive heat, or other discomfort to patients, to provide adequate room for nursing procedures and to minimize the transmission of disease. 405.3 Each standard patient room shall be equipped with or conveniently located near adequate toilet and bathing facilities; at least four (4) patients toilet facilities and three bathing units shall be provided for each thirty-five (35) beds. Each toilet facility shall be in a separate stall. Toilets shall be equipped with hand-washing facilities and toilet paper hangers. 405.4 Each standard patient room shall have hand-washing facilities with both hot and cold running water, unless adequately provided in a nearby room. 405.5 Each patient room shall have direct access to a corridor. 405.6 Rooms extending below ground level shall not be used for patients unless they are dry, well ventilated by required window space, and are otherwise suitable for occupancy. Non-ambulatory patients may not be housed below ground level. 405.7 Each patient room shall have a window not less than one-sixteenth (1/16) of the floor space or outside door arranged and located so that it can be opened from the inside. The window shall be so located that the patients have a reasonable outside view. 405.8 Each patient shall be provided with storage space, closet, or other enclosed space, within his/her room, for clothing and other possessions. 406 INTENSIVE CARE ROOM An intensive care room shall be provided for each thirty-five (35) beds or major portion thereof and shall be located near the nurses' station. Each room shall have the standard square footage as set forth in these regulations. The room shall be provided with standard unit equipment and a lavatory with a gooseneck spout and elbow or wrist-action blade-handle controls, and a soap and a towel dispenser. At least one of these rooms is a single room which can be used for isolation. 407 CORRIDORS Corridors in facilities licensed prior to 1973 shall be at least six (6) feet wide. 408 HANDRAILS Standard handrails shall be provided on each side of the corridor in all areas used by patients; however, a six (6) foot passageway must be maintained. For six (6) foot corridors, a handrail shall be required only on one side. 409 BEDPAN CLEANING AND STORAGE ROOM There shall be one properly equipped bedpan cleaning room with deep metal sink. In addition to bedpan cleaning equipment, appropriate hand-washing facilities shall be provided. The room shall include equipment for sterilization (unless a separate central sterilization is provided). 410 DAY ROOM AND DINING ROOM A well lighted, clean, orderly, and ventilated room or rooms shall be provided for patient activities and for dining areas. A minimum of twenty (20) square feet per bed shall be provided for this purpose. At least half of the required area may be used for dining. 411 CEILINGS, WALLS AND FLOORS

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411.1 Ceilings Kitchens, and other rooms where food and drink are prepared shall have a smooth, nonperforated surface that is washable. Wallpaper shall not be used. 411.2 Walls The walls of the facility shall be a smooth surface with painted or equally washable finish: ● They shall be without cracks, and in conjunction with floors, shall be waterproof and free from spaces which may harbor ants and roaches. The walls in the examining room and treatment room shall have waterproof paint. ● All walls shall be kept clean and in good repair. 411.1 Floors All floor surfaces throughout the building shall provide a surface or finish which is smooth, waterproof, grease proof, and resistant to heavy wear. Safety devices shall be provided on ramps. All floors in baths, toilets, lavatories, beneath kitchen dish washing facilities and bedpan rooms shall have a floor covering of a continuous type. No cracks or joints in the floor covering shall be permitted in these rooms. Carpet is permitted as floor covering for the following areas, provided the carpet meets the following requirements: The carpet has a flame spread rating of seventy-five (75) or less, has a smoke density of one-hundred (100) or less, when the carpet is treated in accordance with NFPA 253, Flooring Radiant Panel Test. ● Offices ● Corridors ● Chapels ● Day rooms No pad will be permitted under the carpet. The carpet is to be glued directly to the floor. Prior approval by the Division is required before the carpet is installed. In nursing homes where carpet is installed, the home must furnish equipment and have written cleaning procedures to clean and maintain the carpet. This equipment must include, as a minimum, a shampooer and wet/dry vacuum. Facilities presently having carpets in areas other than those listed above may keep that carpet as long as it is maintained properly and free of odors. If not properly maintained and free of odors, the carpet will be removed and replaced with a hard smooth surface. 412 HEATING AND COOLING 412.1 The institution shall be equipped with heating and cooling equipment that will maintain a minimum temperature of seventy-five (75) degrees F during winter and eighty (80) degrees F during summer in all patient areas when the temperature outside does not exceed ninety-five (95) degrees F. If temperature outside exceeds one-hundred (100) degrees F, there shall be a fifteen (15) degree F difference in exterior to interior temperature. If air conditioner should break down or malfunction, the OLTC should be notified immediately. Patients' toilets and bathroom temperature shall be maintained at eighty (80) degrees F. 412.2 Central heating systems shall be provided with Underwriters; approved temperature controls throughout the building. 413 LIGHTING 413.1 Each patient's room shall have natural lighting during the day and have general lighting at night. Natural lighting shall be augmented when necessary by artificial illumination. 413.2 Approved "exit" lights shall be provided at all exit areas and shall be continuously illuminated. 414 EMERGENCY POWER 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. The emergency electrical power system must supply power adequate at least for lighting in all means of egress; equipment to maintain fire detection, alarm, and extinguishing systems. Dry battery or wet-cell batteries may be used as emergency power in facilities where life support systems are not used. Where life support systems are used, emergency electrical service is provided by an emergency generator located on the premises.

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415 WATER SERVICE 415.1 The water supply used by the institution shall meet the requirements of the Department of Health. 415.2 There shall be procedures to ensure water to all essential areas in the event of loss of normal water supply. 415.3 The water service shall be brought into the building to comply with the requirements of the Arkansas State Plumbing Code and shall be free of cross connections. 415.4 Hot Water Heaters 415.4.1 Hot water heating and storage equipment shall have sufficient capacity to supply four (4) gallons of water at one-hundred ten (110) degrees F (43 degrees C), per hour per bed for institution fixtures, one (1) gallon at one-hundred sixty (160) degrees F (71 degrees C), per hour per bed for the laundry and one (1) gallon at one-hundred eight (180) degrees F (82 degrees C) per hour per be for the kitchen. The water temperature in patient areas shall not exceed one-hundred ten (110) degrees F (49 degrees C). 415.4. 2 The hot water storage tank, or tanks, shall have a capacity equal to forty (40) percent of heater capacity. 415.4. 3 Tanks and heaters shall be fitted with pressure temperature relief valves. 415.4. 4 Temperatures of hot water at plumbing fixtures used by residents shall be automatically regulated by control valves. Water temperature in patient areas shall be checked weekly. 415.4. 5 All gas, oil, or coal heaters shall be vented to the outside. 415.5 Plumbing and Other Piping Systems All plumbing systems shall be designed and installed in accordance with the requirements of Arkansas State Plumbing Code. From the cold water service and hot water tanks, cold water and hot water mains and branches shall be run to supply all plumbing fixtures and equipment which require hot and cold water or both for their operation. Pipes shall be sized to supply hot and cold water to all fixtures with a minimum pressure of fifteen (15) pounds at the top floor fixtures during maximum demand periods. 415.5. 1 Water closets shall be the elongated type, and water closet seats shall be of the open-front type. 415.5. 2 Gooseneck spouts shall be used for patients' lavatories and sinks which may be used for filling pitchers. 415.5. 3 Knee, elbow, wrist, or foot action faucets shall be used in treatment rooms. 415.5. 4 An electrically operated water fountain shall be so located as to be accessible to patients. 415.5. 5 Backflow preventers (vacuum breakers) shall be installed with any water supply fixture where the outlet's end may at times be submerged. Examples of such fixtures are hoses, sprays, direct flushing valves, aspirators and under-rim water supply connections to a plumbing fixture or receptacle in which the surface of the water in the fixture or receptacle is exposed at all times to atmospheric pressure. 416 NURSES' STATION Nurses' stations shall be provided and so designated that they contain a minimum of sixty (60) square feet per each thirty-five (35) bed patient unit, and are not more than one-hundred twenty (120) linear feet from each patient room. The station shall include adequate storage and preparation areas(s), medication, toilet and hand-washing facilities, and sufficient lighting. 416.1 Separate utility room shall be provided for clean items and soiled items for each nurses' station. They shall be mechanically ventilated to the outside and adequately lighted. Two or more electrical convenience outlets shall be provided for each utility room. Blade handle control faucets shall be provided. Gooseneck spouts shall be in a separate room and ventilated to the outside. 416.2 Closet for soiled linens shall be provided for each nurses' station. This dirty linen storage shall be in a separate room and ventilated to the outside. 417 JANITORS' CLOSETS Janitors' closets shall be provided for each nursing unit, and a separate janitor's closet shall be provided within the kitchen area. These closets shall be provided with hot and cold running water,

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a floor receptor or service sink, and shelves for the storage of janitorial equipment and supplies. The closets shall be mechanically vented to the outside. Janitor closets in patient areas must be kept locked. 418 NURSES' CALL SYSTEM A nurses' call system comprised of an electric buzzer and/or light system shall be so designed that the location of a call can be determined from the corridor and nurses' station. In addition emergency call stations shall be provided in all patient bath, toilet and shower areas. Wireless nurse call systems may be substituted for wired call systems. Wireless call systems shall meet the requirements set forth in Section 440 of these regulations. 419 FIRE ALARM SYSTEM Each nursing home shall have an electrically-supervised, manually-operated fire alarm system in accordance with Section 6-3 NFPA 101, Life Safety Code handbook that applies to their nursing home. 420 PHYSICAL ENVIRONMENT 421 STANDARDS FOR NEW CONSTRUCTION AND/OR ALTERATIONS 422 GENERAL 422.1 A "new institution" is one which had plan approved by the Office of Long Term Care and began operation and/or construction or renovation of a building for the purpose of operating an institution on or after the adoption date of these regulations. The regulations and codes governing new institutions apply if and when the institution proposes to begin operation in a building not previously and continuously used as an institution licensed under these regulations. 422.2 Additions to existing facilities shall meet the standard for new construction. 422.1 The requirements outlined under section 1400, General Standards for Existing Structures, also apply when applicable. 423 SITE LOCATION, INSPECTION, APPROVALS AND SUBSOIL INVESTIGATION 423.1 The building site shall afford good drainage and shall not be subject to flooding or be located near insect breeding areas, noise, or other nuisance producing locations, or hazardous locations, industrial developments, airports, railways, or near penal or other objectionable institutions or near a cemetery. The site shall afford the safety of patients and not be subject to air pollution. 423.2 A site shall be adequate to accommodate roads and walks within the lot lines to at least the main entrance, ambulance entrance, and service entrance. All facility sites shall contain enough square footage to provide at least as much space for walks, drives, and lawn space as the square footage contained in the building. 423.3 The building site shall be inspected and approved by the Division before construction is begun. 424 SUBMISSION OF PLANS, SPECIFICATIONS, AND ESTIMATES 424.1 When construction is contemplated either for new buildings, additions, or major alterations in excess of One-Hundred-Thousand dollars ($100,000), plans and specifications shall be submitted in duplicate one (1) to the OLTC and one (1) to the Plumbing Division of the Arkansas Department of Health, for review, along with a copy of the statement of approval from the Comprehensive Health Planning Agency. Final plan approval will be given by the OLTC. 424.2 Such plans and specifications should be prepared by a registered professional engineer or an architect licensed in the State of Arkansas (Act 270 of 1941 as amended) and should be drawn to scale with the title and date shown thereon. The Division shall be a minimum of three (3) weeks to review the drawing and specifications and submit their comments to the applicant. Any proposed deviations from the approved plans and specifications shall be submitted to the Division prior to making any changes. Construction cannot start until approval of plans and specifications have been reviewed from the Division. The Division shall be notified as soon as construction of a new building or alteration to an existing facility is started. 424.3 An estimate shall accompany all working plans and specifications when the total cost of construction is more than One-Hundred-Thousand dollars ($100,000).

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424.4 Representatives from the Division shall have access to the construction premises and the construction project for purposes of making whatever inspections deemed necessary throughout the course of construction. 425 PLANS AND SPECIFICATIONS 425.4 All institutions licensed under these standards shall be designated and constructed to substantially comply with pertinent local and state laws, codes, ordinances, and standards. All new nursing home construction shall be in accordance with requirements of Section 10-132 if NFPA Standard 101, 1973 edition. Plans shall be submitted to the Division in the following stages. 425.1.1 Preliminary Submission Architect preparing plans should contact Office of Long Term Care for preliminary review. 425.1.2 Final Submission Step (1) Working drawings and specifications which shall be well prepared so that clear and distinct prints may be obtained; accurate dimensions and including all necessary explanatory notes, schedules and legends. Working drawings shall be complete and adequate for contract purposes. Separate drawings shall be prepared for each of the following branches of work; architectural, structural, mechanical and electrical; and shall include the following: Approved plan showing all new topography, newly established levels and grades, existing structures on the site (if any), new buildings and structures, roadways, walks, and the extent of the areas to be seeded. All structures and improvements which are to be removed under the construction contract shall be shown. A print of the survey shall be included with the working drawings. ● Plan of each floor and roof. ● Elevations of each façade. ● Sections through building ● Scale and full size details as necessary to properly indicate portions of the work. ● Schedule of finishes. Step (2) Equipment Drawings: Large scale drawings of typical and special rooms indicating all fixed equipment and major items of furniture and movable equipment. Step (3) Structural Drawings: ● Plans of foundations, floors, roofs, and all intermediate levels shall show a complete design with sizes, sections, and the relative location of the various members. Schedule of beams, girders, and columns shall be included. ● Floor levels, column centers, and offsets shall be dimensioned. ● Special openings and pipe sleeves shall be dimensioned or otherwise noted for easy reference. ● Details of all special connections, assemblies, and expansion joints shall be given. Step (4) Mechanical Drawings: The drawings with specifications shall show the complete heating, steam piping and ventilation systems, plumbing, drainage and standpipe system, and laundry. ● Heating, steam piping, and air-conditioning systems. 1. Radiators and steam heated equipment, such as sterilizers, warmers, and steam tables. 2. Heating and steam mains and branches with pipe sizes. 3. Sizes, types, and heating surfaces of boilers, furnaces, with stokers and oil burners, if any. 4. Pumps, tanks, boiler breeching and piping and boiler room accessories. 5. Air-conditioning systems with required equipment, water and refrigerant piping, and ducts. 6. Exhaust and supply ventilating systems with steam connections and piping. 7. Air quantities for all room supply and exhaust ventilating duct openings. ● Plumbing, drainage, and standpipe systems: 1. Size and elevation of: Street sewer, house sewer, house drains, street water main and water service into the building. 2. Locations and size of soil, waste, and vent stacks with connections to house drains, clean outs, fixtures, and equipment.

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3. Size and location of hot, cold and circulating mains, branches and risers from the service entrance and tanks. 4. Riser diagram to show all plumbing stacks with vents, water risers, and fixture connections. 5. Gas, oxygen, and special connections. 6. Plumbing fixtures and equipment which require water and drain connections. ● Elevators and dumbwaiters: Details and dimensions of shaft, pit and machine room; sizes of car platform and doors. ● Kitchens, laundry, refrigeration and laboratories; These shall be detailed at a satisfactory scale to show the location, size, and connections of all fixed equipment. Step (5) Electrical Drawings: ● Drawings shall show all electrical wirings, outlets, smoke detectors, and equipment which require electrical connections. ● Electrical Service entrances with switches, and feeders to the public service feeders shall be shown. ● Plan and diagram showing main switchboard power panels, light panels, and equipment. ● Light outlets, receptacles, switches, power outlets, and circuits. ● Nurses' call systems with outlets for beds, duty stations, door signal lights, enunciators, and wiring diagrams. ● Fire alarm system with stations, signal devices, control board and wiring diagrams. ● Emergency electrical system with outlets, transfer switch, source of supply, feeders and circuits. Step (6) Specifications: Specifications shall supplement the drawings to fully describe types, sizes, capacities, workmanships, finishes, and other characteristics of all materials and equipment and shall include the following: ● Cover or title sheet ● Index ● General conditions ● General Requirements ● Sections describing material and workmanship in detail for each class of work. 426 CODES AND STANDARDS The following codes and standards are incorporated into and made a part of these regulations: 426.1 The 1973 edition of the National Fire Code (NFPA) applies to new construction and alterations or additions to existing facilities. This edition includes NFPA No. 101, Life Safety Code (1973). 426.2 The 1967-68 edition of the National Fire Code (NFPA) applies to existing facilities which met such standards as of June 1, 1976. 426.3 American National Standards Institute (ANSI) Standard No. A117.1, American Standard Specifications for making building and facilities accessible to, and usable by, the physically handicapped. 426.4 Arkansas State Plumbing Code. 426.5 Fire Resistance Index 1971, Underwriters Laboratories, Inc. 426.6 Handbook of Fundamentals, American Society of Heating, Refrigeration and Airconditioning Engineers (ASHRAE), United Engineer Center, 345 East 47th Street, New York, New York 10017. 426.7 Method of Test for Surface Burning characteristics of Building Materials, Standard No. E 84-61 American Society for Testing and Materials (ASTM) Standard No. 84-61, 1961 Race Street, Philadelphia, Pennsylvania 19103. 426.8 Methods of Fire Test of Building construction and Materials. Standard No. E 119, American Society of Testing and Materials (ASTMO), 1961 Race Street, Philadelphia, Pennsylvania 19103. 426.9 Minimum Power Supply Requirements, Bulletin No. XR4-10 National Electrical Manufacturers Association (NEMA) 155 East 44th Street, New York, New York 10017.

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427 STANDARD PATIENT ROOM AND TOILET DESIGN 427.1 Built-in closets shall be provided in each patient room for storage of clothing and other possessions. 427.2 Each patient bed shall be provided with a suitable fixed light equipped with a noncombustible shade to prevent direct glare for reading or other purposes, and capable of being switched on and off by the patient. 427.3 To ensure privacy in multi-patient rooms, each bed shall be provided with fixed flame retardant cubicle curtain. 427.4 Each patient room shall have an adequate toilet, bathing and hand-washing facility with hot and cold running water unless provided in an adjacent room. 427.5 Each room has direct access to a corridor and outside exposure, with the floor at or above grade level. 427.6 Every patient unit shall be provided with a bedside cabinet with at least two enclosed storage spaces. The top drawer shall be for storage of personal items and the bottom for individually assigned bedpans, urinals, etc. 427.7 Standard patient rooms shall measure at least one-hundred (100) square feet. Multi-patient rooms shall provide a minimum of eighty (80) square feet per bed. 427.8 Multi-patient rooms shall be limited to four beds. 428 INTENSIVE CARE ROOM DESIGN Other than requirements set forth for existing structures, 406, an intensive care room shall be mechanically vented to the outside and provided with a standard private toilet and hand-washing facility. The intensive care room may also serve as an isolation room. 429 CORRIDORS Corridors shall be at least eight (8) feet wide. 430 LAUNDRY Laundry in new facilities must provide complete separation (by partition) of the soiled laundry area (including washer) and the clean laundry area. A lavatory with soap and towel dispensers must be provided for the staff in each area, and a rinsing sink provided in the soiled laundry area. A linen folding table must be provided in the clean laundry area. If the laundry area is included in the main nursing home building, it shall be so located as to be as remove as possible from the patient area. 431 STORAGE There shall be a minimum of five (5) square feet per bed for general storage space provided in those cases where built-in closets are provided in patient rooms. It is recommended that this be concentrated in one general area except for small storage areas within the nursing units for wheelchairs, patient lifts, walkers, etc. 432 DIETETIC SERVICE AREA (LESS DINING AREAS) 432.1 The kitchen shall be located conveniently to the dining area. (Separation of the kitchen and dining areas by corridors should be avoided.) 432.2 The food service area shall provided adequate space and facilities for receiving food deliveries, storage, preparation, tray assembly, and distribution serving of food, dishwashing and utility cleaning, refuse collection and garbage disposal. The total area less dining area, shall not be less than nine (9) square feet per bed for the first one-hundred (100) beds and six (6) square feet per bed for all in excess of one-hundred (100) beds. 432.3 A suitable work area shall be provided for the dietitian or the dietary service supervisor. 432.4 The kitchen shall not serve as a passage between work or patient areas. 432.5 Adequate heat, light, and ventilation shall be provided. 432.6 Hand washing facility shall be provided in the dietary area with wrist-action blade-handle controls and gooseneck spout. 433 ADMINISTRATIVE OFFICES Separate office space shall be provided for administrative and business functions as follows: ● Office for the administrator. ● Office for the director of nursing services. ● Office or space for social and activity director.

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434 RESIDENTS' DINING AND RECREATION AREAS The total area set aside for residents' dining and recreation purposes shall be not less than twenty (20) square feet per bed. Additional space shall be provided if the facility participates in a day care program. The areas shall be well lighted and well ventilated. 435 UTILITY ROOMS 435.1 Separate utility room shall be provided for clean items and soiled items for each nurses' station. 435.2 Utility rooms shall be mechanically ventilated to the outside and adequately lights. Two or more electrical convenience outlets shall be provided for each utility. Blade-handle control faucets shall be provided. Gooseneck spouts shall be provided in the clean utility room. 436 BEDPAN ROOM There shall be at least one bedpan cleaning room. In addition to the bedpan cleaning equipment, hand-washing facilities with blade-handle controls shall be provided. There shall be provisions for equipment sterilization. 437 JANITORS' CLOSETS Janitors' closets shall be provided for each nursing unit, and a separate janitor's closet shall be provided within the kitchen area. These closets shall be provided with hot and cold running water, a floor receptor and service sink, and shelves for the storage of janitorial equipment and supplies. The closets shall be mechanically vented to the outside. Janitor closets in patient areas must be kept locked. 438 LINEN CLOSETS Closets for clean linens shall be provided for each nurses' station. 439 SOILED LINEN CLOSETS Closet for soiled linens shall be provided for each nurses' station. This dirty linen storage shall be in a separate room and ventilated to the outside. 440 NURSES' CALL SYSTEM 440.1 In general patient areas, each room shall be served by at least one calling station, and each bed shall be provided with a call button. Two call buttons serving adjacent beds may be served by one calling station. Calls shall register with the floor staff at the nurses' station and shall activate a visible signal at the patient's room and audible signal at the nursing station. In multi-corridor nursing units, additional visible signals shall be installed at corridor intersections if patient room lights are not visible from the nurses' station. Nurses' calling systems which provide two-way voice communication shall be equipped with an indicating light at each calling station which lights and remains lighted as long as the voice circuit is operating. 440.2 A nurses' call emergency button shall be provided for patients' use at each patients' toilet, bath and shower room. These call lights should be so designed that they can only be turned off in the patient area. 440.3 Wireless Nurse Call Systems - Facilities may substitute a wireless nurse call system for wired call systems or may operate both a wireless and a wired nurse call system in parallel. Wireless nurse call systems shall at a minimum: a. Provide a call button at each patient bed, bath, and toilet and at each whirlpool and each physical therapy room. b. Utilize FCC-approved radio frequencies. Frequencies must not interfere with or disrupt pacemakers, defibrillators, or other medical equipment. c. Receive only signals initiated from the manufacturer’s system. d. Provide signal coverage and penetration throughout the entire facility and all facility grounds. e. Provide an audible signal to any nurses' station that provides coverage to the room from which the signal originates. f. Provide signaling for all wireless devices utilized by staff to receive the signal. Signaling shall include either an audible tone or vibration to alert the person carrying the receiving device, and shall display on the receiving device the specific location from which the signal originated. g. Provide escalation. Escalation means that if a signal is unanswered for a designated period of time, the signal is repeated and sent to other nurses' stations or to facility staff that were not designated to receive the original signal.

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441 NURSES' STATION Nurses' station shall be provided and so designed that they contain a minimum of sixty (60) square feet per each thirty-five (35) bed patient unit, and are not more than one-hundred-twenty (120) linear feet from each patient room. The station shall include adequate storage and preparation area(s), medication, toilet and hand-washing facilities, and sufficient lighting. 442 FIRE ALARM SYSTEM Each nursing home shall be an electrically supervised, manually operated fire alarm system in accordance with Section 6-3 NFPA 101, Life Safety Code handbook that applies to their nursing home. 443 LIMITATIONS The following limitations shall apply: 443.1 No nursing home shall be connected to any building other than a general hospital, chronic disease hospital, rehabilitation facility, boarding home, adult day care, or Home Health Agency. Upon request from the Office of Long Term Care, supporting documentation must be provided to evidence proper allocation of costs and compliance with all applicable state and federal laws and regulations. 443.2 A nursing home shall not be located within thirty (30) feet from another nonconforming structure or the property line of the facility except where prohibited by local codes. 443.3 Occupancies not under the control of, or not necessary to the administration of a nursing home are prohibited therein with the exception of the residence of the owner or manager. 444 CEILINGS, WALLS, AND FLOORS ● Ceilings shall be a minimum of eight (8) feet. (Refer to Section 411 for surfaces.) ● Walls (Refer to Section 411). ● Floors (Refer to Section 411). 445 WATER COOLER An electrically operated water fountain of an approved type shall be provided for each nurses' station. The water fountain shall be accessible to the physically handicapped. Water fountains must be recessed not to obstruct the corridor. 446-449 RESERVED 450 FURNISHINGS, EQUIPMENT, AND SUPPLIES 451 FURNISHINGS 451.1 Each patient's bed unit, bath and toilet shall be provided with a standard type, buzzer/light, nurses' call signal, or, alternatively when a wireless nurse call system is utilized, a call button designed to operate with the wireless nurse call system. 451.2 Each bed shall be provided with a light with a non-combustible shade to prevent direct glare for reading or other purposes. 451.3 To ensure privacy in multi-patient rooms, each bed shall be provided with flame retardant cubicle curtains; in existing facilities, partitions or free-standing folding screens may be used. 451.4 Each patient shall be provided with a rigid single bed in good repair measuring a minimum of thirty-six (36) inches in width. Beds shall be provided with three inch casters and at least two (2) of the four (4) casters shall be of the locking type. (Roll-away beds, cots, or folding beds are not acceptable.) The beds shall be equipped with a comfortable pillow and comfortable, firm mattress at least five (5) inches thick and shall be covered with a moisture repellant material. There shall be hospital type adjustable beds available for patients receiving bed nursing care. 451.5 Each patient shall be provided with a bedside table with a compartment or drawer for personal belongings, such as, soap, hairbrushes, combs, toothbrush and dentifrice, and a lower enclosed compartment for storage of individual bedpan or urinal (open-shelved stands are not acceptable.). 451.6 A comfortable chair shall be provided for each licensed bed and be available at the bedside unless contraindicated by the patient's condition. 451.7 Each window shall be provided with a shade or flame retardant curtains. 451.8 Bed rails shall be provided for bed patients and disoriented patients.

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451.9 Furniture and play equipment used in the care of children shall be painted with lead free paint. 451.10 All wastebaskets shall be the metal type. 452 LINENS AND BEDDING 452.1 Extra pillows shall be available as need for treatment and/or comfort of patients. 452.2 Moisture proof rubber or plastic sheeting shall be provided as necessary to keep mattress of pillows clean or dry. 452.3 A supply of clean bed linen shall be available at all times. A minimum of two clean sheets and one pillowcase shall be provided for each bed on a weekly basis. Linens shall be changed as often as necessary in order to keep the patients clean, comfortable, and dry. 452.4 Each bed shall be covered with a suitable bedspread or blanket at least during the hours of the day when the bed is not occupied. 452.5 The minimum supply of linen based on patient capacity shall be: Sheets -- four (4) times bed capacity Draw Sheets -- three (3) times bed capacity Pillowcases -- three (3) times bed capacity Bath towels -- two (2) per patient per week Washcloths -- four (4) per patient per week Bedspreads or blankets -- two (2) time bed capacity 452.6 Blankets shall be provided to assure the warmth of each patient and shall be laundered to assure cleanliness and freedom from odors. The blankets shall be individually assigned to patients and not passed indiscriminately to patients without first being laundered. 452.7 Where laundry is provided on the facility premises: 452.7.1 An employee shall be designated in charge of the service. 452.7.2 Table linens shall be laundered separately from bed linen and clothing. 452.7.3 Patients and personal laundry shall not be washed with bed linen. 452.7.4 Equipment and doorways in existing laundries must be so arranged that soiled linen and clothing can be delivered to the washing machines without coming near the dryers and clean laundered material. Hand-washing facilities must be provided for the staff with soap and towel dispensers nearby. 452.7.5 Soiled linens shall be covered or placed in enclosed containers before being transported to the laundry. 452.7.6 Soiled linens shall be stored in a vented area designated only for soiled linens. 452.7.7 Infected linens shall be tagged with a label marked "Infected" prior to being sent to the soiled linen storage room. In the laundry, infected linens shall be disinfected by soaking in a chemical solution before being laundered. 453 EQUIPMENT AND SUPPLIES Nursing equipment and supplies shall be provided to meet the patients' needs and maintained in good condition to ensure adequate nursing care of the patients. 453.1 In nursing homes licensed as Intermediate Care Facilities, the following equipment and supplies shall be provided: ● *Individual soap dishes ● *Mouthwash cups ● *Drinking glasses or cups ● *Items for personal care and grooming ● *Denture cups ● *Wash basins ● *Emesis basins ● *Bedpans ● *Bedpan covers ● *Urinals

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● Hypodermic syringes and needles ● Insulin syringes and needles ● Forceps and forceps jars ● Rubber and plastic sheeting ● Hot water bottles and ice caps with covers ● Grab bars in all bathtub, shower, and toilet areas ● Catheter trays and cover ● Irrigation stands or rods ● Suction machine for each thirty-five (35) patients or a major fraction thereof ● Occupational therapy equipment according to patient needs ● Adjustable crutches, canes and walkers for fifteen percent (15%) of licensed capacity ● One oxygen unit ● Enema equipment ● Rubber rings ● Flashlights ● Examination lights ● Gloves ● Footboards ● Bed rails ● Commode chairs ● Weight scales ● Thermometers ● Bedpan brushes and containers ● Sphygmomanometer ● A bed cover cradle ● Stethoscope ● First Aid equipment and supplies ● Heating pads (waterproof type) ● An emergency medical kit ● A stretcher (collapsible stretcher recommended) ● Trapeze frames for five percent (5%) of licensed capacity ● Wheelchairs for ten percent (10%) of licensed capacity ● Dressing cart or tray with sterile supplies NOTE: * These items shall be assigned to individual patients, kept clean, and maintained or stored at patient's bedside cabinet. 453.2 In nursing homes licensed as Skilled Nursing Facilities, the following equipment and supplies shall be provided in addition to the equipment and supplies necessary for facilities licensed as Intermediate Care Facilities: ● Additional trapeze frames as needed ● Oxygen unit (total of two (2) units required) ● Sterile I.V. equipment ● Tube feeding tray for each thirty-five (35) skilled care patients or major fraction thereof. ● One patient life for each thirty-five (35) skilled care patients or major fraction thereof. ● Wheelchairs for fifteen percent (15%) of licensed capacity ● Sphygmomanometer (total of two (2) required) ● Stethoscope (total of two (2) required) 454 CARE AND CLEANING OF MEDICAL SUPPLIES AND EQUIPMENT 454.1 In homes where commercially packaged sterile disposable items, i.e., dressings, syringes, needles, gloves, catheters, etc., are not provided, a method shall be utilized to achieve sterility for these required items. Suitable methods for sterilization are:

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● Steam autoclave ● ressure cooker ● Liquid sterilizing solution ● Dry heat sterilizer 454.2 Thermometers shall be disinfected by methods approved by the OLTC. One suitable method is to clean the thermometer thoroughly with soap and water and place in solution of iodine one percent (1%) and isopropyl alcohol for at least ten (10) minutes, and then rinse thoroughly with cold water before use. 454.3 Methods approved by the OLTC shall be used to sanitize bedpans, urinals, and emesis basins. 455 STORAGE 455.1 If bedpans, urinals, and emesis basins are assigned to individual patients, they shall be name labeled and stored in the patient's bedside cabinet. They shall be cleansed after each use and sanitized by an approved method at least weekly. If the utensils are not individually assigned, they shall be thoroughly cleansed and effectively sanitized between each use and stored in a bedpan room. After the discharge or transfer of any patient, all such equipment shall be cleansed and boiled or autoclaved prior to reuse. 455.2 There shall be convenient storage space for all linens, pillows, and other bedding items. 455.3 There shall be allotted at least five (5) square feet of general storage space per bed. 455.4 Approved storage shall be provided for all materials such as oxygen and flammable gases. One cylinder of oxygen may be chained onto a cart and maintained at each nurses' station for emergency use in the treatment of patients. All other such flammable gases shall be stored outside the building in a sheltered area or in an oxygen storage room having dual ventilation and at least a one and three-quarter (1 3/4) inch solid core door. Such gases shall be chained or secured in such manner to support them in an upright position. They shall not be stored in an exit-way. 455.5 Facilities shall be provided for storage and preparation of medications and treatments and for storage of active and inactive medical records. 455.6 Storage space shall be provided for recreational equipment and supplies. 456-469 RESERVED 470 HOUSEKEEPING/MAINTENANCE 471 HOUSEKEEPING - MAINTENANCE 471. 1 Housekeeping services of the nursing home shall be under the direction of a full-time experienced person. The facility shall have on duty one (1) housekeeper per thirty (30) residents in order to maintain the nursing home. Housekeeping services shall be provided daily, including weekend daytime coverage and for clean up after the evening meal. Additional staff will be required if deficiencies are found that relate to personnel shortage. 471. 2 Sufficient housekeeping and maintenance equipment shall be available to enable the facility to maintain a safe, clean, and orderly interior. 471. 3 If a facility has a contract with an outside resource for housekeeping services, the facility and/or outside resource shall meet the requirements of these standards. 471. 4 All rooms and every part of the building (exterior and interior) shall be kept clean, orderly, and free of offensive odors. Bath and toilet facilities and food areas shall be clean and sanitary at all times. 471. 5 Rooms shall be cleaned and put in order daily. 471. 6 If a patient keeps his own room, he shall be closely supervised to ensure a clean, orderly room. 471. 7 After discharge of a patient, the room and its contents shall be thoroughly cleaned, aired, and disinfected if necessary. Clean linens shall be provided. All patients' utensils shall be washed and sanitized. 471. 8 Polish or wax used on floors shall be of a type that provides a non-slip finish. Floors shall be maintained in a clean and safe condition.

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471. 9 Deodorants shall not be used to cover up odors. Odor control shall be achieved by prompt cleansing of bedpans, urinals, and commodes, by the prompt and proper care of patients and soiled linens, and by approved ventilation. 471. 10 Attics, cellars, beneath stairs, and similar areas shall be kept clean of accumulation of refuse, old newspapers, and discarded furniture. 471. 11 Storage areas shall be kept in a safe and neat order. 471. 12 Combustibles such as rags and cleaning compounds and fluids shall be kept in closed metal containers and should be labeled as to contents. 471. 13 Buildings and grounds shall be kept free from refuse and litter. 471. 14 Storage facilities with proper ventilation shall be provided for mattresses. 471. 15 All useless items and materials shall be removed from the institution area and premises. 471. 16 Matches and other flammable or dangerous items shall be stored in metal containers with tight-fitting lids and labeled as to contents. 471. 17 Mechanical rooms, boiler rooms, and similar areas shall not be used for storage purposes. 471. 18 All inside openings to attics and false ceilings shall be kept closed at all times. The attic area shall be clean at all times. 471. 19 Mop heads shall be of the removable type and shall be laundered or replaced at frequent intervals to ensure a standard of cleanliness. 471. 20 Straw booms shall not be used for cleaning facility floors.