Construction Standards for New Intermediate Care

19 CSR 30-85.012 Construction Standards for New Intermediate Care and Skilled Nursing Facilities and Additions to and Major Remodeling of Intermediate Care and Skilled Nursing Facilities

PURPOSE: This rule establishes construction standards for new intermediate care and skilled nursing facilities and additions to and remodeling of intermediate care and skilled nursing facilities.

Plans and specifications shall be prepared for the construction of all new intermediate care and skilled nursing facilities and additions to and remodeling of existing facilities. The plans and specifications shall be prepared in conformance with Chapter 327, RSMo, by a duly registered architect or registered professional engineer. III

The facility may submit schematic and preliminary plans to the division showing the basic layout of the building and the general types of construction, mechanical and electrical systems. The facility may submit details before the larger and more complicated working drawings and specifications so that necessary corrections can be easily made before the final plans are submitted. The facility shall prepare and submit working drawings and specifications, complete in all respects, for approval by the division. These plans shall cover all phases of the construction project, including site preparation; paving; general construction; mechanical work, including plumbing, heating, ventilating and air conditioning; electrical work; and all built-in equipment, including elevators, kitchen equipment and cabinet work. II/III

Facilities shall begin construction only after the plans and specifications have received the written approval of the division. Facilities shall then build in conformance with the approved plans and specifications. The facility shall notify the division within five (5) days after construction begins. If construction of the project is not started within one (1) year after the date of approval of the plans and specifications are not completed within a period of three (3) years, the facility shall resubmit the plans to the division for its approval and shall amend them, if necessary, to comply with the then current rules before construction work is started or continued. II/III

The facility shall be located on an all-weather road and have easy access for vehicular traffic. III

Facilities shall have access to local fire protection. III

The facility shall provide adequate roads and walks within the lot lines to the main entrance and service entrance. III

In any new addition, an existing licensed facility shall provide all required ancillary service areas, proportional to the number of new beds. However, for existing facilities, these support service areas may be reduced by the amount of existing areas that meet new facility requirements. New support areas required in this project, whether they are to serve the new beds or the existing beds, shall comply with the rules for new facilities. III

Facilities shall have administrative and public areas as listed: business office, administrator’s office (business office and administrator’s office may be combined); director of nurses’ office; lobby and waiting room (may be combined); public restrooms for each sex; and public telephone. III

The facility shall provide recreation, occupational therapy, activity and residents’ dining space at a ratio of at least thirty (30) square feet for each resident. II

Facilities shall provide a bulk storage area consisting of a locked room, shelving, bins and large cans for storing long-term supplies of food and other dietary materials above the floor in a dry room with adequate ventilation, cool, but not freezing. The bulk storage area shall be one

(1) square foot per bed, but in no case shall it be less than one hundred (100) square feet. III

Facilities shall have dry short-term storage areas for daily food supplies and other dietary materials. The dry short-term storage area may include the space required for bulk storage. III

A facility shall provide a preparation area for wrapping removal, vegetable cleaning and peeling and meat cutting. III

Facilities shall provide adequate cooking and baking areas. III

A facility shall have a salad and sandwich preparation area for the preparation of cold foods. III

Facilities shall provide a tray preparation and loading area for preparing trays for residents’ food delivery and food cart loading. III

A facility shall provide a pot and pan washing area consisting of a three (3)-compartment sink with a double drainboard for the washing of utensils during the food preparation period. III

Facilities shall have a dishwashing area provided with a soiled dish receiving counter, space for scraping with a garbage grinder, prerinse sink, counter for racking dishes, dishwasher, clean dish counter, dish rack storage and an exhaust fan. II/III

A facility shall have a dish storage area with shelves adjacent to the tray preparation area. III

Facilities shall provide refrigerators of adequate capacity in all kitchens and other preparation centers where perishable foods will be stored. A minimum of two (2) separate sections or boxes shall be provided in the main kitchen; one (1) for meat and dairy products and one (1) for general storage. III

The refrigerators’ compressors and evaporators shall have sufficient capacity to maintain temperatures of thirty- five degrees Fahrenheit (35°F) in the meat and dairy boxes and forty degrees Fahrenheit (40°F) in the general storage boxes when the boxes are being used for those purposes. II

These compressors shall be automatically controlled. III

Compressors, piping and evaporators shall be tested for leaks and capacity. Certification of these tests shall be made available to the division. III

A facility shall have an office area for planning menus and food purchases next to the dietary area. III

Kitchen shall have handwashing sinks. III

A facility shall have a janitor’s area, exposed or in a closet, in or near the kitchen, that contains a floor receptor or service sink. III

A garbage removal area with garbage and trash cans located inconspicuously shall be easily accessible from both the kitchen and the service drive. III

Housekeeping areas shall be provided as listed: clean linen area, soiled linen area and laundry area. II

The facility shall have a designated physical therapy area large enough to give rehabilitative care to physically disabled residents. This area shall be sized to accommodate all equipment and activities in the facility’s proposed physical therapy program. In no case shall this area be less than two hundred (200) square feet. III

The facility shall provide the following elements: treatment areas and equipment as dictated by the facility’s physical therapy program; a handwashing sink; an exercise area; storage for clean linen, supplies and equipment; a toilet room located in the physical therapy room or within the immediate area of the physical therapy department; and an office or sufficient space for the physical therapy director’s desk and file. The physical therapy area may be located adjacent to an occupational therapy area and share any or all of the required elements providing that the sharing of elements conforms with the facility’s therapy programs. III

If there is a designated occupational therapy area, it shall be large enough to accommodate all the equipment and activities in the facility’s proposed occupational therapy program. When the facility locates physical therapy and occupational therapy in the same area, there shall be a space that can be separated from the rest of the area if ceramics, sculpture, minor woodwork and light mechanical work are a part of the occupational therapy program. III

Facilities shall provide a maintenance room or area. II

A facility shall provide an employees’ dressing or locker room with separate restrooms for each sex. III

Facilities shall provide storage rooms as listed: general storage—ten (10) square feet per bed for the first fifty (50) beds, plus eight (8) square feet per bed for the next twenty- five (25) beds, plus five (5) square feet per bed for any additional beds over seventy-five (75). No storage room shall be less than one hundred (100) square feet of floor space. The required residents’ clothes storage room and storage for outdoor equipment may be included in the minimum area required for general storage. III

A continuous system of unobstructed corridors, referred to as required corridors, shall extend through the enclosed portion of each story of the building. These corridors will connect all rooms and spaces with each other and with all entrances, exit ways and elevators, with the following exceptions: work suites, such as the administrative suite and dietary area, occupied primarily by employed personnel may contain corridors or aisles as necessary, and will not be subject to the rules applicable to required corridors. Areas may be open to this system as permitted by the 1985 edition of the Life Safety Code, for those facilities with plans approved on or before December 31, 1998. All facilities with plans submitted for approval on or after January 1, 1999, shall comply with the provisions of the 1997 Life Safety Code, incorporated by reference in this rule. II/III

A facility shall provide a personal care room with barber and beauty shop facilities. III

There shall be an oxygen storage room that is surrounded by one (1)-hour rated construction with a powered or gravity vent to the outside. II

Facilities shall have one (1) or more nursing units. A nursing unit shall not exceed a maximum of sixty (60) resident beds. Each nursing unit shall be a single floor continuous area which does not require resident care traffic to traverse other areas. A facility shall not locate a resident room door more than one hundred forty feet (140’) from the nurses’ station and the dirty utility room. II

Resident room area shall be a minimum of eighty (80) square feet per bed in multiple bed resident rooms, and one hundred (100) square feet per bed in one (1)-bed resident rooms. A continuous aisle not less than three feet (3’) wide shall be available around the foot and along both sides of each bed. Facilities shall locate beds to avoid drafts, excessive heat and other residents discomforts. Typical minimum clear dimensions for the bed area in resident rooms shall be as follows:

1-Bed 10’ 6‖ × 9’ 3‖

2-Bed 10’ 6‖ × 15’ 6‖

3-Bed 10’ 6‖ × 21’ 9‖

4-Bed 18’ 0‖ × 15’ 6‖

Heating units and hand washing sinks may protrude into this required space. II

To provide for the isolation of a resident(s) with a communicable disease(s), each unit shall have at least two

(2) private resident rooms provided with a separate room equipped with a toilet and handwashing sink to serve the isolation room only. III

Each resident shall have a wardrobe, locker or

A clothes rod and shelf shall be provided. III

No room shall be occupied by more than four (4) beds. III

No resident shall be housed in a room in which the outside grade line is more than three feet (3’) above the floor level on the window side of the resident room for a distance of at least fifteen feet (15’) from the outside wall of the resident room. The resident rooms shall be outside rooms with minimum window sizes as follows:

1-Bed 10 square feet 2-Bed 16 square feet 3-Bed 24 square feet 4-Bed 32 square feet

These areas are for total window size including frames. III

Each resident, without entering the general corridor area, shall have access to a toilet room. III

One (1) toilet room shall serve no more than six (6) beds and no more than two (2) resident rooms. II/III

The toilet room shall contain a water closet and a lavatory. II

If each resident room contains a handwashing sink, the may omit the handwashing sink from a toilet room that serves adjacent resident rooms. When a handwashing sink is located within the same room as the toilet, the minimum area of a room shall be thirty (30) square feet. If the room contains only a toilet, the minimum area of the room shall be eighteen (18) square feet. III

Each nursing unit shall have a centrally located nurses’ work station with a work counter and storage space for charts. The entire counter shall have a four foot (4’) distance between the wall located behind the counter and the edge of the counter nearest the wall. III

Facilities shall provide a medicine preparation room next to each nurses’ station that has at least sixty (60) square feet of useable floor space. Facilities shall provide a special locked medication cabinet for storage of the Class II medications inside the locked medication cabinet. If the outer cabinets are not locked, the facility must provide a closer and hardware that cannot be left unlocked on the door to the medicine room. A facility is also required to have the following in the medicine room: a work counter, handwashing sink, under cabinet storage, a medicine refrigerator, adequate lighting and provisions for proper temperature control. II/III

Each nursing unit shall have a clean utility room accessible directly from the nursing unit corridor and near enough to the nurses’ station to facilitate control by the nurses. The floor and walls shall have impervious surfaces. The facility shall provide this room with adequate lighting and heating, a handwashing sink and at least one (1) locking cabinet. II/III

Each nursing unit shall have a dirty utility room which is accessible directly from the nursing unit corridor. The floor shall have an impervious surface and the walls shall have impervious surfaces to a minimum height of five feet (5’) above the floor. The room shall be provided with adequate lighting and heating, a double sink, clinic sink and at least one (1) locking cabinet. III

Each nursing unit shall contain one (1) training or handicapped toilet per sex, each with a floor area of at least five feet by six feet (5’ × 6’). This toilet may be located in the central bath. III

Each nursing unit shall have a separate bathroom for each sex. II

Tubs shall be institutional-type, free standing with a minimum of three feet (3’) clearance from the wall on each side and four feet (4’) at the end. The shower shall be a minimum of four feet (4’) wide and of ample length for a wheelchair resident. Thirty-inch by sixty-inch (30‖ × 60‖) Americans with Disability Act (ADA)-approved showers will be accepted. The facility may replace required institutional-type tub(s) with whirlpool tubs or other types of bathing fixtures. III

The aggregate number of tubs or showers or both shall not be less than one for each fifteen (1:15) beds on each floor. II/III

The facility shall provide a locked cabinet in or near each bathroom for the storage of cleaning supplies. III

Centralized bathing facilities shall have fixed partitions or fire-resistant curtains to provide a private compartment for each water closet, bathtub and shower. Curtains or doors shall be installed on access openings. III

Clean linen storage with adequate shelving is required in each nursing unit. III

Each nursing unit must have a stretcher and wheelchair parking area. III

Equipment and supply storage is required in each nursing unit. III

Required corridors shall be at least eight feet (8’) wide and shall be wider at elevators and other points of traffic concentration. No part of the area of any required corridor or aisle shall be counted as part of the required area of any space adjacent to the corridor or aisle. II/III

The width of stairways shall not be less than three feet eight inches (3’ 8‖). The width shall be measured between handrails where handrails project more than three and one- half inches (3 1/2‖). II/III

Doors from sleeping and treatment areas through which residents will pass shall be at least forty-four inches (44‖) wide. Doors to centralized toilets, bathrooms, hair care salons and small day rooms shall be at least thirty-six inches (36‖) wide. Doors to individual toilets adjacent to resident rooms shall be at least thirty-two inches (32‖) II

Exit doors shall swing outward. Doors to rooms shall swing into the rooms they serve. Doors to small toilet rooms may swing outward into the next room and, if they swing inward, they shall be equipped for emergency access. No doors shall swing into required corridors or aisles except doors to janitors’ closets, linen closets or doors to similar small spaces that are open only temporarily. II

Ceilings shall be at least eight feet (8’). Ceilings in corridors, storage rooms, toilet rooms and other minor rooms shall not be less than seven feet six inches (7’ 6‖). Suspended tracks, rails and pipes located in the normal traffic path shall be at least six feet eight inches (6’ 8‖) above the floor. III

Drinking fountains shall be located in or near the lobby and recreation area and in each nursing unit. The fountain shall be accessible to residents in wheelchairs. III

Facilities with plans approved on or before December 31, 1998, shall comply with the American National Standards Institute (ANSI) publication A117.1, 1971, Making Buildings and Facilities Accessible to, and Useable by, the Physically Handicapped. All new facilities whose plans were submitted to the division on or after January 1, 1999, shall comply with ANSI A117.1, 1992, Making Buildings and Facilities Accessible to, and Useable by, the Physically Handicapped, incorporated by reference in this rule. III

Handrails shall be provided on both sides of all corridors and aisles used by residents. Corridor handrails shall have ends return to the wall. III

All stairways shall have handrails on both sides. II

Facilities shall provide grab bars or handrails, secured in proper positions to facilitate the bodily movements of residents, next to all bathtubs, within all showers and on at least one (1) side of all toilets. II

Lavatories shall be positioned to be accessible to wheelchair residents and shall not have cabinets underneath or any other unnecessary obstruction to the maneuverability of wheelchairs. III

The facility shall provide mirrors in each resident’s room or adjoining toilet room. Mirrors shall be at least three feet (3’) high with the bottom edge located no more than three feet four inches (3’ 4‖) above the floor or the facility may use framed tilting mirror(s). III

Facilities shall provide fire-resistant divider curtains attached to the ceiling or walls in all resident rooms other than private or single bedrooms. A facility shall place these divider curtains to provide complete privacy for each bed. III

All new facilities and additions to all areas of existing facilities which undergo major remodeling, shall be of sufficient strength in all their parts to resist all stresses imposed by dead loads, live loads and lateral or uplift forces such as wind, without exceeding, in any of the structural materials, the allowable working stresses established for these materials by generally accepted good engineering practice. II

The following unit live loads shall be the minimum distributed live loads acceptable for the occupancies listed:
- Facility bedrooms and all adjoining service rooms which compose a typical nursing unit (except solariums and corridors)—forty pounds per square foot (40 psf); II
- Solariums, corridors in nursing units and all corridors above the first floor, examination and treatment rooms, laboratories, toilet rooms and locker rooms—sixty (60) psf; II

Offices, conference room, library, kitchen, corridors and other public areas on first the floor—eighty (80) psf; II
Stairways, laundry, large rooms used for dining, recreation or assembly areas and workshops—one hundred (100) psf; II

Records file room, storage and supply—one hundred twenty-five (125) psf; II
Mechanical equipment room—one hundred fifty (150) psf; II

Roofs (except use increased value where snow and ice may occur)—twenty (20) psf; and II
Wind—as required by local conditions but not less than fifteen (15) psf. II
For live loads of one hundred (100) pounds or less per square foot, the design live load on any member supporting one hundred fifty (150) square feet or more may be reduced at the rate of eight hundredths of a percent (0.08%) per square foot of area supported by the member, except that no reductions shall be made for roof live loads or for live loads of areas to be occupied as places of public assembly. The reduction shall exceed neither ―R‖, as determined by the following formula nor sixty percent (60%): II

R = 100 x D + L

4.33 L

where

R = reduction in percent;

D = dead load per square foot of area supported by the member; and

L = design live load per square foot of area supported by the member.

For live loads exceeding one hundred (100) psf, no reduction shall be made, except that the design live loads on columns may be reduced twenty percent (20%). II

Floor areas where partition positions are subject to change shall be designed to support a uniformly distributed load of twenty-five (25) psf in addition to all other loads. II

Foundations shall rest on natural solid ground or properly compacted fill and shall be carried to a depth of not less than one foot (1’) below the estimated frost line or shall rest on leveled rock or load-bearing piles when solid ground is not encountered. Footings, piers and foundation walls shall be adequately protected against deterioration from the action of groundwater. A facility shall take reasonable care to establish proper soil bearing values for the building site soil. If the bearing capacity of a soil is in question, a recognized load test may be used to determine the safe bearing value. II

All facilities with plans approved between June 10, 1981 and December 31, 1998, shall comply with the 1985 edition of the Life Safety Code, and all new facilities with plans approved on or after January 1, 1999, shall comply with the 1997 edition of the Life Safety Code (National Fire Protection Association NFPA 101), which are incorporated by reference in this rule. No provision of the 1997 code will be enforced if it is more restrictive than the code of original plan approval. Facilities may only use the fire safety evaluation system found in the 1995 NFPA 101A, incorporated by reference in this rule, if necessary to justify variance from the text of the Life Safety Code and not as a guide for the total design of a new facility. II

Facilities with plans approved on or before December 31, 1998, shall comply with the fire-resistant rating of structural elements equal to those required by the 1985 Life Safety Code (NFPA 101). Facilities with plans approved on or after January 1, 1999, shall comply with the fire- resistant rating of structural elements equal to those required by the 1997 Life Safety Code (NFPA 101), incorporated by reference in this rule. All facilities shall meet the following additional requirement: exterior walls less than thirty feet (30’) from an adjacent building, property line or parallel wing shall have a two (2)-hour fire- resistant rating. This distance may be reduced to fifteen feet (15’) if a one (1)-hour rated wall is provided with sprinkler protection for each window. II

Doors between rooms and the required corridors shall not have louvres or transoms. They shall be one and three- fourths inches (1 3/4‖) solid-core wood doors or metal doors with equivalent or greater fire-resistance. II

Laundry and trash chutes, where used, shall be of fire- resistant material and installed with a flushing ring, vent to atmosphere and floor drain in the basement. Facilities shall provide an automatic sprinkler at the top of each laundry and trash chute. Each floor shall have a self-closing one and one-half (1 1/2)-hour B-label fire door that shall not open to a corridor. II

Hardware on toilet room doors shall be operable from both the inside and the outside. II

The floors of toilets, baths, bedpan rooms, pantries, utility rooms and janitors’ closets shall have smooth, waterproof surfaces which are wear-resistant. The floors of residents’ rooms shall be smooth and easily cleaned. The floors of kitchens and food preparation areas shall be waterproof, greaseproof, smooth and resistant to heavy wear. II/III

The walls of all rooms where food and drink are prepared, served or stored shall have a smooth surface with painted or equally washable finish. At the base, they shall be waterproof and free from spaces which may harbor ants and roaches. The walls of kitchens, sculleries, utility rooms, baths, showers, dishwashing rooms, janitors’ closets and spaces with sinks shall have waterproof painted, glazed or similar finishes to a point above the splash and spray line. III

The ceilings of all sculleries, kitchens and other rooms where food and drink are prepared shall be painted with washable paint. III

All floor construction shall be completely of noncombustible material regardless of the construction type of the building. II

All new floor covering installed and used in new and existing licensed facilities on or after January 1, 1999, shall be Class I in nonsprinklered buildings and Class II in sprinklered buildings. Class I has a critical radiant flux of zero point forty-five (0.45) or more watts per square centimeter when tested according to the 1995 NFPA 253, incorporated by reference in this rule. Class II has a critical radiant flux of zero point twenty-two (0.22) or more watts per square centimeter when tested according to the 1995 NFPA 253. Those facilities who installed new floor covering on or before December 31, 1998, shall comply with the requirements of the 1978 edition of the NFPA 253. III

A facility shall furnish and install the heating system, steam system, boilers and ventilation to meet all requirements of local and state codes and NFPA regulations. II/III

The building shall be heated by a two (2)-pipe steam system, a forced hot water system, a forced hot air system, a system of electrical heating elements or a combination of two (2) or more of these systems. No open flame space heaters or space heaters receiving combustion air from the heated space shall be used. Facilities shall not depend upon fireplaces for required heating. III
The heating system shall be capable of heating resident-occupied areas to a temperature of eighty degrees Fahrenheit (80°F) (27°C) at the winter design temperature. In spaces where radiant panel heating is used, facilities may reduce the temperature as required to maintain an equivalent comfort level. III

The heating system shall have automatic controls adequate to provide comfortable conditions in all portions of the building at all times. III

Neither the heating nor the ventilating system shall require the circulation of air through openings in the required corridor partitions except for the delivery of ventilating air from corridors through each room door at a velocity of not more than two hundred fifty feet (250’) per minute when the door is closed and the space under it is not over one inch (1‖) in No louvres shall be installed in doors in required corridor partitions. II/III