Health, Family Health and Preparedness, Licensing

Rule R432-16

Hospice Inpatient Facility Construction

Notice of Proposed Rule

(Amendment)

DAR File No.: 35470
Filed: 11/18/2011 04:19:36 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

In Section R432-16-5, coordinates with the revised title of updated federal accessibility standards. In Section R432-16-7, updates a referenced standard that is out of date and out of print. In Section R432-16-13, coordinates with the revised title of updated federal accessibility standards. In Section R432-16-14, eliminates outdated requirements. In Section R432-16-15, coordinates references with changes in other rules. These changes have been vetted in two meetings with providers and interested parties and have been approved by the Health Facilities Committee.

Summary of the rule or change:

In Section R432-16-5, coordinates with federal requirements by changing the reference from the Americans with Disabilities Act Accessibility Guidelines (ADAAG) to the new federal standard titles Americans with Disabilities Act and Architectural Barriers Act Accessibility Guidelines (ADA/ABA-AG). In Section R432-16-7, updates the adopted reference from the 2001 Guidelines for Design and Construction of Hospital and Health Care Facilities to the 2010 edition of the Guidelines for Design and Construction of Health Care Facilities. In Section R432-16-13, coordinates with federal requirements by changing the reference from the Americans with Disabilities Act Accessibility Guidelines (ADAAG) to the new federal standard titles Americans with Disabilities Act and Architectural Barriers Act Accessibility Guidelines (ADA/ABA-AG). In Section R432-16-14, eliminates the prohibition on asbestos insulation that is covered in other laws and eliminates the reference to isolation rooms. Eliminates the requirement for kitchen disposals to be NSF approved. In Section R432-16-15, eliminates the reference to NFPA 99 Health Care Facilities and changes the lighting standard from a reference in nursing facilities that has been deleted to a reference in assisted living facilities.

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 21

This rule or change incorporates by reference the following material:

• Updates Guidelines for Design and Construction of Health Care Facilities, published by ASHE (American Society of Healthcare Engineering), 2010 edition

Anticipated cost or savings to:

the state budget:

The cost of purchasing the new referenced standard and the cost of printing and distribution of the revised rule is covered in Rule R432-4, General Construction, which is being amended concurrent with this rule. No others costs are expected. (DAR NOTE: The proposed amendment to Rule R432-4 is under DAR No. 35459 in this issue, December 15, 2011, of the Bulletin.)

local governments:

The rule change has no impact on local government because these standards are enforced at the state level.

small businesses:

Small business architects and engineers that design the buildings will have the cost of purchasing the new standards. The one inpatient hospice in Utah is not a small business. The cost of the new standards is $168. Assuming one architect purchases a copy of the updated standards the aggregate cost to small business is $168.

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

Inpatient Hospice facilities that build new buildings or renovate existing buildings will have the cost of purchasing the new standards. The cost of the new standards is $168. There is currently only one licensed inpatient hospice center in Utah. Assuming the one licensed inpatient hospice purchases a copy of the updated standards the aggregate cost to business is $168.

Compliance costs for affected persons:

The cost to inpatient hospice centers constructing or remodeling buildings and architects and engineers designing them is the purchase of the new referenced standards at $168. The rule change will not increase compliance costs for providers.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule has been extensively discussed with the regulated businesses and they appear to concur that updating the rule to adopt updated federal accessibility standards and the 2010 edition of the Guidelines for Design and Construction of Health Care Facilities is appropriate. Public comment received will be carefully evaluated for any unforeseen fiscal impact.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Family Health and Preparedness, Licensing
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Joel Hoffman at the above address, by phone at 801-538-6279, by FAX at 801-538-6024, or by Internet E-mail at jhoffman@utah.gov
• Andrew Baxter at the above address, by phone at 801-538-6140, by FAX at 801-538-6325, or by Internet E-mail at andrewbaxter@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

01/17/2012

This rule may become effective on:

01/24/2012

Authorized by:

David Patton, Executive Director

R432. Health, Family Health and Preparedness, Licensing.

R432-16. Hospice Inpatient Facility Construction.

R432-16-1. Legal Authority.

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

 

R432-16-2. Purpose.

The purpose of this rule is to promote quality of life in a home-like setting through the establishment and enforcement of construction standards for hospice inpatient facilities.

 

R432-16-3. Definitions.

(1) "Hospice Inpatient Facility" means a freestanding licensed hospice facility or a licensed hospice unit in an existing health care facility.

(2) "Small Hospice Inpatient Facility" means a hospice facility capable of housing two to eight patients.

(3) "Large Hospice Inpatient Facility" means a hospice facility capable of housing nine or more patients.

 

R432-16-4. Hospice Unit.

(1) Each Hospice Unit is an area identified by the Licensee within a licensed health care facility and consists of at least two resident beds, resident care spaces, and service spaces.

(2) If licensed health care facilities share spaces and service areas, as permitted in this rule, the shared spaces and service areas shall be contiguous to each health care facility served.

(3) A hospice inpatient facility operated in conjunction with another licensed health care facility shall comply with all provisions of this section. Dietary, storage, pharmacy, maintenance, laundry, housekeeping, medical records, and laboratory functions may be shared by two or more health care facilities.

(4) Facility service areas shall be accessible from common areas without compromising resident privacy.

 

R432-16-5. General Design Requirements.

R432-4-1 through R432-4-22 apply with the following modifications.

(1) All public, common, and at least 10 percent of resident toilet rooms and bathrooms shall have fixtures that comply with Americans with Disabilities Act and Architectural Barriers Act Accessibility Guidelines, [(ADAAG) 28 CFR 36, Appendix A, (July 1993)](ADA/ABA-AG).

(2) These rooms shall be wheelchair accessible with wheelchair turning space within the rooms.

(3) "Room or Office" when used in this rule describes a specific, separate, enclosed space for the service. When room or office is not used, multiple services may be accommodated in one enclosed space.

 

R432-16-6. Administrative Areas.

(1) There shall be space and equipment for the administrative services as follows:

(a) In large hospice inpatient facilities, an administrative office of sufficient size to store records and equipment.

(b) In small hospice inpatient facilities, an area may be designated for administrative activities and record storage.

(2) Storage shall be provided for securing staff belongings.

(3) A large hospice inpatient facility shall provide a public reception or information area.

(4) A telephone shall be provided for private use by residents and visitors.

 

R432-16-7. Resident Rooms.

(1) Maximum room occupancy is two residents.

(2) Minimum room areas for new construction (exclusive of toilets, closets, lockers, wardrobes, alcoves or vestibules) shall be 120 square feet in single bed rooms and 100 square feet per bed in multiple-bed room. Existing buildings or spaces being licensed as a hospice shall have a minimum of 80 square feet of clear floor area per bed in multiple-bed areas and 100 square feet of clear floor area in single-bed rooms.

(3) In multiple-bed rooms, clearance shall allow for the movement of beds and equipment without disturbing residents. The dimensions and arrangement of rooms shall be such that there is a minimum of three feet clearance at least at one side, the foot, and between another bed.

(4) A nurse call system shall be provided. Each bed shall be provided with a call device. Two call devices serving adjacent beds may be served by one calling station. Calls in a large inpatient hospice facility shall also activate a visible signal in the corridor at the resident's door.

(5) A nurse emergency call device shall be provided at each inpatient toilet, bath, and shower room. The call device shall be accessible to a collapsed resident lying on the floor. Inclusion of a pull cord will satisfy this standard. The emergency call system shall be designed so that a signal activated at a resident's calling station will initiate a visible and audible signal distinct from the regular nurse call system and can be turned off only at the resident calling station. The signal shall activate an annunciator panel at the nurse station or other location appropriate to ensure immediate nurse notification. Emergency calls in a large hospice inpatient facility shall also activate a visible signal in the corridor at the resident's door.

(6) Each resident shall have access to a toilet room without having to enter the corridor area. One toilet room shall serve not more than four beds and no more than two resident rooms. The toilet room shall contain a water closet and a lavatory. The toilet room door shall swing outward.

(7) At least one single-bed room with a private toilet room containing a toilet, lavatory, and bathing facility shall be provided for each eight beds, or fraction thereof, in a hospice facility.

(a) In addition to the lavatory in the toilet room, in new construction and remodeling, a lavatory or hand washing sink shall be provided in the patient room.

(b) Ventilation shall be in accordance with Table [8.1 of Section 8]7-1 of Part 6 of the Guidelines for Design and Construction [and Equipment of Hospital and Medical]of Health Care Facilities, [2001]2010 edition, which is adopted and incorporated by reference.

(8) Each resident room intended for 24-hour occupancy, shall have an operable window open to the building exterior or to a court which is open to the sky.

(9) Each resident closet shall be a minimum of 22 inches deep by 36 inches wide with a shelf to store clothing and a clothes rod positioned at 70 inches to hang full length garments.

(10) Visual privacy shall be provided for each resident in multiple-bed rooms. Design for privacy shall not restrict resident access to the toilet, lavatory, or room entrance.

 

R432-16-8. Service Requirements.

(1) A nurse station shall be provided and have space for charting, storage, medication security, and administrative activities.

(2) Toilet room(s) with hand washing facilities for staff shall be provided and may be unisex.

(3) Hand washing facilities shall be located immediately adjacent to the nursing station and the drug distribution station.

(4) Provisions shall be made for 24-hour distribution of medications by providing a medicine preparation room or a self-contained medicine dispensing unit. If a medical cart is used it shall be under visual control of staff.

(5) A clean workroom or clean holding room shall be provided for resident care items.

(a) The clean work room shall contain a counter, hand washing facilities and storage facilities.

(b) The work counter and hand washing facilities may be omitted in rooms used only for storage and holding, as part of a larger system for distribution of clean and sterile supply materials.

(6) A soiled workroom shall be provided.

(a) The soiled workroom shall contain a clinical sink, a sink equipped for hand washing, a work counter, waste receptacles, and a linen receptacle.

(b) Hand washing sinks, clinical sinks, and work counters may be omitted in rooms used only for temporary holding of soiled, bagged material.

(c) In small hospice inpatient facilities, accommodations shall be available for cleaning and sanitizing patient service items.

(7) Clean linen shall be stored in a separate closet or room. If a closed cart is used for clean linen storage, it shall be stored in a room with a self closing door. Storage in an alcove in a corridor is prohibited. Clean linen may be stored in the clean work room or a clean holding room.

(8) Resident bathing facilities shall be provided in each hospice unit at a ratio of one bathing facility for each eight beds, or fraction thereof, not otherwise served by bathing facilities within individual resident rooms.

(a) Each resident bathtub or shower shall be in a separate room or enclosure large enough to ensure privacy and to allow staff to assist with bathing, drying, and dressing.

(b) A toilet and hand sink shall be provided at each common bathing area.

(9) An equipment storage room with a minimum area of five square feet for each licensed bed, but no less than 30 square feet, for portable equipment shall be provided.

(10) In small hospice inpatient facilities, accommodation shall be made for storage of portable equipment.

 

R432-16-9. Resident Support Areas.

(1) There shall be resident living areas equipped with tables, reading lamps, and comfortable chairs designed to be usable by all residents. The total area set aside for dining, resident lounges, and recreation area shall be at least 35 square feet per bed with a minimum total area of at least 225 square feet. At least 20 square feet per bed shall be available for dining.

(2) There shall be a general purpose room with a minimum area of 100 square feet. It shall accommodate family gatherings and shall be equipped with a table, comfortable chairs and incandescent lighting. In small hospice inpatient facilities, this room may be omitted if the required living area includes an enclosed lounge.

(3) A minimum area of ten square feet per bed shall be provided for outdoor recreation. This space shall be provided in addition to the setbacks on street frontages required by local zoning ordinances.

 

R432-16-10. General Services.

(1) Large inpatient hospice facilities shall have linen services that comply with R432-4-24(3).

(2) Small inpatient hospice facilities shall have space and equipment to store and process clean and soiled linen as required for patient care.

(3) There shall be one housekeeping room for each hospice unit. There shall be an exhaust for this room that exhausts air to the outside.

(4) Yard equipment and supply storage areas shall be located so that equipment may be moved directly to the exterior without passing through building rooms or corridors.

 

R432-16-11. Food Service.

(1) Food service facilities and equipment shall comply with R392-100, the Utah Department of Health Food Service Sanitation Rules.

(2) Food service space and equipment shall be provided as follows:

(a) Storage area for food supplies, including a cold storage area for a seven-day supply of staple foods and a three-day supply of perishable foods;

(b) Food preparation area;

(c) An area to serve and distribute resident meals;

(d) An area for receiving, scraping, sorting, and washing soiled dishes and tableware;

(e) A storage area for waste located next to an outside facility exit for direct pickup;

(f) An area for meal planning.

 

R432-16-12. Waste Storage and Disposal.

Facilities and equipment shall be provided for the sanitary storage and treatment or disposal of all categories of waste, including hazardous and infectious wastes if applicable, using techniques required by the Utah Department of Environmental Quality, and the local health department having jurisdiction.

 

R432-16-13. Details and Finishes.

Details and finishes shall comply with the following:

(1) Corridor handrails shall be provided. [and]Handrail design shall comply with [ADAAG]ADA/ABA-AG.

(2) Cubicle curtains and draperies shall be affixed to permanently mounted tracks or rods. Portable curtains or visual barriers are not permitted.

(3) Signs shall be provided as follows:

(a) general and circulation direction signs in corridors;

(b) identification at each door; and

(c) emergency directional signs;

(d) all signs in corridors shall comply with [ADAAG]ADA/ABA-AG.

(4) All partition and all floor and ceiling construction in resident areas shall comply with the noise reduction criteria of Table 1 for sound control.

(5) Floor materials shall be easily cleanable.

(6) Floors in areas used for food preparation or food assembly shall be water-resistant. Floor surfaces, including tile joints, shall be resistant to food acids.

(7) In areas subject to frequent wet-cleaning, the floor materials shall be sealed to prevent contamination by germicidal cleaning solutions.

(8) Floors and wall bases of kitchens, toilet rooms, bath rooms, and housekeeping rooms shall be homogeneous or joints shall be tightly sealed. Bases shall be integrated with the floor and coved.

(9) Wall finishes shall be washable and, in the immediate vicinity of plumbing fixtures, smooth and moisture-resistant.

(10) Finish, trim, floor, and wall construction in food preparation areas shall be free of insect and rodent harboring spaces.

(11) Floor and wall openings for pipes, ducts, conduits, and joints of structural elements shall be tightly sealed to prevent entry of pests.

(12) Carpet and padding shall be stretched taut and be free of loose edges.

(13) Finishes of all exposed ceilings and ceiling structures in resident rooms and staff work areas shall be cleanable.

(14) Finished ceilings are not required in mechanical and equipment spaces, shops, general storage areas, and similar spaces, unless required for fire resistive purposes.

(15) Finished ceilings shall be provided in areas where dust fallout might occur.

 

TABLE 1

Sound Transmission Limitations
in Hospice Care Facilities

Airborne Sound Transmissions

Class (STC)(a)


Class (IIC) (b)                      Partitions     Floors

(Residents')

room to resident's room                  35           40

Public space to

(residents) room (b)                     40           40

Service areas to

(residents') room (c)                    45           45



     (a)  Sound transmissions (STC) shall be determined by

tests in accordance with Standard E90 and ASTM Standard E413.

Where partitions do not extend to the structure above, the

designer shall consider sound transmissions through ceilings

and composite STC performance.

     (b)  Public space includes lobbies, dining rooms,

recreation rooms, treatment rooms, and similar space.

     (c)  Service areas include kitchens, elevators, elevator

machine rooms, laundry rooms, garages, maintenance rooms,

boilers and mechanical equipment rooms and similar spaces of

high noise.  Mechanical equipment located on the same floor or

above patient rooms, offices, nurses' stations, and similarly

occupied space shall be effectively isolated from the floor.

 

R432-16-14. Mechanical Standards.

(1) Mechanical tests shall be conducted prior to final Department construction inspection.

(2) Written test results shall be retained in facility maintenance files and available for Department review.

[(3) Insulation containing any asbestos is prohibited.

(4)](3) Air conditioning, heating, and ventilating systems shall include:

(a) A heating system capable of maintaining a temperature of 80 degrees Fahrenheit in areas occupied by residents.

(b) A cooling system capable of maintaining a temperature of 72 degrees Fahrenheit in areas occupied by residents.

(c) Evaporative coolers may not be used.

[(d) Isolation rooms may be ventilated by reheat induction units in which only the primary air supplied from a central system passes through the reheat unit. No air shall be recirculated into the building system.

(e)](d) Supply and return systems must be within a duct. Common returns using corridor or attic spaces as return plenums are prohibited.

[(f)](e) Filtration shall be provided when mechanically circulated outside air is used.

[(g) Gravity exhaust may be used, where conditions permit, for boiler rooms, central storage, and other nonresident areas.

(5)](4) Plumbing and other Piping Systems shall include:

(a) Hand washing facilities that are arranged to provide sufficient clearance for single-lever operating handles.

(b) Dishwashers[, disposals] and other kitchen food storage or cooking appliances [that are]shall be National Sanitation Foundation (NSF) approved and have the NSF seal affixed.

(c) Kitchen grease trap location shall comply with local health department rules.

(d) Hot water provided in patient tubs, showers, whirlpools, and hand washing facilities shall be regulated by thermostatically controlled automatic mixing valves. These valves may be installed on the recirculating system or on individual inlets to appliances. The temperature of hot water for patient fixtures shall range between 105 and 115 degrees Fahrenheit.

 

R432-16-15. Electric Standards.

(1) The Licensee shall maintain written certification to the Department verifying that systems and grounding comply with NFPA 99 and NFPA 70.

(2) Approaches to buildings and all spaces within buildings occupied by people, machinery, or equipment shall have fixtures for lighting in accordance with the requirements of the Illuminating Engineering Society of North America (IESNA). Parking lots shall have fixtures for lighting to provide light levels as recommended in IES Recommended Practice RP-20-1998, Lighting for parking facilities by Illuminating Engineering Society of North America.

(3) Automatic emergency lighting shall be provided in accordance with [NFPA 99 and] NFPA 101.

(4) General lighting shall be provided as required in [R432-5-15(2)]R432-6, table 4.

 

R432-16-16. Penalties.

The Department may assess a civil money penalty up to $10,000 and deny approval for patient utilization of new or remodeled areas if a health care provider does not submit architectural drawings to the Bureau of Licensing. The Department may assess a civil money penalty of up to $10,000 if the licensee fails to follow Department-approved architectural plans. The Department may assess a civil money penalty of up to $1,000 per day for each day a new or renovated area is occupied prior to licensing agency approval.

 

KEY: health care facilities

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

Notice of Continuation: February 11, 2008

Authorizing, and Implemented or Interpreted Law: 26-21-5; 26-21-16