SubPart 713-2 - Standards for nursing home construction projects completed or approved between August 25, 1975 and July 1, 1990

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete
Statutory Authority: 
Public Health Law Section 2803

Section 713-2.1 - Applicability

713-2.1 Applicability.

(a) This Subpart sets forth minimum construction and physical environment standards applicable to: (1) nursing home facilities built and to portions of nursing home facilities renovated or altered pursuant to department or commissioner approval granted between August 25, 1975 and July 1, 1990; and (2) other nursing home facility construction projects that did not require department or commissioner approval and were completed between August 25, 1975 and July 1, 1990.

(b) This Subpart applies to skilled nursing facilities. Chronic disease hospitals shall comply with the requirements for general hospitals set forth in Part 712 of this Title, except that the functional requirements shall be modified as required by the department, to satisfy the specific needs of the chronic disease program.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.2 - Pertinent standards

713-2.2 Pertinent standards.

Nursing homes shall comply with all pertinent requirements, technical standards and codes set forth or incorporated by reference into Part 711 of this Title, including, but not limited to, Chapter 19, "Existing Health Care Occupancies", of NFPA 101, Life Safety Code, 2000 edition, which is referenced in more detail in section 711.2(a) of this Title.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.3 - Minimum bed capacities

713-2.3 Minimum bed capacities.

Unless the commissioner approves fewer beds, a nursing home unit of a hospital shall have a minimum of thirty certified beds and a freestanding nursing home facility shall have a minimum of sixty certified beds.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.4 - Space and area requirements

713-2.4 Space and area requirements.

The commissioner may approve modifications or deletions in space requirements set forth in this Subpart when nursing home services or facilities are permitted to be shared. The sizes of the various departments will depend upon program requirements and organization of services within the facility. Some functions requiring separate spaces or rooms may be combined, provided that the resulting plan will not compromise the best standards of safety and of medical and nursing practices.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
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Section 713-2.5 - Nursing units

713-2.5 Nursing units.

(a) The number of certified beds on a nursing unit shall not exceed sixty unless additional services are provided. At least two-thirds of the total certified beds in any facility shall be located in rooms designed for one or two beds. At least one-tenth of the total certified beds in any facility shall be located in single bedrooms, each equipped with a private bath and toilet.

(b) Each resident bedroom shall meet the following requirements:

(1) The maximum room capacity shall be four residents.

(2) The minimum room areas exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules shall be one hundred twenty five square feet in single bedrooms and one hundred square feet per bed in multi-bed rooms.

(3) Each room shall have a window that can be opened without the use of tools. The windowsills shall not be higher than three feet above the finished floor and shall be above grade.

(4) A nurses' calling system shall be provided.

(5) One lavatory shall be provided in each resident room. The lavatory may be omitted from a single or a double bedroom when a lavatory is located in an adjoining toilet room, which serves that room only.

(6) Each resident shall have access to a toilet room without entering the general corridor area. One toilet room shall serve no more than four certified beds and no more than two resident rooms. The toilet room shall contain a water closet and a lavatory. The lavatory may be omitted only from a toilet room that serves not more than two single bedrooms if each such single bedroom contains a lavatory.

(7) Each resident shall have a wardrobe, locker, or closet with minimum clear dimensions of one foot ten inches by one foot eight inches. An adjustable clothes rod and shelf shall be provided.

(8) Visual privacy shall be provided for each resident in multi-bed rooms with non-combustible cubicle curtains.

(9) No resident bedroom shall be located more than one hundred twenty feet from the soiled workroom or the soiled holding room, or the clean work room or clean holding room.

(c) The following service areas shall be located in or be readily available to each nursing unit:

(1) A nurses' station with space for nurses' charting, doctors' charting, and storage for administrative supplies.

(2) A lounge and toilet room(s) for nursing staff.

(3) Individual closets or compartments for the safekeeping of coats and personal effects of nursing personnel. These shall be located convenient to the duty station of personnel or in a central location.

(4) Nursing homes that do not have exclusively single bedrooms shall have a medical treatment and examination room for residents. This room shall have a minimum floor area of one hundred twenty square feet excluding space for vestibule, toilet, closets, and work counters, whether fixed or movable. The minimum room dimension shall be ten feet. The room shall contain a lavatory or sink equipped for handwashing; a work counter; storage facilities; and a desk, counter or shelf space for writing.

(5) A clean workroom with a work counter, handwashing, and storage facilities or a clean holding room that is part of a system for storage and distribution of clean and sterile supply materials. The clean holding room shall be similar to the clean workroom except that the work counter and handwashing facilities may be omitted.

(6) A soiled workroom that contains a clinical sink or equivalent flushing rim fixture, a sink equipped for handwashing, work counter, waste receptacle, and linen receptacle, or a soiled holding room that is part of an approved system for collection and disposal of soiled materials. The soiled holding room and shall be similar to the soiled workroom except that the clinical sink and work counter may be omitted.

(7) A medication preparation room, or self contained medication dispensing unit or a department approved medication dispensing system for the convenient and prompt twenty four hour distribution of medication to residents. If used, a medicine preparation room or unit shall be under the nursing staff's visual control and contain a work counter, refrigerator, and locked storage for biologicals and drugs. A medication dispensing unit may be located at the nurses' station, in the clean workroom, or in an alcove or other space under direct control of the nursing or pharmacy staff.

(8) A separate closet, designated area within the clean workroom or closed cart system for storage of clean linen. If a closed cart system is used, storage may be in an alcove.

(9) A nourishment station that contains a sink equipped for handwashing, equipment for serving nourishment between scheduled meals, a refrigerator and storage cabinets. Ice for residents' service and treatment shall be provided only by ice-maker dispenser units.

(10) A storage room for equipment such as intravenous stands, inhalators, air mattresses, and walkers.

(11) An area out of the path of normal traffic for parking for stretchers and wheelchairs.

(12) At least one bathtub or shower for every twelve beds in rooms that are not otherwise served by bathing facilities. At least one bathtub shall be provided in each nursing unit. Each tub or shower shall be in a room or enclosure with space for the private use of the bathing fixture, for drying and dressing, and for a wheelchair and an attendant. Showers in central bathing facilities shall be at least four feet square, without curbs and designed to permit use by a wheelchair bound resident.

(13) Facilities for the sterilization of equipment and supplies.

(d) Residents' toilet facilities shall comply with the following:

(1) The minimum dimensions of a room containing only a water closet shall be three feet by six feet; additional space shall be provided if a lavatory is located within the same room. Water closets must be conveniently located and usable by wheelchair bound residents.

(2) At least one room with a lavatory and water closet on each nursing floor shall be provided for toilet training. It shall be accessible from the nursing corridor. A clearance of three feet shall be provided at the front and at each side of the water closet.

(3) A toilet room shall be accessible to each central bathing area without going through the general corridor. This may be arranged to serve as the required toilet training facility.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.6 - Resident dining and recreation areas

713-2.6 Resident dining and recreation areas.

(a) Resident dining and recreation areas shall be not less than thirty square feet per certified bed for the first one hundred certified beds and twenty seven square feet per certified bed for all certified beds in excess of one hundred. Additional space shall be provided for visitors who participate in an adult day health care program.

(b) Storage space shall be provided for recreational equipment, within or adjacent to dining room.

(c) Toilets for resident use shall be located within or immediately adjacent to the dining room.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.7 - Physical therapy facilities

713-2.7 Physical therapy facilities.

Physical therapy facilities shall include the following:

(a) Treatment areas with space and equipment for thermotherapy, diathermy, ultrasound and hydrotherapy. Provision shall be made for cubicle curtains around each individual treatment area, handwashing facility(ies) (one lavatory or sink may serve more than one cubicle), and facilities for the collection of soiled linen and other material.

(b) An exercise area.

(c) Storage for clean linen, supplies, and equipment.

(d) Residents' dressing areas, showers, lockers, and toilet rooms, as may be required by the functional program approved by the department.

(e) A service sink.

(f) Wheelchair and stretcher storage.

(g) Office space.

(h) The requirements of subdivisions (c), (d), (e), (f) and (g) of this section may be planned and arranged for shared use by residents receiving occupational therapy and staff if the approved functional program reflects this sharing concept.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.8 - Occupational therapy facilities

713-2.8 Occupational therapy facilities.

Occupational therapy facilities shall include the following:

(a) An activities area with a sink or lavatory and facilities for collection of waste products prior to disposal.

(b) Storage for supplies and equipment.

(c) Residents' toilet rooms, which may be shared with residents receiving physical therapy and staff, if the approved narrative program reflects this sharing concept.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.9 - Personal care rooms

713-2.9 Personal care rooms.

A separate room shall be provided for hair care and grooming needs of residents.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.10 - Dietary facilities

713-2.10 Dietary facilities.

(a) Construction, equipment, and installation of dietary facilities shall comply with the standards in Part 14 of this Title (State Sanitary Code). Food service facilities shall be designed and equipped to meet the requirements of the narrative program. These may consist of an on-site conventional food preparation system, a convenience food service system, or an appropriate combination thereof.

(b) The following functional elements shall be provided in such size as required to implement the type of food service system selected:

(1) A control station for receiving food supplies.

(2) Storage space for four days' supply including cold storage.

(3) Food preparation facilities as required by the narrative program. Conventional food preparation systems require space and equipment for preparing, cooking and baking. Convenience food service systems such as frozen prepared meals, bulk packaged entrees, individual packaged portions, or systems using contractual commissary services will require space and equipment for thawing, portioning, cooking, or baking.

(4) Handwashing facility(ies) in the food preparation area.

(5) Resident meal service space including facilities for tray assembly and distribution.

(6) Dining area for ambulatory residents, staff, and visitors.

(7) Ware washing in a room or an alcove separate from food preparation and serving areas. This shall include commercial-type dishwashing equipment. Space also shall be provided for receiving, scraping, sorting, and stacking soiled tableware and for transferring clean tableware to the using areas. A lavatory shall be conveniently available.

(8) Pot washing facilities.

(9) Sanitizing facilities and storage areas for cans, carts, and mobile tray conveyors. The sanitizing facilities may be combined with those required for linen services.

(10) Waste storage facilities in a separate room that is easily accessible to the outside for direct pickup or disposal.

(11) Office or suitable workspace for the dietitian or the dietary service manager.

(12) Toilets for dietary staff with handwashing facilities immediately available.

(13) A janitors' closet located within the dietary department. It shall contain a floor receptor or service sink and storage space for housekeeping equipment and supplies.

(14) Self-dispensing ice making facilities.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.11 - Administration and public areas

713-2.11 Administration and public areas.

Administration and public areas shall include and comply with the following:

(a) An entrance at grade level, sheltered from the weather and able to accommodate wheelchairs.

(b) A lobby, which shall include:

(1) storage space for wheelchairs;

(2) a reception and information counter or desk;

(3) waiting space(s);

(4) public toilet facilities;

(5) public telephone(s); and

(6) drinking fountain(s).

(c) Interview space(s) for private interviews relating to social services, credit and admissions.

(d) General or individual office(s) for business transactions, medical and financial records, and administrative and professional staff.

(e) A multi-purpose room for conferences, meetings and health education purposes including facilities for showing visual aids.

(f) Storage for office equipment and supplies.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.12 - Linen services

713-2.12 Linen services.

(a) If linen is to be processed on the site, the following shall be provided:

(1) A laundry processing room with commercial-type equipment that can process seven days' needs within a regularly scheduled work week. Handwashing facilities shall be provided.

(2) A soiled linen receiving, holding and sorting room with handwashing facilities.

(3) Storage for laundry supplies.

(4) A clean linen inspection and mending room or area.

(5) A clean linen storage, issuing and holding room area.

(6) A janitors' closet containing a floor receptor or service sink and storage space for housekeeping equipment and supplies.

(7) Sanitizing facilities and storage area for carts. The sanitizing facilities may be combined with those required for dietary facilities.

(b) If linen is processed off the site, the following shall be provided:

(1) A soiled linen holding room.

(2) Clean linen receiving, holding, inspection and storage room(s).

(3) Sanitizing facilities and storage area for carts. The sanitizing facilities may be combined with those required for dietary facilities.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.13 - Central stores

713-2.13 Central stores.

General storage room(s) shall have a total area of not less than ten square feet per certified bed and shall generally be concentrated in one area.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.14 - Employees' facilities

713-2.14 Employees' facilities.

In addition to employees' facilities such as locker rooms, lounges, toilets or shower facilities called for in certain departments, a sufficient number of such facilities as required to accommodate the needs of all personnel and volunteers shall be provided.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.15 - Janitors' closets

713-2.15 Janitors' closets. In addition to the janitors' closets called for in certain departments, sufficient janitors' closets shall be provided throughout the facility to maintain a clean and sanitary environment. These shall contain a floor receptor or service sink and storage space for housekeeping equipment and supplies.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.16 - Engineering service and equipment areas

713-2.16 Engineering service and equipment areas.

Engineering service and equipment areas shall include the following:

(a) equipment room(s), which shall consist of room(s) or separate building(s) for boilers, mechanical equipment and electrical equipment;

(b) engineers' quarters providing office or suitable desk space for engineers;

(c) maintenance shop(s);

(d) storage room(s) for building maintenance supplies which may be part of maintenance shop in nursing homes of less than one hundred beds; and

(e) yard equipment storage which shall consist of a separate room or building for year maintenance equipment and supplies.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.17 - Waste processing facilities and services

713-2.17 Waste processing facilities and services.

(a) Space and facilities shall be provided for the sanitary storage and disposal of waste by incineration, mechanical destruction, compaction, containerization, removal or by a combination of these techniques.

(b) A gas, electric or oil-fired incinerator shall be provided on site or by off-site shared services for the complete destruction of infectious waste. Infectious waste shall include, but shall not be limited to, dressings from open wounds, laboratory specimens, and all waste material from isolation rooms. If an incinerator is on site, it shall be located in a separate room or outdoors and shall meet the following requirements:

(1) Design and construction of incinerators and trash chutes shall be in accordance with NFPA 82, Standard on Incinerators and Waste and Linen Handling Systems and Equipment. Further details concerning this referenced material are contained in section 711.2(a) of this Title.

(2) Incinerators shall be designed and installed in accordance with the terms of the permit to construct, issued by the Department of Environmental Conservation.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.18 - Details and finishes

Section 713-2.18 Details and finishes.

A high degree of safety for the occupants shall be provided to minimize the incidence of accidents with special consideration for ambulatory residents to enhance their ability to care for themselves. Hazards such as sharp corners shall be avoided.

(a) Details shall comply with the following requirements:

(1) Compartmentation, corridors, widths, exits, automatic extinguishment systems, and other details relating to fire prevention and fire protection shall comply with requirements applicable to existing health care occupancies set forth in NFPA 101, Life Safety Code, 2000 edition. Further details concerning this referenced material are contained in section 711.2(a) of this Title.

(2) Items such as drinking fountains, telephone booths, vending machines, and portable equipment shall be located so as not to restrict corridor traffic or reduce the corridor width below the required minimum.

(3) All rooms containing bathtubs, sitz baths, showers and water closets that are used or subject to occupancy by residents shall be equipped with doors and hardware that permit access from the outside in any emergency. When such rooms have only one opening or are small, the doors shall be capable of opening outwards or be otherwise designed to be opened without need to push against a resident who may have collapsed within the room.

(4) The minimum width of all doors to rooms needing access for beds or stretchers shall be three feet eight inches. Doors to resident toilet rooms and other rooms needing access for wheelchairs shall have a minimum width of two feet ten inches.

(5) Doors on all openings between corridors and rooms or spaces subject to occupancy, except elevator doors, shall be swing type. Openings to showers, baths, residents' toilets, and other small wet-type areas not subject to fire hazard are exempt from this requirement.

(6) Windows and other doors which may be frequently left in an open position shall be provided with insect screens.

(7) Windows shall be designed to prevent accidental falls when open, or shall be provided with security screens.

(8) Except for doors to spaces that are not subject to occupancy such as small closets, all doors shall not swing into corridors in a manner that might obstruct traffic flow or reduce the required corridor width. Large walk-in type closets are considered spaces subject to occupancy.

(9) Doors, sidelights, borrowed lights, and windows in which the glazing extends down to within eighteen inches of the floor, thereby creating possibility of accidental breakage by pedestrian traffic, shall be glazed with safety glass, wire glass, or plastic glazing material that will resist breaking and will not create dangerous cutting edges when broken. Similar materials shall be used in wall openings of recreation rooms and exercise rooms unless required otherwise for fire safety. Glazing materials as noted above shall be used for shower doors and bath enclosures.

(10) Where labeled fire doors are required, these shall be certified by an independent testing laboratory as meeting the construction requirements equal to those for fire doors in NFPA 80, Standard for Fire Doors and Fire Windows, 1999 edition. Reference to a labeled door shall be construed to include labeled frame and hardware. Further details concerning the material referenced herein are contained in section 711.2(a) of this Title.

(11) Elevator shaft openings shall have Class B 1-1/2-hour labeled fire doors.

(12) Linen and refuse chutes shall meet or exceed the following requirements:

(i) Service openings to chutes shall not be located in corridors or passageways but shall be located in a room of construction having a fire resistance of not less than two hours. Doors to such rooms shall be not less than Class B 1-1/2-hour labeled fire doors.

(ii) Service openings to chutes shall be approved self-closing Class B 1-1/2-hour labeled fire doors.

(iii) Minimum cross-sectional dimension of gravity chutes shall be not less than two feet.

(iv) Chutes shall discharge directly into collection rooms separate from incinerators, laundry, or other services. Separate collection rooms shall be provided for trash and for linen. The enclosure construction for such rooms shall have a fire resistance of not less than two hours, and the doors thereto shall be not less than Class B 1-1/2 fire doors.

(v) Gravity chutes shall extend through the roof with provisions for continuous ventilation as well as for fire and smoke ventilation. Openings for fire and smoke ventilation shall have an effective area of not less than four feet above the roof and not less than six feet clear of other vertical surfaces. Fire and smoke ventilating openings may be covered with single strength sheet glass.

(13) Dumbwaiters, conveyors and material handling systems shall not open directly into a corridor or exit way but shall open into a room enclosed by construction having a fire resistance of not less than one hour and provided with Class C 3/4 labeled fire doors. Service entrance doors to vertical shafts containing dumbwaiters, conveyors, and material handling systems shall be not less than Class B 1-1/2-hour labeled fire doors. Where horizontal conveyors and material handling systems penetrate fire-rated walls or smoke partitions, such openings must be provided with Class B 1-1/2-hour labeled fire doors for two hour walls and Class C 3/4-hour labeled fire doors for one hour walls or partitions.

(14) Thresholds and expansion joint covers shall be made flush with the floor surface to facilitate use of wheelchairs and carts.

(15) Grab bars shall be provided at all residents' toilets, showers, tubs and sitz baths. The bars shall have one and one-half inch clearance to walls and shall have sufficient strength and anchorage to sustain a concentrated load of two hundred fifty pounds.

(16) Recessed soap dishes shall be provided in showers and bathrooms.

(17) Handrails for use by residents shall be provided on both sides of corridors. A clear distance of one and a half inches shall be provided between the handrail and the wall.

(18) Ends of handrails and grab bars shall be constructed to prevent snagging the clothes of residents.

(19) Location and arrangement of handwashing facilities shall permit their proper use and operation. Particular care should be given to the clearances required for blade-type operating handles. Lavatories intended for use by residents shall be installed to permit use by residents in wheelchairs.

(20) Mirrors shall be arranged for convenient use by residents in wheelchairs as well as by residents in a standing position.

(21) Paper towel dispensers and waste receptacles shall be provided at all handwashing fixtures.

(22) Ceiling heights shall be as follows:

(i) Boiler rooms shall have ceiling clearances not less than two feet six inches above the main boiler header and connecting piping.

(ii) Rooms containing ceiling-mounted equipment shall have height required to accommodate the equipment.

(iii) All other rooms shall have not less than eight foot ceilings except that corridors, storage rooms, toilet rooms, and other minor rooms may be not less than seven feet eight inches. Suspended tracks, rails and pipes located in path of normal traffic shall be not less than six feet eight inches above the floor.

(23) Recreation rooms, exercise rooms, and similar spaces where impact noises may be generated shall not be located directly over resident bed unless special provisions are made to minimize such noise.

(24) Rooms containing heat-producing equipment, such as boiler or heater rooms and laundries, shall be insulated and ventilated to prevent any floor surface above from exceeding a temperature ten degrees Fahrenheit above the ambient room temperature.

(b) Finishes shall comply with the following:

(1) Cubicle curtains and draperies shall be noncombustible and shall pass both the large and small scale test of set forth in NFPA 701, Standard Methods of Fire Tests for Flame Propagation of Textiles and Films, 1999 edition. Further details concerning this material referenced herein are contained in section 711.2(a) of this Title.

(2) Floor materials shall be easily cleanable and have wear resistance appropriate for the location involved. Floors in areas used for food preparation or food assembly shall be water-resistant and greaseproof. Joints in tile and similar material in such areas shall be resistant to food acids. In all areas frequently subject to wet cleaning methods, floor materials shall not be physically affected by germicidal and cleaning solutions. Floors that are subject to traffic while wet, such as shower and bath areas, kitchen and similar work areas, shall have a nonslip surface.

(3) Wall bases in kitchen, soiled workrooms, and other areas which are frequently subject to wet cleaning methods shall be made integral and coved with the floor, tightly sealed within the wall, and constructed without voids that can harbor insects.

(4) Wall finishes shall be washable and the immediate area surrounding plumbing fixtures shall be smooth and moisture resistant. Finish, trim, and wall and floor construction in dietary and food preparation areas shall be free from spaces that can harbor rodents and insects.

(5) Floor and wall penetrations by pipes, ducts and conduits shall be tightly sealed to minimize entry of rodents and insects. Joints of structural elements shall be similarly sealed.

(6) Ceilings throughout the facility shall be easily cleanable. Ceilings in the dietary and food preparation areas shall have a finished ceiling covering all overhead piping and duct work. Finished ceilings may be omitted in mechanical and equipment spaces, shops, general storage areas, and similar spaces, unless required for fire-resistive purposes.

(7) Acoustical ceilings shall be provided for corridors in resident areas, nurses' stations, dayrooms, recreation rooms, dining areas and waiting areas.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.19 - Construction, including fire-resistive requirements

713-2.19 Construction, including fire-resistive requirements.

(a) Every building and every portion thereof shall be designed and constructed to sustain all dead and live load in accordance with accepted engineering practices and standards, including seismic forces, where they apply.

(b) Foundations shall rest on natural solid bearing if a satisfactory bearing is available at reasonable depths. Proper soil-bearing values shall be established in accordance with recognized standards. If solid bearing is not encountered at practical depths, the structure shall be supported on driven piles or drilled piers designed to support the intended load without detrimental settlement, except that one-story buildings may rest on a fill designed by a soils engineer. When engineered fill is used, site preparation and placement of fill shall be done under the direct full-time supervision of the soils engineer. The soils engineer shall issue a final report on the compacted fill operation and certification of compliance with the job specifications. All footings shall extend to a depth not less than one foot below the estimated maximum frost line.

(c) Construction standards for nursing home facilities shall comply with the following:

(1) One-story buildings shall be of Type I, or Type II (222) or (111) construction; buildings with two or more stories shall be of Type I construction. Building construction types shall be as defined in NFPA 220, Standard on Types of Building Construction, 1999 edition. Further details concerning the material referenced herein are contained in section 711.2(a) of this Title.

(2) Enclosures for stairs, elevator shafts, chutes and other vertical shafts, boiler rooms, and storage rooms of one hundred square feet or greater area, shall be of construction having a fire resistance rating of at least two hours.

(d) Separate freestanding buildings housing the boiler plant, laundry, shops, or general storage may be of Type I, or Type II (222) or (111) construction. Building construction types shall be as defined in NFPA 220, Standard on Types of Building Construction, 1999 edition. Further details concerning the material referenced herein are contained in section 711.2(a) of this Title.

(e) Building insulation materials, unless sealed on all sides and edges, shall have a flame spread rating of twenty five or less and a smoke developed rating of one hundred fifty or less when tested in accordance with NFPA 255,

Standard Method of Test of Surface Burning Characteristics of Building Materials, 2000 edition.

Further details concerning the material referenced herein are contained in section 711.2(a) of this Title.

(f) An emergency radio communication system shall be provided in each facility. This system shall be self-sufficient in times of emergency and capable of operation without reliance on the building service or emergency electric power supply. It shall also be linked with the available community or State emergency communication network, including connections with police and fire department or system.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.20 - Elevators

713-2.20 Elevators.

All buildings that have residents' facilities such as bedrooms, dining rooms or recreation areas, or critical services, such as diagnostic or therapy areas located on a floor other than the main entrance floor shall have electric or electrohydraulic elevators. All buildings with elevators shall comply with the requirements of this section.

(a) The facility shall have the following minimum number of elevators:

(1) At least one hospital-type elevator shall be installed where one to fifty nine resident beds are located on any floor other than the main entrance floor.

(2) At least two elevators, one of which shall be hospital-type, shall be installed where sixty to two hundred certified resident beds are located on floors other than the main entrance floor, or where the major resident services are located on a floor other than those containing certified resident beds. Elevator service may be reduced for those floors that provide only partial resident services.

(3) At least three elevators, one of which shall be hospital-type shall be installed where two hundred one to three hundred fifty certified resident beds are located on floors other than the main entrance floor, or where a major resident services are located on a floor other than those containing certified resident beds. Elevator service may be reduced for those floors that provide only partial resident services.

(4) For facilities with more than three hundred fifty certified resident beds, the number of elevators shall be determined from a study of the facility plan and the estimated vertical transportation requirements.

(b) Hospital-type elevator cars shall have inside dimensions that will accommodate a resident bed and attendants, and shall be at least five feet wide by seven feet six inches deep. The car door shall have a clear opening of not less than three feet eight inches wide.

(c) Elevators shall be equipped with an automatic leveling device of the two-way automatic maintaining type with an accuracy of one-half inch.

(d) Elevators, except freight elevators, shall be equipped with a two-way special service switch to permit cars to bypass all landing button calls and be dispatched directly to any floor.

(e) Elevator controls, alarm button and telephones shall be accessible to wheelchair occupants.

(f) Elevator call buttons, controls and door safety stops shall be of a type that will not be activated by heat or smoke.

(g) Field inspections and tests shall be made and the owner and licensed operator shall be furnished written certification that the installation meets the requirements set forth in this section and all applicable safety regulations and codes.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.21 - Mechanical systems and equipment requirements

713-2.21 Mechanical systems and equipment requirements.

(a) Prior to completion and acceptance of the facility, all mechanical systems shall be tested, balanced and operated to demonstrate to the owner or his or her representative that the installation and performance of these systems conform to the requirements of the plans and specifications. Upon completion of the contract, the owner shall be furnished with a complete set of manufacturers' operating, maintenance, and preventive maintenance instructions, parts lists with numbers and description for each piece of equipment and instructions on the operation and use of systems and equipment. 

(b) Thermal insulation and acoustical insulation (if applicable) shall be provided on the following fixtures and equipment within a nursing home facility and shall comply with the following:

(1) boilers, smoke breeching and stacks;

(2) steam supply and condensate return piping;

(3) hot water piping above one hundred eighty degrees Fahrenheit and all hot water heaters, generators and converters;

(4) hot water piping above one hundred twenty five degrees Fahrenheit, which is exposed to contact by residents; 

(5) chilled water, refrigerant, other process piping and equipment operating with fluid temperatures below ambient dew point;

(6) water supply and drainage piping on which condensation may occur; 

(7) air ducts and casings with outside surface temperatures below ambient dew point; and 

(8) other piping, ducts, and equipment as necessary to maintain the efficiency of the system. 

(9) Insulation may be omitted from hot water and steam condensate piping not subject to contact by residents when such insulation is unnecessary for preventing excessive system heat loss or excessive heat gain. 

(10) Insulation, including finishes and adhesives on the exterior surfaces of ducts, pipes and equipment, shall have a flame spread rating of twenty five or less and a smoke developed rating of one hundred fifty or less as determined by an independent testing laboratory in accordance with NFPA 255, Standard Methods of Test of Surface Burning Characteristics of Building Materials, 2000 edition. Further details concerning the material referenced herein are contained in section 711.2(a) of this Title. 

(11) Linings in air ducts and equipment including coatings and adhesives, and insulation on exterior surfaces of pipes and ducts in building spaces used as air supply plenums, shall have a flame spread rating of twenty five or less and a smoke developed rating of fifty or less as determined by an independent testing laboratory in accordance with NFPA 255, Standard Method of Test of Surface Burning Characteristics of Building Materials, 2000 edition. Further details concerning the material referenced herein are contained in section 711.2(a) of this Title.

(c) Steam and hot water systems shall comply with the following: 

(1) Boilers shall have the capacity to supply the normal requirements of all systems and equipment. The number and arrangement of boilers shall be such that when one boiler breaks down or routine maintenance requires that one boiler be temporarily taken out of service, the capacity of the remaining boiler(s) shall be at least seventy percent of the total required capacity.

(2) Boiler feed pumps, heating circulating pumps, condensate return pumps and fuel oil pumps shall be connected and installed to provide normal and standby service.

(3) Supply and return mains and risers of cooling, heating and process steam systems shall be valved to isolate the various sections of each system. Each piece of equipment shall be valved at the supply and return ends.

(d) Heating and ventilating systems shall comply with the following: 

(1) A minimum design temperature of seventy-five degrees Fahrenheit at winter design conditions shall be provided for all occupied areas.

(2) All air-supply and air-exhaust systems shall be mechanically operated. All fans serving exhaust systems shall be located at the discharge end of the system. The ventilation rates shown in Table 8 shall be considered as minimum acceptable rates and shall not be construed as precluding the use of higher ventilation rates. 

(i) Outdoor air intakes shall be located as far as practical but not less than twenty five feet from exhaust outlets of ventilating systems, combustion equipment stacks, medical-surgical vacuum systems, plumbing vent stacks, or from areas which may collect vehicular exhaust and other noxious fumes. The bottom of outdoor air intakes serving central systems shall be located as high as practical but not less than six feet above ground level, or if installed above the roof, three feet above roof level.

(ii) The ventilation systems shall be designed and balanced to provide the pressure relationship as shown in Table 8, below.

TABLE 8

PRESSURE RELATIONSHIPS AND VENTILATION OF CERTAIN AREAS OF NURSING HOME FACILITIES 

Area Designation

Pressure relationship to adjacent areas

Minimum air changes of outdoor air per hour supplied to room

Minimum total air changes per hour supplied to room

All air exhausted directly to outdoors

Recirculated within room units

Patient Room

E

2

2

Optional

Optional

Patient Area Corridor

E

2

4

Optional

Optional

Examination & Treatment Room

E

2

6

Optional

Optional

Physical Therapy

N

2

6

Optional

Optional

Occupational Therapy

N

2

6

Optional

Optional

Soiled workroom or soiled holding

N

2

10

Yes

No

Clean workroom or clean holding

P

2

4

Optional

Optional

Toilet room

N

Optional

10

Yes

No

Bathroom

N

Optional

10

Yes

No

Janitor closet

N

Optional

10

Yes

No

Sterilizer Equipment room

N

Optional

10

Yes

No

Linen & trash chute room

N

Optional

10

Yes

No

Food Prep Center

E

2

10

Yes

No

Warewashing Room

N

Optional

10

Yes

No

Dietary Day Storage

E

Optional

2

Yes

No

General Laundry

E

2

10

Yes

No

Soiled linen sorting & storage

N

Optional

10

Yes

No

Clean linen storage

P

2

2

Optional

Optional

P=Positive N=Negative E=Equal

(iii) The bottoms of ventilation openings shall be not less than three inches above the floor of any room. 

(iv) Corridors shall not be used to supply air to or exhaust air from any room, except that air from corridors may be used to ventilate bathrooms, toilet rooms, janitors' closets, and small electrical or telephone closets opening directly on corridors.

(v) All central ventilation or air conditioning systems shall be equipped with filters having efficiencies no less than those specified in Table 9, below. The filter bed shall be located upstream of the air conditioning equipment, unless a prefilter is employed. In this case, the prefilter shall be upstream of the equipment and the main filter may be located further downstream.

TABLE 9

FILTER EFFICIENCES FOR CENTRAL VENTILATION AND AIRCONDITIONING SYSTEMS IN NURSING HOME FACILITIES

Area Designation

Minimum number of filter beds

Filter efficiency (percent) of main filter bed

Resident Care, Treatment, Diagnostic and Related Areas

1

80*

Food Preparation Areas and Laundries

1

80

Administrative, Bulk Storage and Soiled Holding Areas

1

25

*May be reduced to 35 percent for all outdoor air systems. 

(vi) All filter(s) efficiencies shall be average atmospheric dust spot efficiencies tested in accordance with ANSI/ASHRAE Standard 52.2-1999, Method of Testing Air-Cleaning Devices for Removal Efficiency by Particle Size, 1999 edition. Further details concerning this referenced material are contained in section 711.2(b) of this Title. 

(vii) Filter frames shall be durable and carefully dimensioned and shall provide an air-tight fit with the enclosing duct work. All joints between filter segments and the enclosing duct work shall be gasketed or sealed to provide seal against air leakage.

(viii) A manometer shall be installed across each filter bed serving central air systems. 

(ix) Air handling duct systems shall meet the requirements of NFPA 90A, Standard for the Installation of Air Conditioning and Ventilating Systems, 1999 edition. Further details concerning the material referenced herein are contained in section 711.2(a) of this Title. 

(x) Fire and smoke dampers shall be constructed, located and installed in accordance with the requirements of NFPA 90A,Standard for the Installation of Air Conditioning and Ventilating Systems, 1999 edition. Access for maintenance shall be provided at all dampers. Further details concerning the material referenced herein are contained in section 711.2(a) of this Title.

(a) Supply and exhaust ducts which pass through a required smoke barrier and through which smoke can be transferred to another area shall be provided with dampers at the barrier, controlled to close automatically to prevent flow of air or smoke in either direction when the fan, which moves the air through the duct, stops. Dampers shall be equipped with remote control reset devices except that manual reopening will be permitted if dampers are conveniently located. 

(b) Return air ducts which pass through a required smoke barrier shall be provided with a damper at the barrier actuated by smoke or products of combustion (other than heat) detectors. These dampers shall be operated by the detectors used to actuate door closing devices in the smoke partition or by detectors located to sense smoke in the return air duct from the smoke zone 

(xi) Exhaust hoods in food preparation centers shall have an exhaust rate of not less than fifty cubic feet per minute per square foot of face area. Face area is defined for this purpose as the open area from the exposed perimeter of the cooking surfaces. All hoods over cooking ranges shall be equipped with grease filters, fire extinguishing systems, and heat actuated fan controls. Cleanout openings shall be provided every twenty feet in horizontal exhaust duct systems serving these hoods. 

(xii) Boiler room shall be provided with sufficient outdoor air to maintain combustion rates of equipment and to limit temperature in working stations to ninety-seven degrees Fahrenheit. 

(e) All plumbing and other piping systems shall comply with this subdivision. 

(1) Plumbing fixtures shall comply with the following: 

(i) The material used for plumbing fixtures shall be of non-absorptive acid-resistant material. 

(ii) The water supply spout for lavatories and sinks required in resident care areas shall be mounted so that its discharge point is a minimum distance of five inches above the rim of the fixture. All fixtures used by medical and nursing staff, and all lavatories used by residents and food handlers shall be trimmed with valves, which can be operated without the use of hands. Where blade handles are used for this purpose, they shall not exceed four and one-half inches in length, except that handles on clinical sinks shall be not less than six inches long. 

(iii) Clinical sinks shall have an integral trap in which the upper portion of a visible trap seal provides a water surface. 

(iv) Shower bases and tubs shall provide non-slip surfaces for standing residents. 

(2) Water supply systems shall comply with the following: 

(i) Systems shall be designed to supply water at sufficient pressure to operate all fixtures and equipment during maximum demand periods. 

(ii) Each water service main, branch main, riser and branch to a group of fixtures shall be valved. Stop valves shall be provided at each fixture.

(iii) Backflow preventers (vacuum breakers) shall be installed on hose bibbs, janitors' sinks, bedpan flushing attachments, and on all other fixtures to which hoses or tubing can be attached.

(iv) Flush valves installed on plumbing fixtures shall be of a quiet operating type, equipped with silencers. 

(v) Bedpan flushing devices shall be provided in each resident toilet room. 

(vi) Water distribution systems shall be arranged to provide hot water at each hot water outlet at all times. Hot water at shower, bathing and handwashing facilities shall not exceed one hundred ten degrees Fahrenheit. 

(3) Hot water heaters and tanks shall comply with the following: 

(i) The hot water heating system shall have sufficient capacity to supply water at the temperatures and amounts indicated below. Water temperatures shall be taken at hot water point of use or inlet to processing equipment. 

(ii) Storage tank(s) shall be fabricated of corrosion-resistant metal or lined with non-corrosive material.

Use

Gallons 
(per hour per bed)

Liters 
(per second per bed)

Temperature (degrees Fahrenheit)

Clinical

6-1/2

.007

110

Dietary

4

.004

180

Laundry

4-1/2

.005

180

(4) Drainage systems shall comply with the following: 

(i) Insofar as is possible drainage piping shall not be installed within the ceiling, or installed in an exposed location in food preparation centers, food serving facilities, food storage areas, or other critical areas. Special precautions shall be taken to protect these areas from possible leakage or condensation from necessary overhead piping systems. 

(ii) Building sewers shall discharge into a community sewage system. Where such a system is not available, a facility providing sewage treatment must conform to applicable local and State regulations.

(5) If used, nonflammable medical gas systems installations shall be in accordance with the requirements of NFPA 99, Standard for Health Care Facilities, 1999 edition. Further details concerning this referenced material are contained in section 711.2(a) of this Title.

(6) If used, clinical vacuum (suction) system installations shall be in accordance with the requirements of Compressed Gas Association, Inc. (CGA) Pamphlet E-10, Maintenance of Medical Gas and Vacuum Systems in Health Care Facilities. Further details concerning this referenced material are contained in section 711.2(b) of this Title.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.22 - Electrical requirements

713-2.22 Electrical requirements.

(a) All material including equipment, conductors, controls and signaling devices shall be installed to provide a complete electrical system with the necessary characteristics and capacity to supply the electrical facilities shown in the specifications or indicated on the plans. Materials and installation shall conform to NFPA 70, National Electrical Code, 1999 edition, and NFPA 99,Standard for Health Care Facilities. 1999 edition. Further details concerning these referenced materials are contained in section 711.2(a) of this Title. All electrical installations and systems shall be tested to show that the equipment is installed and operates as planned or specified.

(b) Circuit breakers or fusible switches that provide disconnecting means and overcurrent protection for conductors connected to switchboards and panel boards shall be enclosed or guarded to provide a deadfront type of assembly. The main switchboard shall be located in a separate enclosure accessible only to authorized persons. The switchboard shall be convenient for use, readily accessible for maintenance, clear of traffic lanes, and in a dry ventilated space free of corrosive fumes or gases. Overload protective devices shall be suitable for operating properly in ambient temperature conditions.

(c) Panel boards serving lighting and appliance circuits shall be located on the same floor as the circuits they serve. This requirement does not apply to emergency system circuits.

(d) All spaces occupied by people, machinery, equipment within buildings, approaches to buildings and parking lots shall have lighting. Residents' rooms shall have general lighting and night lighting. A reading light shall be provided for each resident. At least one light fixture for night lighting shall be switched at the entrance to each resident room. All switches for control of lighting in resident areas shall be of the quiet operating type.

(e) Receptacles (convenience outlets) shall comply with the following:

(1) Each resident room shall have duplex grounding-type receptacles as follows: one location each side of the head of each bed; one for television, if used; and one on another wall.

(2) Duplex receptacles for general use shall be installed approximately fifty feet apart in all corridors and within twenty-five feet of the ends of corridors.

(f) The electrical circuit(s) to fixed or portable equipment in hydrotherapy units shall be provided with five milliampere ground fault interrupters.

(g) Nurses' calling systems shall comply with the following:

(1) A call button shall be provided at each resident bedside, which calls to the nurse's station. Two call buttons serving adjacent beds may be served by one calling station. Calls shall register with the floor staff and shall activate a visible signal in the corridor at the resident's door, in the clean workroom, in the soiled workroom, and in the nourishment station of the nursing unit. In multi-corridor nursing units, additional visible signals shall be installed at corridor intersections. In rooms containing two or more calling stations, indicating lights shall be provided at each station. Nurses' calling systems that provide two-way voice communication shall be equipped with an indicating light at each calling station with lights, and remain lighted as long as the voice circuit is operating.

(2) A nurses' call emergency button shall be provided for residents' use at each resident's toilet, bath and shower room.

(h) Emergency electric services shall comply with the following:

(1) To provide electricity during an interruption of the normal electric supply, an emergency source of electricity shall be provided and connected to certain circuits for lighting and power.

(2) The source of this emergency electric service shall be as follows:

(i) an emergency generating set when the normal service is supplied by one or more central station transmission lines; and

(ii) an emergency generating set or a central station transmission line when the normal electric supply is generated on the premises.

(3) Emergency electric service shall be provided to the distribution systems as follows:

(i) Illumination for means of egress, exit signs and exit directional signs as required in NFPA 101, Life Safety Code, 2000 edition. Further details concerning this referenced material are contained in section 711.2(a) of this Title.

(ii) Corridor duplex receptacles in resident areas.

(iii) Nurses' calling systems.

(iv) Equipment necessary for maintaining telephone service.

(v) Elevator service that will reach every resident floor when resident rooms are located on other than ground floor. Throwover facilities shall be provided to allow temporary operation of any elevator for release of persons who may be trapped between floors.

(vi) A fire pump, if installed.

(vii) Equipment for heating resident rooms, except where the facility is served by two or more electrical services supplied from separate generators of a utility distribution network having multiple power input sources and arranged to provide mechanical and electrical separation so that a fault between the facility and the generating sources will not likely cause an interruption of its service feeders.

(viii) General illumination and selected receptacles in the vicinity of the generator set;

(ix) Paging or speaker systems if intended for communication during emergency. Radio transceivers where installed for emergency use shall be capable of operating for at least one hour upon total failure of both normal and emergency power.

(x) Alarm systems, including fire alarms activated at manual stations, water flow alarm devices of sprinkler system if electrically operated, fire- and smoke-detecting systems, and alarms required for nonflammable medical gas systems if installed.

(4) The emergency lighting shall be in operation within ten seconds after the interruption of normal electric power supply. Emergency service to receptacles and equipment may be delayed automatic or manually connected. Receptacles connected to emergency power shall be distinctively marked. When the generator is operated by fuel, which is normally piped underground to the site from a utility distribution system, fuel storage facilities on the site will not be required.

(5) Each resident sleeping room shall be protected by an automatic smoke and heat detection system that includes an approved and operational automatic smoke and heat detector in such room. The detectors shall conform to the applicable provisions of NFPA 72, National Fire Alarm Code, 1999 edition, and shall be electrically connected to the fire alarm system. Additional information regarding this material is available in section 711.2(a) of this Title.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.23 - Physical environment standards for long-term ventilator programs

713-2.23 Physical environment standards for long-term ventilator programs.

(a) Each bedroom occupied by a resident receiving long term ventilator care shall comply applicable criteria in section 713-2.3 of this Subpart and shall provide the following:

(1) adequate space for a bedside mechanical ventilator for each bed;

(2) adequate space for wheelchair access to all functional areas of the room as well as for its storage and parking when not in use;

(3) adequate space for oxygen administration and suction equipment for each resident;

(4) a wheelchair accessible toilet room with adequate space for staff to assist residents; and,

(5) at least one duplex outlet connected to the emergency electrical service per bed.

(b) At least one isolation room shall be provided on each nursing unit where ventilator dependent residents are housed.

(c) Facilities with long term ventilator programs shall provide the following service areas:

(1) a conference room for in-service education and training of respiratory care staff;

(2) a treatment room equipped with facilities for the administration of oxygen and suction;

(3) adequate office space for staff serving ventilator dependent residents;

(4) adequate storage and maintenance space to ensure routine servicing of ventilators and related equipment;

(5) dining space that is wheelchair accessible; and

(6) adequate therapy space for respiratory rehabilitation.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 713-2.24 REPEALED

Effective Date: 
Wednesday, December 29, 2010