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Title: Section 415.29 - Physical environment

Effective Date


415.29 Physical environment. The nursing home shall be designed, constructed, equipped and maintained to provide a safe, healthy, functional, sanitary and comfortable environment for residents, personnel and the public.

(a) Life safety from fire and other hazards. (1) Buildings and equipment shall be maintained and operated so as to prevent fire and other hazards to personal safety.

(2) Nursing homes shall comply with subdivision (a) of section 711.2 of this Title.

(3) The nursing home shall maintain a procedure to investigate fires. A written report of the investigation containing all pertinent information shall be made. The report shall remain on file for not less than six years.

(4) The nursing home shall maintain a procedure for reporting to a designated administrative officer on a standard form adopted for the purpose, all accidents to residents, staff, employees or visitors. The report shall include all pertinent information and shall be kept on file for not less than six years after the occurrence was reported.

(b) Equipment. The nursing home shall maintain all essential mechanical, electrical, and resident care equipment in safe operating condition.

(c) Resident rooms. Resident rooms shall be designed and equipped for adequate nursing care, comfort and privacy of residents. The nursing home shall provide each resident with:

(1) a separate bed of proper size and height for the convenience of the resident;

(2) a clean, comfortable mattress;

(3) bedding appropriate to the weather and climate; and

(4) functional furniture appropriate to the resident's needs, and individual closet space in the resident's bedroom with clothes racks and shelves accessible to the resident.

(d) Toilet, Handwashing and Bathing facilities. Plumbing and plumbing fixtures shall be properly maintained and operable.

(e) Dining and resident activities. The facility shall provide one or more rooms designated for resident dining and activities. These rooms shall:

(1) be well lighted;

(2) be well ventilated, with smoking areas identified;

(3) be adequately furnished; and

(4) have sufficient space to accommodate all activities.

(f) Water supplies. Water supplies of nursing homes shall be operated in conformance with the following requirements:

(1) all water used in operation shall be provided from a public water supply or from an alternate source, in either event as approved by the department;

(2) no changes shall be made in the source or treatment of the water supply without approval of the department;

(3) water shall be adequate in volume and pressure for all medical purposes;

(4) the water system shall not be operated with physical connections to other piping systems or connections to fixtures that may permit contamination of the water supply;

(5) the water system shall be operated with a hot water system adequate for all medical purposes;

(6) the hot water supply used by residents or the public shall be regulated to maintain hot water temperature within the range of 90 degrees to 120 degrees F; and

(7) the nursing home shall ensure that water is available to essential areas when there is a loss of normal water supply.

(g) Waste systems. Waste systems shall be operated so that all sewage and other liquid wastes are disposed of by connection to a public sewer system or by an alternate method, in either event as approved by the department.

(h) Ventilating, heating, and air conditioning systems. Such systems shall:

(1) be maintained in good repair and shall be operated in a manner which will not allow for the spread of infection and provide for resident health and comfort; and

(2) be maintained and operated in such manner that air shall not be circulated from resident isolation rooms, laboratories in which work is done in pathology, virology or bacteriology, autopsy rooms, kitchen and dishwashing areas, toilet and bath rooms, janitors' closets and soiled utility rooms or soiled linen rooms, to other parts of the facility.

(i) Grounds and building. Grounds and buildings shall be maintained:

(1) in a clean condition free of safety hazards;

(2) in such manner as will prevent standing water, flooding or leakage; and

(3) free of excessive noise, odors, pollens, dusts or other environmental pollutants and such nuisances as may adversely affect the health or welfare of residents.

(j) Housekeeping.

(1) The entire nursing home, including but not limited to the floors, walls, windows, doors, ceilings, fixtures, equipment and furnishings, shall be clean. The facility shall be maintained in good repair including, but limited to buildings, utilities, fixed equipment, resident care equipment and furnishings.

(2) Responsibility for direct supervision of housekeeping service shall be assigned to a person, properly qualified by training and experience. (3) Dusting, mopping and vacuum cleaning shall be done in a manner which will not spread dust or other particulate matter.

(4) Adequate supplies and equipment for housekeeping functions shall be provided with cleaning compounds and hazardous substances properly labeled and stored.

(5) The facility shall maintain an effective pest control program so that it is free of insects and rodents.

(6) Waste:

(i) solid wastes, including garbage, rubbish and other refuse, biological wastes and infectious materials, shall be collected, stored and disposed of in a manner that will prevent the transmission of disease and not create a nuisance or fire hazard, nor provide a breeding place for insects or rodents; and

(ii) facilities shall manage regulated medical waste in accordance with the provisions of Part 70 of this Title.

(k) Linen and laundry. The nursing home shall:

(1) provide a sufficient quantity of clean linen to meet the requirements of residents; nursing homes shall maintain a linen inventory equal to at least three times the average daily census, and of this one-third shall be in use, one-third in laundry and one-third in reserve;

(2) maintain linen in proper condition for use, free from rips and tears;

(3) provide for satisfactory laundering of linens and other washable fabrics;

(4) handle, store and process laundry in a manner that will prevent the spread of infection and assure the maintenance of clean linen;

(5) wash all linen, including blankets, between resident use;

(6) bag or enclose all used linen in suitable containers within the resident care unit for transportation to the laundry;

(7) separately bag or enclose used linens from residents with a communicable disease in readily identifiable containers distinguishable from other laundry;

(8) properly maintain space and equipment for laundry storage and transportation;

(9) launder only in areas and with equipment properly maintained and approved for such purpose by the department;

(10) launder in a manner designed to prevent contamination of clean linen and to prevent infection; and

(11) transport clean linen in clean covered containers used exclusively for the purpose, and store clean linen in clean storage areas in a manner to prevent its contamination.

(l) Animals.

(1) Animals, exclusive of those required for laboratory purposes, shall not be allowed in a nursing home, except in a nursing home animal visitation or animal-assisted therapy program as permitted in paragraphs (2) and (3) of this subdivision. Also, service dogs and other service animals which have been individually trained to do work or perform tasks for the benefit of an individual with a disability may accompany such persons when the presence of such sanimals will not pose a significant risk to the health and safety of others that cannot be eliminated by reasonable accommodation and is not medically containdicated. However, if the safe operation of the facility would be jeopardized, a service animal need not be allowed to enter. A finding by appropriate medical personnel at the facility that the presence or use of a service animal would pose a significant health risk in certain designated area of a nursing home may serve as a basis for excluding service animals in those areas.

(2) A nursing home may board animals as part of an animal-assisted therapy program, provided that:

(i) the health, safety, welfare and rights of all residents on the unit are assured;

(ii) a staff member has been designated to be responsible for the care and management of the anima or animals and has had appropriate training for such responsibilities;

(iii) the animal or animals are free from disease and have received all immunizations as recommended by a licensed veterinarian;

(iv) the animal or animals shall not be allowed in laundry, utensil storage or food preparation areas; and (v) the well-being of the participating animal or animals is considered and maintained.

(3) Animal visitations are permitted in a nursing home provided that:

(i) the visit is prescheduled and approved by the facility; (ii) the animal shall not be allowed in laundry, utensil storage or food preparation areas; and

(iii) the animal will at all times be accompanied by a person familiar with and capable of controlling the animal's behavior.


VOLUME C (Title 10)