Title: Section 713-3.4 - Nursing units
713-3.4 Nursing units.
(a) The layout and location of each nursing unit shall comply with the following:
(1) Nursing units shall be arranged to avoid travel through adjacent nursing units to gain access to resident service areas.
(2) The number of residents in a nursing unit arranged in a linear layout shall not exceed forty. However, the department will consider exceptions to this requirement to enhance the quality of life for residents when a higher number of residents clearly achieves a savings in operational costs, improves resident services and is based upon sub-groups of residents (sub-units).
(3) The maximum travel distance from a resident room door to a staff work area shall not exceed one hundred fifty feet. When sub-units are used, each sub-unit shall be arranged so as to provide access to a bathing room and a soiled workroom or soiled holding room located within, or readily accessible to, the sub-unit.
(4) At least one-tenth of the total number of residents in any facility shall be located in single rooms, with at least one toilet shared between two single rooms.
(5) The need for and the number of required airborne infection isolation room(s) in a nursing facility shall be determined by an infection control risk assessment.
(b) Each resident bedroom shall meet the following requirements:
(1) The maximum room capacity shall be two residents. Changes to the maximum number of two residents per room may be made upon a determination by the department that an alternate room configuration provides a clearly superior resident environment for residents with unusual care requirements. The maximum capacity of single rooms is one resident and such capacity shall not be exceeded.
(2) The net useable area and configuration of each room shall permit wheelchair accessibility. The bedroom shall be designed to permit wheelchair access and a minimum five foot (5'-0") diameter turnaround adjacent to at least one side of each bed. Where one side of a bed is permitted to be placed against a side wall of the room and resident care needs require additional space between the bed and the wall, the room shall be of sufficient dimension to maintain the required five foot (5'-0") turning space. Furniture and equipment intended for resident use shall be made accessible and useable by residents confined to a wheelchair.
(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 floor and shall be above grade. Windows with operable sashes shall be provided with insect screens. Window openings shall be designed to prevent accidental falls when open, or shall be provided with security screens.
(4) A nurses' calling system shall be provided.
(5) Each resident shall have access to a toilet room without entering the general corridor area. One toilet room shall serve no more than two residents. The toilet room shall contain a water closet and a lavatory. Changes to the number of residents using one toilet room may be made on a case-by-case basis upon a determination by the department that such alternative does not adversely affect resident care and/or as special care needs of resident may require.
(6) Each resident shall have a wardrobe or closet with minimum clear inside dimensions of three feet long by one foot ten inches deep. An adjustable clothes rod and shelf shall be provided at heights useable by residents.
(7) Visual privacy shall be provided for each resident in multi-bed rooms through the use of non-combustible cubicle curtains.
(8) Medical equipment for the care and treatment of residents shall be provided in a resident's room as required by the resident's medical condition. In addition, each resident shall be provided with the following room furnishings:
(i) a bed;
(ii) a dresser and nightstand or a dresser/night stand combination which provides sufficient space for residents' personal effects;
(iii) over-bed tables as may be required;
(iv) a wall tackboard/display panel;
(v) a lockable drawer to personal valuables and storage of medications; and,
(vi) chairs for visitors and socialization.
(c) The service areas described in this subdivision shall be located in or be readily accessible to each nursing unit: The size and location of each service area will depend upon the number and types of residents served and the efficiency of the facility's staffing patterns. Although identifiable spaces are required to be provided for each of the indicated service areas, consideration will be given to design solutions, which would accommodate some services without a specific designation of areas or rooms. Decentralized service areas within nursing units will be encouraged.
The following service areas shall be provided:
(1) A staff work station with space for carrying out the administrative functions of the unit.
(2) Lounge and toilet room(s) for staff.
(3) Individual closets or lockers for the safekeeping of coats and personal effects of staff. These shall be located convenient to the duty station of personnel or in a central location.
(4) Room(s) to serve the function of clinical staff office or consultation room for up to four people.
(5) A clean workroom with a work counter sized to store clean and sterile supplies as required by the functional program, or a clean holding facility that is part of an approved system for storage and distribution of clean and sterile supply materials. The location(s) of the clean workroom and the clean holding facility shall be based on the functional program and physical layout of the nursing unit.
(6) A soiled workroom that contains a clinical sink or equivalent, flushing rim fixture with a rinsing hose or a bed pan sanitizer, handwashing facilities, work counter, and an area for soiled linen holding and waste receptacle(s) in a number and type as required by the functional program. The location of the soiled workroom shall be based on the functional program and the physical layout of the nursing unit. A soiled holding facility, if not provided within the workroom, shall be part of an approved system for collection and disposal of soiled materials.
(7) A closet, designated area within the clean workroom or a closed cart system for clean linen storage. If a closed cart system is used, storage may be in an alcove.
(8) A medication preparation room, self-contained medication dispensing unit, or an equivalent system for convenient and prompt distribution of medications to residents twenty-four hours a day. If used, a medication preparation room or a medication distribution unit shall be under the nursing staff's visual control and contain a work counter, refrigerator, and locked storage for biological and controlled substances.
(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 shall be provided by self-dispensing ice making unit.
(10) Storage for equipment in current use shall be provided.
(11) Sufficient space for the parking and holding of stretchers and wheelchairs shall be located out of the path of normal traffic.
(12) Bathing rooms for scheduled bathing shall be provided on each nursing unit at a ratio of one bathing fixture for each fifteen residents or fraction thereof, who are not otherwise served by bathing facilities within residents' room and shall be located away from public areas of the nursing unit. Each tub or shower shall be in a room or enclosure with space provided for the private use of the bathing fixture, for drying and dressing, and for a wheelchair and an attendant. The dressing area and the showers, without curbs, shall be designed to permit use by a wheelchair resident with staff assistance.
(13) Residents' toilet facilities shall comply with the following:
(i) Each resident toilet room shall be designed to permit wheelchair access and use. The size and configuration of the room, including the placement of fixtures within, shall allow space for staff assistance in transferring a wheelchair resident to the water closet.
(ii) A toilet room shall be accessible to each central bathing area without going through the general corridor.
(14) A minimum of one telephone per nursing unit shall be provided for residents' use. The telephone shall be wheelchair accessible and located to assure privacy of conversation.
VOLUME D (Title 10)