R432.  Health, Family Health and Preparedness, Licensing.
R432-10.  Specialty Hospital - Long-Term Acute Care Construction Rule.
R432-10-1.  Legal Authority.
	This rule is adopted pursuant to Title 26, Chapter 21.

R432-10-2.  Purpose.
	The purpose of this rule is to establish construction standards for hospitals that provide services for the diagnosis, treatment or care of persons needing medical services and care in excess of services usually provided in a general acute hospital or skilled nursing home for chronic or long-term illness, injury or infirmity.

R432-10-3.  General Design Requirements.
	(1) Refer to R432-4-1 through R432-4-23.
	(2) All fixtures in public and resident toilet and bathrooms shall be wheelchair accessible with wheelchair turning space within the room.

R432-10-4.  General Construction, Patient Facilities.
	(1)  The requirements of R432-4-24 and the requirements of Sections 2.1 and 2.6 of the Guidelines for Design and Construction of Health Care Facilities 2010 edition (Guidelines) shall be met.  Where a modification is cited, the modification supersedes conflicting requirements of the Guidelines.
	(2)  The maximum number of beds on each nursing unit shall be 60.
	(a)  The minimum number of beds in a nursing unit shall be four.
	(b)  Rooms and spaces comprising the nursing unit shall be contiguous.
	(3)  At least two single-bed rooms, with a private toilet room containing a toilet, lavatory, and bathing facility, shall be provided for each nursing unit.
	(a)  The minimum patient room area shall be 120 feet.
	(b)  In addition to the lavatory in the toilet room, in new construction a lavatory or handwashing sink shall be provided in the patient room.
	(c)  Ventilation shall be in accordance with Part 6, Table 7-1 of Guidelines with all air exhausted to the outside.
	(4)  The nurses' station shall have handwashing facilities located near the nurses' station and the drug distribution station.  The nurses' toilet room, located in the unit, may also serve as a public toilet room.
	(5)  A nurse call system is not required in facilities that care for developmentally disabled or mentally retarded persons.  With the prior approval of the Department, facilities which serve patients who pose a danger to themselves or others may modify the system to alleviate hazards to patients.
	(6)  Patient rooms shall include a wardrobe, closet, or locker having minimum clear dimensions of 22 inches deep by 36 inches wide, suitable for hanging full length garments.
	(7)  A clean workroom or clean holding room with a minimum area of 80 square feet for preparing patient care items which shall contain a counter, handwashing facilities, and storage facilities.
	(a)  The work counter and handwashing 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.
	(8)  A soiled workroom with a minimum area of 80 square feet which shall contain a clinical sink, a sink equipped for handwashing, a work counter, waste receptacles and a linen receptacle.
	(a)  Handwashing sinks and work counters may be omitted in rooms used only for temporary holding of soiled, bagged materials.
	(9)  If a medication dispensing unit is used it shall be under visual control of staff, including double locked storage for controlled drugs.
	(10)  Clean Linen Storage.
	(a)  If a closed cart system is used it shall be stored in a room with a self closing door.
	(b)  Storage of a closed cart in an alcove in a corridor is prohibited.
	(11)  Each nursing unit shall have equipment to provide ice for patient treatment and nourishment.
	(a)  Ice making equipment may be located in the clean workroom or at the nourishment station if access is controlled by staff.
	(b)  Ice intended for human consumption shall be dispensed by self-dispensing ice makers.
	(12)  At least one room for toilet training, accessible from the nursing corridor, shall be provided on each floor containing a nursing unit.
	(a)  All fixtures in this room shall comply with the Americans with Disabilities Act and Architectural Barriers Act Accessibility Guidelines (ADA/ABA-AG).
	(b)  A toilet room, with direct access from the bathing area, shall be provided at each central bathing area.
	(c)  Doors to toilet rooms shall comply with ADA/ABA-AG.  The doors shall permit access from the outside in case of an emergency.
	(d)  A handwashing fixture shall be provided for each toilet in each toilet room.
	(13)  Storage.  There shall be an equipment storage room with a minimum area of 120 square feet for portable storage.
	(14)  Resident Support Areas Shall Include the Following:
	(a)  Occupational Therapy may be counted in the required space of Guidelines section 2.6-2.3 Patient Living Areas.
	(b)  Physical Therapy, personal care room and public waiting lobbies may not be included in the calculation of space of Guidelines section 2.6-2.3 Patient Living Areas.
	(c)  Storage space for recreation equipment and supplies shall be provided and secured for safety.
	(d)  There shall be a general purpose room with a minimum area of 100 square feet equipped with table, and comfortable chairs.
	(e)  A minimum area of ten square feet per bed shall be provided for outdoor recreation.  Recreation areas shall be enclosed by a secure fence.
	(15)  An examination and treatment Room shall be provided except when all patient rooms are single-bed rooms.
	(a)  The examination and treatment room may be shared by multiple nursing units.
	(b)  The room shall have a minimum floor area of 100 square feet, excluding space for vestibules, toilet, closets, and work counters, whether fixed or movable.
	(c)  The minimum allowable room dimension shall be ten feet.
	(d)  The room shall contain a lavatory or sink equipped for handwashing; work counter; storage facilities; and desk, counter, or shelf space for writing.
	(16)  A room shall be arranged to permit evaluation of patient needs and progress.
	(a)  The room shall include a desk and work area for the evaluators, writing and work space for patients, and storage for supplies.
	(b)  If psychological services are provided, then the unit shall contain an office and work space for testing, evaluation, and counseling.
	(c)  If social services are provided, then the unit shall contain office space for private interviewing and counseling.
	(d)  If vocational services are provided, then the unit shall contain office and work space for vocational training, counseling, and placement.
	(e)  Evaluation, psychological services, social services, and vocational services may share the same office space when the owner provides evidence in the functional program that the needs of the population served are met in the proposed space arrangement.
	(17)  Pediatric and Adolescent Unit.
	(a)  Pediatric and adolescent nursing units shall comply with the spatial standards in section 2.2-2.13 of the Guidelines.
	(b)  There shall be an area for hygiene, toileting, sleeping, and personal care for parents if the program allows parents to remain with young children.
	(c)  Service areas in the pediatric and adolescent nursing unit shall conform to the standards of section 2.2-2.13.6 of the Guidelines and the following:
	(i)  Multipurpose or individual rooms shall be provided in the nursing unit for dining, education, and recreation.
	(ii)  A minimum of 20 square feet per bed shall be provided.
	(iii)  Insulation, isolation and structural provisions shall minimize the transmission of impact noise through the floor, walls, or ceiling of multipurpose rooms.
	(iv)  Service rooms may be shared by more than one pediatric or adolescent nursing unit, but may not be shared with adult patient units.
	(v)  A patient toilet room, in addition to those serving bed areas, shall be conveniently located to each multipurpose room and to each central bathing facility.
	(vi)  Storage closets or cabinets for toys, educational, and recreational equipment shall be provided.
	(d)  At least one single-bed isolation room shall be provided in each pediatric unit.  Each isolation room shall comply with the following:
	(i)  Room entry shall be through an adjacent work area which provides for aseptic control, including facilities separate from patient areas for handwashing, gowning, and storage of clean and soiled materials.  The work area entry may be a separate, enclosed anteroom.
	(ii)  A separate, enclosed anteroom for an isolation room is not required but, when provided, shall include a viewing panel for staff observation of the patient from the anteroom.
	(iii)  One anteroom may serve several isolation rooms.
	(iv)  Toilet, bathing, and handwashing facilities shall be arranged to permit access from the bed area without entering or passing through the work area of the vestibule or anteroom.
	(17)  Rehabilitation therapy, Physical Therapy and Occupational Therapy areas shall include:
	(a)  Waiting areas to accommodate patients in wheelchairs, including room for turning wheelchairs.
	(b)  Storage space, with separate storage rooms for clean and soiled linen.

R432-10-5.  General Construction.
	(1)  Yard equipment and supply storage areas shall be located so that equipment may be moved directly to the exterior without passing though building rooms or corridors.
	(2)  Grab bars and handrails shall comply with ADA/ABA-AG and shall be installed in all toilet rooms.
	(a)  Handrails shall be provided on both sides of corridors used by patients.
	(b)  The top of the rail shall be 32 inches above the floor, except for special care areas.
	(c)  Ends of the handrails and grab bars shall be constructed to prevent persons from snagging their clothes.
	(3)  Cubicle curtains and draperies shall be affixed to permanently mounted tracks or rods.  Portable curtains or visual barriers may not be used.
	(4)  Signs.  The following signs shall comply with ADA/ABA-AG and be located in corridors:
	(a)  general circulation direction signs in corridors.
	(b)  identification sign or number at each door.
	(c)  emergency evacuation directional signs.
	(6)  At least one window in each patient sleeping room shall open to the exterior and shall be operable.

R432-10-6.  Construction Features.
	(1)  Mechanical tests shall be conducted prior to the final Department construction inspection.  Written test results shall be retained in facility maintenance files and available for Department review.
	(2)  The heating system shall be capable of maintaining temperatures of 80 degrees F. in areas occupied by patients.
	(a)  The cooling system shall be capable of maintaining temperatures of 72 degrees F. in areas occupied by patients.
	(b)  Furnace and boiler rooms shall be provided with sufficient outdoor air to maintain equipment combustion rates and to limit work station temperatures to a temperature not to exceed 90 degrees F.  When ambient outside air temperature is higher, maximum temperature may be 97 degrees F.
	(c)  A relative humidity between 30 percent and 60 percent shall be provided in all patient areas.
	(d)  The bottom of ventilation supply and return opening shall be at least three inches above the floor.
	(3)  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 20 feet in horizontal sections of the duct systems serving these hoods.
	(4)  Kitchen grease traps shall be located and arranged to permit easy access without the need to enter the food preparation or storage area.
	(5)  Hot water systems.  Hot water provided in patient tubs, showers, whirlpools, and handwashing facilities shall be regulated by thermostatically controlled automatic mixing valves.  Mixing valves may be installed on the recirculating system or on individual inlets to appliances.
	(6)  Drainage Systems.  Building sewers shall discharge into community sewerage except, where such a system is not available, the facility shall treat its sewage in accordance with local requirements and Department of Environmental Quality requirements.
	(7)  Piping and Valve systems.  All piping and valves in all systems, except control line tubing, shall be labeled to show content of line and direction of flow.  Labels shall be permanent type, either metal or paint, and shall be clearly visible to maintenance personnel.
	(8)  Oxygen and suction systems shall be installed in accordance with the requirements of a level 1 system per NFPA 99 and Table 2.1-6 of the Guidelines.
	(9)  Electric materials shall be new and listed as complying with standards of Underwriters Laboratories, Inc., or other equivalent nationally recognized standards.  The owner shall provide written certification to the Department verifying that systems and grounding comply with NFPA 99 and NFPA 70.
	(10)  Approaches to buildings and all spaces within buildings occupied by people, machinery, or equipment shall have fixtures for lighting in accordance with requirements shown in Tables 3A and 3B of Illuminating Engineering Society of North America IESNA, publication RP-29-06, Lighting for Hospitals and Health Care Facilities, 2006 edition.  Automatic Emergency lighting shall be provided in accordance with NFPA 99 and NFPA 101.
	(11)  Receptacles shall include:
	(a)  Each examination and work table shall have access to minimum of two duplex receptacles.
	(b)  Receptacle cover plates on electrical receptacles supplied for the emergency system shall be red.
	(12)  Emergency Electrical Service shall include:
	(a)  An on-site emergency generator shall be provided.
	(b)  The following services shall be connected to the emergency generator:
	(i)  life safety branch, as defined in section 517-32 of the National Electric Code NFPA 70;
	(ii)  critical branch as defined in 517-33 of the National Electric Code NFPA 70;
	(iii)  equipment system, as defined in 517-34 of the National Electric Code NFPA 70;
	(iv)  telephone;
	(v)  nurse call;
	(vi)  heating equipment necessary to provide adequate heated space to house all patients under emergency conditions;
	(vii)  one duplex receptacle in each patient room;
	(viii)  one duplex receptacle at each nurse station;
	(ix)  duplex receptacles in the emergency heated area at a ratio of one for each ten patients.
	(c)  fuel storage capacity shall permit continuous operation for 48 hours.

R432-10-7.  Excluded Section of the Guidelines.
	The following sections of the Guidelines do not apply:
	(1)  Linen Services, Section 2.6-5.2.

R432-10-8.  Penalties.
	The Department may assess a civil money penalty of 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:  February 21, 2012
Notice of Continuation:  March 4, 2019
Authorizing, and Implemented or Interpreted Law:  26-21-5; 26-21-2.1; 26-21-20