Ala. Admin. Code r. 420-5-17-.25

Current through Register Vol. 43, No. 1, October 31, 2024

Section 420-5-17-.25 - Physical Plant Inpatient Hospices

The provisions of this section shall apply to all inpatient hospices licensed by the State Board of Health.

(1)General Requirements. The hospice shall have physical space for private patient and family visiting.

(a) The hospice shall provide accommodations for family members to remain with the patient throughout the night.

(b) The hospice shall provide accommodations for family privacy after a patient's death.

(c) The patient areas in the hospice shall have decor which is homelike in design and function.

(d) Patients shall be permitted to receive visitors, including small children, at any hour.

(2)Location.

(a) Each hospice shall be located so that they are free from undue noises, smoke, dust, or foul odors and shall not be located adjacent to railroads, freight yards, airports, industrial plants, disposal plants, cemeteries, funeral homes, or any other similar facility or activity. This rule shall not prevent additions to existing facilities.

(b) The location and construction of all facilities shall comply with local zoning, building and fire ordinances. Evidence to this effect, signed by local fire, building, and zoning officials, shall be furnished to the State Board of Health.

(c) Facilities shall be located on streets or roads which are kept passable at all times. Facilities constructed after the effective date of these rules shall be located on paved roads.

(3)Submission of Plans and Specifications. When construction is contemplated, either for new buildings, conversions, additions, or major alterations to existing buildings coming within the scope of these rules, plans and specifications shall be submitted for review and approval to the Alabama Department of Public Health, in accordance with Alabama Administrative Code Rule 420-5-22, "Submission of Plans and Specifications for Health Care Facilities."

(a) Minor alterations and remodeling which do not affect the structural integrity of the building, do not change functional operation, do not affect fire safety, and do not add beds over those for which the facility is licensed, need not be submitted for approval.

(4)Inspections. The State Board of Health and its authorized representative shall have access to the site for inspection.

(5)Remolding and Alterations. The remodeled area of existing facilities shall be upgraded to comply with the current requirements for new construction.

(a) Any remodeling to existing facilities shall not diminish the level of safety which existed prior to the start of the work.

(6)General Requirements - Inpatient Hospices. The provisions of this section shall apply to all inpatient hospices licensed by the State Board of Health on the effective date of these regulations.

(a) All hospices shall comply with the applicable regulations of the State Board of Health and the codes and standards as adopted by the State Board of Health, see Alabama Administrative Code, Rule 420-5-22, "Submission of Plans and Specifications for Health Care Facilities."

(b) The occupancy classification for all hospice facilities shall be "health care - limited care facility" as defined in the NFPA 101 Life Safety Code.

1. Exception 1 - a hospice located within a hospital shall meet the NFPA 101 Life Safety Code requirement for "health care - hospital" and all requirements for hospitals by the Department of Public Health in addition to those requirements contained within these regulations.

2. Exception 2 - a hospice located within a nursing home shall meet the NFPA 101 Life Safety Code requirement for "healthcare - nursing home" and all requirements for nursing homes by the Department of Public Health in addition to those requirements contained within these regulations.

(c) Water supply.

1. If at all possible, all water shall be obtained from a public water supply. If it is impossible to connect to a public water system, the private water supply shall be approved by the State Board of Health.

2. Water under pressure of not less than 15 lbs. per square inch shall be piped within the building to all sinks, toilets, lavatories, tubs, showers, and other fixtures requiring water.

3. An adequate supply of hot water shall be provided at all times throughout the facility. Temperature of hot water at plumbing fixtures used by patients shall be automatically regulated thermostatically by control valves and will not exceed 120 degree F.

4. In the laundry, provision shall be made to increase the water temperature to 160 degree F.

5. There shall be procedures established to ensure that water can be provided for all essential services in the event of loss of the normal water supply.

(d) Disposal of liquid and human wastes.

1. There shall be installed within the building a properly designed waste disposal system connecting to all fixtures to which water under pressure is piped.

2. All liquid and human waste, including floor wash water and liquid waste from refrigerators, shall be disposed of through trapped drains into a public sanitary sewer system in localities where such system is available.

3. In localities where a public sanitary sewer is not available, liquid and human waste shall be disposed through trapped drains into a sewage disposal system approved by the county health department and/or the State Board of Health.

4. The sewage disposal system shall be of a size and capacity based on the number of patients and personnel housed and employed in the institution. Where the sewage disposal system is installed prior to the opening of the institution, it shall be assumed, unless otherwise proven, that the system was designed for 10 or fewer persons.

5. Plumbing shall be sized, installed, and maintained to carry adequate quantities of water to required locations throughout the facility, to prevent contamination of the water supply, and to properly convey sewage and liquid wastes from the establishment to the sewerage or sewage disposal system, in a manner not to constitute a source of contamination or create an unsanitary condition or nuisance.

(e) Solid waste.

1. Solid, non-infectious wastes shall be kept in leakproof, non-absorbent containers which shall be kept covered with tight-fitting lids, and shall be disposed of with sufficient frequency and in a manner to prevent a nuisance.

2. Solid wastes which are potentially infectious shall be burned on the premises in an incinerator approved by the State Board of Health or disposed of in a manner approved by the State Board of Health or its appropriate designated agency.

3. Trash chutes are prohibited.

(f) No part of a hospice may be rented, leased, or used for any purpose that is disruptive to the operation of the facility. Building uses not necessary to the facility operation shall be distinctly separated from the licensed facility operation. The State Board of Health shall approve all plans for functions not necessary to the operation of the facility. These areas shall be separated from the licensed facility by a two-hour fire separation.

(g) Construction type. The construction type of all buildings shall be classified according to National Fire Protection Association 220. All buildings shall meet the minimum construction requirements called for in the applicable occupancy sections of National Fire Protection Association 101 including automatic sprinkler system, if required.

(h) The building shall be structurally sound from leaks and excessive moisture, in good repair, and painted at sufficient intervals to be reasonably attractive inside and out.

(i) Distance to property line or adjacent structures.

1. There shall be a minimum of 30 feet of clear space measured perpendicular between a patient bedroom window and any building or the property line.

2. There shall be, as a minimum, 30 feet between any part of the building and any adjacent building(s) not conforming to the requirements of these regulations.

(j) The building area shall not occupy more than 40 percent of the site.

(k) There shall be telephones, as necessary, to summon help in case of fire or other emergency.

(l) Lighting.

1. All lighting shall be electric.

2. Each patient's room and bathroom shall have artificial light adequate for eating and other uses as needed. All entrances, hallways, stairways, ramps, cellars, rooms, storerooms, kitchens, laundries, and service units shall have sufficient artificial lighting to prevent accidents and promote efficiency of service.

3. Night lights shall be provided in bedrooms, hallways, and toilets and/or bathrooms that open into patient rooms. Glowing toggle switches are acceptable in toilets and/or bathrooms.

(m) Floors.

1. All floors are smooth and free from cracks and finished so that they can be easily cleaned. All floors in the facility except mechanical rooms shall be covered wall-to-wall with inlaid linoleums, resilient tile, hard tile, carpet, or the equivalent. A painted floor finish is not acceptable except in mechanical rooms and electrical rooms. Carpet is not acceptable in kitchens, utility rooms, toilets, baths, and janitor's closets.

2. All carpet must meet NFPA 101 requirements for "Class I" interior floor finishes.

(n) Patient bedrooms shall have an outside window, installed so that it can be opened from the inside without the use of tools or keys. Screens shall be provided on all operable windows.

(o) Walls and ceilings shall be of sound construction with an acceptable surface and maintained in good repair.

(p) A ceiling height of 8 feet or more (does not include furred area) shall be provided throughout the facility. After the effective date of these regulations, a ceiling height of 7 feet 6 inches is allowed in corridors.

(q) Doors. To avoid the danger of a patient falling and blocking the swing of a door, all doors to patients' baths and toilets shall swing out or be double-acting and equipped with an emergency stop release.

(r) Fire hydrants. All facilities shall have access to public fire hydrant protection, or the equivalent approved by the local fire department or state fire marshal. Access to fire hydrants shall be within 500 feet.

(s) Handrails shall be installed on both sides of all corridors and shall be maintained in safe repair. Handrails shall return to the wall at the end of each handrail section.

(t) Nurse call system.

1. The facility shall have an electrical nurse call system at the side of each bed which will provide an audible and visual signal on an annunciator panel at the nurses' station.

2. Each facility shall have a light over the door to the bedroom in the corridor.

3. Nurse call system shall be provided in each patient toilet and bath.

(u) Elevators.

1. Facilities with patients on one or more floors above the first floor shall be equipped with at least one automatic elevator of a size sufficient to carry a patient on a stretcher.

2. Routine inspections shall be made of elevators in accordance with codes and city ordinances.

(v) Exit signs. Exit signs shall be provided at all required exits. Additional exit signs shall be provided in corridors to indicate two directions of exit travel from any point. Additional exit signs for suites and places of assembly shall be installed as required.

(w) General storage. A general storage room shall be provided for the central storage of equipment, supplies, etc., at the rate of 8 square feet per bed and concentrated in one area. The storage room shall be designed to provide adequate and orderly storage so as to prevent the use of corridors and non-storage areas for storage purposes. When any part of the facility is remodeled or renovated, general storage shall be provided at the rate of 8 square feet per bed. The general storage room shall be adequately ventilated. Space under stairs shall not be used for storage purposes.

(x) Facilities for physically handicapped. Necessary physical accommodations shall be made to meet the needs of persons with physical disabilities, sight and hearing disabilities, disabilities of coordination, as well as other disabilities in accordance with the standards adopted by the State Board of Health.

(y) Heating ventilation and air conditioning. The building shall be well ventilated at all times. Patients bedrooms shall be ventilated in such a manner as to supply fresh air and to prevent accumulation of objectionable odors. Kitchens, laundries, service rooms, toilets, bathrooms, and all inside rooms shall be vented to prevent offensive odors from entering other parts of the building.

1. Ventilating fans and blowers. Ventilating fans and blowers, if installed, shall not be so located that they will obstruct any required exit, stairway, or corridor and shall not create a draft from one floor to another.

2. Temperature to be maintained. The heating and cooling system must be capable of maintaining a temperature of 70 degree F. throughout the patient/resident section of the building. The heating of all facilities shall be restricted to steam, hot water, or warm air systems employing central heating plants, or UL listed electric heating. The use of portable heaters of any kind is prohibited.

3. A laboratory, if provided, shall be ventilated and temperature controlled for proper equipment operation and/or test results.

(z) Ramps and inclines. Exterior and interior ramps and inclines, shall not be steeper than 1 footing rise in 12 feet of run, shall be finished with a non-slip surface and shall be provided with handrails on both sides.

(aa) Basements.

1. The basement shall be considered as a story if one-half or more of its perimeter is level with or above grade.

2. No patient/resident shall be housed in any room that is more than 50 percent below ground level.

(bb) Emergency power. An emergency generator shall be provided to supply power to the following:

1. Emergency corridor illumination.

2. Exit signs.

3. An exterior light at each exit.

4. Fire alarm system.

5. Smoke detection system.

6. Sprinkler system.

7. Life support systems by providing wall receptacles in the corridor at least every 50 feet and in at least two bedrooms in each nursing unit.

8. Telephone system.

9. Public address system.

10. Nurses' call system.

11. Medicine preparation area.

12. Sprinkler riser room.

13. Main electrical panel room.

14. Emergency generator location.

(cc) Existing mechanical and electrical systems. Mechanical and electrical systems installed prior to the effective date of these rules shall be inspected by local building, electrical, plumbing officials, or the state fire marshal or such other persons as the State Board of Health may request, and the recommendations regarding adequacy and safety shall be presented to the board.

(dd) Smoke dampers.

1. Smoke dampers shall be located in all ducts passing through smoke partitions. They shall be arranged to close upon activation of the fire alarm system by an initiating device.

2. Dampers shall remain closed while the fire alarm system is in the silence mode and shall remain closed until the fire alarm system is reset to normal.

(ee) Fire alarm.

1. A manual fire alarm system shall be provided to generate an audible and visual alarm throughout the facility.

2. Manual pull stations shall be installed at each exit.

3. The visual signal shall continue to flash while the alarm system is in the silence mode.

4. The fire alarm system shall sound upon activation of the automatic detection system, extinguishing system, and manual system.

5. In all buildings and additions connected by a common wall and corridor, the fire alarm system shall operate in all parts of the facility as one system.

(ff) Sprinkler. Building protection shall be provided throughout by an approved supervised automatic sprinkler system installed in accordance with NFPA 13 "standard for the installation of sprinkler systems."

(gg) Dead-end corridor shall not exceed 20 feet in length.

(hh) Rooms, spaces and equipment.

1. Each nursing unit shall have:

(i) Nurses' station.

(ii) Clean utility room.

(iii) Soiled utility room.

(iv) Medicine preparation area.

(v) Clean linen storage area. Cabinets on the corridor are not allowable.

(vi) Wheelchair and stretcher storage areas.

(vii) Janitor's closet.

(viii) On a nursing unit, no patient bedroom door shall be more than 120 feet from the nurses' station.

2. Bedrooms.

(i) Patients' bedrooms shall be located so as to minimize the entrance of odors, noise and other nuisances.

(ii) Patients' bedrooms shall be directly accessible from the main corridor of the nursing unit. In no case shall a patient's bedroom be used for access to another patient's room.

(iii) The bed capacity of any room shall not exceed four.

(iv) The minimum floor area of bedrooms (exclusive of toilets, closets, wardrobes, alcoves or vestibules) shall be as follows:

Private bedroom 120 square feet per bed

Multi-patient bedroom 80 square feet per bed

(v) There shall be sufficient space to permit nursing procedures to be performed and to permit the placing of beds at least 3 feet apart and 2 feet from the wall at the side of the bed and 3 feet from the wall at the foot of the bed.

(vi) Private bedrooms shall be provided at the ratio of 1 per 15 beds, or a major fraction thereof, which may include the special care or isolation room(s).

(vii) Each multi-patient room shall have permanently installed cubicle curtains and tracks to permit enclosing each bed with curtains to allow for the privacy of each patient without obstructing the passage of other patients to the corridor, closet, and toilet/lavatory.

(viii) Cubicle curtains installed in sprinklered building shall have 1\2 inch mesh openings extending 18 inches below the sprinkler deflector.

3. Accommodations for patients. The minimum accommodations for patient shall include the following:

(i) Bed patients shall be provided with an adjustable hospital bed with proper fitting mattress and personal care items.

(ii) Ambulatory patients shall be provided with a standard or adjustable hospital bed.

(iii) Pillows and necessary coverings.

(iv) Chair and bedside table.

(v) Chest for storage of clothing, toilet articles, and personal belongings.

(vi) Bedside electrical call system for summoning aid.

(vii) Waste paper receptacle.

(viii) Closet or wardrobe unit for each bed.

(ix) All facilities shall have a bed light mounted on the wall at the head of the bed, (operable by patient).

(x) All facilities shall provide a hand washing lavatory in each room. They may be omitted from a single-bed or a two-bed room when a lavatory is provided in an adjoining toilet or bathroom.

4. Isolation rooms shall be provided at the rate of not less than 1 private bedroom per 50 beds or major fraction thereof for the isolation of patients suffering from infectious diseases. The bedroom shall meet all of the requirements for bedrooms in these rules. Isolation bedrooms may be used to provide for the special care of patients with special needs. Isolation rooms shall have a private toilet.

5. The nurses' station for each nursing unit shall include as a minimum the following:

(i) Annunciator board for receiving patients' calls.

(ii) Cabinet space.

(iii) Storage space for current patients' charts.

(iv) Working space and accommodations for recording and charting purposes by facility staff.

(v) Medicine preparation room/area. (See storage of drugs and biologicals for specific requirements.)

6. All facilities shall provide a separate clean and soiled utility room for each nursing unit.

(i) The clean utility room shall contain as a minimum:

(I) Wall and base cabinets.

(II) Counter space.

(III) Single-compartment counter sink.

(IV) Paper towel cabinet.

(V) Soap dispenser.

(ii) The soiled utility room shall contain as a minimum:

(I) Paper towel and soap dispensers.

(II) Shelves.

(III) Cabinets for storage of poisonous substances; i.e., cleaning supplies, urine test products, etc.

(IV) Table or counter.

(V) Service sink for chemical sterilization of bed pans, urinals and commode pails, and/or pressure sterilizer.

(VI) Lavatory.

(VII) Soiled linen hamper.

7. Toilet and bathing facilities.

(i) For all patients bedrooms which do not have adjoining toilet and bath facilities, plumbing fixtures shall be provided within the nursing unit according to the following ratio:

bathtubs or showers 1 per 12 beds

lavatories 1 per 6 beds

toilets (water closets) 1 per 6 beds

(ii) Non-skid mats or equivalent and grab bars shall be provided at tubs and showers. Grab handles on soap dishes are not acceptable for grab bars.

(iii) Grab bars shall be provided at each water closet.

(iv) Only one tub or shower shall be installed in a bath or shower room. The room may also contain a lavatory and a water closet.

8. Nourishment units.

(i) All facilities shall have a nourishment station containing the following:

(I) Work counter.

(II) Refrigerator.

(III) Hot plate or microwave.

(IV) Storage cabinet.

(V) Sink in the counter.

(VI) Ice machine.

(VII) Storage space for trays and dishes.

(VIII) Hand washing lavatory.

(ii) A clean utility room, separate from a soiled utility room, may be used as a nourishment station when the above requirements are met.

9. Patient dining and recreation areas shall be provided in accordance with the following:

(i) The total area set aside for these purposes shall be at least 20 square feet per bed.

(ii) The area shall contain at least one sitting area and a dining area.

(iii) Each nursing unit shall contain at least one sitting area.

(iv) The dining room shall be of such size and dimensions as to permit placing of dining tables and chairs to seat not less than 50 percent of the patients in the facility at one seating. The dining room may also be used for recreational purposes. The kitchen shall not be used as a dining room for patients or personnel. Facilities shall provide a minimum of 12 square feet per person in the dining room.

(v) Dietary manager's office shall be located within the department and shall be equipped with necessary equipment.

10. Physical therapy areas, if provided, shall be in a specifically designated area and shall include equipment and areas as needed to meet specific patient requirements and shall also include storage space for linens, supplies, and equipment, a lavatory and a sink.

11. The Administrative Department and services shall be located in a specifically designated area and shall include the following:

(i) Administration.

(ii) Business Office/Accounting Services.

(iii) Lobby or waiting area.

12. All facilities shall provide maintenance services.

13. Employee toilets. Employee toilets shall be provided and shall include the following:

(i) Water closet.

(ii) Lavatory.

(iii) Soap dispenser.

(iv) Disposable towel dispenser.

(v) Covered waste receptacle.

Author: Jimmy D. Prince

Ala. Admin. Code r. 420-5-17-.25

New Rule: Filed August 20, 1993; effective September 23, 1993. Repealed and New Rule: Filed June 14, 2000; effective July 19, 2000. Amended: Filed June 18, 2002; effective July 23, 2002. ADDENDUM National Fire Protection Association 1 Battery March Park P.O. Box 9101 Quincy, MA 02269-9904 1-800-344-3555 Life Safety Code, NFPA-101 National Electrical Code, NFPA-70 Installation of Sprinkler Systems, NFPA-13 Air Conditioning and Ventilation Systems, NFPA-90a & 90b Standard Building and Plumbing Codes Standard Plumbing Gas & Mechanical Southern Building Code Congress International 900 Montclair Road Birmingham, AL 35213 1-205-591-1853 National Plumbing Code American Society of Heating, Refrigeration and Air Conditioning Engineers (ASHREA) Publication Sales 1791 Tullie Circle, NE Atlanta, GA 30329-2305 American Society of Mechanical Engineers United Engineering Center 345 East 47th Street, NE New York, NY 10017 American Gas Association 1515 Wilson Boulevard Arlington, VA 22209

Statutory Authority:Codeof Ala. 1975, §§ 22-21-20, etseq.