Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 87 - Sanitation Requirements for Long-Term Care Facilities › Section 19 CSR 30-87.020 - General Sanitation Requirements for New and Existing Long-Term Care Facilities

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes standards related to
				  general sanitation and housekeeping in a long-term care facility to protect the
				  health and safety of the residents.
PUBLISHER'S NOTE: The secretary of state has
				  determined that the publication of the entire text of the material which is
				  incorporated by reference as a portion of this rule would be unduly cumbersome
				  or expensive. Therefore, the material which is so incorporated is on file with
				  the agency who filed this rule, and with the Office of the Secretary of State.
				  Any interested person may view this material at either agency's headquarters or
				  the same will be made available at the Office of the Secretary of State at a
				  cost not to exceed actual cost of copy reproduction. The entire text of the
				  rule is printed here. This note refers only to the incorporated by reference
				  material.
(1) All parts of
				property used in connection with the operation of the facility shall be kept
				free of litter. Only articles necessary for the operation or maintenance of the
				facility shall be stored on the premises. III
(2) The walking and driving surfaces of all
				exterior areas of the facility shall be surfaced with concrete or asphalt, or
				with gravel or similar material effectively treated to facilitate maintenance
				and minimize dust. These surfaces shall be graded to prevent pooling and shall
				be kept free of litter. III
(3)
				There shall be present in the facility only those poisonous or toxic materials
				necessary for maintaining the establishment, cleaning and sanitizing equipment
				and utensils and controlling insects and rodents. II
(4) Containers of poisonous or toxic
				materials shall be prominently and distinctly labeled according to law for easy
				identification of contents. II
(5)
				Poisonous or toxic materials consist of the following categories: insecticides
				and roden-ticides; disinfectants, sanitizer and related cleaning or drying
				agents; and caustics, acids, polishes and other chemicals. Each of these three
				(3) categories set forth shall be stored and physically located separate from
				each other. All poisonous or toxic materials shall be stored in locked cabinets
				or in a similar physically separate place used for no other purpose which is
				not accessible to residents. II
(6)
				Bactericides, cleaning compounds or other compounds intended for use on
				food-contact surfaces shall not be used in a way that leaves a toxic residue on
				surfaces or that constitutes a hazard to residents, employees or other persons.
				II
(7) Poisonous or toxic materials
				shall not be used in a way that contaminates food, equipment or utensils, nor
				in a way that constitutes a hazard to residents, employees or other persons,
				nor in a way other than in full compliance with the manufacturer's labeling.
				II
(8) All rooms shall have
				sufficient ventilation to keep them free of excessive heat, steam,
				condensation, vapors, obnoxious odors, smoke and fumes. Ventilation systems
				shall be installed and operated according to law and, when vented to the
				outside, shall not create an unsightly, harmful or unlawful discharge.
				I/II
(9) Intake and exhaust air
				ducts shall be maintained to prevent the entrance of dust, dirt and other
				contaminating materials. III
(10)
				In new or extensively remodeled facilities, all rooms from which obnoxious
				odors, vapors or fumes originate shall be mechanically vented to the outside.
				II
(11) Deodorizers or sprays shall
				not be used to cover up odors. Odors shall be eliminated to the source by
				prompt cleaning of bed pans and commodes, floors, furniture and equipment and
				by proper ventilation. II/III
(12)
				All floors in the facility shall be clean and shall be maintained in good
				repair. Floors and floor coverings of all food-preparation, food-storage and
				utensil-washing areas, and the floors of all walk-in refrigerating units,
				dressing rooms, locker rooms, toilet rooms and vestibules shall be constructed
				of smooth durable material such as sealed concrete, terrazzo, ceramic tile,
				durable grades of linoleum or plastic, or tight wood impregnated with plastic.
				Nothing in this section shall prohibit the use of antislip floor covering in
				areas where necessary for safety reasons. III
(13) Carpeting, if used as a floor covering,
				shall be of closely woven construction, properly installed, easily cleanable
				and maintained in good repair. Carpeting is prohibited in food-preparation,
				equipment-washing and utensil-washing areas where it would be exposed to large
				amounts of grease and water, in food-storage areas and toilet room areas where
				urinals or toilet fixtures are located. III
(14) Mats and duckboards shall be of
				nonab-sorbent, grease-resistant materials and of that size, design and
				construction as to facilitate their being easily cleaned. Duckboards shall not
				be used as storage racks. III
(15)
				Walls and ceilings, including doors, windows and skylights, shall be clean and
				maintained in good repair. III
(16)
				Wall- and ceiling-covering materials shall be attached and sealed so as to be
				easily cleanable.
(17) The walls,
				including nonsupporting partitions, wall coverings and ceilings of walk-in
				refrigerating units, food-preparation areas, equipment-washing and
				utensil-washing areas, toilet rooms and vestibules shall be smooth,
				nonabsorbent and easily cleanable. Concrete or pumice blocks used for interior
				wall construction in these locations shall be finished and sealed to provide an
				easily clean-able surface. III
(18)
				Studs, joists and rafters, shall not be exposed in walk-in refrigerating units,
				food-preparation areas, equipment-washing areas, toilet rooms and vestibules.
				III
(19) Light fixtures, vent
				covers, wall-mounted fans, decorative materials and similar equipment attached
				to walls and ceilings shall be easily cleanable and shall be maintained clean
				and in good repair. III
(20)
				Cleaning of floors and walls, except emergency cleaning of floors, shall be
				done during periods when the least amount of food is exposed, such as between
				meals. Mops used for cleaning bathrooms shall be disinfected after use and
				before using in other areas. III
(21) In new or extensively remodeled
				facilities for more than twelve (12) residents at least one (1) utility sink or
				curbed facility with a floor drain shall be provided and used for the cleaning
				of mops or similar wet-floor cleaning tools and for the disposal of mop water
				or similar liquid wastes. The use of lavatories, utensil washing or equipment
				washing or food-preparation sinks for this purpose is prohibited. III
(22) Enough potable water for the needs of
				the facility shall be provided from a source constructed and operated according
				to law. Compliance is required with sections 1401, 1411, 1414, 1431 and 1445 of
				the Public Service Act as amended by the Safe Drinking Water Act, Public Law
				93-523 CFR 11990 as set forth in 10 CSR 60. Water shall be from a source
				approved by the regulating agency. I/II
(23) All potable water not provided directly
				by pipe to the facility from the source shall be transported in a bulk
				water-transport system and shall be delivered to a closed-water system. Both of
				these systems shall be constructed and operated according to law.
				I/II
(24) All sewage, including
				liquid waste, shall be disposed of by public sewage system or by a sewage
				disposal system constructed and operated according to law. Nonwater-carried
				sewage disposal facilities are prohibited. II
(25) Plumbing shall be sized, installed and
				maintained according to the
National Plumbing Code
.
				II/III
(26) There shall be no
				cross-connection between the potable water supply nor any source of pollution
				through which the potable water supply might become contaminated. II
(27) A nonpotable water system is permitted
				only for purposes such as air conditioning and fire protection and only if the
				system is installed according to law and the nonpotable water does not contact,
				directly or indirectly, food, potable water, equipment that contacts food or
				utensils. The piping of any non-potable water system shall be durably
				identified so that it is readily distinguishable from piping that carries
				potable water. II
(28) The potable
				water system shall be installed to preclude the possibility of back-flow.
				Devices shall be installed to protect against backflow and back siphonage at
				all fixtures and equipment where an air gap at least twice the diameter of the
				water supply inlet is not provided between the water supply inlet and the
				fixture's flood level rim. A hose shall not be attached to a faucet unless a
				backflow prevention device is installed. II
(29) Except for properly trapped open sinks,
				there shall be no direct connection between the sewage system and any drains
				originating from equipment in which food, portable equipment or utensils are
				placed. When a dishwashing machine is located within five feet (5') of a
				trapped floor drain, the dishwasher waste outlet may be connected directly on
				the inlet side of a properly vented floor drain trap if permitted by law.
				II
(30) Garbage and refuse shall be
				kept in durable, easily-cleanable, insect-proof and rodent-proof containers
				that do not leak and do not absorb liquids. Plastic bags and wet-strength paper
				bags may be used to line these containers, and they may be used for storage
				inside the facility. III
(31) Waste
				containers used in food-preparation and utensil-washing areas shall be kept
				covered when not in actual use. III
(32) Waste containers stored outside the
				establishment and dumpsters, compactors and compactor systems shall be easily
				clean-able, shall be provided with tight-fitting lids, doors or covers and
				shall be kept covered when not in actual use. In containers designed with
				drains, drain plugs shall be in place at all times, except during cleaning.
				III
(33) Cardboard or other
				packaging material not containing garbage or food wastes need not be stored in
				covered containers. III
(34) Soiled
				containers shall be cleaned at a frequency to prevent insect and rodent
				attraction. Liquid waste from compacting or cleaning operations shall be
				disposed of as sewage. III
(35)
				Garbage or refuse storage rooms, if used, shall be constructed of easily
				cleanable, nonabsorbent, washable materials, shall be kept clean, shall be
				insect-proof and rodent-proof and shall be large enough to store the garbage
				and refuse containers that accumulate. III
(36) Outside storage areas or enclosures
				shall be large enough to store the garbage and refuse containers that
				accumulate and shall be kept clean. III
(37) Garbage and refuse shall be disposed of
				often enough to prevent the development of odor and the attraction of insects
				and rodents. III
(38) Where refuse
				is burned on the premises, it shall be done in accordance with fire safety
				regulations. III
(39) Effective
				measures intended to minimize the presence of rodents, flies, cockroaches and
				other insects on the premises shall be utilized. The premises shall be kept in
				such condition as to prevent the harborage or feeding of insects or rodents.
				II/III
(40) Openings to the outside
				shall be effectively protected against the entrance of rodents. Outside
				openings shall be protected against the entrance of insects by tight-fitting,
				self-closing doors, closed windows, screening, control of air currents or other
				means. Screen doors shall be self-closing and screens for windows, doors,
				skylights, transoms, intake and exhaust air ducts, and other openings to the
				outside shall be tight-fitting and free of breaks. Screening material shall not
				be less than sixteen (16) mesh to the inch. II/III
(41) Toilet rooms shall be conveniently
				located and easily accessible to residents and employees. Toilet rooms shall be
				completely enclosed. Toilet fixtures shall be kept clean and in good repair. A
				supply of toilet tissue shall be provided at each toilet at all times. Easily
				cleanable receptacles shall be provided for waste materials. Toilet rooms used
				by women employees shall have at least one (1) covered waste receptacle.
				III
(42) Lavatories shall also be
				located in or immediately adjacent to toilet rooms or vestibules and shall be
				easily accessible to residents and employees. Lavatories shall be located to
				permit convenient use by all employees in food-preparation areas and
				utensil-washing areas. In new facilities, sinks used for food-preparation or
				for washing equipment or utensils shall not be used for handwashing.
				III
(43) Each lavatory, bathtub or
				shower shall be provided with hot and cold water tempered by means of mixing
				valve or combination faucet. Any self-closing, slow-closing or metering faucet
				used shall be designed to provide a flow of water for at least fifteen (15)
				seconds without the need to reactivate the faucet. Steam-mixing valves are
				prohibited. III
(44) A supply of
				hand-cleansing soap or detergent shall be available at each employee-use
				lavatory. A supply of sanitary towels or a hand-drying device providing heated
				air shall be conveniently located near each lavatory, except that hand towels
				for individual use are permitted. Common towels are prohibited. If disposable
				towels are used, easily cleanable waste receptacles shall be conveniently
				located near the hand-washing facilities. III
(45) Lavatories, soap dispensers, hand-drying
				devices and all related fixtures shall be kept clean and in good repair.
				III
(46) If employees routinely
				change clothes within the facility, rooms or areas shall be designated and used
				for that purpose. These designated rooms or areas shall not be used for food
				preparation, storage or service, or for utensil washing or storage. Lockers or
				other suitable facilities shall be provided and used for the orderly storage of
				employee clothing and other belongings. Lockers or other suitable facilities
				may be located only in the designated dressing rooms or in food-storage rooms
				or areas containing only completely packaged food or packaged single-service
				articles. III
(47) Laundry
				facilities shall be so designed and procedures instituted to prevent
				cross-contamination of clean and dirty linen. II
(48) If laundry for the facility is done
				commercially, either entirely or in part, space shall be provided for sorting,
				processing and storing soiled linen. II/III
(49) Storage space shall be located to
				facilitate convenient pickup and delivery by commercial laundry. III
(50) Equipment shall be provided to prewash
				linen soiled by incontinent residents before it is sent to the laundry.
				II/III
(51) For intermediate care
				and skilled nursing facilities, existing assisted living facilities and new
				residential care facilities and assisted living facilities licensed for more
				than twelve (12) residents, if laundry is done in the facility entirely or
				partially, the laundry room shall be in a separate room from the kitchen, the
				residents' room(s), the sitting or living room and the bathrooms or the nursing
				utility room. Adequate space shall be provided in the laundry room for storing,
				sorting and processing soiled linen. Table linen shall be laundered separately
				from bed linen, towels and clothing. Space shall be provided for storing clean
				linen in a separate room from the laundry. Nothing in this rule shall prohibit
				a facility from providing a laundry area for use by residents. II/III
(52) Provision shall be made for the proper
				care of soiled linen and clean linen on each floor of each building. A laundry
				hamper, with lid, laundry chute or some other suitable arrangement shall be
				provided. II/III
(53) Soiled
				clothes and linens shall be stored in nonabsorbent containers or washable
				laundry bags and shall be transported for laundering in tightly enclosed bags
				or containers. Nothing in this rule shall require residents to use tightly
				enclosed bags or containers when transporting their personal laundry items to
				the resident laundry area referred to in section (51). III
(54) Linen soiled by incontinent residents
				shall be washed or prewashed immediately. II/III
(55) Clean clothes and linens shall be stored
				in a clean place and protected from contamination until used. III
All rules relating to long-term care facilities licensed by
					 the department are followed by a Roman Numeral notation which refers to the
					 class (either Class I, II or III) of standard as designated in section
					 198.085.1, RSMo.
*Original authority: 198.005, RSMo 2006; 198.009, RSMo
					 1979, amended 1993, 1995; and 198.073, RSMo 1979, amended 1984, 1992, 1999,
					 2006.