Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 85 - Intermediate Care and Skilled Nursing Facility › Section 19 CSR 30-85.012 - Construction Standards for New Intermediate Care and Skilled Nursing Facilities and Additions to and Major Remodeling of Intermediate Care and Skilled Nursing Facilities

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes construction standards
				  for new intermediate care and skilled nursing facilities and additions to and
				  remodeling of intermediate care and skilled nursing facilities.
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.
PUBLISHER'S NOTE: All rules relating to long-term
				  care facilities licensed by the Division of Aging 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 1986.
(1) Plans and specifications shall be
				prepared for the construction of all new intermediate care and skilled nursing
				facilities and additions to and remodeling of existing facilities. The plans
				and specifications shall be prepared in conformance with Chapter 327, RSMo, by
				a duly registered architect or registered professional engineer. III
(2) The facility may submit schematic and
				preliminary plans to the division showing the basic layout of the building and
				the general types of construction, mechanical and electrical systems. The
				facility may submit details before the larger and more complicated working
				drawings and specifications so that necessary corrections can be easily made
				before the final plans are submitted. The facility shall prepare and submit
				working drawings and specifications, complete in all respects, for approval by
				the division. These plans shall cover all phases of the construction project,
				including site preparation; paving; general construction; mechanical work,
				including plumbing, heating, ventilating and air conditioning; electrical work;
				and all built-in equipment, including elevators, kitchen equipment and cabinet
				work. II/III
(3) Facilities shall
				begin construction only after the plans and specifications have received the
				written approval of the division. Facilities shall then build in conformance
				with the approved plans and specifications. The facility shall notify the
				division within five (5) days after construction begins. If construction of the
				project is not started within one (1) year after the date of approval of the
				plans and specifications are not completed within a period of three (3) years,
				the facility shall resubmit the plans to the division for its approval and
				shall amend them, if necessary, to comply with the then current rules before
				construction work is started or continued. II/III
(4) The facility shall be located on an
				all-weather road and have easy access for vehicular traffic. III
(5) Facilities shall have access to local
				fire protection. III
(6) The
				facility shall provide adequate roads and walks within the lot lines to the
				main entrance and service entrance. III
(7) In any new addition, an existing licensed
				facility shall provide all required ancillary service areas, proportional to
				the number of new beds. However, for existing facilities, these support service
				areas may be reduced by the amount of existing areas that meet new facility
				requirements. New support areas required in this project, whether they are to
				serve the new beds or the existing beds, shall comply with the rules for new
				facilities. III
(8) Facilities
				shall have administrative and public areas as listed: business office,
				administrator's office (business office and administrator's office may be
				combined); director of nurses' office; lobby and waiting room (may be
				combined); public restrooms for each sex; and public telephone. III
(9) The facility shall provide recreation,
				occupational therapy, activity and residents' dining space at a ratio of at
				least thirty (30) square feet for each resident. II
(10) Facilities shall provide a bulk storage
				area consisting of a locked room, shelving, bins and large cans for storing
				long-term supplies of food and other dietary materials above the floor in a dry
				room with adequate ventilation, cool, but not freezing. The bulk storage area
				shall be one (1) square foot per bed, but in no case shall it be less than one
				hundred (100) square feet. III
(11)
				Facilities shall have dry short-term storage areas for daily food supplies and
				other dietary materials. The dry short-term storage area may include the space
				required for bulk storage. III
(12)
				A facility shall provide a preparation area for wrapping removal, vegetable
				cleaning and peeling and meat cutting. III
(13) Facilities shall provide adequate
				cooking and baking areas. III
(14)
				A facility shall have a salad and sandwich preparation area for the preparation
				of cold foods. III
(15) Facilities
				shall provide a tray preparation and loading area for preparing trays for
				residents' food delivery and food cart loading. III
(16) A facility shall provide a pot and pan
				washing area consisting of a three (3)-compartment sink with a double
				drainboard for the washing of utensils during the food preparation period.
				III
(17) Facilities shall have a
				dishwashing area provided with a soiled dish receiving counter, space for
				scraping with a garbage grinder, prerinse sink, counter for racking dishes,
				dishwasher, clean dish counter, dish rack storage and an exhaust fan.
				II/III
(18) A facility shall have a
				dish storage area with shelves adjacent to the tray preparation area.
				III
(19) Facilities shall provide
				refrigerators of adequate capacity in all kitchens and other preparation
				centers where perishable foods will be stored. A minimum of two (2) separate
				sections or boxes shall be provided in the main kitchen; one (1) for meat and
				dairy products and one (1) for general storage. III
(20) The refrigerators' compressors and
				evaporators shall have sufficient capacity to maintain temperatures of
				thirty-five degrees Fahrenheit (35oF) in the meat
				and dairy boxes and forty degrees Fahrenheit (40oF)
				in the general storage boxes when the boxes are being used for those purposes.
				II
(21) These compressors shall be
				automatically controlled. III
(22)
				Compressors, piping and evaporators shall be tested for leaks and capacity.
				Certification of these tests shall be made available to the division.
				III
(23) A facility shall have an
				office area for planning menus and food purchases next to the dietary area.
				III
(24) Kitchen shall have
				handwashing sinks. III
(25) A
				facility shall have a janitor's area, exposed or in a closet, in or near the
				kitchen, that contains a floor receptor or service sink. III
(26) A garbage removal area with garbage and
				trash cans located inconspicuously shall be easily accessible from both the
				kitchen and the service drive. III
(27) Housekeeping areas shall be provided as
				listed: clean linen area, soiled linen area and laundry area. II
(28) The facility shall have a designated
				physical therapy area large enough to give rehabilitative care to physically
				disabled residents. This area shall be sized to accommodate all equipment and
				activities in the facility's proposed physical therapy program. In no case
				shall this area be less than two hundred (200) square feet. III
(29) The facility shall provide the following
				elements: treatment areas and equipment as dictated by the facility's physical
				therapy program; a handwashing sink; an exercise area; storage for clean linen,
				supplies and equipment; a toilet room located in the physical therapy room or
				within the immediate area of the physical therapy department; and an office or
				sufficient space for the physical therapy director's desk and file. The
				physical therapy area may be located adjacent to an occupational therapy area
				and share any or all of the required elements providing that the sharing of
				elements conforms with the facility's therapy programs. III
(30) If there is a designated occupational
				therapy area, it shall be large enough to accommodate all the equipment and
				activities in the facility's proposed occupational therapy program. When the
				facility locates physical therapy and occupational therapy in the same area,
				there shall be a space that can be separated from the rest of the area if
				ceramics, sculpture, minor woodwork and light mechanical work are a part of the
				occupational therapy program. III
(31) Facilities shall provide a maintenance
				room or area. II
(32) A facility
				shall provide an employees' dressing or locker room with separate restrooms for
				each sex. III
(33) Facilities shall
				provide storage rooms as listed: general storage-ten (10) square feet per bed
				for the first fifty (50) beds, plus eight (8) square feet per bed for the next
				twenty-five (25) beds, plus five (5) square feet per bed for any additional
				beds over seventy-five (75). No storage room shall be less than one hundred
				(100) square feet of floor space. The required residents' clothes storage room
				and storage for outdoor equipment may be included in the minimum area required
				for general storage. III
(34) A
				continuous system of unobstructed corridors, referred to as required corridors,
				shall extend through the enclosed portion of each story of the building. These
				corridors will connect all rooms and spaces with each other and with all
				entrances, exit ways and elevators, with the following exceptions: work suites,
				such as the administrative suite and dietary area, occupied primarily by
				employed personnel may contain corridors or aisles as necessary, and will not
				be subject to the rules applicable to required corridors. Areas may be open to
				this system as permitted by the 1985 edition of the
Life Safety
				Code,
for those facilities with plans approved on or before December
				31, 1998. All facilities with plans submitted for approval on or after January
				1, 1999, shall comply with the provisions of the 1997
Life Safety
				Code,
incorporated by reference in this rule. II/III
(35) A facility shall provide a personal care
				room with barber and beauty shop facilities. III
(36) There shall be an oxygen storage room
				that is surrounded by one (1)-hour rated construction with a powered or gravity
				vent to the outside. II
(37)
				Facilities shall have one (1) or more nursing units. A nursing unit shall not
				exceed a maximum of sixty (60) resident beds. Each nursing unit shall be a
				single floor continuous area which does not require resident care traffic to
				traverse other areas. A facility shall not locate a resident room door more
				than one hundred forty feet (140') from the nurses' station and the dirty
				utility room. II
(38) Resident room
				area shall be a minimum of eighty (80) square feet per bed in multiple bed
				resident rooms, and one hundred (100) square feet per bed in one (1)-bed
				resident rooms. A continuous aisle not less than three feet (3') wide shall be
				available around the foot and along both sides of each bed. Facilities shall
				locate beds to avoid drafts, excessive heat and other residents discomforts.
				Typical minimum clear dimensions for the bed area in resident rooms shall be as
				follows:
1-Bed 10' 6" x 9' 3"
2-Bed 10' 6" x 15' 6"
3-Bed 10' 6" x 21' 9"
4-Bed 18' 0" x 15' 6"
Heating units and handwashing sinks may protrude into this
				  required space. II
(39) To
				provide for the isolation of a resident(s) with a communicable disease(s), each
				unit shall have at least two (2) private resident rooms provided with a
				separate room equipped with a toilet and handwashing sink to serve the
				isolation room only. III
(40) Each
				resident shall have a wardrobe, locker or closet. A clothes rod and shelf shall
				be provided. III
(41) No room shall
				be occupied by more than four (4) beds. III
(42) No resident shall be housed in a room in
				which the outside grade line is more than three feet (3') above the floor level
				on the window side of the resident room for a distance of at least fifteen feet
				(15') from the outside wall of the resident room. The resident rooms shall be
				outside rooms with minimum window sizes as follows:
1-Bed 10 square feet
2-Bed 16 square feet
3-Bed 24 square feet
4-Bed 32 square feet
These areas are for total window size including frames.
				  III
(43) Each resident,
				without entering the general corridor area, shall have access to a toilet room.
				III
(44) One (1) toilet room shall
				serve no more than six (6) beds and no more than two (2) resident rooms.
				II/III
(45) The toilet room shall
				contain a water closet and a lavatory. II
(46) If each resident room contains a
				hand-washing sink, the may omit the handwashing sink from a toilet room that
				serves adjacent resident rooms. When a handwashing sink is located within the
				same room as the toilet, the minimum area of a room shall be thirty (30) square
				feet. If the room contains only a toilet, the minimum area of the room shall be
				eighteen (18) square feet. III
(47)
				Each nursing unit shall have a centrally located nurses' work station with a
				work counter and storage space for charts. The entire counter shall have a four
				foot (4') distance between the wall located behind the counter and the edge of
				the counter nearest the wall. III
(48) Facilities shall provide a medicine
				preparation room next to each nurses' station that has at least sixty (60)
				square feet of useable floor space. Facilities shall provide a special locked
				medication cabinet for storage of the Class II medications inside the locked
				medication cabinet. If the outer cabinets are not locked, the facility must
				provide a closer and hardware that cannot be left unlocked on the door to the
				medicine room. A facility is also required to have the following in the
				medicine room: a work counter, handwashing sink, under cabinet storage, a
				medicine refrigerator, adequate lighting and provisions for proper temperature
				control. II/III
(49) Each nursing
				unit shall have a clean utility room accessible directly from the nursing unit
				corridor and near enough to the nurses' station to facilitate control by the
				nurses. The floor and walls shall have impervious surfaces. The facility shall
				provide this room with adequate lighting and heating, a hand-washing sink and
				at least one (1) locking cabinet. II/III
(50) Each nursing unit shall have a dirty
				utility room which is accessible directly from the nursing unit corridor. The
				floor shall have an impervious surface and the walls shall have impervious
				surfaces to a minimum height of five feet (5') above the floor. The room shall
				be provided with adequate lighting and heating, a double sink, clinic sink and
				at least one (1) locking cabinet. III
(51) Each nursing unit shall contain one (1)
				training or handicapped toilet per sex, each with a floor area of at least five
				feet by six feet (5' x 6'). This toilet may be located in the central bath.
				III
(52) Each nursing unit shall
				have a separate bathroom for each sex. II
(53) Tubs shall be institutional-type, free
				standing with a minimum of three feet (3') clearance from the wall on each side
				and four feet (4') at the end. The shower shall be a minimum of four feet (4')
				wide and of ample length for a wheelchair resident. Thirty-inch by sixty-inch
				(30" x 60") Americans with Disability Act (ADA)-approved showers will be
				accepted. The facility may replace required institutional-type tub(s) with
				whirlpool tubs or other types of bathing fixtures. III
(54) The aggregate number of tubs or showers
				or both shall not be less than one for each fifteen (1:15) beds on each floor.
				II/III
(55) The facility shall
				provide a locked cabinet in or near each bathroom for the storage of cleaning
				supplies. III
(56) Centralized
				bathing facilities shall have fixed partitions or fire-resistant curtains to
				provide a private compartment for each water closet, bathtub and shower.
				Curtains or doors shall be installed on access openings. III
(57) Clean linen storage with adequate
				shelving is required in each nursing unit. III
(58) Each nursing unit must have a stretcher
				and wheelchair parking area. III
(59) Equipment and supply storage is required
				in each nursing unit. III
(60)
				Required corridors shall be at least eight feet (8') wide and shall be wider at
				elevators and other points of traffic concentration. No part of the area of any
				required corridor or aisle shall be counted as part of the required area of any
				space adjacent to the corridor or aisle. II/III
(61) The width of stairways shall not be less
				than three feet eight inches (3' 8"). The width shall be measured between
				handrails where handrails project more than three and one-half inches (3 1/2").
				II/III
(62) Doors from sleeping and
				treatment areas through which residents will pass shall be at least forty-four
				inches (44") wide. Doors to centralized toilets, bathrooms, hair care salons
				and small day rooms shall be at least thirty-six inches (36") wide. Doors to
				individual toilets adjacent to resident rooms shall be at least thirty-two
				inches (32") wide. II
(63) Exit
				doors shall swing outward. Doors to rooms shall swing into the rooms they
				serve. Doors to small toilet rooms may swing out-ward into the next room and,
				if they swing inward, they shall be equipped for emergency access. No doors
				shall swing into required corridors or aisles except doors to janitors'
				closets, linen closets or doors to similar small spaces that are open only
				temporarily. II
(64) Ceilings shall
				be at least eight feet (8'). Ceilings in corridors, storage rooms, toilet rooms
				and other minor rooms shall not be less than seven feet six inches (7' 6").
				Suspended tracks, rails and pipes located in the normal traffic path shall be
				at least six feet eight inches (6' 8") above the floor. III
(65) Drinking fountains shall be located in
				or near the lobby and recreation area and in each nursing unit. The fountain
				shall be accessible to residents in wheelchairs. III
(66) Facilities with plans approved on or
				before December 31, 1998, shall comply with the American National Standards
				Institute (ANSI) publication A117.1, 1971,
Making Buildings and
				Facilities Accessible to, and Useable by, the Physically Handicapped
.
				All new facilities whose plans were submitted to the division on or after
				January 1, 1999, shall comply with ANSI A117.1, 1992,
Making Buildings
				and Facilities Accessible to, and Useable by, the Physically
				Handicapped,
incorporated by reference in this rule. III
(67) Handrails shall be provided on both
				sides of all corridors and aisles used by residents. Corridor handrails shall
				have ends return to the wall. III
(68) All stairways shall have handrails on
				both sides. II
(69) Facilities
				shall provide grab bars or handrails, secured in proper positions to facilitate
				the bodily movements of residents, next to all bathtubs, within all showers and
				on at least one (1) side of all toilets. II
(70) Lavatories shall be positioned to be
				accessible to wheelchair residents and shall not have cabinets underneath or
				any other unnecessary obstruction to the maneuverability of wheelchairs.
				III
(71) The facility shall provide
				mirrors in each resident's room or adjoining toilet room. Mirrors shall be at
				least three feet (3') high with the bottom edge located no more than three feet
				four inches (3' 4") above the floor or the facility may use framed tilting
				mirror(s). III
(72) Facilities
				shall provide fire-resistant divider curtains attached to the ceiling or walls
				in all resident rooms other than private or single bedrooms. A facility shall
				place these divider curtains to provide complete privacy for each bed.
				III
(73) All new facilities and
				additions to all areas of existing facilities which undergo major remodeling,
				shall be of sufficient strength in all their parts to resist all stresses
				imposed by dead loads, live loads and lateral or uplift forces such as wind,
				without exceeding, in any of the structural materials, the allowable working
				stresses established for these materials by generally accepted good engineering
				practice. II
(74) The following
				unit live loads shall be the minimum distributed live loads acceptable for the
				occupancies listed:
(A) Facility bedrooms and
				all adjoining service rooms which compose a typical nursing unit (except
				solariums and corridors)- forty pounds per square foot (40 psf); II
(B) Solariums, corridors in nursing units and
				all corridors above the first floor, examination and treatment rooms,
				laboratories, toilet rooms and locker rooms-sixty (60) psf; II
(C) Offices, conference room, library,
				kitchen, corridors and other public areas on first the floor-eighty (80) psf;
				II
(D) Stairways, laundry, large
				rooms used for dining, recreation or assembly areas and workshops-one hundred
				(100) psf; II
(E) Records file
				room, storage and supply-one hundred twenty-five (125) psf; II
(F) Mechanical equipment room-one hundred
				fifty (150) psf; II
(G) Roofs
				(except use increased value where snow and ice may occur)-twenty (20) psf; and
				II
(H) Wind-as required by local
				conditions but not less than fifteen (15) psf. II