Facility specifications; intermediate care.
"Board" means the Commission for Health Economics Control in Kentucky."License" means an authorization issued by the Board for the purpose of operating an intermediate care facility."Licensure agency" means the Division for Licensing and Regulation in the Office of the Inspector General, Cabinet for Human Resources.Preparation and Approval of Plans and Specifications. After receiving certificate of need approval from the board, the following procedures shall be followed:Before construction is begun for the erection of new buildings or alterations to existing buildings or any change in facilities for an intermediate care facility, the licensee or applicant shall submit plans in the detail specified in Section 3 of this administrative regulation to the licensure agency for approval.All architectural, mechanical and electrical drawings shall bear either the seal of an architect registered in the Commonwealth of Kentucky or the seal of a professional engineer registered in the Commonwealth of Kentucky, or both.Drawings shall not exceed thirty-six (36) inches by forty-six (46) inches when trimmed.All such plans and specifications must be approved by the licensure agency prior to commencement of construction of new buildings or alterations of existing buildings.Plans and specifications in specific detail as required by the Kentucky Building Code shall be submitted together with architectural and/or engineering stamps as required by KRS Chapters 322 and 323, to the Department of Housing, Buildings and Construction for determining compliance with the Kentucky Building Code. All such plans and specifications must be approved by the Department of Housing, Buildings and Construction, and appropriate local building permits shall be obtained prior to commencement of construction.Submission of Plans and Specifications.First stage. Schematic plans.Single line drawings of each floor shall show the relationship of the various departments or services to each other and the room arrangement in each department. The name of each room shall be noted. Drawings shall include typical patient room layouts (scaled one-fourth (1/4) inch = one (1) foot) with dimensions noted. The proposed roads and walks, service and entrance courts, parking and orientation shall be shown in a plot plan.If the project is an addition, or is otherwise related to existing buildings on the site, the plans shall show the facilities and general arrangements of those buildings.Second stage. Preliminary plans: preliminary sketch plans shall include the following:Architectural: plans of basement and floors.General description of the construction, including interior finishes, types and locations of acoustical material, and special floor covering;Description of the air-conditioning, heating, and ventilation systems and their controls, duct and piping systems; and dietary, laundry, and other special equipment;General description of electrical service including voltage, number of feeders, and whether feeders are overhead or underground.Third stage. Contract documents.Working drawings. Working drawings shall be complete and adequate for bid, contract, and construction purposes. Drawings shall be prepared for each of the following branches of the work: architectural, structural, mechanical, and electrical. They shall include the following:Approach plan showing all new topography, newly established levels and grades, existing structures on the site (if any), new building structures, roadways, walks, and parking areas;Plan of each basement, floor and roof;Elevations of each facade;Sections through building;Required scale and full-size details;Schedule of doors, windows, and room finishes;Equipment. Location of all fixed equipment. Layout of typical and special rooms indicating all fixed equipment and major items of movable equipment. Equipment not included in contract shall be so indicated;Conveying systems. Details of construction, machine and control spaces necessary, size and type of equipment, and utility requirements for the following: dumbwaiters: electric, hand, hydraulic; elevators: freight, passenger, patient; loading dock devices; pneumatic tube systems.Plans for foundations, floors, roofs, and all intermediate levels with sizes, sections, and the relative location of the various structural members;Dimensions of special openings;Details of all special connections, assemblies, and expansion joints.Heating, steam piping, and air-conditioning systems: radiators and steam heated equipment, such as warmers and steam tables; heating and steam mains and branches with pipe sizes; diagram of heating and steam risers with pipe sizes; sizes, types, and capacities of boilers, furnaces, hot water heaters with stokers, oil burners, or gas burners; pumps, tanks, boiler breeching, and piping and boiler room accessories; air-conditioning systems with required equipment, water and refrigerant piping and ducts; supply and exhaust ventilation systems with heating/cooling connections and piping; air quantities for all room supply and exhaust ventilating duct openings.Plumbing, drainage, and standpipe systems: size and elevation of: street sewer, house sewer, house drains, street water main, and water service into the building; location and size of soil, waste, and water service with connections to house drains, clean-outs, fixtures, and equipment; size and location of hot, cold and circulating branches, and risers from the service entrance, and tanks; riser diagram of all plumbing stacks with vents, water risers, and fixture connections; oxygen and vacuum systems; standpipe and sprinkler systems where required; all fixtures and equipment that require water and drain connections.Electric service entrance with switches and feeders to the public service feeders, characteristics of the light and power current, transformers and their connections if located in the building;Location of main switchboard, power panels, light panels, and equipment. Diagram of feeders and conduits (with schedule of feeder breakers or switches);Light outlets, receptacles, switches, power outlets, and circuits;Telephone layout showing service entrance, telephone switchboard, strip boxes, telephone outlets, and branch conduits;Nurses' call systems with outlets for beds, duty stations, door signal light, annunciators, and wiring diagrams;Emergency electrical system with outlets, transfer switch, sources of supply, feeders, and circuits.Specifications. Specifications shall supplement the drawings to fully describe types, sizes, capacities, workmanship, finishes and other characteristics of all materials and equipment and shall include:Sections describing materials and workmanship in detail for each class of work.Access to the work. Representatives of the appropriate state agencies shall have access at all reasonable times to the work wherever it is in preparation or progress, and the contractor shall provide proper facilities for such access and inspection.Compliance with Building Codes, Ordinances and Administrative Regulations.This section may be administered independently from other sections of this administrative regulation.General. Nothing stated herein shall relieve the sponsor from compliance with building codes, ordinances, and administrative regulations which are enforced by city, county, or state jurisdictions.The following requirements shall apply where applicable and as adopted by the respective agency authority.Requirements for safety pursuant to 815 KAR 10:020, as amended.Requirements for plumbing pursuant to 815 KAR 20:010 through 191, as amended.Requirements for air contaminants for incinerators pursuant to 401 KAR 59:020 and 401 KAR 61:010.Requirements for elevators pursuant to 803 KAR 4:010.Requirements for making buildings and facilities accessible to and usable by the physically handicapped, pursuant to KRS 198B.260 and administrative regulations promulgated thereunder.Prior to occupancy, facility must have final approval from appropriate agencies.All facilities shall be currently approved by the Fire Marshal's Office in accordance with the Life Safety Code, before relicensure is granted by the licensure agency.Facility Requirements and Special Conditions.Independent facilities with a capacity of fifty (50) beds or less present special problems. The sizes of the various departments shall depend upon the requirements of the facilities. Some functions allotted separate spaces or rooms in these general standards may be combined provided that the resulting plan will not compromise the standard of safety and of medical and nursing practices and the social needs of patients. Otherwise, the general standards set forth herein, including the area requirements, shall apply.Facilities shall be available to the public, staff, and patients who may be physically handicapped with special attention given to ramps, drinking fountain height, mirrors, etc.The number of beds in a nursing unit shall not exceed sixty (60) unless additional services are provided, as deemed necessary by the board. At least sixty-six (66) percent of the beds shall be located in rooms designed for one (1) or two (2) beds unless health program needs indicate otherwise in intermediate care mentally retarded/developmentally disabled facilities.Access to the facility shall be by means of a paved or gravel roadway which shall be available for use by traffic prior to a license being issued to the facility for occupancy.Patient rooms. Each patient room shall meet the following requirements:Maximum room capacity: four (4) patients.Patient rooms shall be designed to permit not less than a four (4) foot space between beds, and at least three (3) foot space between the side of a bed and the nearest wall, fixed cabinet, or heating/cooling element. A minimum of four (4) feet is required between foot of bed and opposite wall, or foot of opposite bed in multibed rooms.Window. All patient rooms must have windows opening to the outside. The sill shall not be higher than three (3) feet above the floor and shall be above grade. Window area shall be at least eight (8) percent of patient room floor area.Lavatory. In single and two (2) bed rooms with a private toilet room, the lavatory may be located in the toilet room. Where two (2) patient rooms share a common toilet, a lavatory shall be provided in each patient room;Wardrobe or closet for each patient. Minimum clear dimensions shall be one (1) foot and ten (10) inches deep by one (1) foot and eight (8) inches wide with full length hanging space with a clothes rod and shelf.Cubicle curtains, or equivalent built-in devices shall be provided for complete privacy for each patient in each multibed patient room and in tub, shower and toilet rooms.No patient room shall be located more than 120 feet from the nurses' station, the clean workroom, and the soiled workroom. No room shall be used as a patient room where the access is through another patient's room.Where a centralized toilet area is used, the facility shall provide for each sex on every floor the following: one (1) toilet for each eight (8) residents or major fraction thereof and one (1) lavatory for each sixteen (16) residents or major fraction thereof. Toilets must be separated by a permanent partition and at least one (1) toilet for each sex must be designed for wheelchair use.Grab bars shall be provided at all toilets. At least one (1) toilet shall be easily usable by wheelchair patients.Doors to toilet rooms shall have a minimum width of two (2) feet and ten (10) inches to admit wheelchair.Service areas in each nursing unit. The size of each service area will depend on the number and types of beds within the unit and shall include:Nurses' station. For nurses' charting, doctors' charting, communications, and storage for supplies and nurses' personal effects.Staff lounge area with personal storage space and a toilet room for staff.Visitors toilet room. The facility shall provide a toilet for visitors. The staff toilet room may serve as the visitors toilet room if marked and accessible.Clean workroom for storage and assembly of supplies for nursing procedures with a work counter and sink.Soiled workroom with a clinical sink, work counter with two (2) compartment sink, waste receptacles, and soiled linen receptacles.Medication area adjacent to nurses' station with sink, refrigerator, locked storage, and facilities for preparation and dispensing of medication. (May be designated area within clean workroom if a self-contained cabinet is provided.) The controlled substances locker must be under double lock.Clean linen storage with enclosed storage space. (May be designated area within the clean workroom.)Equipment storage room for storage of IV stands, inhalators, air mattresses, walkers, and similar bulky equipment.Patient baths. One (1) shower stall or one (1) bathtub shall be required for each twelve (12) beds not individually served. There shall be at least one (1) free standing bathtub in each bathroom. Grab bars or patient lift with a safety device shall be provided at all tubs. Grab bars shall be provided at all shower stalls. Each bathtub or shower enclosure in central bathing facilities shall provide space for private use, for dressing and for a wheelchair and attendant. At least one (1) shower in the central bathing facilities shall not be less than four (4) feet square, without curbs, and designed to permit use from a wheelchair. Soap dishes in showers and bathrooms shall be recessed.Janitor's closet for storage of housekeeping supplies and equipment with floor receptor or service sink.Bedpan washing facilities on each floor and located so that bedpans need not be carried through lobbies and dining areas.Patients' dining, TV viewing and recreation areas:The total areas set aside for these purposes shall be not less than thirty (30) square feet per bed for the first fifty (50) beds and twenty (20) square feet per bed for all beds in excess of fifty (50). Additional space shall be provided for outpatients if they participate in a day care program.Storage shall be provided for recreational equipment and supplies. (Such as wall cabinets or closets.)The areas set aside for these purposes must be readily accessible to wheelchair patients and shall be of sufficient size to accommodate equipment and permit unobstructed movement of wheelchair patients and personnel responsible for instructing and supervising patients.Dietary Department. If a commercial service will be used or meals will be provided by an adjacent hospital, dietary areas and equipment shall be designed to accommodate the requirements for sanitary, efficient, and safe storage, processing, and handling, otherwise the following shall be provided:Food preparation center with a lavatory but no mirror.Food serving facilities to accommodate patient and staff.Dishwashing and pot-washing facilities. Dish and utensil washing equipment shall be used that will result in sanitized serviceware and will prevent recontamination.Refrigerated storage which can accommodate a three (3) day supply minimum.Dry storage which can accommodate a three (3) day supply minimum.Food carts. If the facility uses food carts, space shall be provided in the kitchen or in a separate storage area for the cleaning and storage of food carts.Janitor's closet for storage for housekeeping supplies and equipment with a floor receptor or service sink.A toilet room conveniently accessible to the dietary department. If a toilet room is built within the dietary department it must have a two (2) door separation from food preparation area or dining areas.Administration Department. The facility shall have adequate administrative, public, and staff facilities (e.g., offices, lobby, toilet facilities) to accommodate the needs of the public, patients, and staff without interfering with the provision of medical care services.Laundry. The following shall be included:Lavatory accessible from soiled, clean, and processing rooms;Laundry processing room, and storage for laundry supplies. (Need not be provided if laundry is processed outside the facility.);Janitor's closet with storage for housekeeping supplies and equipment and floor receptor or service sink.Storage and Service Areas. The following shall be included:Sufficient storage space for general storage requirements.Engineering service and equipment areas. The following shall be provided where applicable:Mechanical and electrical equipment room(s) (can be combined with boiler room);Storage room for housekeeping equipment (need not be provided if space is available in janitor's closets or elsewhere);Refuse area for holding trash prior to disposal which is located convenient to service entrance.Details and Finishes. A high degree of safety for the occupants to minimize the incidence of accidents shall be provided. Hazards such as sharp corners shall be avoided. All details and finishes shall meet the following requirements:Handrails shall be provided on both sides of corridors used by patients in intermediate care facilities with a clear distance of one and one-half (1 1/2) inches between handrail and wall.All doors to patient-room toilet rooms and patient-room bathrooms shall swing outward or shall be equipped with hardware which will permit access in any emergency.All doors opening onto corridors shall be swing-type except elevator doors. Alcoves and similar spaces which generally do not require doors are excluded from this requirement.Thresholds and expansion joint covers, if used, shall be flush with the floor.Grab bars and accessories in patient toilet rooms, shower rooms, and bathrooms shall have sufficient strength and anchorage to sustain a load of 250 pounds for five (5) minutes.Lavatories intended for use by patients shall be installed to permit wheelchairs to slide under.Mirrors shall be arranged for convenient use by patients in wheelchairs as well as by patients in standing position.Towel rack or dispenser shall be provided at all lavatories and sinks used for hand-washing.Boiler room. Not less than two (2) feet and six (6) inches above the main boiler header and connecting piping with adequate headroom under piping for maintenance and access;Corridors, storage rooms, patients' toilet rooms, and other minor rooms. Not less than seven (7) feet and six (6) inches;All other rooms. Not less than eight (8) feet.Boiler room, food preparation centers, and laundries shall be insulated and ventilated to prevent any floor surface above from exceeding a temperature of eighty-five (85) degrees Fahrenheit.Noise reduction criteria. The ceilings of the following areas shall be designed to reduce noise transmission:Corridors in patient areas;Work areas, such as utility rooms;Lobbies and recreation areas.Special attention shall be given to sound transmission from boiler rooms, mechanical rooms, and kitchen, to patient bedroom areas.Floors generally shall be easily cleanable and shall have the wear resistance appropriate for the location involved. Floors in kitchen and related spaces shall be waterproof and grease-proof. In all areas where floors are subject to wetting, they shall have a nonslip finish.Adjacent dissimilar floor materials shall be flush with each other to provide an unbroken surface.Walls generally shall be washable and in the immediate area of plumbing fixtures, the finish shall be moisture-proof. Wall bases in dietary areas shall be free of spaces that can harbor insects.Ceilings generally shall be washable or easily cleanable. This requirement does not apply to boiler rooms, mechanical and building equipment rooms, shops and similar spaces.Elevators. Elevators shall conform with 815 KAR 4:010. Elevators, where required. All facilities where either patient beds or inpatient facilities such as diagnostic, recreation, patient dining or therapy rooms are located on other than the first floor, shall have electric or electrohydraulic elevators as follows:Number of elevators. All facilities with either patient beds or inpatient facilities located on any floor other than the first floor shall have at least one (1) hospital-type elevator and such additional elevators as determined by the licensure agency from a study of the facility plan and the estimated vertical transportation requirements.Cars and platforms. Cars of hospital-type elevators shall have inside dimensions that will accommodate a patient's bed and attendants and shall be at least five (5) feet wide by seven (7) feet and six (6) inches deep; car doors shall have a clear opening of not less than three (3) feet and eight (8) inches. Cars of all other required elevators shall have a clear opening of not less than three (3) feet.Leveling. Elevators shall have automatic leveling of the two (2) way automatic maintaining type with accuracy within plus or minus one-half (1/2) inch.Construction. Foundations shall rest on natural solid ground if a satisfactory soil is available at reasonable depths. Proper soil bearing values shall be established in accordance with recognized standards. If solid ground is not encountered at practical depths, the structure shall be supported on driven piles or drilled piers designed to support the intended load without detrimental settlement.Steam and hot water systems.Boilers. If boilers are used a minimum of two (2) must be provided; the combined capacity of the boilers, based upon the published Steel Boiler Institute or Institute of Boiler and Radiator Manufacturer's net rating, must be able to supply 150 percent of the normal requirements of all systems and equipment.The design and installation of boilers in the facility shall comply with 815 KAR 15:010 through 060.Temperature and ventilating systems.Temperatures. A minimum temperature of seventy-two (72) degrees Fahrenheit shall be provided for in occupied areas in winter conditions. A maximum temperature of eighty-five (85) degrees Fahrenheit shall be provided for in occupied areas in summer conditions.Ventilation systems details. All air-supply and air-exhaust systems shall be mechanically operated. All fans serving exhaust systems shall be located at or near the point of discharge from the building. The ventilation rates shown in Table 1, Section 16 of this administrative regulation, shall not be considered as precluding the use of higher ventilation rates if they are required to meet design conditions.Outdoor ventilation air-intakes, other than for individual room units, shall be located as far away as practicable but not less than twenty-five (25) feet from the exhausts from any ventilating system or combustion equipment. The bottom of outdoor intakes serving central air systems shall be located as high as possible but not less than eight (8) feet above the ground level or if installed through the roof, three (3) feet above roof level.The ventilation systems shall be designed and balanced to provide the general pressure relationship to adjacent areas shown in Table 1, Section 16 of this administrative regulation.Room supply air inlets, recirculation, and exhaust air outlets shall be located not less than three (3) inches above the floor.Corridors shall not be used to supply air to or exhaust air from any room, except that exhaust air from corridors may be used to ventilate rooms such as bathrooms, toilet rooms, or janitor's closets which open directly on corridors.Plumbing and other piping systems.Lavatories and sinks required in patient care areas shall have the water supply spout mounted so that its discharge point is a minimum distance of five (5) inches above the rim of the fixture. All fixtures used by medical and nursing staff, and all lavatories used by patients and food handlers shall be trimmed with valves which can be operated without the use of hands. Where blade handles are used for this purpose, they shall be at a distance from the center line of the sink to be operational.Clinical sinks shall have an integral trap in which the upper portion of a visible trap seal provides a water surface.Systems shall be designed to supply water to the fixtures and equipment on the upper floors at a minimum pressure of fifteen (15) pounds per square inch during maximum demand periods.Each water service main, branch main, riser and branch to a group of fixtures shall be valved. Stop valves shall be provided at each fixture.Hot, cold and chilled water piping and waste piping on which condensation may occur shall be insulated. Insulation of cold and chilled water lines shall include an exterior vapor barrier.Backflow preventers (vacuum breakers) shall be installed on hose bibbs and on all fixtures to which hoses or tubing can be attached such as janitor's sinks and bedpan flushing attachments.Hot water distribution systems shall be arranged to provide hot water at each fixture at all times.Piping over food preparation centers, food serving facilities, food storage areas, and other critical areas shall be kept to a minimum and shall not be exposed. Special precautions shall be taken to protect these areas from possible leakage of, or condensation from, necessary overhead piping systems.Hot water heaters and tanks.The hot water heating equipment shall have sufficient capacity to supply the water at the temperature and amounts indicated below:Storage tank(s) shall be provided and shall be fabricated of corrosion-resistant metal, or have noncorrosive lining.Plumbing approval. Prior to final approval of the plans and specifications by the licensure agency, the plumbing plans and specifications must be approved by the Division of Plumbing, Department of Housing, Buildings and Construction.General. Electrical requirements of the Kentucky Building Code shall apply where applicable.The wiring in each facility shall be inspected by a certified electrical inspector and a certificate of approval shall be issued to the facility, prior to occupancy; however, the wiring in existing buildings shall be approved by a certified electrical inspector only when the building has not been previously so approved for health care occupancy or where the State Fire Marshal finds that a hazardous condition exists.Switchboard and power panels. All breakers and switches shall be indexed.All spaces occupied by people, machinery, and equipment within buildings, and the approaches thereto, and parking lots shall have electric lighting.Patients' bedrooms shall have general lighting. A reading light shall be provided for each patient when appropriate. Patients' reading lights and other fixed lights not switched at the door shall have switch controls convenient for use at the luminaire. Fixed type night lights shall be provided in each patient's room.Lighting levels for the facility shall comply with the requirements of Table 2, Section 16 of this administrative regulation.Receptacles (convenience outlets).Bedroom. Each patient bedroom shall have duplex receptacles as follows: one (1) each side of the head of each bed (for parallel adjacent beds, only one (1) receptacle is required between the beds), receptacles for luminairies, television and motorized beds, if used, and one (1) receptacle on another wall.Corridors. Duplex receptacles for general use shall be installed approximately fifty (50) feet apart in all corridors and within twenty-five (25) feet of ends of corridors.Nurses' calling system. A nurses' visible signal calling station shall be installed at each patient bed and in each patient toilet, bath, and shower room. The nurses' call in toilet, bath, or shower room, shall be an emergency call. All calls shall register at the nurses' station and shall actuate a visible signal in the corridor at the patient's door, in the clean workroom, and the soiled workroom of the nursing unit.Emergency electric service.General. To provide electricity during an interruption of the normal electric supply that could affect the nursing care, treatment, or safety of the occupants, an emergency source of electricity shall be provided and connected to certain circuits for lighting and power.Sources. The source of this emergency electric service shall be an emergency generating set, when normal service is supplied by one (1) or more central station transmission lines.Emergency generating set.The required emergency generating set, including the prime mover and generator, shall be located on the premises and shall be reserved exclusively for supplying the emergency electrical system. The emergency generator set shall be sufficient kilowatt capacity to supply all lighting and power load demands of the emergency system. The power factor rating of the generator shall be not less than eighty (80) percent.When the facility is supplied by at least two (2) dedicated and separate utility service feeders, an emergency generating set is not required.Emergency electrical connections. Emergency electric service shall be provided to circuits as follows:Exitways and all necessary ways of approach thereto, including exit signs and exit direction signs, exterior of exits, exit doorways, stairways, and corridors;Dining and recreation rooms;Nursing station and medication preparation area;Generator set location, switch-gear location, and boiler room;Elevator (if required for emergency).Equipment. Essential to life safety and for protection of important or vital materials:Sewage or sump lift pump, if installed;At least one (1) duplex receptacle in each patient room;Equipment such as burners and pumps necessary for operation of one (1) or more boilers and their necessary auxiliaries and controls, required for heating and sterilization;Details. The emergency system shall be so controlled that after interruption of the normal electric power supply, the generator is brought to full voltage and frequency and connected within ten (10) seconds through one (1) or more primary automatic transfer switches to all emergency lighting, all alarms, nurses' call, and receptacles in patient corridors. All other lighting and equipment required to be connected to the emergency system shall either be connected through the above described primary automatic transfer switching or shall be subsequently connected through other automatic or manual transfer switching. Receptacles connected to the emergency system shall be distinctively marked for identification. Storage-battery-powered lights shall not be used as a substitute for the requirement of a generator. Where fuel is normally stored on the site, the storage capacity shall be sufficient for twenty-four (24) hour operation of required emergency electric services. Where fuel is normally piped underground to the site from a utility distribution system, storage facilities on the site will not be required.Emergency heating. Where electricity is the only source of power normally used for space heating, an alternate emergency heating system for the heating of corridors will be required. Emergency heating of corridors will not be required in areas where the facility is supplied by at least two (2) utility service feeders, each supplied by separate generating sources or a network distribution system fed by two (2) or more generators, with the facility feeders so routed, connected, and protected so that a fault any place between the generators and the facility will not be likely to cause an interruption of more than one (1) of the intermediate care facility's service feeders. If there is written plan for the transfer of patients within a reasonable time to other facilities with which the intermediate care facility has written transfer agreements, the above alternate emergency heating system will not be required.
(8 Ky.R. 234; eff. 11-5-1981; 16 Ky.R. 982; eff. 1-12-1990; Crt eff. 4-30-2019; TAm eff. 3-20-2020.)
Facility specifications; intermediate care.
"Board" means the Commission for Health Economics Control in Kentucky."License" means an authorization issued by the Board for the purpose of operating an intermediate care facility."Licensure agency" means the Division for Licensing and Regulation in the Office of the Inspector General, Cabinet for Human Resources.Preparation and Approval of Plans and Specifications. After receiving certificate of need approval from the board, the following procedures shall be followed:Before construction is begun for the erection of new buildings or alterations to existing buildings or any change in facilities for an intermediate care facility, the licensee or applicant shall submit plans in the detail specified in Section 3 of this administrative regulation to the licensure agency for approval.All architectural, mechanical and electrical drawings shall bear either the seal of an architect registered in the Commonwealth of Kentucky or the seal of a professional engineer registered in the Commonwealth of Kentucky, or both.Drawings shall not exceed thirty-six (36) inches by forty-six (46) inches when trimmed.All such plans and specifications must be approved by the licensure agency prior to commencement of construction of new buildings or alterations of existing buildings.Plans and specifications in specific detail as required by the Kentucky Building Code shall be submitted together with architectural and/or engineering stamps as required by KRS Chapters 322 and 323, to the Department of Housing, Buildings and Construction for determining compliance with the Kentucky Building Code. All such plans and specifications must be approved by the Department of Housing, Buildings and Construction, and appropriate local building permits shall be obtained prior to commencement of construction.Submission of Plans and Specifications.First stage. Schematic plans.Single line drawings of each floor shall show the relationship of the various departments or services to each other and the room arrangement in each department. The name of each room shall be noted. Drawings shall include typical patient room layouts (scaled one-fourth (1/4) inch = one (1) foot) with dimensions noted. The proposed roads and walks, service and entrance courts, parking and orientation shall be shown in a plot plan.If the project is an addition, or is otherwise related to existing buildings on the site, the plans shall show the facilities and general arrangements of those buildings.Second stage. Preliminary plans: preliminary sketch plans shall include the following:Architectural: plans of basement and floors.General description of the construction, including interior finishes, types and locations of acoustical material, and special floor covering;Description of the air-conditioning, heating, and ventilation systems and their controls, duct and piping systems; and dietary, laundry, and other special equipment;General description of electrical service including voltage, number of feeders, and whether feeders are overhead or underground.Third stage. Contract documents.Working drawings. Working drawings shall be complete and adequate for bid, contract, and construction purposes. Drawings shall be prepared for each of the following branches of the work: architectural, structural, mechanical, and electrical. They shall include the following:Approach plan showing all new topography, newly established levels and grades, existing structures on the site (if any), new building structures, roadways, walks, and parking areas;Plan of each basement, floor and roof;Elevations of each facade;Sections through building;Required scale and full-size details;Schedule of doors, windows, and room finishes;Equipment. Location of all fixed equipment. Layout of typical and special rooms indicating all fixed equipment and major items of movable equipment. Equipment not included in contract shall be so indicated;Conveying systems. Details of construction, machine and control spaces necessary, size and type of equipment, and utility requirements for the following: dumbwaiters: electric, hand, hydraulic; elevators: freight, passenger, patient; loading dock devices; pneumatic tube systems.Plans for foundations, floors, roofs, and all intermediate levels with sizes, sections, and the relative location of the various structural members;Dimensions of special openings;Details of all special connections, assemblies, and expansion joints.Heating, steam piping, and air-conditioning systems: radiators and steam heated equipment, such as warmers and steam tables; heating and steam mains and branches with pipe sizes; diagram of heating and steam risers with pipe sizes; sizes, types, and capacities of boilers, furnaces, hot water heaters with stokers, oil burners, or gas burners; pumps, tanks, boiler breeching, and piping and boiler room accessories; air-conditioning systems with required equipment, water and refrigerant piping and ducts; supply and exhaust ventilation systems with heating/cooling connections and piping; air quantities for all room supply and exhaust ventilating duct openings.Plumbing, drainage, and standpipe systems: size and elevation of: street sewer, house sewer, house drains, street water main, and water service into the building; location and size of soil, waste, and water service with connections to house drains, clean-outs, fixtures, and equipment; size and location of hot, cold and circulating branches, and risers from the service entrance, and tanks; riser diagram of all plumbing stacks with vents, water risers, and fixture connections; oxygen and vacuum systems; standpipe and sprinkler systems where required; all fixtures and equipment that require water and drain connections.Electric service entrance with switches and feeders to the public service feeders, characteristics of the light and power current, transformers and their connections if located in the building;Location of main switchboard, power panels, light panels, and equipment. Diagram of feeders and conduits (with schedule of feeder breakers or switches);Light outlets, receptacles, switches, power outlets, and circuits;Telephone layout showing service entrance, telephone switchboard, strip boxes, telephone outlets, and branch conduits;Nurses' call systems with outlets for beds, duty stations, door signal light, annunciators, and wiring diagrams;Emergency electrical system with outlets, transfer switch, sources of supply, feeders, and circuits.Specifications. Specifications shall supplement the drawings to fully describe types, sizes, capacities, workmanship, finishes and other characteristics of all materials and equipment and shall include:Sections describing materials and workmanship in detail for each class of work.Access to the work. Representatives of the appropriate state agencies shall have access at all reasonable times to the work wherever it is in preparation or progress, and the contractor shall provide proper facilities for such access and inspection.Compliance with Building Codes, Ordinances and Administrative Regulations.This section may be administered independently from other sections of this administrative regulation.General. Nothing stated herein shall relieve the sponsor from compliance with building codes, ordinances, and administrative regulations which are enforced by city, county, or state jurisdictions.The following requirements shall apply where applicable and as adopted by the respective agency authority.Requirements for safety pursuant to 815 KAR 10:020, as amended.Requirements for plumbing pursuant to 815 KAR 20:010 through 191, as amended.Requirements for air contaminants for incinerators pursuant to 401 KAR 59:020 and 401 KAR 61:010.Requirements for elevators pursuant to 803 KAR 4:010.Requirements for making buildings and facilities accessible to and usable by the physically handicapped, pursuant to KRS 198B.260 and administrative regulations promulgated thereunder.Prior to occupancy, facility must have final approval from appropriate agencies.All facilities shall be currently approved by the Fire Marshal's Office in accordance with the Life Safety Code, before relicensure is granted by the licensure agency.Facility Requirements and Special Conditions.Independent facilities with a capacity of fifty (50) beds or less present special problems. The sizes of the various departments shall depend upon the requirements of the facilities. Some functions allotted separate spaces or rooms in these general standards may be combined provided that the resulting plan will not compromise the standard of safety and of medical and nursing practices and the social needs of patients. Otherwise, the general standards set forth herein, including the area requirements, shall apply.Facilities shall be available to the public, staff, and patients who may be physically handicapped with special attention given to ramps, drinking fountain height, mirrors, etc.The number of beds in a nursing unit shall not exceed sixty (60) unless additional services are provided, as deemed necessary by the board. At least sixty-six (66) percent of the beds shall be located in rooms designed for one (1) or two (2) beds unless health program needs indicate otherwise in intermediate care mentally retarded/developmentally disabled facilities.Access to the facility shall be by means of a paved or gravel roadway which shall be available for use by traffic prior to a license being issued to the facility for occupancy.Patient rooms. Each patient room shall meet the following requirements:Maximum room capacity: four (4) patients.Patient rooms shall be designed to permit not less than a four (4) foot space between beds, and at least three (3) foot space between the side of a bed and the nearest wall, fixed cabinet, or heating/cooling element. A minimum of four (4) feet is required between foot of bed and opposite wall, or foot of opposite bed in multibed rooms.Window. All patient rooms must have windows opening to the outside. The sill shall not be higher than three (3) feet above the floor and shall be above grade. Window area shall be at least eight (8) percent of patient room floor area.Lavatory. In single and two (2) bed rooms with a private toilet room, the lavatory may be located in the toilet room. Where two (2) patient rooms share a common toilet, a lavatory shall be provided in each patient room;Wardrobe or closet for each patient. Minimum clear dimensions shall be one (1) foot and ten (10) inches deep by one (1) foot and eight (8) inches wide with full length hanging space with a clothes rod and shelf.Cubicle curtains, or equivalent built-in devices shall be provided for complete privacy for each patient in each multibed patient room and in tub, shower and toilet rooms.No patient room shall be located more than 120 feet from the nurses' station, the clean workroom, and the soiled workroom. No room shall be used as a patient room where the access is through another patient's room.Where a centralized toilet area is used, the facility shall provide for each sex on every floor the following: one (1) toilet for each eight (8) residents or major fraction thereof and one (1) lavatory for each sixteen (16) residents or major fraction thereof. Toilets must be separated by a permanent partition and at least one (1) toilet for each sex must be designed for wheelchair use.Grab bars shall be provided at all toilets. At least one (1) toilet shall be easily usable by wheelchair patients.Doors to toilet rooms shall have a minimum width of two (2) feet and ten (10) inches to admit wheelchair.Service areas in each nursing unit. The size of each service area will depend on the number and types of beds within the unit and shall include:Nurses' station. For nurses' charting, doctors' charting, communications, and storage for supplies and nurses' personal effects.Staff lounge area with personal storage space and a toilet room for staff.Visitors toilet room. The facility shall provide a toilet for visitors. The staff toilet room may serve as the visitors toilet room if marked and accessible.Clean workroom for storage and assembly of supplies for nursing procedures with a work counter and sink.Soiled workroom with a clinical sink, work counter with two (2) compartment sink, waste receptacles, and soiled linen receptacles.Medication area adjacent to nurses' station with sink, refrigerator, locked storage, and facilities for preparation and dispensing of medication. (May be designated area within clean workroom if a self-contained cabinet is provided.) The controlled substances locker must be under double lock.Clean linen storage with enclosed storage space. (May be designated area within the clean workroom.)Equipment storage room for storage of IV stands, inhalators, air mattresses, walkers, and similar bulky equipment.Patient baths. One (1) shower stall or one (1) bathtub shall be required for each twelve (12) beds not individually served. There shall be at least one (1) free standing bathtub in each bathroom. Grab bars or patient lift with a safety device shall be provided at all tubs. Grab bars shall be provided at all shower stalls. Each bathtub or shower enclosure in central bathing facilities shall provide space for private use, for dressing and for a wheelchair and attendant. At least one (1) shower in the central bathing facilities shall not be less than four (4) feet square, without curbs, and designed to permit use from a wheelchair. Soap dishes in showers and bathrooms shall be recessed.Janitor's closet for storage of housekeeping supplies and equipment with floor receptor or service sink.Bedpan washing facilities on each floor and located so that bedpans need not be carried through lobbies and dining areas.Patients' dining, TV viewing and recreation areas:The total areas set aside for these purposes shall be not less than thirty (30) square feet per bed for the first fifty (50) beds and twenty (20) square feet per bed for all beds in excess of fifty (50). Additional space shall be provided for outpatients if they participate in a day care program.Storage shall be provided for recreational equipment and supplies. (Such as wall cabinets or closets.)The areas set aside for these purposes must be readily accessible to wheelchair patients and shall be of sufficient size to accommodate equipment and permit unobstructed movement of wheelchair patients and personnel responsible for instructing and supervising patients.Dietary Department. If a commercial service will be used or meals will be provided by an adjacent hospital, dietary areas and equipment shall be designed to accommodate the requirements for sanitary, efficient, and safe storage, processing, and handling, otherwise the following shall be provided:Food preparation center with a lavatory but no mirror.Food serving facilities to accommodate patient and staff.Dishwashing and pot-washing facilities. Dish and utensil washing equipment shall be used that will result in sanitized serviceware and will prevent recontamination.Refrigerated storage which can accommodate a three (3) day supply minimum.Dry storage which can accommodate a three (3) day supply minimum.Food carts. If the facility uses food carts, space shall be provided in the kitchen or in a separate storage area for the cleaning and storage of food carts.Janitor's closet for storage for housekeeping supplies and equipment with a floor receptor or service sink.A toilet room conveniently accessible to the dietary department. If a toilet room is built within the dietary department it must have a two (2) door separation from food preparation area or dining areas.Administration Department. The facility shall have adequate administrative, public, and staff facilities (e.g., offices, lobby, toilet facilities) to accommodate the needs of the public, patients, and staff without interfering with the provision of medical care services.Laundry. The following shall be included:Lavatory accessible from soiled, clean, and processing rooms;Laundry processing room, and storage for laundry supplies. (Need not be provided if laundry is processed outside the facility.);Janitor's closet with storage for housekeeping supplies and equipment and floor receptor or service sink.Storage and Service Areas. The following shall be included:Sufficient storage space for general storage requirements.Engineering service and equipment areas. The following shall be provided where applicable:Mechanical and electrical equipment room(s) (can be combined with boiler room);Storage room for housekeeping equipment (need not be provided if space is available in janitor's closets or elsewhere);Refuse area for holding trash prior to disposal which is located convenient to service entrance.Details and Finishes. A high degree of safety for the occupants to minimize the incidence of accidents shall be provided. Hazards such as sharp corners shall be avoided. All details and finishes shall meet the following requirements:Handrails shall be provided on both sides of corridors used by patients in intermediate care facilities with a clear distance of one and one-half (1 1/2) inches between handrail and wall.All doors to patient-room toilet rooms and patient-room bathrooms shall swing outward or shall be equipped with hardware which will permit access in any emergency.All doors opening onto corridors shall be swing-type except elevator doors. Alcoves and similar spaces which generally do not require doors are excluded from this requirement.Thresholds and expansion joint covers, if used, shall be flush with the floor.Grab bars and accessories in patient toilet rooms, shower rooms, and bathrooms shall have sufficient strength and anchorage to sustain a load of 250 pounds for five (5) minutes.Lavatories intended for use by patients shall be installed to permit wheelchairs to slide under.Mirrors shall be arranged for convenient use by patients in wheelchairs as well as by patients in standing position.Towel rack or dispenser shall be provided at all lavatories and sinks used for hand-washing.Boiler room. Not less than two (2) feet and six (6) inches above the main boiler header and connecting piping with adequate headroom under piping for maintenance and access;Corridors, storage rooms, patients' toilet rooms, and other minor rooms. Not less than seven (7) feet and six (6) inches;All other rooms. Not less than eight (8) feet.Boiler room, food preparation centers, and laundries shall be insulated and ventilated to prevent any floor surface above from exceeding a temperature of eighty-five (85) degrees Fahrenheit.Noise reduction criteria. The ceilings of the following areas shall be designed to reduce noise transmission:Corridors in patient areas;Work areas, such as utility rooms;Lobbies and recreation areas.Special attention shall be given to sound transmission from boiler rooms, mechanical rooms, and kitchen, to patient bedroom areas.Floors generally shall be easily cleanable and shall have the wear resistance appropriate for the location involved. Floors in kitchen and related spaces shall be waterproof and grease-proof. In all areas where floors are subject to wetting, they shall have a nonslip finish.Adjacent dissimilar floor materials shall be flush with each other to provide an unbroken surface.Walls generally shall be washable and in the immediate area of plumbing fixtures, the finish shall be moisture-proof. Wall bases in dietary areas shall be free of spaces that can harbor insects.Ceilings generally shall be washable or easily cleanable. This requirement does not apply to boiler rooms, mechanical and building equipment rooms, shops and similar spaces.Elevators. Elevators shall conform with 815 KAR 4:010. Elevators, where required. All facilities where either patient beds or inpatient facilities such as diagnostic, recreation, patient dining or therapy rooms are located on other than the first floor, shall have electric or electrohydraulic elevators as follows:Number of elevators. All facilities with either patient beds or inpatient facilities located on any floor other than the first floor shall have at least one (1) hospital-type elevator and such additional elevators as determined by the licensure agency from a study of the facility plan and the estimated vertical transportation requirements.Cars and platforms. Cars of hospital-type elevators shall have inside dimensions that will accommodate a patient's bed and attendants and shall be at least five (5) feet wide by seven (7) feet and six (6) inches deep; car doors shall have a clear opening of not less than three (3) feet and eight (8) inches. Cars of all other required elevators shall have a clear opening of not less than three (3) feet.Leveling. Elevators shall have automatic leveling of the two (2) way automatic maintaining type with accuracy within plus or minus one-half (1/2) inch.Construction. Foundations shall rest on natural solid ground if a satisfactory soil is available at reasonable depths. Proper soil bearing values shall be established in accordance with recognized standards. If solid ground is not encountered at practical depths, the structure shall be supported on driven piles or drilled piers designed to support the intended load without detrimental settlement.Steam and hot water systems.Boilers. If boilers are used a minimum of two (2) must be provided; the combined capacity of the boilers, based upon the published Steel Boiler Institute or Institute of Boiler and Radiator Manufacturer's net rating, must be able to supply 150 percent of the normal requirements of all systems and equipment.The design and installation of boilers in the facility shall comply with 815 KAR 15:010 through 060.Temperature and ventilating systems.Temperatures. A minimum temperature of seventy-two (72) degrees Fahrenheit shall be provided for in occupied areas in winter conditions. A maximum temperature of eighty-five (85) degrees Fahrenheit shall be provided for in occupied areas in summer conditions.Ventilation systems details. All air-supply and air-exhaust systems shall be mechanically operated. All fans serving exhaust systems shall be located at or near the point of discharge from the building. The ventilation rates shown in Table 1, Section 16 of this administrative regulation, shall not be considered as precluding the use of higher ventilation rates if they are required to meet design conditions.Outdoor ventilation air-intakes, other than for individual room units, shall be located as far away as practicable but not less than twenty-five (25) feet from the exhausts from any ventilating system or combustion equipment. The bottom of outdoor intakes serving central air systems shall be located as high as possible but not less than eight (8) feet above the ground level or if installed through the roof, three (3) feet above roof level.The ventilation systems shall be designed and balanced to provide the general pressure relationship to adjacent areas shown in Table 1, Section 16 of this administrative regulation.Room supply air inlets, recirculation, and exhaust air outlets shall be located not less than three (3) inches above the floor.Corridors shall not be used to supply air to or exhaust air from any room, except that exhaust air from corridors may be used to ventilate rooms such as bathrooms, toilet rooms, or janitor's closets which open directly on corridors.Plumbing and other piping systems.Lavatories and sinks required in patient care areas shall have the water supply spout mounted so that its discharge point is a minimum distance of five (5) inches above the rim of the fixture. All fixtures used by medical and nursing staff, and all lavatories used by patients and food handlers shall be trimmed with valves which can be operated without the use of hands. Where blade handles are used for this purpose, they shall be at a distance from the center line of the sink to be operational.Clinical sinks shall have an integral trap in which the upper portion of a visible trap seal provides a water surface.Systems shall be designed to supply water to the fixtures and equipment on the upper floors at a minimum pressure of fifteen (15) pounds per square inch during maximum demand periods.Each water service main, branch main, riser and branch to a group of fixtures shall be valved. Stop valves shall be provided at each fixture.Hot, cold and chilled water piping and waste piping on which condensation may occur shall be insulated. Insulation of cold and chilled water lines shall include an exterior vapor barrier.Backflow preventers (vacuum breakers) shall be installed on hose bibbs and on all fixtures to which hoses or tubing can be attached such as janitor's sinks and bedpan flushing attachments.Hot water distribution systems shall be arranged to provide hot water at each fixture at all times.Piping over food preparation centers, food serving facilities, food storage areas, and other critical areas shall be kept to a minimum and shall not be exposed. Special precautions shall be taken to protect these areas from possible leakage of, or condensation from, necessary overhead piping systems.Hot water heaters and tanks.The hot water heating equipment shall have sufficient capacity to supply the water at the temperature and amounts indicated below:Storage tank(s) shall be provided and shall be fabricated of corrosion-resistant metal, or have noncorrosive lining.Plumbing approval. Prior to final approval of the plans and specifications by the licensure agency, the plumbing plans and specifications must be approved by the Division of Plumbing, Department of Housing, Buildings and Construction.General. Electrical requirements of the Kentucky Building Code shall apply where applicable.The wiring in each facility shall be inspected by a certified electrical inspector and a certificate of approval shall be issued to the facility, prior to occupancy; however, the wiring in existing buildings shall be approved by a certified electrical inspector only when the building has not been previously so approved for health care occupancy or where the State Fire Marshal finds that a hazardous condition exists.Switchboard and power panels. All breakers and switches shall be indexed.All spaces occupied by people, machinery, and equipment within buildings, and the approaches thereto, and parking lots shall have electric lighting.Patients' bedrooms shall have general lighting. A reading light shall be provided for each patient when appropriate. Patients' reading lights and other fixed lights not switched at the door shall have switch controls convenient for use at the luminaire. Fixed type night lights shall be provided in each patient's room.Lighting levels for the facility shall comply with the requirements of Table 2, Section 16 of this administrative regulation.Receptacles (convenience outlets).Bedroom. Each patient bedroom shall have duplex receptacles as follows: one (1) each side of the head of each bed (for parallel adjacent beds, only one (1) receptacle is required between the beds), receptacles for luminairies, television and motorized beds, if used, and one (1) receptacle on another wall.Corridors. Duplex receptacles for general use shall be installed approximately fifty (50) feet apart in all corridors and within twenty-five (25) feet of ends of corridors.Nurses' calling system. A nurses' visible signal calling station shall be installed at each patient bed and in each patient toilet, bath, and shower room. The nurses' call in toilet, bath, or shower room, shall be an emergency call. All calls shall register at the nurses' station and shall actuate a visible signal in the corridor at the patient's door, in the clean workroom, and the soiled workroom of the nursing unit.Emergency electric service.General. To provide electricity during an interruption of the normal electric supply that could affect the nursing care, treatment, or safety of the occupants, an emergency source of electricity shall be provided and connected to certain circuits for lighting and power.Sources. The source of this emergency electric service shall be an emergency generating set, when normal service is supplied by one (1) or more central station transmission lines.Emergency generating set.The required emergency generating set, including the prime mover and generator, shall be located on the premises and shall be reserved exclusively for supplying the emergency electrical system. The emergency generator set shall be sufficient kilowatt capacity to supply all lighting and power load demands of the emergency system. The power factor rating of the generator shall be not less than eighty (80) percent.When the facility is supplied by at least two (2) dedicated and separate utility service feeders, an emergency generating set is not required.Emergency electrical connections. Emergency electric service shall be provided to circuits as follows:Exitways and all necessary ways of approach thereto, including exit signs and exit direction signs, exterior of exits, exit doorways, stairways, and corridors;Dining and recreation rooms;Nursing station and medication preparation area;Generator set location, switch-gear location, and boiler room;Elevator (if required for emergency).Equipment. Essential to life safety and for protection of important or vital materials:Sewage or sump lift pump, if installed;At least one (1) duplex receptacle in each patient room;Equipment such as burners and pumps necessary for operation of one (1) or more boilers and their necessary auxiliaries and controls, required for heating and sterilization;Details. The emergency system shall be so controlled that after interruption of the normal electric power supply, the generator is brought to full voltage and frequency and connected within ten (10) seconds through one (1) or more primary automatic transfer switches to all emergency lighting, all alarms, nurses' call, and receptacles in patient corridors. All other lighting and equipment required to be connected to the emergency system shall either be connected through the above described primary automatic transfer switching or shall be subsequently connected through other automatic or manual transfer switching. Receptacles connected to the emergency system shall be distinctively marked for identification. Storage-battery-powered lights shall not be used as a substitute for the requirement of a generator. Where fuel is normally stored on the site, the storage capacity shall be sufficient for twenty-four (24) hour operation of required emergency electric services. Where fuel is normally piped underground to the site from a utility distribution system, storage facilities on the site will not be required.Emergency heating. Where electricity is the only source of power normally used for space heating, an alternate emergency heating system for the heating of corridors will be required. Emergency heating of corridors will not be required in areas where the facility is supplied by at least two (2) utility service feeders, each supplied by separate generating sources or a network distribution system fed by two (2) or more generators, with the facility feeders so routed, connected, and protected so that a fault any place between the generators and the facility will not be likely to cause an interruption of more than one (1) of the intermediate care facility's service feeders. If there is written plan for the transfer of patients within a reasonable time to other facilities with which the intermediate care facility has written transfer agreements, the above alternate emergency heating system will not be required.
(8 Ky.R. 234; eff. 11-5-1981; 16 Ky.R. 982; eff. 1-12-1990; Crt eff. 4-30-2019; TAm eff. 3-20-2020.)