450.3 Additional Physical Plant Requirements for Nursing Homes
In addition to the codes and standards referenced in Section 450.2 the following minimum standards of construction and specified minimum essential facilities shall apply to all new nursing homes, and all additions, alterations or renovations to an existing licensed nursing home, as described in Section 450.1 and listed in this section.
Because nursing homes may provide care utilizing two basic organizational models, two alternate design models are permitted to meet some of the specific physical plant requirements of this section. These alternate design models, the institutional design model and the household design model for personcentered care, are described in Sections 4220.127.116.11 and 418.104.22.168 of this code and are further defined by the physical plant requirements for each model as described in the applicable paragraphs of Section 450.3.
Either one or both of these design models may be used in the design of the nursing home as described by the functional program of the facility.
An institutional design model may utilize specific physical plant requirements of a household design model without being required to incorporate all of the household design elements.
Where no alternate design model is permitted, all nursing homes shall meet the described requirement.
Each resident unit shall consist of the resident rooms and support areas, and shall be arranged to avoid unnecessary and unrelated travel through the unit. It shall be designed to meet the organizational patterns of staffing, functional operations, and care programs as described in the functional program of the facility. Based on these aspects of the functional program, the resident unit may be designed to meet one of the following models:
This model is based on an institutionalized medical program similar in arrangement to that found in some hospitals. If this model is utilized for the design of the resident unit, it shall consist of the resident rooms, nurse station(s), and resident support areas and services as described in Section 422.214.171.124. Dining, activity, and social areas may be centralized and located away from the resident unit.
Each resident unit shall be limited to a maximum of 60 beds.
Travel distance from the entrance to a nurses' station, and from a clean utility and a soiled utility room(s) or function(s) to the middle of the entrance door of the farthest resident room served shall be a maximum of 150 feet (45.72 m).
This model is based on a home-like environment similar in arrangement to that found in a typical home. If this model is utilized for the design of the resident unit, it shall consist of the resident rooms and resident support areas and services as described in Section 4126.96.36.199. Dining, activity, and social areas shall be decentralized and included within the resident household.
Each resident household (unit) shall be limited to a maximum of 20 residents.
Two individual resident households (units) may be grouped into a distinct neighborhood with a maximum of 40 residents. This neighborhood, composed of the two resident households, may share the required resident support areas and services as described in Section 4188.8.131.52.
Each resident room shall meet the following minimum standards:
In new construction and additions, the maximum room capacity of each resident room shall be two persons.
Nursing homes designed to serve only for children 0 through 20 years of age may have a maximum room capacity of four persons.
Where renovation work of an existing resident room alters the physical configuration of the room and the present capacity of the room is more than two persons, the maximum room capacity shall be no more than two persons at the conclusion of the renovation.
Each resident room shall have a minimum of 100 square feet (9.29 m2) of clear floor area per bed in a double occupancy resident room and 120 square feet (11.15 m2) of clear floor area in a single occupancy resident room, exclusive of the space consumed by the toilet room, closet(s), wardrobe(s), lavatory(ies), alcove(s), and either the space for the door swing(s) into the room or the space for entrance vestibule, whichever is greater. For the purpose of determining the minimum clear floor area, the entrance vestibule is defined as that floor area located between the room entrance door and the room floor area containing the resident bed(s).
Where renovation work is undertaken that alters the room configuration, every effort shall be made to meet these minimum space standards. When this is not possible due to existing physical conditions or constraints, and with the approval of the Agency, a resident room shall have no less than 80 square feet (7.43 m2) of clear floor area per bed in a double occupancy resident room and 100 square feet (9.29 m2) of clear floor area in a single occupancy resident room. Clear floor area is as described in Section 4184.108.40.206.
For planning purposes, a full-size bed is assumed to be 3 feet 6 inches (1.07 m) wide by 8 feet (2.43 m) long.
A 3 feet (0.91 m) wide clear access space to each bed shall be provided along at least 75 percent of the length of one side of the bed and shall be designed to allow access for the use of a wheelchair and other portable equipment.
For a bed equipped with a piped in medical gas headwall unit, there shall be a minimum of 3 feet clearance (0.91 m) along the entire length of the bed between both sides and foot of the bed and any other bed, wall or any other fixed obstruction.
The dimensions and arrangement of each resident room shall be such that at least two bed locations are designed to accommodate resident personal choice. All such alternate bed locations shall meet the clearance requirements of Section 4220.127.116.11 and shall be designed so the bed will not obstruct access to the supporting utilities serving the bed including the nurse call station, individual reading lamp or fixture, and the required electrical outlets that provide service for the bed or other equipment. In a double occupancy resident room, only one bed must meet this requirement and any bed equipped with a piped in medical gas headwall unit shall meet the requirements of Section 418.104.22.168 and is exempt from this requirement.
The configuration of each resident room shall be designed to meet one of the following models:
If a double occupancy resident room is designed where the beds are located side by side, there shall be a minimum clearance of 3 feet (0.91 m) between both sides of each bed and any wall or any other fixed furniture, fixed obstruction or adjacent bed for at least 75 percent of the length of the bed, and a clearance of 3 feet 8 inches (1.11 m) to any fixed furniture, fixed obstruction, or adjacent bed at the foot of each bed to permit the passage of equipment or beds.
At a minimum, visual privacy shall be provided for each person by the installation of flame-retardant cubicle curtains or equivalent built-in devices.
The design for privacy shall not restrict resident access at any time to the room entrance, resident armchair, toilet or bathroom, wardrobe, or closet.
Individual resident sleeping areas in a double occupancy resident room shall be separated from each other by a full height wall or a permanently installed sliding or folding door or partition that provides visual privacy for each person.
Either doors or cubicle curtains to these individual resident sleeping areas shall be provided.
The design for privacy shall not restrict resident access at any time to the room entrance, resident armchair, toilet room, bathroom, window, wardrobe, or closet.
Each resident room shall be provided with a bedside table or equivalent furniture, a reading lamp, a well-constructed appropriate bed, and a nonfolding type armchair for each individual resident. As determined by the functional program of the facility, there shall be a number of over-bed tables available to bed restricted residents.
Each new resident room, and each individual resident sleeping area, as described in Section 422.214.171.124.2, shall have an exterior window(s) to the outside that is physically accessible to each resident at all times and visible from the resident's bed except when a cubicle curtain is closed. The window shall be sized with a clear opening of 8 percent of the gross square footage of the resident sleeping room or individual resident sleeping area as described in Section 4126.96.36.199.2. The clear opening of the window width and height shall have a minimum of 20 feet (6.10 m) unobstructed vista to any permanent structure, or equipment, and 15 feet (4.57 m) unobstructed vista to any vehicular driveway or property line measured horizontally from the plane of the window.
A handwashing facilily complete with mixing faucet shall be provided within each resident toilet room and within each resident room that shares a toilet room with another resident room. Separate resident sleeping areas, as described in Section 4188.8.131.52.2, do not constitute a separate resident room.
Each resident shall have access to a toilet room without having to enter the general corridor area or another resident bed area in a double occupancy resident room. One toilet room shall serve no more than two residents and no more than two resident rooms. A plumbing connection for a rinsing device shall be provided at the resident toilet within each resident toilet room unless the functional program provides a method for disposing of bedpans, urinals, and emesis basins after each and every use and is approved by AHCA.
The door to the toilet room shall be side hinged, and either swing out from the toilet room or be equipped with emergency release hardware. A sliding door equipped with sliding door hardware located on the resident room side of the wall and not equipped with a bottom door track shall be permitted. Unless otherwise required by this code, the door shall be at least 32 inches (813 mm) in clear width opening. The toilet room door that swings open into the resident room shall not impede the swing of any other door that opens into the resident room.
Each resident room shall be provided with a wardrobe or closet for each resident. Each wardrobe or closet shall have minimum inside dimensions of 1 foot 10 inches (0.55 m) in depth by 2 feet 6 inches (0.58 m) in width. Each wardrobe or closet shall be accessible to the resident at all times and shall have an adjustable shelf(s) and an adjustable clothes rod that is adjustable in a maximum of 4 inches (10.16 cm) increments from 4 feet (1.22 m) to 5 feet 8 inches (1.73 m) above finished floor or higher as wardrobe or closet size permits. When the wardrobe or closet is designed to meet the requirements for accessibility in accordance with the Florida Building Code, Accessibility, it shall include additional accessible storage area(s) for full-length garments. The shelf may be omitted if the clothing unit provides at least two drawers. Locked storage for a resident's personal items shall be provided within the resident sleeping room if required by the functional program.
The size and features of each resident support area will depend upon the number and type of residents served. The resident support areas shall be located inside of or readily accessible to each resident unit. The support areas and services shall be designed in accordance with one of the following design models.
A central and/or decentralized staff work area(s) shall be provided. Where a centralized staff work model is utilized it shall have space for supervisory administrative work activities, charting, and storage. The minimum area required shall be equal to 2 square feet (0.19 m2) for each resident bed served. Where a decentralized staff work model is utilized it shall provide for charting or transmitting charted data and for any storage of administrative activities.
A clean utility or clean holding room for storage and distribution of clean supply materials shall be provided. If the room is used for preparing resident care items, it shall contain a work counter, a hand-washing facility, and storage facilities for clean and sterile supplies. If the room is used only for storage and holding as a part of a system for distribution of clean and sterile supply materials, the work counter and handwashing facility requirements may be omitted. The minimum size of the room shall be 60 square feet (5.57 m2).
A clean linen storage room, closet or area shall be provided. This area may be located within the clean utility or clean holding room. It shall be large enough to accommodate the storage of linen carts. If in compliance with the Florida Fire Prevention Code a closed-cart system may be used and stored in an alcove open to the corridor.