Section 1225 [OSHPD 2] Skilled Nursing and Intermediate-Care Facilities
The provisions of this section shall apply to skilled nursing and intermediate-care facilities, including distinct part skilled nursing and intermediate-care services of a general acute-care or acute psychiatric hospital license, provided either is in a separate unit or a freestanding building. Skilled nursing facilities and intermediate-care facilities shall provide all common elements and support services. The required services for skilled nursing and intermediate-care facility licensure: physician, skilled nursing, dietary, pharmaceutical services, and activity program shall be provided. At the option of the provider, the medical model or the household model may be used.
Skilled nursing facilities participating in the Small House Nursing Facilities Pilot Program established by and in conformance with Section 1323.5 of the California Health and Safety Code, shall meet all the provisions of Section 1225.4 Common Elements and Section 1225.5.2 Household Model applicable to small house skilled nursing facilities.
New buildings and additions, alterations or repairs to existing buildings subject to licensure shall comply with applicable provisions of the California Electrical Code, California Mechanical Code, California Plumbing Code, California Fire Code (Parts 3, 4, 5 and 9 of Title 24), and this section.
Exception: See Section 1224.2.
Services/systems and utilities that are necessary to the operation of a skilled nursing facility or intermediate care facility shall meet the requirements of this section. Examples of services/systems and utilities include but are not limited to normal power; emergency power; nurse call; fire alarm; communication and data systems; space-heating systems; process load systems; cooling systems; domestic hot and cold water systems; means of egress systems; fire-suppression systems; building drain and sewer systems; and medical gas systems that support licensed services.
Services/systems and utilities for new buildings, additions, alterations and remodels shall only originate in, pass through or under structures which are under the jurisdiction of the Office of Statewide Health Planning and Development (OSHPD).
Means of egress for single-story wood frame or light-steel frame skilled nursing facilities and intermediate care facilities shall only pass through buildings that are under the jurisdiction of the Office of Statewide Health Planning and Development (OSHPD).
Refer to Section 1224.3.
A nurses' station in freestanding skilled nursing and intermediate-care facilities shall be provided within each nursing unit. Nurses' stations shall be designed to serve no more than 60 beds.
Nurses' stations shall be provided with a cabinet, a desk, space for records, a bulletin board, a telephone, a specifically designated, lockable and illuminated medicine storage compartment, and a handwashing fixture. If a separate medicine room is provided, it shall have a lockable door and a sink. This sink cannot replace the required nurses' station handwashing fixture.
Nurses' stations serving 25 or less beds shall have a minimum floor area of 100 square feet (9.29 m2). Nurses' stations servicing more than 25 beds shall have a minimum floor area of 125 square feet (11.6 m2). The minimum dimension of any nurses' station shall not be less than 8 feet (2438 mm).
In free-standing skilled nursing and intermediate-care facilities, the distance between the nurses station entrance and the center of the doorway of the most remote patient bedroom shall not exceed 150 linear feet (45,720 mm).
Exception: The 150-foot (45,720 mm) limit does not apply to distinct part skilled nursing and intermediate-care services provided as a separate unit in a general acute-care hospital or acute psychiatric hospital.
Each patient room shall be labeled with an identification number, letter, or combination of the two.
Exception: Small house skilled nursing facilities.
Utility rooms shall be provided in each nursing unit. Soiled and clean utility or holding rooms shall be separated and have no direct connection.
If the room is used for preparing patient care items, it shall contain a work counter, a handwashing fixture, and storage facilities for clean and sterile supplies. If the room is used only for storage and holding as part of a system for distribution of clean and sterile materials, the work counter and handwashing fixture may be omitted.
This room shall be separate from the clean utility room. The soiled workroom/utility room shall contain a clinical sink (or equivalent flushing-rim fixture). The room shall contain a handwashing fixture. The above fixtures shall both have a hot and cold mixing faucet. The room shall have a work counter and space for separate covered containers for soiled linen and waste. Rooms used only for temporary holding of soiled material may omit the clinical sink and work counter. If the flushing-rim clinical sink is eliminated, facilities for cleaning bedpans shall be provided elsewhere.
A method of assuring visual privacy for each patient shall be provided in patient rooms and in tub, shower and toilet rooms.
If provided, the treatment or exam room shall comply with all of the requirements of Section 1224.4.4.
Separate toilet room facilities shall be provided for the use of patients, staff, and the public. Fixtures serving individual patient rooms shall not be considered as meeting the required ratios for bedrooms not served by individual adjoining toilet room or bathrooms.
Each toilet, bathtub and shower serving patients shall be provided with conveniently located grab bars.
A patient/nurse call system complying with Section 517.123, California Electrical Code, shall be provided.
In small house skilled nursing facilities, visitor toilet room(s) shall be equipped with a nurse call station.
Special-purpose rooms for the purpose of single-patient occupancy shall be provided at a ratio of one room for every 35 patients or fraction thereof. Airborne infection isolation rooms may be included in determining the number of special-purpose rooms required for the facilities.
Exception: The special-purpose room may be omitted if all patient rooms are single-resident rooms.
If provided, the airborne infection isolation room shall comply with all of the requirements of Section 1224.14.3.
If provided, the protective environment room shall comply with all of the requirements of Section 1224.14.4.
Food service facilities and equipment shall conform with these standards, the standards of the National Sanitation Foundation, and the requirements of the local public health agency.
Provision(s) shall be made for transport of hot and cold foods as required, appropriate for the type of food service selected.
Separate dining spaces shall be provided for patients and staff. These spaces shall be separate from the food preparation and distribution areas.
Exception: Shared dining shall be provided for patients and staff in small house skilled nursing facilities.
The design and location of dining facilities shall encourage patient use.
Facilities shall be furnished to provide nourishment and snacks between scheduled meal service.
The following facilities, in the size and number appropriate for the type of food service selected, shall be provided:
Food-service areas shall be directly accessible to the entry for food supply deliveries and for the removal of kitchen wastes.
A control station shall be provided for the receiving and control of incoming dietary supplies.
Food preparation facilities shall be provided to accommodate the method of food preparation required.
- Conventional food preparation systems require space and equipment for preparing, cooking, and baking.
- Convenience food service systems using frozen prepared meals, bulk packaged entrees, individual packaged portions, or those using contractual commissary services require space and equipment for thawing, portioning, cooking, and baking.
Handwashing stations shall be located in the food preparation area.
Ice-making facilities may be located in the food preparation area or in a separate room. They shall be easily cleanable and immediately accessible to the dietary function.
A patient tray assembly area shall be provided and shall be immediately accessible to the food preparation and distribution areas.
- If food service carts are utilized, a cart distribution system shall accommodate spaces for storage, loading, distribution, receiving, and sanitizing of the food service carts. Cart circulation shall not be through food preparation areas.
Ware-washing space shall be provided in a room separate from the food preparation and serving area. It shall be designed to prevent contamination of clean wares with soiled wares through cross-traffic. The clean wares shall be transferred for storage or use in the dining area without having to pass through food preparation areas.
- Commercial-type ware-washing equipment shall be provided.
- Space shall be provided for receiving, scraping, sorting, and stacking soiled tableware, and for transferring clean tableware to the using areas.
- Handwashing stations shall be provided in the ware-washing space.
Pot-washing facilities shall include multi-compartmented sinks.
Office or other space shall be provided for the dietician or dietetic service supervisor.
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Food storage space, including cold storage, shall be provided for a supply of food of at least a 7 day staple, 2 day frozen, 2 day perishable, and an emergency food and water supply. All food shall be stored clear of the floor. The lowest shelf shall be not less than 12 inches (305 mm) above the floor or shall be closed in and sealed tight, for ease of cleaning.
As a minimum, dietary storage space shall be provided in accordance with the following schedule:
Licensed Bed Capacity Storage Space 1 to 99 beds 2 square feet (0.19 m2) per bed 100 to 199 beds 200 square feet (18.58 m2) plus 1 square foot 0.0929 m2) per bed in excess of 100 beds 200 beds and over 300 square feet (27.99 m2), plus 1/2 square foot (0.0465 m2) per bed in excess of 200 beds Space to allow refrigeration for the storage of frozen and chilled foods shall be provided at a minimum of 2 cubic feet (0.057 m3) of usable space per bed.
- Additional storage space for dietetic service supplies, such as paper products, equipment, tray delivery carts, etc. shall be provided.
- Storage areas and sanitizing facilities for cans, carts, and mobile-tray conveyors shall be provided.
- Waste, storage, and recycling facilities (per local requirements) shall be located in a separate room easily accessible to the outside for direct pickup or disposal.
Toilet rooms shall be provided for the exclusive use of the dietary staff. They shall not open directly into the food preparation areas, but shall be readily accessible.
Exception: Small house skilled nursing facilities utilizing staff trained for dietary and care-giving responsibilities may provide toilet room(s) serving both the dietary and nursing service areas.
An enclosed, separate area shall be provided for dietetic service employees' clothing and personal belongings.
Exception: Small house skilled nursing facilities utilizing staff trained for dietary and care-giving responsibilities may provide common locker room(s) serving both the dietary and nursing service areas.
A housekeeping room meeting the requirements of Section 1224.4.15 shall be located within the dietary department for the exclusive use of the dietary department.
On approval of the Licensing Agency, when food is provided by an outside food service, the facility shall maintain adequate space, equipment, and food supplies to accommodate required functional elements listed in Section 1225.4.2.2, as required to provide patient food service in the event that the outside food service is interrupted.
Space shall be provided for the storage of medical records.
An office for the director of nurses shall be provided.
Small house skilled nursing facility units may provide the administration and public spaces, medical record storage and the nursing director's office in a separate centralized support area attached to the unit(s) or detached in a separate building in close proximity to the unit(s), as a part of the small house skilled nursing facility. This building shall be under OSHPD jurisdiction.
Each facility shall provide space for the storage of disposable sterile supplies or provide space for sterilization and disinfection equipment.
Exception: Facilities with contractual arrangements for outside autoclaving and sterilizing services.
If provided, shall accommodate the following: