1225.5 Skilled Nursing Unit Models
The requirements of the Medical Model or the Household Model shall apply to the Nursing Unit(s) in its entirety.
The dimensions and arrangement shall be such that there is a minimum distance of 3 feet (914 mm) between the sides and foot of the beds and any wall or any other fixed obstruction. In multiple-bed rooms, in addition to the above, a minimum clearance of 3 feet (914 mm) shall be provided between beds and a clearance of 4 feet (1219 mm) shall be available at the foot of each bed to permit the passage of equipment and beds.
Each patient bed area shall have an outside exposure and shall not be below ground level. The window or glazed opening shall provide an unobstructed view from the head of each patient bed to the outdoors and shall be accessible to approach using a wheelchair or other patient-operated mobility device.
Adequate space shall be provided at each nursing station for the storage of drugs and preparation of medication doses.
All spaces and areas used for the storage of drugs shall be lockable and accessible to authorized personnel only.
Facilities shall provide for storage of drugs requiring refrigeration.
The pharmacy shall not serve the general public unless a separate public entrance or a separate public serving window is utilized.
Designated activity areas appropriate to independent and group needs of patients shall be provided as follows:
- Recreation room. Each floor of each building accommodating six or more patients shall be provided with a recreation room with a minimum of 100 square feet (9.29 m2).
- Recreation and dining. A minimum of 100 square feet (9.29 m2) plus 12 square feet (1.11 m2) per bed shall be provided for recreation and dining activities.
- Recreation room. Each floor of each building accommodating five or more patients shall be provided with a recreation room with a minimum of 150 square feet (13.94 m2).
- Recreation and dining. A minimum of 30 square feet (2.79 m2) per bed for recreation and dining activities.
- Outdoor space for activities and recreation.
A seating area(s) located out of the required egress width shall be provided along the access corridor that is used by patients.
All patient use plumbing fixtures and door operating hardware shall be equipped with lever type hardware for easy gripping and turning.
A minimum of one drinking fountain shall be provided per resident floor, unless drinking water is available from the resident dietary area.
Each resident unit shall consist of the resident rooms, resident support areas, and resident living areas. The unit shall be designed as a cluster/household resident unit or as a resident unit with double or single loaded access corridors. If the cluster/household unit design is utilized, it shall be designed around resident support and living areas with a maximum of 20 patients per cluster/household unit. If the double or single loaded corridor resident unit design is utilized, the access corridor shall be designed so that travel distance from the entrance of the resident unit to the furthest resident room door is no more than 60 feet (18.29 m) without a change of corridor direction or a node for a resident sitting area.
Exception: Small house skilled nursing facilities are limited to household units with a maximum of 12 patients per unit. Small house household units may also be developed as individual, free-standing facilities.
Each resident unit shall be arranged to avoid unnecessary and unrelated travel through the unit.
Both the cluster/household unit and resident unit designs may be grouped into distinct parts or neighborhoods to a maximum of 60 patients. These distinct parts or neighborhoods composed of the resident unit(s) as described in Section 1188.8.131.52.1 may share the functional requirements of the resident support areas as described in Sections 1184.108.40.206 and 1220.127.116.11 of this code.
In new construction and additions, the maximum room capacity shall be two patients. Resident sleeping areas in all double resident room designs shall be visually separated from each other by a full height wall or a permanently installed sliding or folding door or partition, and shall provide each patient direct use of and direct access to an exterior window at all times. Walls, doors, or partitions used to separate resident beds shall provide visual and acoustical separation. A door leading to each resident bed area in addition to the corridor door is not required. Other resident room arrangements where a permanent partition or door is not used to separate the resident sleeping areas may be utilized if adequate visual separation such as a cubicle curtain(s) and an exterior window for each individual resident sleeping area is provided. In this case individual thermostats for the resident bed areas shall not be required.
Exception: In small house skilled nursing facilities, resident sleeping areas in all double-resident room designs shall be visually separated from each other by a full-height wall or a permanently installed sliding or folding door or partition, and shall provide each patient direct use of and direct access to an exterior window at all times. Walls, doors, or partitions used to separate resident beds shall provide visual and acoustical separation.
Rooms shall have a minimum of 100 square feet (9.29 m2) of clear floor area per bed in double resident rooms and 120 square feet (11.15 m2) of clear floor area in single resident rooms, exclusive of the space consumed by toilet rooms, closets, lockers, wardrobes, lavatories, alcoves, and door swings into the room or entrance vestibules, whichever is greater. For the purpose of 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).
Dimensions and arrangement of resident rooms shall be designed to accommodate at least two bed positions to provide patient choice of bed placement. All such bed positions shall be designed so that the bed will not obstruct access to the supporting utilities serving the bed, such as the nurse call station, and the required electrical outlets that provide service for that bed. Only one bed position design shall be required for a bed that is equipped with a piped medical gas headwall unit, unless special requirements such as providing care for bariatric patients does permit the design of two bed positions in the room.
A 3 feet (0.91 m) wide clear access 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 beds equipped with a piped-in medical gas headwall unit, there shall be a minimum of 3 feet (0.91 m) between the sides and foot of the bed and any wall or any other fixed obstruction. 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.
For renovations that alter the physical configuration of the resident room but have existing structural limitations that require two resident beds to be located in a shared resident sleeping area, there shall be a minimum of 3 feet (0.91 m) between the sides and foot of the bed and the adjacent bed. If one bed must be located to the side of the other bed, there shall be a clearance of 4 feet (1.22 m) to any fixed obstruction available at the foot of this bed to permit the passage of equipment and bed without moving the resident's bed located nearest to the room door.
Exception: In small house skilled nursing facilities, two beds shall not be permitted in a shared resident sleeping area.
Each patient shall have access to a toilet room without having to enter the general corridor area or the resident bed area in a shared resident room. One toilet room shall serve no more than two patients and no more than two resident rooms. 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. Sliding doors 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. If a sliding door is used in a resident toilet or bath room, a D-shaped handle at least 4 inches (10.16 cm) long shall be provided to open the door. The sliding door shall permit access, and negate the need to push against a patient who may have collapsed within the toilet room. Unless otherwise required by this code, this door shall be at least 36 inches (914.4 mm) wide. A lavatory shall be provided in each resident toilet room.
Each resident room shall be provided with a wardrobe or closet for each patient. Each wardrobe or closet shall have minimum inside dimensions of 2 feet (0.61 m) in depth by 1 foot 8 inches (0.51 m) in width. Each shall be accessible to the patient at all times and shall have adjustable shelf(s) and an adjustable clothes rod that is adjustable in at most 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 closet size permits. When the wardrobe or closet is designed to meet the requirements for accessibility per Chapter 11B of this code, 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 personal items shall be provided within the resident sleeping room or area.
Size and features of each resident support area will depend upon the number and type of patients served. The resident support area may be arranged and located to serve more than one resident unit, but at least one such support area shall be provided on each resident floor. The following resident support areas shall be located in or be readily accessible to each resident unit.
A centralized staff work area shall be provided. It shall have space for supervisory administrative work activities, charting, and storage. In each resident unit, the functions of administrative work, charting and storage may be located among several separate direct care staff work areas. In this case, a centralized staff work area is not required.