Hospice Residence Operational Requirements

Section 280 Section 280.4040  Hospice Residence Operational Requirements a)         A supply of clean linen, washcloths and towels, available at all times and adequate for the number of residents, shall be provided.  Storage, handling, processing and transportation of clean and soiled linen shall prevent cross-contamination and odors. b)         Nutritional Issues If the integrated care plan identifies that patient intake of adequate nutrition or hydration is a problem, a nutritional plan shall be developed that is consistent with the patient's advance directives or the patient's stated choices as noted in the clinical record. c)         Meal Service Meals shall be scheduled in accordance with times customary in the community. The hospice residence shall provide a variety of menus that recognize patient preferences. d)         Food Service Sanitation 1)         Food shall be free from spoilage, filth, and other contamination, and shall be safe for human consumption.  Scheduled meals shall be prepared in a food service establishment that has been inspected by a local health department. 2)         Food shall be protected from potential contamination while being stored, prepared, served, or transported.  Potentially hazardous food shall be maintained at temperatures in accordance with Section 750.10 of the Food Service Sanitation Code. 3)         Adequate refrigeration facilities and hot food storage facilities shall be provided to ensure the maintenance of food at the required temperature during storage. 4)         No person shall work in food service while infected with a disease in a communicable form that can be transmitted by foods, or who is a carrier of organisms that cause a communicable disease, or while afflicted with a boil or infected wound or an acute respiratory infection. 5)         Staff shall wash their hands thoroughly with soap and warm water before starting work, during work as often as necessary to keep the hands clean, and after smoking, eating, drinking, or using the toilet.  Staff shall not use tobacco in any form while engaged in food preparation or service, or while in any equipment or utensil washing or food preparation area. 6)         Food contact surfaces shall be easily cleanable, smooth, free of breaks, open seams, cracks, chips, pits, and similar imperfections, and be free of difficult-to-clean internal corners and crevices.  Non-food-contact surfaces of equipment shall be designed and fabricated to be smooth, washable, free of unnecessary ledges, projections, or crevices, and shall be maintained in a clean, sanitary condition.  Food-contact and non-food-contact surfaces shall be maintained in a clean condition. 7)         Equipment and utensils shall be washed, rinsed, and sanitized after each use.  For manual cleaning and sanitizing, items shall be washed in a hot detergent solution, rinsed with clear water, and sanitized by one of the following methods: A)        Immersion for at least one-half minute in clean, hot water of at least 170ºF; B)        Immersion for at least one minute in a clean solution of at least 50 parts per million of available chlorine as a hypochlorite and having a temperature of at least 75ºF; C)        Immersion for at least one minute in a clean solution containing at least 12.5 parts per million of available iodine and having a pH not higher than 5.0 and a temperature of at least 75ºF; or D)        Immersion in a clean solution containing any other chemical sanitizing agent allowed under 21 CFR 178.1010 that will provide the equivalent bactericidal effect of a solution containing at least 50 parts per million of available chlorine as a hypochlorite and having a temperature of at least 75ºF for one minute. 8)         Mechanical cleaning and sanitizing may be done by spray-type or immersion dishwashing machines, or by any other type of machine or device demonstrated to thoroughly clean and sanitize equipment and utensils.  Machines shall be installed and maintained in good repair, and shall be operated in accordance with the manufacturer's instructions.  The final sanitizing rinse shall be at least 180ºF or equivalent. 9)         Utensils shall be air dried before being stored or shall be stored in a self-draining position. 10)         Garbage and refuse shall be kept in durable, easily cleanable insect- and rodent-proof containers that do not leak or absorb liquid. 11)         The facility shall be kept in such a condition as to prevent insects and rodents from harboring or feeding.  Screen doors shall be self-closing, and screening material shall not be less than 16 mesh to the inch. 12)         Floors, floor coverings, walls and ceilings shall be easily cleanable and maintained in good repair. 13)         Poisonous or toxic materials shall be properly labeled.  Insecticides and rodenticides and detergents, sanitizers, and other cleaning agents shall be stored physically separate from each other and not stored above or intermingled with food, food equipment, and utensils. e)         Physical Plant Requirements 1)         New hospice residences shall submit drawings for the proposed hospice residence for review by the Department.  The drawing shall  be in compliance with the requirements of NFPA 101, Chapter 18, New Health Care Occupancies. 2)         Existing hospice residences shall comply with the requirements of NFPA 101, Chapter 19, Existing Health Care Occupancies. 3)         Each hospice residence shall be in full compliance with local building codes and fire safety/protection requirements. 4)         Exits shall not be blocked. 5)         The following patient areas shall be designed and equipped for the comfort and privacy of each patient and his or her family members: A)        Physical space for private patient/family visiting; B)        Accommodations for family members to remain with the patient throughout the night; C)        Accommodations for family privacy after a patient's death; D)        A living room with a minimum area of 10 square feet per patient bed; and E)        A dining room with a minimum area of 10 square feet per patient bed. 6)         Decor shall be homelike in design and function. 7)         Not more than two people shall share a bedroom.  No room commonly used for other purposes, including, but not limited to, a hall, stairway, attic, garage, storage area, shed or similar detached building, shall be used as a sleeping room for any patient. 8)         The patient rooms shall be designed and equipped for adequate nursing care and the comfort and privacy of patients and shall comply with the following: A)        Be equipped with or conveniently located near toilet and bathing facilities; B)        Be at or above grade level; C)        Contain a suitable bed for each patient and other appropriate furniture; D)        Have closet space that provides security and privacy for clothing and personal belongings; E)        Contain no more than two beds; F)         Measure at least 100 square feet for a single patient room or 80 square feet for each patient in a multi-patient room; and G)        Be equipped with a device for calling the staff member on duty. 9)         Toilets and bathroom facilities shall be conveniently located.  At least one toilet, washbasin, and bathtub or shower shall be provided per six patients. If the bathing area or toilet room contains more than one of each fixture, a means of allowing individual privacy shall be provided.  Toilets and bathroom facilities shall be designed to provide the following: A)        An adequate supply of hot water at all times for patient use; and B)        Plumbing fixtures with control valves that automatically regulate the temperature of the hot water used by patients. 10)         Isolation areas.  The hospice shall isolate patients with infectious diseases. 11)         Garbage shall be disposed of in accordance with State and local requirements.  Potentially infectious medical wastes shall be disposed of in accordance with State and local requirements.  All solid waste shall be handled in the hospice residence to prevent transmission of disease.  Sharps shall be stored and disposed of in rigid, puncture-resistant containers. 12)         Water supply, sewage disposal, and plumbing systems shall comply with all applicable State and local codes and ordinances. 13)         Hospice residences shall be limited to 20 patient beds.