440 IAC 1.5-3-8 Physical plant; maintenance and environmental services

Sec. 8. (a) The private mental health institution shall be constructed, arranged, and maintained to ensure the safety of the consumer and to provide facilities for services authorized under the private mental health institution license as follows: (1) The plant operations and maintenance service, equipment maintenance, and environmental service shall meet the following requirements: (A) Be staffed to meet the scope of the services provided. (B) Be under the direction of a person or persons qualified by education, training, or experience. (2) The facility shall have a designated safety officer to assume responsibility for the safety program. (3) The facility shall have a physical plant and equipment that meet the statutory requirements and regulatory provisions of the rules of the fire prevention and building safety commission, including 675 IAC 22, Indiana fire codes, and 675 IAC 13, Indiana building codes. (b) The condition of the physical plant and the overall environment shall be developed and maintained in such a manner that the safety and well-being of consumers are assured as follows: (1) No condition in the facility or on the grounds shall be maintained that may be conducive to the harborage or breeding of: (A) insects; (B) rodents; or (C) other vermin. (2) No condition shall be created or maintained that may result in a hazard to: (A) consumers; (B) employees; or (C) the public. (3) The facility shall have a plan for emergency fuel and water supply. (4) Provision shall be made for the periodic inspection, preventive maintenance, and repair of the physical plant and equipment by qualified personnel as follows: (A) Operation, maintenance, and spare parts manuals shall be available, along with training or instruction of the appropriate personnel, in the maintenance and operation of the fixed and movable equipment. (B) Operational and maintenance control records shall be: (i) established; (ii) retained; (iii) analyzed periodically; and (iv) readily available on the premises. (C) Maintenance and repairs shall be carried out in accordance with applicable codes, rules, standards, and requirements of: (i) local jurisdictions; (ii) the fire prevention and building safety commission; and (iii) the Indiana state department of health. (5) The food service of the private mental health institution shall comply with the administrative rules of the Indiana state department of health contained in 410 IAC 7-24. (c) A facility shall comply with the following provisions regarding new construction, a renovation, or an addition to the facility: (1) The standards contained in the 2001 edition of the national "Guideline for Construction and Equipment of Private Mental Health Institution and Medical Facilities" (Guidelines) shall apply to all facilities covered by this rule, except as provided in subdivision (2). (2) Codes and rules adopted by the fire prevention and building safety commission that pertain to building requirements, fire safety, and access for individuals with disabilities shall: (A) apply to all facilities covered by this rule; and (B) take precedence over the requirements of the Guidelines on those topics. (3) When renovation or replacement work is done within an existing facility, all new work or addition, or both, shall comply, insofar as practical, with applicable sections of the Guidelines and for certification with appropriate parts of National Fire Protection Association (NFPA) 101 and the applicable rules of the fire prevention and building safety commission. (4) Proposed sites shall: (A) be located away from detrimental nuisances; (B) be well drained; and (C) not be subject to flooding. A site survey and recommendations shall be obtained from the Indiana state department of health prior to site development. (5) Water supply and sewage disposal services shall be obtained from municipal or community services. Outpatient facilities caring for consumers less than twenty-four (24) hours per day that do not provide surgery, laboratory, or renal dialysis services may be served by approved private on-site septic tank absorption field systems. (6) Site utility installations for water, sprinkler, sanitary, and storm sewer systems, and wells for emergency potable water supplies shall comply with applicable sections of Bulletin S.E. 13, "On-Site Water Supply and Wastewater Disposal for Public and Commercial Establishments", 1988 edition. (7) As early in the construction, addition, or renovation project as possible, the functional and operational description shall be submitted to the division. This submission shall include at least the following: (A) A functional program narrative as required in the Guidelines. (B) Schematics, based upon the functional program, and consisting of drawings (as single-line plans), outline specifications, and other documents illustrating the scale and relationship of project components. (8) Before beginning a construction, addition, or renovation project, the facility shall submit all documentation required under the rules of the fire prevention and building safety commission to the division of fire and building safety, plan review section of the department of homeland security, including the following documentation: (A) Working drawings, project manual, and specifications. (B) Prior to the submission of final plans and specifications, recognized standards and codes, including infection control standards, shall be reviewed as required under section 5(g)(3) of this rule. (C) All required construction design releases shall be obtained from the division of fire and building safety, plan review section, of the department of homeland security. (9) Before the division's issuance of a letter of occupancy, the facility shall provide the division with any final approval required from the division of sanitary engineering of the Indiana state department of health. (10) All backflow prevention devices shall be installed as required by 327 IAC 8-10 and the current edition of the Indiana plumbing code. Such devices shall be listed as approved by the Indiana state department of health. (11) Upon receipt of a construction design release from the division of fire and building safety, plan review section of the department of homeland security and documentation of a completed plan review by the division of sanitary engineering of the Indiana state department of health, an entity, which is not yet licensed by the division under this article, shall submit a license application to the division on a form approved and provided by the division. (d) The equipment requirements are as follows: (1) All equipment shall be: (A) in good working order; and (B) regularly serviced and maintained. (2) The facility shall have sufficient equipment and space to assure the safe, effective, and timely provision of the available services to consumers as follows: (A) All mechanical equipment (pneumatic, electric, or other) shall be on a documented maintenance schedule of appropriate frequency and with the manufacturer's recommended maintenance schedule. (B) The facility shall retain the following: (i) Evidence of preventive maintenance on all equipment. (ii) Appropriate records to document equipment maintenance, repairs, and current leakage checks. (3) Defibrillators shall be discharged at a minimum in accordance with manufacturers' recommendations. A discharge log with initialed entries shall be maintained. (4) Electrical safety shall be practiced in all areas. (e) The building or buildings, including fixtures, walls, floors, ceiling, and furnishings throughout, shall be kept clean and orderly in accordance with current standards of practice as follows: (1) Environmental services shall be provided in such a way as to guard against the transmission of disease to consumers, health care workers, the public, and visitors by using the current principles of the following: (A) Asepsis. (B) Cross infection. (C) Safe practice. (2) Refuse and garbage shall be: (A) collected; (B) transported; (C) sorted; and (D) disposed of; by methods that will minimize nuisances or hazards. (f) The safety management program shall include, but not be limited to, the following: (1) An ongoing facility wide process to evaluate and collect information about hazards and safety practices to be reviewed by the safety committee. (2) A safety committee appointed by the chief executive officer that includes representatives from: (A) administration; (B) consumer services; and (C) support services. (3) The safety program that includes, but is not limited to, the following: (A) Consumer safety. (B) Health care worker safety. (C) Public and visitor safety. (D) Hazardous materials and wastes management in accordance with federal and state rules. (E) A written fire control plan that complies with the provisions of the Indiana Fire Code and contains provisions for the following: (i) The extinguishing of fires. (ii) Protection of consumers, personnel, and guests. (iii) Evacuation. (iv) Cooperation with firefighting authorities. (F) Maintenance of written evidence of regular inspection and approval by state or local fire inspection authorities. (G) Emergency and disaster preparedness coordinated with appropriate community, state, and federal agencies.