Resident Comfort, Safety, Accommodations and Equipment

(A) All facilities shall provide for the comfort, safety and mental and physical well-being of residents. (B) Personal Care. (1) Every resident shall have a reasonable amount of privacy. (2) Residents shall be treated with dignity and kindness at all times. (3) Residents’ personal effects shall be treated with respect and care. (4) Residents shall be encouraged and assisted to dress and move about from sleeping quarters to sitting rooms, dining areas and out-of-doors when their conditions permit. (C) Safety and Personal Protection. (1) At all times a responsible staff member shall be on duty and immediately accessible, to whom residents can report injuries, symptoms of illness, emergencies, any other discomfort or complaint, and who is responsible for ensuring prompt, appropriate action is taken. (2) Non-skid wax shall be used on all waxed floors. Throw rugs or scatter rugs shall not be used. Non-slip entrance mats may be used. Non-skid treads shall be used on stairs. (3) Facilities providing only Level IV care shall provide a first-aid kit in a convenient place. (4) A check-out system shall be maintained for residents leaving the facility. The resident’s name, the destination, the name of the person assuming responsibility, the time of departure, and the estimated time of return shall be recorded. (5) Phones: (a) There shall be at least one functioning telephone available to staff at all times on each floor or in each unit where patients, residents or personnel reside. These telephones shall be free of locks and shall be available for use in emergency for both incoming and outgoing calls. (b) Facilities shall provide access to phone service to residents to make calls in private. (6) All hospital beds shall have brakes set and all wheelchairs shall be equipped with brakes. (D) Fire Protection. (1) All facilities shall have an approved quarterly fire inspection by local fire department. (2) At least once a year, employees of the long term care facility shall be instructed by the head of the local fire department or his or her representative on their duties in case of fire and this noted in the facility’s record. (3) Fire extinguishers shall be recharged and so labeled at least once a year. (4) The water pressure shall be checked weekly by the individual in charge of the facility, and the pressure recorded in the facility’s records. (5) Emergency lights shall be checked weekly by the individual in charge of the facility, and if deficient, repaired immediately. (6) All exits shall be clearly identified by exit signs, adequately lighted and free from obstruction. (7) Clothes dryers shall be inspected at the time of installation and annually and necessary repairs made immediately. (8) Draperies, upholstery and other such fabrics or decorations shall be fire resistant and flame proof. (9) No residents shall be permitted to have access to lighter fluid or wooden household matches. (10) Routine storage of oxygen tanks shall be permitted only in facilities providing Level I, II or III care unless specifically approved by the Department: (a) Wherever oxygen is used or stored it shall be in accordance with the National Fire Protection Code. (b) Carriers shall be provided when oxygen is being used or transported. (c) Signs indicating oxygen is available, currently in use or stored shall be conspicuously posted. (d) Oxygen tanks shall be safely stored and labeled when empty. (E) Emergency and Disaster Plans. (1) Every facility shall have a written plan and procedures to be followed in case of fire, or other emergency, developed with the assistance of local and state fire and safety experts, and posted at all nurses’ and attendants’ stations and in conspicuous locations throughout the facility. The plan shall specify persons to be notified, locations of alarm signals and fire extinguishers, evacuation routes, procedures for evacuating residents, and assignment of specific tasks and responsibilities to the personnel of each shift. (3) All personnel shall be trained to perform assigned tasks. (4) Simulated drills testing the effectiveness of the plan shall be conducted for all shifts at least twice a year. (5) Each facility shall ensure a reliable means is available at all times, in accordance with Department guidelines; for: (a) sending information to the Department regarding incidents and emergencies occurring on the premises; and (b) receiving information from the Department and other state and local authorities in the event of an emergency. (F) Residents’ Accommodations. (1) All resident areas shall be cheerful, homelike, pleasant, clean, well-kept, free from unpleasant odors, sights and noises, and maintained in good repair. Space and furnishing shall provide each resident with comfortable and reasonably private living accommodations. Beds shall be placed to avoid drafts, heat from radiators, unpleasant noises or other discomforts. (3) Every bedroom and every bed location shall be permanently, clearly and distinctively identified by a number or letter in addition to the resident’s name. (4) All resident areas must have adequate lighting, heating and ventilation. (a) Each resident’s room shall have direct outside exposure with adequate, unobstructed natural light and adequate ventilation. (b) Adequate artificial lighting shall be available in all rooms, stairways, hallways, corridors, bathrooms toilets, nurses’ or attendants’ stations. (c) Adequate heating shall be provided in all rooms used by residents in order to maintain a minimum temperature of 75°F at winter temperatures for the hours between 6:00 A.M through 10:00 P.M.; and a minimum temperature of 70°F at winter temperatures for the hours between 10:00 P.M. through 6:00 A.M. (G) Residents’ Equipment and Supplies. (1) Equipment and supplies appropriate in quantity and kind shall be provided for the routine care, comfort and special nursing care of residents. (2) All equipment and supplies shall be kept in good working condition and in a clean and sanitary manner. (3) All facilities shall use techniques approved by the Department to sterilize, disinfect or dispose of equipment and supplies. (4) Every resident shall be provided with the following basic equipment and supplies: (a) A comfortable bed. In facilities providing Level I or II care, each resident shall have a hospital-type bed which shall not be less than 76 inches long and 36 inches wide and shall be equipped with a headboard and swivel lock casters. In facilities providing Level III and IV care, beds of household size or hospital beds may be used. Cots and folding beds are prohibited. (b) Bed springs and a clean, comfortable mattress with waterproof covering on all beds. Each mattress shall be at least four inches thick, 36 inches wide and not less than 72 inches long. (c) At least two comfortable pillows of standard hospital size. Other pillows shall be available if requested or needed by the resident. (d) An adequate supply of clean bed linen, blankets, bedspreads, washcloths, and towels of good quality and in good condition. This shall mean a supply of linen equal to at least three times the usual occupancy. In facilities providing Level I or II care, towels and washcloths shall be changed and laundered everyday; in facilities providing Level IIIand IV care, at least every week and more frequently, if indicated. Bed linen shall be laundered at least weekly and more frequently if needed. (e) An easy chair or a comfortable padded or upholstered straight back chair with arms, suited to individual resident needs. (f) A bedside cabinet that accommodates the needs of the resident. (g) All facilities shall ensure each resident has an individual mouthwash cup, a tooth brush and dentifrice, containers for the care of residents’ dentures if necessary, an individual comb and brush, soap dish, bar of soap, shaving equipment, individual sputum containers (when needed), and other equipment for personal care. (h) All facilities shall provide for each resident a permanently located, readily accessible, storage space equipped with a lock and key, th large enough to accommodate small personal possessions such as letters, jewelry, pictures or small amounts of money. Storage space shall be located within each resident’s room. A key to secure personal storage space shall be in the possession of each resident, and the facility administrator or his designee shall hold a master key to any such locked space. (H) Behavior Modification Programs in a SNCFC. (1) Time out means a procedure designed to improve a resident’s behavior by removing positive reinforcement or by removing the resident physically from the environment when his or her behavior is undesirable. (2) Time-out procedures shall only be used as part of approved behavior modification exercises and only by an individual (or individuals) appropriately trained to carry out such exercises and under the supervision of a behavior modification trainer. Time-out shall not be used for longer than one hour for time-out involving removal from a situation. (3) Behavior modification programs involving the use of time-out procedures shall be conducted only after documented failure of less severe alternatives and with the consent of the resident or his or her guardian; and shall be described in the care plan along with written plans kept on file.