Construction and Equipment

(A) New Construction, Alterations and Conversions. (1) The establishment and construction of new long-term care facilities, conversions of other types of facilities to long-term care facilities, or any alterations or additions to existing facilities now licensed by the Department shall conform to the Department’s most current standards of construction and shall be constructed, converted or altered for the specific purpose of providing a specific (level or levels) of long-term care. (2) New construction, conversions, alterations, additions or other structural changes or acquisition of special equipment in a proposed or existing facility shall not be made until a letter of intent and proper application forms have been filed with the Department and approval of the final plans and specifications for construction or acquisition have been issued by the Department of Public Health and the Office of Public Safety and Inspections. (3) No facility presently licensed as a rest home shall be licensed as a facility that provides Level I, II or III care unless it conforms to the Department’s most recent standards for new construction, alterations and conversions. (B) Construction and Equipment Requirements for Facilities Constructed on or Before March 19, 1968. (1) General. (a) Facilities shall comply with all state laws and local ordinances applicable to buildings, fire protection, public safety or public health. (b) In facilities that provide Level I or II care and are not of class one or two construction, all residents with handicaps (such as impaired vision, impaired ambulation, etc.) shall be housed on floors that have access to grade level, and no residents shall be housed above the second floor. Occupancy of rooms above the second floor shall be restricted to employees and members of the immediate family of the licensee. Nursing Units shall consist of at least the following: an identifiable unit of approximately 40 beds in facilities that provide Level I or II care, and not more than 60 beds in facilities that provide Level III or IV care; a nurses’ or attendants’ station conveniently located to resident beds; a medicine cabinet or closet; a utility room in facilities that provide Level I, II or III care; storage space for medical supplies and equipment; and a storage closet for linen. (3) Resident Bedrooms. (a) Resident bedrooms must adhere to the following requirements: 1. Single rooms shall have a minimum of 60 square feet of floor area; multi-bedrooms shall have a minimum of 60 square feet of floor area per bed. 2. Any increase in the quota must provide, in the room or rooms under consideration, that single rooms shall have a minimum of 110 square feet of floor area; multi-bedrooms shall have a minimum of 80 square feet of floor area per bed. 3. No resident bedroom should contain more than four beds, although exceptions will be allowed for existing facilities upon written approval of the Department. 4. Each bed shall be placed at least three feet from any other bed. Facilities must maximize the distance between resident beds and ensure that bed placement is in accordance with Department guidelines, if any. Each bed shall be at least three feet from any window or radiator. An unobstructed passageway of at least three feet shall be maintained at the foot of each bed. 5. Rooms below grade level shall not be used for resident occupancy. Rooms without basement foundations shall not be used for resident occupancy, unless there is adequate heating and insulation. 6. All rooms used for residents shall be outside rooms. No room off the kitchen shall be used for resident care, unless another acceptable means of entrance to this room is provided. No resident room shall be used as a passageway. 7. Adequate closet and drawer space shall be provided for each resident. In general, this shall mean closet space of not less than two feet by two feet by the height of the closet per resident for the storage of personal belongings, and either a built-in or freestanding multiple drawer bureau not less than two-feet, six inches wide with a minimum of one drawer per individual. When feasible, these should be located within the resident’s room. 8. All resident bedrooms shall be clearly identified by number on or beside each entrance door. (b) On and after April 30, 2022, in facilities that provide Level I, II or III care, resident bedrooms must adhere to the following occupancy and square footage requirements: 1. No resident bedroom shall contain more than two beds; and 2. For facilities that provide Level I, II or III care, in the event of new construction or reconstruction, as defined by CMS, of a building or nursing care unit, affected resident bedrooms must: a. Be shaped and sized so that each bed can be placed with a minimum clearance of four feet from any lateral wall, window or radiator on the transfer side of the resident bed and three feet from any lateral wall, window or radiator on the non-transfer side of the resident bed. In single occupancyrooms, an unobstructed passageway of at least three feet shall be maintained at the foot of each bed. In double occupancy rooms, an unobstructed passageway of at least four feet shall be maintained at the foot of each bed. In double occupancy rooms, resident beds must be spaced at least six feet apart. b. The floor area of each of the affected resident bedrooms shall not be less than 110 square feet for single occupancy rooms and 108 square feet per bed for double occupancy rooms. Facilities that are unable to fully comply with 105 CMR 150.017(3)(b)(1) by April 30, 2022 must demonstrate to the Department that the licensee has made good faith efforts to comply with 105 CMR 150.017(3)(b)(1), in accordance with Department guidelines. (c) Nurses’ or Attendants’ Station. A nurses’ or attendants’ station shall be provided for every unit in a central location. (Exceptions may be allowed upon written approval of the Department.) At a minimum, each nurses’ station shall be provided with a desk or counter, chair, sufficient cabinets and an acceptable record holder or chart rack. (d) Medicine Cabinet or Room. See 105 CMR 150.008(D). (e) Utility Room. 1. Facilities that provide Level I or II care shall provide a utility room for every unit and for each floor. Facilities that provide Level III care shall provide a utility room for each unit. The utility room shall be physically partitioned from any toilet or bathing area for residents or personnel and shall have a separate entrance directly from a corridor. 2. A minimum of 35 square feet of floor area shall be provided for utility rooms. 3. The following equipment shall be provided in utility rooms: slop sink with gooseneck faucet and hot and cold running water; adequate cupboard and work space; adequate facilities for the storage of clean equipment used in the administration of resident care; adequate space for the storage of individual resident equipment; adequate facilities for the cleansing, disinfection and sterilization of individual resident equipment; adequate facilities for emptying, cleansing and disinfecting bedpans and urinals; an instrument sterilizer; adequate facilities for the proper storage of all rubber goods, such a hot water bottles, ice caps, rectal tubes, catheters, rubber air rings and rubber gloves; and handwashing facilities with hot and cold running water. (f) Utility rooms are not required in facilities that provide only Level IV care. (g) Janitor’s Closets. See 105 CMR 150.016(E)(3). (h) Handrails shall be provided on both sides of all indoor and outdoor stairways. Specifications as to height, width and anchorage as listed in 105 CMR 150.600(B) shall apply. They shall have curved returns. General Storage. Adequate storage space and equipment shall be provided for residents’ towels and wash cloths when not in use, clothing during all seasons of the year, personal effects and valuables; beds, bedsides, bed springs, mattresses, bed pillows and blankets, when not in use; clean linen; glassware, enamelware, instruments, syringes and needles, rubber goods, mouth and rectal thermometer and other such equipment and supplies. (5) Examination and Treatment Room. If an examination and treatment room is provided, it shall be equipped with a sink with hot and cold running water, soap dispenser, disposal towel dispenser, treatment table, instrument table, instrument sterilizer, locked storage cabinet, a hospital scale, and a noncombustible waste receptacle with a foot-operated top. Activity Areas. All facilities shall provide on every floor and for every unit a comfortable, pleasant, convenient, well-lit and ventilated sitting room, dayroom, or solarium with a direct outside exposure that is separate from resident bedrooms. (Exceptions may be allowed upon written approval of the Department.) This room shall be so constructed, arranged and maintained that residents have a place to read, play cards, visit or watch television. This room shall be large enough to meet resident needs and shall be suitably located. (7) Rehabilitation Service Units. (a) The rooms and areas shall be sized, arranged and equipped so that they are consistent with the programs of treatment within the particular facility. The unit shall be well-lit, well-ventilated and adequately heated and it shall be separate and apart from rooms used for resident living. (b) There shall be a signal system to summon aid in an emergency. (c) Adequate storage facilities shall be provided and maintained in a sanitary and safe manner and in good repair. (d) A handwashing sink with hot and cold running water shall be provided and equipped with a plaster trap if occupational therapy is given. (e) All physical therapy equipment shall be of known quality and serviced at least annually by a qualified person. No repairs shall be made except by a qualified person. (f) The following basic equipment shall be provided for the physical therapy unit: 1. Treatment table, footstool and chairs; 2. Adequate linen supply; 3. Sanitary waste containers; 4. Hamper for soiled linen; 5. Disposable towels; 6. Curtains or cubicles to assure privacy; and 7. Desk or table and chair for clerical use. (g) All plumbing and electrical installations required for the administration of physical therapy shall be inspected and approved in writing by the appropriate local or state authorities. (8) Toilet, Bath and Shower Rooms. (a) Adequate toilets, handwashing sinks, baths and showers shall be provided on each floor. (b) Toilets and washrooms shall be provided for staff separate from those rooms used by residents. The number shall be appropriate to the size and needs of the facility. (c) Toilet and handwashing sinks shall be provided on a ratio of one toilet and sink per every eight to ten residents. There shall be at least one separate toilet for males and one separate toilet for females on each floor. (Exceptions may be made upon written approval of the Department.) (d) A shower or tub shall be provided in a ratio of one per 15 residents. Separate showers or tub baths for males and females are required only if they are located in the same room with toilets. (Exceptions may be made upon written approval of the Department.) Mixing valves and controls in Level I, II and III facilities shall be mounted outside shower stalls. (e) Toilets, bath or shower compartments shall be separated from all rooms by solid walls or partitions. Adequate provision to insure resident privacy shall be made. (f) Toilets for residents’ use may not be located off the kitchen. (g) Handrails or grab bars shall be provided near showers, tub baths and toilets. (h) Toilet, handwashing and bathing equipment and areas must be kept in good repair, and the floor area surrounding the toilet must be maintained in a sanitary manner and in good repair. (i) Facilities shall provide all toilet rooms with toilet paper holders and paper, towels, soap dispensers with soap, mirrors and adequate lighting. (j) Hot water supplied to fixtures accessible to residents shall be controlled to maintain a temperature between 110EF and 120EF. (9) Kitchen. (a) The main kitchen shall be located in a suitable area. There shall be adequate work space for the sanitary preparation and serving of meals for residents and personnel, in accordance with the size of the facility. All main kitchens shall be provided with a mechanical ventilator. (b) Kitchens and other areas when located below grade level and used for the preparation and serving of food shall either have direct access to the outside by means of suitable windows or ventilation shall be provided to permit an air supply and exhaust of at least ten air changes an hour. Ventilating units shall be maintained in a sanitary manner and kept in good repair. (c) Adequate sanitarystorage space and cabinets shall be provided for the proper storage of all foods, dishes, silverware and cooking equipment and maintained in a sanitary manner and kept in good repair. (d) Auxiliary kitchens shall be provided and adequately equipped when the size of the facility or the physical plant indicates the need, as determined by the Department. (e) A dumb-waiter when provided for the transportation of food shall be suitably located and used exclusively for the transportation of food. It shall be cleaned daily and kept in good repair. (f) Stoves, sinks, counters, cabinets, shelves, tables, refrigerating equipment and all other equipment necessary for the preparation and serving of food shall be provided in accordance with the size of the facility. This equipment shall be so constructed that it can be easily cleaned, maintained in a sanitary manner and kept in good repair. (g) A handwashing sink with hot and cold running water, a soap dispenser and disposable towels in a towel dispenser shall be located in the kitchen area. (h) All facilities shall provide by January 1, 1972, an automatic dishwasher capable of handling the needs of the facility. For dishwashing machines, the temperature of the water shall be between 140EF and 160º F with a final rinse at a temperature of 170º F or higher. (i) Appropriate areas shall be provided for cart washing and can washing. (10) Dining Rooms. All facilities shall provide at least one dining area for or residents, including wheelchair cases, who can and wish to eat at a table. (Exceptions may be made upon written approval of the Department.) Dining rooms shall be: (a) Suitably located in an attractive, well-lit, ventilated and heated area that is separate from sleeping quarters and areas of congestion. (b) Equipped with tables of sturdy construction with hard surfaced, washable tops. (c) Equipped with comfortable chairs of sturdy construction and of a sanitary type. (d) Provided with floors that have a waterproof and greaseproof covering. Only nonskid wax shall be used in the dining room area. (11) Laundry Room. (a) All facilities shall provide a laundry that is located in an area separate and apart from any area used for the storage, preparation or serving of food. (b) When total laundry service is to be performed on the premises, sufficient space and equipment for such service shall be provided. (c) When adequate space and equipment are not available on the premises for the proper and sanitary washing of all linens and other washable goods, or if a facility chooses not to perform total laundry service on the premises, a commercial laundry or laundry rental service shall be utilized. Even if such commercial laundry services are used, a laundry room of sufficient size to wash, dry, iron and fold bed, bath and other linen in case of an emergency, as well as to meet the personal needs of the residents, shall be provided. (d) A laundry room shall contain set tubs equipped with hot and cold running water automatic washer, drier, ironing equipment and shelving for the storage of soaps, bleaches and other laundry supplies. (e) All space and equipment shall be adequate to meet the needs of the facility and to assure the proper and sanitary washing of linen and other washable goods. (12) Office Space. Appropriate space and equipment shall be provided for administrative activities and for the storage of medical records. Additional space and equipment shall be provided for staff and consultants as needed. (13) Architectural and Engineering Details. (a) Doors, Screens and Windows. No hooks or locks shall be installed on doors used by residents. Outside doors, windows and openings shall be protected against flies and other insects by the seasonal use of screens. All outside doors and doorways shall be made draft-free bythe installation of weather stripping or caulking material. (b) Walls and Floors. Interior finished surfaces shall conform to local and state codes. Walls shall have a waterproof, glazed, painted or similar surface that will withstand washing; and floors shall be waterproof, greaseproof and resistant to heavy wear in the following areas: kitchen (main and auxiliary), food preparation and service areas, bathrooms and toilets, utility rooms and laundry. (c) If carpeting is used in a facility, it shall conform to standards established by the Department. (14) Heating and Air Conditioning Equipment. (a) The heating system shall be in conformity with the rules and regulations outlined by the Office of Public Safety and Inspections under M.G.L. c. 148. (b) Every facility shall be equipped with a heating system that is sufficient to maintain a minimum temperature of 75º F throughout the facility at all times at winter temperatures. (c) Portable room heaters, such as space heaters, plug-in electric heaters, or heaters using kerosene, gas or other open-flame methods, are prohibited. (d) Heating fixtures and all exposed pipes in resident areas shall be shielded for the safety of residents. (e) Every facility shall provide by June 21, 2000, air conditioning in dining rooms, activity rooms, day rooms, solariums, sitting rooms or equivalent other common resident areas that is capable of maintaining a maximum temperature of 75º F in those areas at all times at summer design temperatures. Temperatures must be maintained at a level which ensures the comfort and health of residents of the facility. (15) Ventilation. (See 105 CMR 150.015(F)(5).) (a) Each resident room shall have adequate ventilation. (b) Bathrooms, toilets and utility rooms shall have direct access to the outside by means of suitable windows or a forced system of exhaust that shall be maintained in a sanitary manner and kept in good repair. (16) Lighting. (a) Adequate electric lighting maintained in good repair shall be provided throughout the facility in accordance with the provisions of the M.G.L. c. 111, § 72C, as amended, and the recommended Levels of the Illuminating Engineering Society. All electrical installations shall be in accordance with 527 CMR 12.00: Massachusetts Electrical Code (Amendments) and all local regulations. (b) Adequate lighting shall be provided in each resident room to provide an adequate, uniform distribution of light. No electric bulb under 60 watts shall be used for illumination for residents’ use. (c) Night lights shall be provided in corridors, stairways, bathrooms, toilets and nurses or attendants’ stations and residents’ bedrooms. Night lights for hallways stairways and bathrooms shall have at least 15 watt bulbs. (d) Outside walks, parking lots and entrances shall be adequately lit. (17) Emergency Electrical Systems. All facilities providing Level I/II care shall provide an emergency source of electricity that meets the following requirements. (a) The emergency source of electricity shall be connected to circuits designated in 105 CMR 150.017(B)(16)(c) through (e) for lighting and power to provide electricity during an interruption of normal electric supply that could affect the nursing care, treatment or safety of the occupants. (b) The emergency source of electricity shall consist of a generating set, including a prime mover and generator. It shall be located on the facility premises and shall be reserved exclusively for supplying the emergency electrical system. The set shall be of sufficient kilowatt capacity to supply all lighting and power demands of the emergency system. The power factor rating of the generator shall not be less than 80%. NON-TEXT PAGE (c) The emergency electrical system shall be connected to circuits for lighting of nurses’ stations, attendants’ stations, medicine preparation areas, generator set location and boiler room. (d) The emergency electrical system shall be connected to circuits necessary to provide protection of vital equipment and material and for operation of equipment essential to the health and safety of occupants, including but not limited to nurse’s call system, alarm system, fire pumps (if installed), sewage or sump lift pumps (if installed), corridor duplex receptacles in resident areas, equipment for maintaining telephone service, paging or speaker systems, refrigerators, freezers, burners and pumps necessary for the operation of one or more boilers and their controls required for heating. (e) Where electricity is the only source of power normally used for space heating, the emergency service shall provide for heating of resident rooms unless the nursing home is supplied by at least two utility service feeders, each supplied by separate generating sources. (f) An automatic transfer switch shall be installed to transfer to emergency power within ten seconds. (C) A SNCFC shall provide a specially adapted vehicle, either purchased or leased, or shall contract for the services of a specially adapted vehicle. Such vehicle shall be properly insured and staffed for the safe transport of residents to off-site habilitative, therapeutic recreational and non-emergency medical services.