General Sanitation Requirements for New and Existing LongTerm Care Facilities

PURPOSE: This rule establishes standards related to general sanitation and housekeeping in a long-term care facility to protect the health and safety of the residents. PUBLISHER’S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. Therefore, the material which is so incorporated is on file with the agency who filed this rule, and with the Office of the Secretary of State. Any interested person may view this material at either agency’s headquarters or the same will be made available at the Office of the Secretary of State at a cost not to exceed actual cost of copy reproduction. The entire text of the rule is printed here. This note refers only to the incorporated by reference material. Editor’s Note: All rules relating to long-term care facilities licensed by the department are followed by a Roman Numeral notation which refers to the class (either Class I, II or III) of standard as designated in section 198.085.1, RSMo. (1) All parts of property used in connection with the operation of the facility shall be kept free of litter. Only articles necessary for the operation or maintenance of the facility shall be stored on the premises. III (2) The walking and driving surfaces of all exterior areas of the facility shall be surfaced with concrete or asphalt, or with gravel or similar material effectively treated to facilitate maintenance and minimize dust. These surfaces shall be graded to prevent pooling and shall be kept free of litter. III (3) There shall be present in the facility only those poisonous or toxic materials necessary for maintaining the establishment, cleaning and sanitizing equipment and utensils and controlling insects and rodents. II (4) Containers of poisonous or toxic materials shall be prominently and distinctly labeled according to law for easy identification of contents. II (5) Poisonous or toxic materials consist of the following categories: insecticides and rodenticides; disinfectants, sanitizer and related cleaning or drying agents; and caustics, acids, polishes and other chemicals. Each of these three (3) categories set forth shall be stored and physically located separate from each other. All poisonous or toxic materials shall be stored in locked cabinets or in a similar physically separate place used for no other purpose which is not accessible to residents. II (6) Bactericides, cleaning compounds or other compounds intended for use on foodcontact surfaces shall not be used in a way that leaves a toxic residue on surfaces or that constitutes a hazard to residents, employees or other persons. II (7) Poisonous or toxic materials shall not be used in a way that contaminates food, equipment or utensils, nor in a way that constitutes a hazard to residents, employees or other persons, nor in a way other than in full compliance with the manufacturer’s labeling. II (8) All rooms shall have sufficient ventilation to keep them free of excessive heat, steam, condensation, vapors, obnoxious odors, smoke and fumes. Ventilation systems shall be installed and operated according to law and, when vented to the outside, shall not create an unsightly, harmful or unlawful discharge. I/II (9) Intake and exhaust air ducts shall be maintained to prevent the entrance of dust, dirt and other contaminating materials. III (10) In new or extensively remodeled facilities, all rooms from which obnoxious odors, vapors or fumes originate shall be mechanically vented to the outside. II (11) Deodorizers or sprays shall not be used to cover up odors. Odors shall be eliminated to the source by prompt cleaning of bed pans and commodes, floors, furniture and equipment and by proper ventilation. II/III (12) All floors in the facility shall be clean and shall be maintained in good repair. Floors and floor coverings of all food-preparation, food-storage and utensil-washing areas, and the floors of all walk-in refrigerating units, dressing rooms, locker rooms, toilet rooms and vestibules shall be constructed of smooth durable material such as sealed concrete, terrazzo, ceramic tile, durable grades of linoleum or plastic, or tight wood impregnated with plastic. Nothing in this section shall prohibit the use of antislip floor covering in areas where necessary for safety reasons. III (13) Carpeting, if used as a floor covering, shall be of closely woven construction, properly installed, easily cleanable and maintained in good repair. Carpeting is prohibited in food-preparation, equipment-washing and utensil-washing areas where it would be exposed to large amounts of grease and water, in food-storage areas and toilet room areas where urinals or toilet fixtures are located. III (14) Mats and duckboards shall be of nonabsorbent, grease-resistant materials and of that size, design and construction as to facilitate their being easily cleaned. Duckboards shall not be used as storage racks. III (15) Walls and ceilings, including doors, windows and skylights, shall be clean and maintained in good repair. III (16) Wall- and ceiling-covering materials shall be attached and sealed so as to be easily cleanable. (17) The walls, including nonsupporting partitions, wall coverings and ceilings of walk-in refrigerating units, food-preparation areas, equipment-washing and utensil-washing areas, toilet rooms and vestibules shall be smooth, nonabsorbent and easily cleanable. Concrete or pumice blocks used for interior wall construction in these locations shall be finished and sealed to provide an easily cleanable surface. III (18) Studs, joists and rafters, shall not be exposed in walk-in refrigerating units, foodpreparation areas, equipment-washing areas, toilet rooms and vestibules. III (19) Light fixtures, vent covers, wall-mounted fans, decorative materials and similar equipment attached to walls and ceilings shall be easily cleanable and shall be maintained clean and in good repair. III (20) Cleaning of floors and walls, except emergency cleaning of floors, shall be done during periods when the least amount of food is exposed, such as between meals. Mops used for cleaning bathrooms shall be disinfected after use and before using in other areas. III (21) In new or extensively remodeled facilities for more than twelve (12) residents at least one (1) utility sink or curbed facility with a floor drain shall be provided and used for the cleaning of mops or similar wet-floor cleaning tools and for the disposal of mop water or similar liquid wastes. The use of lavatories, utensil washing or equipment washing or food-preparation sinks for this purpose is prohibited. III (22) Enough potable water for the needs of the facility shall be provided from a source constructed and operated according to law. Compliance is required with sections 1401, 1411, 1414, 1431 and 1445 of the Public Service Act as amended by the Safe Drinking Water Act, Public Law 93—523 CFR 11990 as set forth in 10 CSR 60. Water shall be from a source approved by the regulating agency. I/II (23) All potable water not provided directly by pipe to the facility from the source shall be transported in a bulk water-transport system and shall be delivered to a closed-water system. Both of these systems shall be constructed and operated according to law. I/II (24) All sewage, including liquid waste, shall be disposed of by public sewage system or by a sewage disposal system constructed and operated according to law. Nonwater-carried sewage disposal facilities are prohibited. II (25) Plumbing shall be sized, installed and maintained according to the National Plumbing Code. II/III (26) There shall be no cross-connection between the potable water supply nor any source of pollution through which the potable water supply might become contaminated. II (27) A nonpotable water system is permitted only for purposes such as air conditioning and fire protection and only if the system is installed according to law and the nonpotable water does not contact, directly or indirectly, food, potable water, equipment that contacts food or utensils. The piping of any nonpotable water system shall be durably identified so that it is readily distinguishable from piping that carries potable water. II (28) The potable water system shall be installed to preclude the possibility of backflow. Devices shall be installed to protect against backflow and back siphonage at all fixtures and equipment where an air gap at least twice the diameter of the water supply inlet is not provided between the water supply inlet and the fixture’s flood level rim. A hose shall not be attached to a faucet unless a backflow prevention device is installed. II (29) Except for properly trapped open sinks, there shall be no direct connection between the sewage system and any drains originating from equipment in which food, portable equipment or utensils are placed. When a dishwashing machine is located within five feet (5') of a trapped floor drain, the dishwasher waste outlet may be connected directly on the inlet side of a properly vented floor drain trap if permitted by law. II (30) Garbage and refuse shall be kept in durable, easily-cleanable, insect-proof and rodent-proof containers that do not leak and do not absorb liquids. Plastic bags and wetstrength paper bags may be used to line these containers, and they may be used for storage inside the facility. III (31) Waste containers used in food-preparation and utensil-washing areas shall be kept covered when not in actual use. III (32) Waste containers stored outside the establishment and dumpsters, compactors and compactor systems shall be easily cleanable, shall be provided with tight-fitting lids, doors or covers and shall be kept covered when not in actual use. In containers designed with drains, drain plugs shall be in place at all times, except during cleaning. III (33) Cardboard or other packaging material not containing garbage or food wastes need not be stored in covered containers. III (34) Soiled containers shall be cleaned at a frequency to prevent insect and rodent attraction. Liquid waste from compacting or cleaning operations shall be disposed of as sewage. III (35) Garbage or refuse storage rooms, if used, shall be constructed of easily cleanable, nonabsorbent, washable materials, shall be kept clean, shall be insect-proof and rodentproof and shall be large enough to store the garbage and refuse containers that accumulate. III (36) Outside storage areas or enclosures shall be large enough to store the garbage and refuse containers that accumulate and shall be kept clean. III (37) Garbage and refuse shall be disposed of often enough to prevent the development of odor and the attraction of insects and rodents. III (38) Where refuse is burned on the premises, it shall be done in accordance with fire safety regulations. III (39) Effective measures intended to minimize the presence of rodents, flies, cockroaches and other insects on the premises shall be utilized. The premises shall be kept in such condition as to prevent the harborage or feeding of insects or rodents. II/III (40) Openings to the outside shall be effectively protected against the entrance of rodents. Outside openings shall be protected against the entrance of insects by tight-fitting, self-closing doors, closed windows, screening, control of air currents or other means. Screen doors shall be self-closing and screens for windows, doors, skylights, transoms, intake and exhaust air ducts, and other openings to the outside shall be tight-fitting and free of breaks. Screening material shall not be less than sixteen (16) mesh to the inch. II/III (41) Toilet rooms shall be conveniently located and easily accessible to residents and employees. Toilet rooms shall be completely enclosed. Toilet fixtures shall be kept clean and in good repair. A supply of toilet tissue shall be provided at each toilet at all times. Easily cleanable receptacles shall be provided for waste materials. Toilet rooms used by women employees shall have at least one (1) covered waste receptacle. III (42) Lavatories shall also be located in or immediately adjacent to toilet rooms or vestibules and shall be easily accessible to residents and employees. Lavatories shall be located to permit convenient use by all employees in food-preparation areas and utensil-washing areas. In new facilities, sinks used for food-preparation or for washing equipment or utensils shall not be used for handwashing. III (43) Each lavatory, bathtub or shower shall be provided with hot and cold water tempered by means of mixing valve or combination faucet. Any self-closing, slow-closing or metering faucet used shall be designed to provide a flow of water for at least fifteen (15) seconds without the need to reactivate the faucet. Steam-mixing valves are prohibited. III (44) A supply of hand-cleansing soap or detergent shall be available at each employeeuse lavatory. A supply of sanitary towels or a hand-drying device providing heated air shall be conveniently located near each lavatory, except that hand towels for individual use are permitted. Common towels are prohibited. If disposable towels are used, easily cleanable waste receptacles shall be conveniently located near the hand-washing facilities. III (45) Lavatories, soap dispensers, hand-drying devices and all related fixtures shall be kept clean and in good repair. III (46) If employees routinely change clothes within the facility, rooms or areas shall be designated and used for that purpose. These designated rooms or areas shall not be used for food preparation, storage or service, or for utensil washing or storage. Lockers or other suitable facilities shall be provided and used for the orderly storage of employee clothing and other belongings. Lockers or other suitable facilities may be located only in the designated dressing rooms or in foodstorage rooms or areas containing only completely packaged food or packaged single-service articles. III (47) Laundry facilities shall be so designed and procedures instituted to prevent crosscontamination of clean and dirty linen. II (48) If laundry for the facility is done commercially, either entirely or in part, space shall be provided for sorting, processing and storing soiled linen. II/III (49) Storage space shall be located to facilitate convenient pickup and delivery by commercial laundry. III (50) Equipment shall be provided to prewash linen soiled by incontinent residents before it is sent to the laundry. II/III (51) For intermediate care and skilled nursing facilities, existing assisted living facilities and new residential care facilities and assisted living facilities licensed for more than twelve (12) residents, if laundry is done in the facility entirely or partially, the laundry room shall be in a separate room from the kitchen, the residents’ room(s), the sitting or living room and the bathrooms or the nursing utility room. Adequate space shall be provided in the laundry room for storing, sorting and processing soiled linen. Table linen shall be laundered separately from bed linen, towels and clothing. Space shall be provided for storing clean linen in a separate room from the laundry. Nothing in this rule shall prohibit a facility from providing a laundry area for use by residents. II/III (52) Provision shall be made for the proper care of soiled linen and clean linen on each floor of each building. A laundry hamper, with lid, laundry chute or some other suitable arrangement shall be provided. II/III (53) Soiled clothes and linens shall be stored in nonabsorbent containers or washable laundry bags and shall be transported for laundering in tightly enclosed bags or containers. Nothing in this rule shall require residents to use tightly enclosed bags or containers when transporting their personal laundry items to the resident laundry area referred to in section (51). III (54) Linen soiled by incontinent residents shall be washed or prewashed immediately. II/III (55) Clean clothes and linens shall be stored in a clean place and protected from contamination until used. III AUTHORITY: sections 198.009, RSMo 2000 and 198.005 and 198.073, RSMo Supp. 2006.* This rule originally filed as 13 CSR 15-17.020. Original rule filed July 13, 1983, effective Oct. 13, 1983. Emergency rule filed Aug. 1, 1984, effective Aug. 13, 1984, expired Dec. 10, 1984. Amended: Filed Sept. 12, 1984, effective Dec. 13, 1984. Amended: Filed Aug. 1, 1988, effective Nov. 11, 1988. Moved to 19 CSR 30-87.020, effective Aug. 28, 2001. Amended: Filed Aug. 23, 2006, effective April 30, 2007. *Original authority: 198.005, RSMo 2006; 198.009, RSMo 1979, amended 1993, 1995; and 198.073, RSMo 1979, amended 1984, 1992, 1999, 2006.