Appendix

Appendix A - Tennessee Department of Health and Environment Environmental Standards applicable to maternity homes. APPENDIX A ENVIRONMENTAL STANDARDS FOR MATERNITY HOMES (A) FOOD SANITATION. Food service under a maternity home shall be considered a single food service operation whether operated as a central dining facility or in multiple units of that facility. Facilities shall comply with state, and local food service codes, or regulations where applicable; otherwise the following standards shall be met for food sanitation: 1. All food shall be from sources approved or considered satisfactory by the health authority. The use of hermetically sealed containers (home canned food) is prohibited. 2. All milk and fluid milk products including dry milk and dry milk products shall be from a Grade A pasteurized source. 3. Raw fruits and vegetables shall be washed before being cooked or served. 4. Poultry, poultry stuffings, stuffed meats and stuffings containing meat shall be cooked to heat all parts of the food to at least 165° F with no interruption of the cooking process. Pork and any food containing pork shall be cooked to heat all parts of the food to at least 150° F. 5. If a family style feeding process is used at a facility, all left-over food from the eating table shall be discarded. Milk and food used in family style feeding shall not be placed on the dining table longer than 15 minutes prior to beginning of meal. Food intended for family style feeding that has not been placed on the dining table and maintained at acceptable temperatures may be used at another meal, provided it is covered, refrigerated properly reheated properly and used promptly. 6. Potentially hazardous foods requiring cold storage shall be maintained at 45° F or below, and accurate thermometers shall be kept in the refrigerators. Potentially hazardous foods requiring hot storage shall be at an internal temperature of 140° F or above. Frozen foods shall be maintained at a temperature of 10° F or below. Thermometers are required in all freezers and all other cold storage equipment. 7. Milk and other potentially hazardous foods shall be kept in the proper temperature ranges, and be protected properly, except during necessary periods of preparation. 8. All foods including dry foods shall be stored in a manner to prevent possible contamination, and permit, easy cleaning of the storage area. Containers of food shall be stored a minimum of six inches above the floor or on movable dollies. 9. All food shall be protected from contamination during storage, preparation, transportation, and serving. 10. No poisonous or toxic materials except those required to maintain sanitary conditions and for sanitzation purposes may be used in the food service operation. STANDARDS FOR MATERNITY HOMES CHAPTER 0250-4-7 Poisonous and toxic materials shall be identified, stored and used only in such manner, and under such conditions as will not contaminate food or constitute a hazard to population of a facility. 11. All equipment and utensils shall be so designed and constructed of such material and workmanship as to be smooth, easily, and durable. Equipment and utensils shall be in good repair. 12. The food-contact surfaces of equipment and utensils shall be easily accessible for cleaning, and be of nontoxic, corrosion resistant, and non-absorbent materials. 13. All equipment shall be installed and maintained to facilitate the cleaning thereof, and of all adjacent areas. 14. All eating and drinking utensils shall be thoroughly cleaned and sanitized after each use with the exception of single service utensils which shall be discarded following use. 15. Single-service articles shall be made from nontoxic materials and shall be stored, handled and dispensed in a sanitary manner. 16. All kitchenware and food-contact surfaces of equipment, exclusive of cooking surfaces of equipment, used in the preparation or serving of food or drink, and all food-storage utensils shall be thoroughly cleaned and sanitized after each use. 17. Cooking surfaces of equipment shall be cleaned at least once a day. 18. All utensils and food-contact surfaces of equipment used in the preparation, transportation, service, display, or storage of potentially hazardous food shall be thoroughly cleaned and sanitized after each use. 19. Surfaces of equipment not intended for contact with food, but which are exposed to splash or food debris or which otherwise require frequent cleaning, shall be designed and fabricated to be smooth, washable, free of unnecessary ledges, projections, or crevices, and readily accessible for cleaning, and shall be of material and in such repair as to be easily maintained in a clean and sanitary condition. 20. All food-contact surfaces of equipment and utensils shall be stored and handled by methods that protect them from contamination by splash, dust and other means. 21. In facilities defined by the Department of Children’s Services as existing, a two-compartment sink can be used for washing and rinsing utensils, provided an additional container or sink be used for sanitization of the utensils. For facilities defined by the Department of Children’s Services as new, a three-compartment sink is required when manual dishwashing procedures are utilized for washing, rinsing and sanitization of utensils. Domestic type dishwashing machines are acceptable provided the temperature at the utensil surface be 160° F after the end of one complete cycle. If 160° F is not obtained at the end of one complete cycle, an additional rinse for utensils shall be provided in a separate container or sink. Facilities which do not have adequate and effective facilities for cleaning and sanitizing utensils shall use single-service articles. STANDARDS FOR MATERNITY HOMES CHAPTER 0250-4-7 (B) WATER SUPPLY. 1. The drinking water supply serving maternity home facilities shall be from a source approved by the health authority having jurisdiction. 2. There shall be sufficient hot and cold water under pressure to supply the dally needs of a maternity home. 3. An approved drinking fountain or individual single service paper cups shall be provided in rooms or adjacent to rooms regularly occupied by the residents. 4. All equipment shall be clean and in good repair. (C) SEWAGE DISPOSAL AND PLUMBING. 1. A private sewage disposal system at a facility shall be operating satisfactorily. 2. When the private sewage disposal system at an existing facility fails and where a public sewage system is available, the facility shall be connected. 3. All plumbing shall be installed to prevent the possibility of cross connection, back siphonage, or sewage leaks. (D) SOLID WASTE. 1. An adequate number of suitable storage containers approved by local health authorities shall be provided and shall be kept clean and in good repair. 2. Garbage and refuse storage areas shall be kept clean. 3. Storage containers, other than bulk, shall be secured properly to prevent spillage. 4. Garbage deposited in outside bulk storage shall be in flytight containers (example; plastic bags). 5. All garbage shall be removed from the building daily. 6. Garbage and rubbish shall be collected from the premises at least twice weekly. 7. At facilities where twice weekly collection is not provided, all garbage and rubbish shall be disposed of in a manner acceptable to the health authority having jurisdiction (supplement collection by individual hauling, acceptable burying, etc.) 8. Combustible rubbish may be burned, provided such burning meets all local and state laws and regulations relative to incinerators, incineration, and air pollution. (E) TOILETS, HANDWASHINGS AND BATHING. 1. One flush toilet, one hand-washing facility and one tub or shower, for every four (4) residents be provided. 2. All facilities shall be approved, in good repair and clean. 3. A tightly covered container with plastic liner shall be used for diaper disposal and stored inaccessible to children. This container shall be emptied a minimum of twice daily by closing the liner and disposing of it into an outside garbage receptacle. STANDARDS FOR MATERNITY HOMES CHAPTER 0250-4-7 4. There shall be soap, hot and cold water under pressure, and individual towels provided where handwashing lavatory is located. 5. Toilet tissue shall be provided on tissue holder at each commode. 6. Handwashing and bathing water for residents shall be provided under pressure at a temperature at least 90° F and not greater than 120° F without manual adjustment of the faucets. (F) BUILDINGS. 1. Structure (a) The building foundation, roof, walls, and window frames shall be free of visible cracks and unsealed openings to prevent entrance of insects and rodents. (b) Buildings shall be kept clean, in good repair and painted when necessary. (c) Gutters and down spouts shall be kept clean and in good repair. 2. Materials Facilities having any presence of friable asbestos shall have a written plan approved by Department of Health and Environment for providing acceptable measures of control. The plan is to include a time frame not to exceed five years. This plan is to be on file with the Department of Health and Environment. 3. Floors (a) Floors shall be clean and in good repair. 4. Walls and Ceilings (a) Walls and ceilings shall be kept clean and in good repair. 5. Doors and Windows (a) All doors and windows shall be kept clean and in good repair (this includes screens when used). (b) Windows shall be openable unless the room is air conditioned. (c) All windows used for ventilation shall be screened unless building is air conditioned, 6. Bedding Each occupant shall be provided an individual bed with acceptable mattress and waterproof cover springs, clean linen, and clean cover. 7. Lighting (a) Natural and/or artificial fighting shall be distributed throughout the maternity home at the following ratio: STANDARDS FOR MATERNITY HOMES CHAPTER 0250-4-7 (1) Classroom - 25 foot candles. (2) Food preparation surfaces, food service equipment or utensil-washing work levels, food service utensils and equipment, storage areas and in lavatory and toilet areas - 20-foot candles. (3) Walk-in refrigeration units, dry food storage areas, other storage areas, and halls - 10 foot candles. 8. Heating and Ventilation (a) All rooms used by residents shall be heated by a system capable of maintaining a temperature of 68° F. (b) When the outside temperature is 65° F or below, the temperature within the facility shall be no lower than 65° F nor higher than 75° F. (c) Stoves, hot radiators, steam and hot water pipes or other heated objects and electrical outlets shall be adequately protected by screens, guards, insulation, or any suitable means. (d) Heat and ventilation units shall be clean and in good repair. (G) INSECT AND RODENT CONTROL. 1. The facility shall be reasonably free from flies, other insects and breeding sites. 2. Screens which are approved and in good repair shall be provided for all doors and windows used for ventilation purposes. 3. When air conditioning is used, doors and windows shall be kept closed. 4. The facility shall be free of rodents. 5. There shall be no rodent harborage areas. 6. Proper supervision and caution shall be exercised according to label directions when applying approved insecticides and rodenticides. (H) SAFETY. Pesticides, medicines, polishes, disinfectants, and cleaning compounds shall be stored in a manner approved by the local health authority. 2. Sturdy safety rails shall be provided for ramps and steps where there are three or more risers. 3. Bathtubs, if used, shall be provided with safety strips or mats. 4. Glass in hazardous locations in the facility shall be shielded when safety glass is not used. Broken glass objects shall not be permitted in any part of the building or on grounds. STANDARDS FOR MATERNITY HOMES CHAPTER 0250-4-7 5. All furniture shall be of durable construction, free of sharp projecting comers or surfaces and in good repair. 6. Grounds shall be free of hazards that are likely to cause falls. 7. Buildings and grounds shall be free of any unprotected, abandoned well, cistern, refrigerator or similar hazards. 8. Fencing, or other acceptable barriers, shall be provided for hazardous drainage ditches, cliffs, bluffs, or other similar hazards. 9. Grounds shall have adequate drainage. 10. All play equipment shall be safe and in good repair. (I) SWIMMING POOL. 1. Facilities located in municipalities or counties that have an adopted swimming pool ordinance or regulations shall comply with the said ordinance or regulation, where applicable. 2. Facilities located in municipalities or counties that do not have an adopted swimming pool ordinance or regulation shall comply with the Hotel, Food Service Establishment and Public Swimming Pool Inspection Act of 1985, where applicable. 3. Facilities utilizing a swimming pool on-site or at another location shall be assured of an approved lifeguard, or the number of guards required, on duty. (J) CONTROL OF ANIMALS. 1. If live animals or birds are kept in classrooms as pets, they shall be caged; cages shall be kept clean. (Turtles shall not be kept as pets because (a) a proper environment is elaborate and difficult to achieve and (b) they are carriers of salmonella). 2. In all cases animals and birds shall not be allowed in areas of food storage, preparation, or service. 3. Pets requiring vaccination against rabies shall be currently protected, evidence of which shall be on file.