Section 4 - Physical Environment



NURSING HOME ADMINISTRATOR LICENSURE

EXAM REVIEW COURSE | |

(National Exam ◘ MODULE 5

FORM B

referencsection

Physical Environment

Speed Reader

Examination 1

Examination 2

Stan Mucinic, LNHA

Legal Notices

Individuals enrolled in the “national nursing home administration licensing course” are purchasing the professional knowledge of the instructor to assist the student to prepare for the national “nursing home administrator’s” exam administered by the national association of boards of examiners (NAB).

THE COURSE IS A 5-WEEK INTENSIVE SELF-STUDY TEST PREPARATION PROGRAM DESIGNED TO PROVIDE THE STUDENT A UNIQUE PERSONALIZED AND STRUCTURED LEARNING ENVIRONMENT WHERE PROGRESS IS MONITORED BY THE INSTRUCTOR THROUGH EMAIL TO HELP STUDENTS MAINTAIN FOCUS AND COMPLETE SCHEDULED ASSIGNMENTS TIMELY. THE STUDENT AND INSTRUCTOR CAN NEGOTIATE ADDITIONAL INSTRUCTION TIME AND FEES IF NECESSARY.

THE INSTRUCTOR MAKES NO EXPRESS OR IMPLIED WARRANTY OR REPRESENTATION OF ANY KIND THAT COMPLETION OF THIS OR ANY LICENSURE PREPARATION COURSE OFFERED BY INSTRUCTOR WILL GUARANTEE A PASSING SCORE ON ANY LICENSING EXAM.

An individual’s ultimate success in passing the licensure exam is dependent on an individual’s professional experience, academic preparation, and the time and energy the individual can commit to exam study and preparation.

A student’s work schedule or other commitments may require more time to prepare for an exam than allotted. The student is solely responsible for licensing exam registration/testing and retesting fees.

How to Use the Study Guides

Step 1. Speed Reader – First, read the speed reader for each module once or twice before taking the module exam(s). The speed reader is designed to quickly familiarize you with most of the concepts and information you will be studying. Take a few days to just read the guide over and over again until you familiarize yourself with its contents. THE MORE TIMES YOU READ IT THE MORE LIKELY YOU ARE TO REMEMBER IT.

Step 2 – Exam Packet - The exam packet contains questions designed to measure your comprehension and retention of the material you read. Take each exam over again until you score 100%. You must score each exam and record the results in the test score grid. Make sure you score each exam so you and I can gauge your progress.

The exam questions are cross referenced to the speed reader to allow you to quickly find and review material you missed on the exam as follows:

Page Number ---- 2/1.8(13) ------ Section Number

The specific reference material would be found on page 2 of the speed reader, section 1.8, subparagraph 13.

Contact Information

You may contact Stan Mucinic by email smucinic@ with any questions or after you score each exam.

Physical Environment

Table of Contents

| | Topic |Page |

|1 |Purpose of Maintenance Program |3 |

|2 |Equipment Replacement and Depreciation |3 |

|3 |Laws and Regulations |3 |

|4 |Maintenance Procedures |3 |

|5 |Resident Environment |4 |

|6 |Housekeeping |4 |

|7 |Limits to Personal Possessions |4 |

|8 |Infection Control Program |4 |

|9 |Pest Control Program |5 |

|10 |Resident Safety |6 |

|11 |Disaster and Emergency Management Procedures |6 |

|12 |Life Safety Code |6 |

|13 |Quality Assurance Plan |11 |

|14 |Resident Rights re: Environment |11 |

|15 |JCAHO |12 |

|16 |Americans with Disabilities Act |12 |

|17 |Key to Effective Maintenance Program |16 |

|18 |Policies and Procedures |16 |

|19 |Quality Assurance and Assessment Committee |16 |

|20 |Miscellaneous Terms |16 |

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Physical Environment

|Section 1 - Purpose of Maintenance Program |

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|1.1 - Purpose of Maintenance Program |

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|MUST PLAN AND IMPLEMENT A SYSTEM TO MAINTAIN THE GROUNDS, BUILDINGS AND EQUIPMENT |

|The administrator is responsible for the facility maintenance program |

|The facility must be equipped to protect the health and safety of residents, staff and visitors |

|Preventative maintenance is critical to extend the useful life of the plant and equipment |

|A facility has hundreds of different systems that require expert knowledge |

|A facility must have a maintenance and replacement schedule for all systems |

|Doorway thresholds must not rise above ¼ inch |

|All components have a useful life |

|Buildings have a useful life of 40 years |

|Staff must be familiar with construction requirements of the Life Safety Code |

|Section 2 - Equipment Replacement/Depreciation |

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|2.1 – equipment Replacement and Depreciation |

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|ONLY 10% OF FACILITIES SET ASIDE FUNDS EACH YEAR TO REPLACE EQUIPMENT |

|Buildings and equipment depreciate in value, and facilities must use one or more IRS depreciation schedules for each system or item |

|For-profit facilities deduct for depreciation and non-profits do not |

|Cars and trucks must be depreciated over 5 years |

|The main criteria whether to replace an item must be resident safety (equipment critical to resident safety must be repaired or replaced immediately)|

|Most facilities use the depreciation deduction to fund other purposes than the repair or replacement of capital assets |

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|Section 3 - Laws and Regulations |

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|3.1 – Laws and Regulations |

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|THE NATIONAL FIRE PROTECTION ASSOCIATION PUBLISHES THE LIFE SAFETY CODE |

|Compliance with the ADA is enforced by the Architecture and Transportation Barriers Compliance Board regarding access to public buildings and |

|transportation and the EEOC regarding discrimination in hiring of people with physical disabilities/handicaps |

|The ADA sets the rules for handicap access to buildings and are developed and modified by CABO (Council of American Building Officials) and ANSI |

|(American National Standards Institute) |

|Federal regulations are published in the Federal Register |

|Section 4 - Maintenance Procedures |

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|4.1 - Maintenance Procedures |

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|A FACILITY NEEDS PROCEDURES TO DOCUMENT AND COMMUNICATE MAINTENANCE NEEDS |

|A facility must prioritize maintenance needs |

|A facility must have an effective maintenance program with the following elements: |

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|Good recordkeeping |

|Document repair requests, turnaround times and costs |

|Identify equipment requiring major repairs |

|Section 5 - Resident Environment |

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|5.1 – Resident Environment |

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|A RESIDENT HAS THE RIGHT TO REASONABLE ACCOMMODATION OF PERSONAL PREFERENCES AND NEEDS |

|Must adapt facility environment to allow residents to function independently if practicable |

|Must provide adaptive equipment (grab bars, transfer boards, elevated toilet seat) |

|Must provide a clean, safe, homelike and comfortable environment |

|Must allow residents to use personal belongings |

|Must provide residents closet and drawer space |

|Must provide residents comfortable lighting and comfortable room temperature and sound levels |

|Must provide residents a homelike and personalized rooms environment |

|The resident environment includes resident rooms, bathroom, activity and therapy areas |

|Must encourage residents to have personal photos, mementos, and religious symbols |

|Section 6 – Housekeeping |

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|6.1 - Housekeeping |

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|SANITARY MEANS PREVENTING SPREAD OF DISEASE |

|Must clean resident care equipment (denture cups, toothbrushes, bedpans, urinals) |

|Must provide clean linen and beds |

|Must provide residents comfortable lighting adequate for tasks (minimize glare) but adequate to allow the visually impaired to function  (residents |

|determine if lighting is adequate) |

|A comfortable temperature zone is between 71( and 81( F |

|Must control noise levels – if staff needs to raise their voice to be heard then sound level on television or radio is too high |

|Section 7 - Limits to Personal Possessions |

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|7.1 – Limits to Personal Possessions |

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|MUST LIMIT DRAPERIES AND DECORATIONS PER LIFE SAFETY CODE (FIRE HAZARDS) |

|Any combustible material is prohibited in a facility |

|Must use only flame retardant decorations |

|Maintenance department must inspect and approve all resident owned electrical appliances |

|Extension cords are not permitted in a facility |

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|Section 8 - Infection Control Program |

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|8.1 – Infection Control Program |

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|MUST MAINTAIN AN INFECTION CONTROL PROGRAM WHICH CAN: |

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|Investigate, identify, control and prevent occurrence and spread of infection |

|Employ isolation procedures |

|Maintain records of incidents and corrective action |

|Analyze clusters and spread of infection in facility |

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|Must maintain a separate record of infection for each resident |

|Nosocomial Infection means an infection that originates from within a facility |

|Employees with a Communicable Disease or infected skin legion must be prohibited from contact with residents or their food |

|Must have infection control policies which detail how a facility will identify and respond to different types of infections |

|Must contact a state epidemiologist in the event of a widespread infection |

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|8.1 Infection Control Program (cont’d) |

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|Body Fluid Precautions |

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|Universal body fluid precautions (universal precautions) is required by OSHA in nursing homes and requires using hand washing, gloves, gowns and |

|masks to prevent contact with all bodily fluids. |

|Standard precautions is covering the body completely so no skin comes in contact with any bodily fluids with gowns, caps, plastic shields, shoe |

|coverings, gloves, hand washing, etc. (this is used more frequently in a hospital setting and OSHA allows hospitals to substitute Standard |

|precautions for Universal Precautions) |

|For purposes of the exam, both Universal Precautions and Standard precautions treat all of the following bodily fluids as if infected with HIV |

|whether or not confirmed by any lab tests: |

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|Blood |

|Semen and vaginal secretions |

|Cerebrospinal, synovial, pleural and peritoneal fluid |

|Amniotic and amniotic fluid |

|Fluid with visible blood |

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|These precautions do not apply to the following unless visibly contaminated with blood: |

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|Feces |

|nasal secretions |

|sputum |

|sweat |

|tears |

|urine |

|vomitus |

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|Residents with HIV do not need to be isolated unless they have an opportunistic infection or cannot contain their bodily fluids |

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|Handwashing is the most effective means to prevent the spread of disease |

|Linens – Staff must safely handle and store clean linens by doing the following: |

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|Store soiled linens in rooms with negative pressure |

|Prevent cross contamination |

|Transport soiled linens in covered leak proof containers |

|Transport clean linen on covered carts |

|Decontaminate carts weekly |

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|Handwashing – Staff must wash hands and glove hands before resident care tasks and |

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|Prevent cross contamination |

|Follow hospital environmental control guidelines of 1985 |

|Change gloves after providing direct care |

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|Resident Isolation – attending physician determines isolation needs |

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|A private room can be used as an isolation room |

|Isolation is required if a patient: |

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|Has poor hygiene |

|Contaminates the environment |

|Cannot assist in preventing the spread of infection |

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|If a private room is not available then an infected resident can be placed in a semi-priateroom with a roommate with the same infection |

|Must use least restrictive isolation method |

|Must use standard precautions for HIV |

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|Sharps Container s must be placed in the laundry room and on all med carts |

|A physician must determine whether a resident requires isolation |

|Influenza is the most common infectious epidemic in nursing homes |

|Section 9 - Pest Control Program |

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|9.1 – Pest Control Program |

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|MUST HAVE AN ACTIVE PEST CONTROL PROGRAM TO ERADICATE ALL PESTS AND VERMIN |

|Staff must be vigilant o pest infestations |

|Must use a professional pest control company to destroy and control vermin |

|Residents and visitors bring vermin into the facility from the outside |

|Section 10 - Resident Safety |

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|10.1 – Resident Safety |

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|EMOTIONAL AND PHYSICAL SAFETY |

|High staff turnover, bed sores and med errors do not make residents feel safe |

|Must protect residents from staff abuse |

|Do background screening of all employees |

|Control access and egress from facilities with locks and electronic access systems |

|Answer call lights promptly |

|Have an effective incident reporting system |

|Safety is a mind set and must constantly train staff |

|OSHA safety guidelines are advisory only and focus mainly on ergonomics, exposure to blood, |

|decreasing falls |

|Clean up spills promptly, control hazardous chemicals, and respond quickly to infectious outbreaks |

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|Section 11 - Disaster and Emergency Procedures |

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|11.1 – Disaster and Emergency Procedures |

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|MUST HAVE AN EMERGENCY MANAGEMENT PLAN THAT MUST BE UPDATED ANNUALLY AND REVIEWED BY LOCAL EMERGENCY MANAGEMENT AGENCY |

|Must anticipate fire and natural disaster and have supplies, food and power to defend in place |

|Must have regular preparedness drills |

|Local fire, police, disaster management agencies can assist before, during and after a disaster |

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|Section 12 - Life Safety Code |

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|12.1 – Life Safety Code |

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|MUST FOLLOW LIFE SAFETY CODE OF 2000 (NOT ALL STATES HAVE ADOPTED THE CODE) |

|Main focus of Life Safety Code is to defend in place by using superior construction, quick discovery of fire, fast notification to fire department |

|and quick containment of smoke and fire, and fast extinquishment (water sprinklers, fire extinguishers) |

|Main defense is smoke and fire barriers and remove those in proximity of fire quickly and protect all others who cannot be quickly evacuated |

|REMOVE patients and not beds |

|Must have a written fire plan |

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|12.2 – Resident BEDRooms |

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|CEILING PRIVACY CURTAINS MUST BE SUSPENDED 18 INCHES FROM CEILING UNLESS IT HAS A MESH PANEL THAT ALLOWS WATER FLOW TO PASS THROUGH FROM SPRINKLER |

|HEADS |

|Each room should have access to a toilet (not required to have a toilet in room just nearby) |

|No more than 4 people in a room |

|Must have a resident call system |

|No items in a room can be higher than 18 inches from ceiling (can block sprinklers) |

|Minimum space for resident bedrooms is: |

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|Semiprivate = 80 sq ft |

|Private = 100 sq ft |

|7. All penetrations of wall openings (i.e., pipe openings) must be protected by metal plates, masonry fill |

|or equivalent product that can prevent the spread of fire and smoke |

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|12.3 - Fire Drills |

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|MUST HAVE FIRE DRILLS QUARTERLY, UNANNOUNCED FOR ALL THREE SHIFTS WITH 12 DRILLS EACH YEAR |

|Fire drills include the transmission of a fire alarm and a simulated emergency |

|Can use a coded word instead of an audible alarm and an object to represent a fire |

|Drills must be random |

|Do not need to use an audible alarm between 9:00 PM and 6:00 AM |

|Do not need to remove bedridden patients from their beds |

|Must close all doors to contain smoke |

|Must train all employees on life safety procedures |

|The fire safety plan must be reviewed by the fire department annually |

|Drills must be performed in all types of weather |

|Must notify the telephone operator immediately who will call the fire department |

|Must post fire procedures in facility |

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|12.4 – R-A-C-E |

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|Remove residents from fire area |

|Alarm – pull alarm asap |

|Contain fire and smoke by closing all smoke and fire doors |

|Extinguish fire with extinguishers |

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|12.5 – Upon Discovering a Fire |

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|Upon discovering a fire the rescuer must do the following: |

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|If no one in immediate danger, pull alarm themselves |

|If a resident is in the fire area, the rescuer must raise the alarm to nearby staff and immediately remove the resident from the fire area |

|12.6 – Char Length |

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|1. NEWLY UPHOLSTERED FURNITURE MUST HAVE A MAX CHAR LENGTH OF 1.5 INCHES |

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|12.7 – Written Fire Plan |

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|1. WRITTEN FIRE PLAN MUST INCLUDE: |

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|Using alarms |

|Transmitting alarm to fire dept |

|Responding to an alarm |

|Isolating a fire |

|Evacuating resident from the fire area |

|Evacuating the building |

|Extinguishing the fire |

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|12.8 – Closing Doors |

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|CLOSING DOORS HAS MOST EFFECT IN CONTAINING FIRE AND SMOKE |

|12.9 - Resident Smoking |

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|SMOKING IS NOT PERMITTED IN ANY AREA WITH COMBUSTIBLE MATERIALS |

|Staff must supervise smoking by non-responsible individuals |

|Ashtrays must be metal with closable containers to hold ash/embers |

|Staff must exercise full control over all smoking |

|Most fires in facilities caused by smoking in bed |

|The second leading cause of fire is placing smoking materials in a proper receptacle |

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|12.10 - Soiled Linen/Trash |

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|LIMIT CONTAINERS TO 32 GALLONS PER 64 SQ FT AREA |

|Containers more than 33 gallons must be mobile/kept in protected area |

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|12.11 - Doors |

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|PATIENT DOORS MAY BE LOCKED IF STAFF HAS KEYS TO OPEN THE DOOR IMMEDIATELY |

|Locks allowed on patient doors where staff can open from outside and resident can open from inside |

|Exit doors cannot have lock that can only be opened from the outside |

|Only one locked door is allowed on any single length of egress corridor |

|Doors protecting openings must have a positive latch (completely close and seal) that cannot be held in a retracted position |

|Doors must be kept closed at all times (prevents the passage of smoke in a fire) |

|Roller latches are not allowed |

|Doors protecting openings in corridor partitions must be able to resist smoke |

|Exit doors must be lit by battery powered lights and must open to the outside for safe egress |

|Doors locks that are released with a key pad must open within 15 seconds of holding down the bar that releases the locking mechanism |

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|12.12 - Construction Additions |

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|ADDITIONS NOT MEETING THE NEW BUILDING CODE MUST BE SEPARATED BY A 2-HOUR FIRE RESISTANCE BARRIER |

|Sprinklers are required in all new construction |

|Multi story buildings must be constructed of non-combustible materials |

|A 3+ story building needs a 2 hr fire barrier in major elements |

|A building with 2 or less stories must have a 1 hr fire barrier in major elements |

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|12.13 - Stairs |

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|INTERIOR STAIRS – CLEAR WIDTH 44” |

|Stair risers min height 4” and max height is 7” |

|Min stair tread depth is 11” |

|Min stair headroom is 6’8” |

|Max height between landings is 12 ft |

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|12.14 Handrails |

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|REQUIRED BOTH SIDES OF STAIRS |

|Not less than 34” nor more than 38” above tread |

|Min clearance from wall is 1 ½ “ |

|Must be smooth, slide hand along rail without obstruction |

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|12.15 - Ramps |

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|RAMP SLOPE |

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|0 – 7 degrees = ramp |

|7-20 degrees = stairway/landing |

|20-50 degrees = stairway |

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|Nearly horizontal landings are required at both ends of a ramp |

|Ramps must be a minimum of 44” wide and slip resistant |

|Maximum rise of a ramp is 30 degrees |

|Aisles, corridors and ramps used as an exit must be 8 feet wide |

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|12.16 - Exits |

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|MUST HAVE AT LEAST 2 EXITS REMOTELY LOCATED ON EACH FLOOR |

|One exit must lead directly outside |

|An exit passageway cannot lead back through the compartment of origin |

|An exit ramp or stair must lead directly outside at grade level or be an enclosed passage meting all fire resistance requirements |

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|12.17 - Egress Corridors |

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|SLEEPING AREAS – 120 SQ FT PER PERSON |

|In-patient treatment areas – 240 sq ft per person |

|Each patient room must have a door that opens to an exit corridor |

|Travel distance from inside patient room to exit corridor door= 200’ |

|Travel distance from inside patient room to exit access door = 150’ |

|Distance from any point of patient room to exit access corridor=50’ |

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|12.18 - Horizontal exits (corridors) (stairways are vertical exits) |

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|AN EXIT CORRIDOR MUST PROVIDE A MINIMUM OF 30 SQ FT PER PERSON |

|A single door on an exit corridor must be a minimum of 41.5 inches wide |

|Doors separating 2 fire areas must swing in opposite directions |

|A horizontal exit usually has no stairs or a ramp |

|Two doors separating 2 fire areas in a horizontal exit must be at least 41.5” wide each |

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|12.19 - Lighting/Exit Signage |

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|LIGHTING OF MEANS OF EGRESS MUST BE CONTINUOUS WITH EXIT FLOOR SURFACES ILLUMINATED AT THE LEVEL OF 1 FOOT CANDLE FROM THE FLOOR |

|Overlapping lights sources are required to prevent any area in darkness |

|A facility should use T-5 and T-8 light bulb to minimize glare |

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|12.20 - Emergency Lighting |

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|MUST HAVE AUTOMATIC TRANSFER BETWEEN NORMAL POWER AND EMERGENCY POWER SOURCE |

|Storage battery power okay if it provides 1 ½ hours of power |

|Onsite electrical generator power is normally required as a second power source |

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|12.21 - Signage |

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|EXIT SIGNS MUST BE VISIBLE FROM ANY DIRECTION |

|Exit access routes can be no longer than 100 ft |

|Signage lettering must be a minimum of 6” high and not less ¾” wide and with contrasting color |

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|12.22 - Fire Alarm and Detection |

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|MUST HAVE A MANUALLY OPERATED FIRE ALARM SYSTEM THAT IS ELECTRONICALLY MONITORED |

|If a manually operated fire alarm system malfunctions a continuous alert indication is sent electronically to a continuously attended location |

|A fire alarm system must alert all occupants when alarm is activated |

|The fire dept must be notified automatically if a fire alarm is activated |

|Activating a fire alarm automatically activates all sprinkler systems, alarms and door releases |

|New facilities must have an automatic smoke detector system |

|Smoke detectors must be located no further than 30’ apart and not more than 15’ from any wall |

|Automatic smoke detection and fire detection systems must be connected electronically |

|A supervisory signal sent to a constantly attended location in event of malfunction reducing sprinkler system performance |

|The sprinkler and alarm systems must automatically close fire doors |

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|12.23 - Emergency power |

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|AN EMERGENCY GENERATOR MUST GO ON WITHIN 10 SECONDS OF A POWER FAILURE |

|A generator is only mandatory if you have patients on a respirator or life support |

|Emergency battery power is required for all facilities to power the following: |

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|Emergency lighting |

|Exit signs |

|Egress and stairways |

|Medicinal prep areas |

|4. An emergency generator must be visually inspected every week and run under full load for 30 |

|minutes every month |

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|12.24 - ALARM SYSTEMS |

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|Must provide power to light all entrances and exits |

|Must provide power to fire detection alarm systems |

|Must provide power to life support systems |

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|12.25 - Fire Extinguishers |

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|A SUPERVISED AUTOMATIC SPRINKLER SYSTEM MUST BE INSTALLED |

|Quick response sprinklers must be used in smoke compartments |

|Portable fire extinguishers must be installed in the facility |

|Hand fire extinguishers are required on each floor and in fire hazard areas |

|Travel distance to extinguishers is as followed: |

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|Class A fire extinguisher no more than 75 feet |

|Class B or C extinguisher no more than 50 feet |

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|Fire extinguishers must be checked or inspected quarterly and serviced annually |

|Classification of fires |

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|Class A – wood, cloth, paper - use water to put out |

|Class B- grease, gasoline, oil – use dry chemicals, foam, CO2 |

|Class C – electrical equipment – use dry chemicals, CO2 |

|Class D – magnesium, titanium, zirconium- use special agents only |

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|When extinguishing a fire, must aim at the base of the fire |

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|12.26 - Communicating Openings (fire barriers) |

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|MUST HAVE SELF CLOSING DOORS HELD OPEN BY AUTO RELEASE DEVICES |

|Doors normally kept closed |

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|12.27 - Smoke Proof Enclosures |

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|1. SMOKE PROOF ENCLOSURES MUST HAVE ENCLOSED STAIRS WITH A 2 HOUR FIRE RESISTANCE AND A DOOR WITH A 1 |

|½ hour fire resistance rating |

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|12.28 - Kitchen |

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|1. STOVES MUST HAVE FIXED AUTOMATIC FIRE EXTINGUISHERS |

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|12.29 - Hazardous areas |

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|MUST HAVE 1 HOUR FIRE PROTECTION AND AUTO EXTINGUISHING SYSTEM |

|Areas include mechanical equip room, laundry, kitchen |

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|12.30 - Smoke Compartments |

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|EVERY STORY MUST BE DIVIDED INTO 2 SMOKE COMPARTMENTS |

|Every story with 50 or more persons must be divided into 2 smoke compartments |

|A smoke compartment cannot be larger than 22,500 sq ft |

|Travel distance to an exit can be no longer than 200 feet in smoke compartment |

|Doors must be 1 ¾ “ thick, solid bodied wood core construction of 20 minute fire resistance rating |

|Vision panels required in swinging doors |

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|12.31 - Partitions |

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|EXTERIOR WALL MUST BE FIRE STOPPED AND CUT OFF TO CONCEAL DRAFT OPENINGS |

|Wood for fire stopping must be 2 inches thick |

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|12.32 - Windows |

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|EACH RESIDENT BEDROOM MUST HAVE ONE WINDOW OR DOOR TO THE OUTSIDE |

|Max sill height from floor is 36 inches |

|The window does not have to be operable |

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|12.33 – Housekeeping Cart |

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|HOUSEKEEPING CARTS MUST BE STORED IN A HAZARD PROTECTED AREA |

|Portable heating devices are prohibited except in staff work areas aand the heating element cannot exceed 212(F |

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|12.34 – Combustible Materials |

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|DRAPERIES AND FURNITURE MUST BE TESTED TO MEET HEAT RELEASE STANDARDS |

|Combustible materials can be sprayed with a fire resistant solution |

|Photographs and paintings are permitted in limited quantities |

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|12.35 – Facility Lighting Plan |

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|A FACILITY MUST PROVIDE ADEQUATE LIGHTING FOR RESIDENT’S VISUAL NEEDS |

|A facility must address resident vision, mobility and sensory comfort |

|Residents have problems differentiating colors and walls from floors |

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|12.36 – Vertical Openings |

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|1. ANY STAIRWAY, RAMP. ELEVATOR, HOIST OR CHUTE BETWEEN BUILDING FLOORS REQUIRES THE FOLLOWING: |

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|1 hour protection for buildings required to have 1 hour protection |

|1 hour protection for a building with 2 or less stories |

|2 hour protection for buildings with 3 or more stories |

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|SECTION 13 – QUALITY ASSURANCE PLAN |

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|13.1 - QUALITY ASSURANCE PLAN |

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|MUST HAVE A QUALITY ASSURANCE PLAN |

|QA committee must meet quarterly |

|Committee identifies problems with quality of life |

|The QA committee is comprised of the director of nursing, a physician and 3 staff members |

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|SECtION 14 – RESIDENT RIGHTS RE: ENVIRONMENT |

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|14.1 - RESIDENT RIGHTS RE: ENVIRONMENT |

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|RESIDENT RIGHTS ARE INTEGRAL TO PHYSICAL ENVIRONMENT AND ATMOSPHERE |

|Residents have a right to full information on living arrangements and physical environment |

|Residents have a right to voice complaints about their physical environment |

|Must have privacy curtain and window blinds to ensure visual privacy |

|Clean bed and linens |

|Décor must be appropriate for adult’s home |

|Should use contrasting colors for visually impaired |

|Must provide appropriate furniture and equipment for activities and social needs |

|Comfortable room temperature of 71-81 Degrees F |

|Comfortable noise levels not to exceed 120 decibels |

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|SECTION 15 – JCAHO |

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|15.1 - JCAHO |

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|JCAHO is a voluntary accreditation organization |

|JCAHO standards require an environment that meets residents needs while encouraging positive self image |

|Section 16 - Americans with Disabilities Standards |

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|16.1 - ENFORCEMENT |

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|THE ADA IS ENFORCED BY THE ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD, DEPT OF JUSTICE |

|Standards developed and approved by ANSI (American national Standards Institute) |

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|16.2 - Aisles/Accessible Routes |

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|AN ACCESS AISLE IS THE SPACE BETWEEN ELEMENTS |

|Clear floor space is the unobstructed floor space needed to accommodate wheel chairs and their occupants |

|An accessible route is a continuous unobstructed path and must be at least 36” wide (3 feet) |

|Must have passing spaces in a accessible route every 200 feet |

|Must have an 80 inch turn space for wheelchairs |

| |

|16.3 - Protruding Objects |

| |

|OBJECTS BETWEEN 27” AND 80” ABOVE THE FLOOR CANNOT PROTRUDE BEYOND 4” INTO A HALLWAY |

|Freestanding objects mounted on a post may overhang 12” when mounted between 27” and 80” above the floor |

| |

|16.4 - Changes in Floor Level |

| |

|0-1/4” CHANGE IN LEVEL; VERTICAL AND WITHOUT EDGE |

|Between ¼” and ½”; beveled edge |

|Over ½”; ramp treatment |

| |

|16.5 - Carpeting |

| |

|CARPETS MUST BE SECURELY ATTACHED |

|Carpet pile may be no higher than ½”, level cut, trimmed along edges |

| |

|16.6 - Gratings |

| |

|THE MAXIMUM WIDTH OF A GRATING IS ½” AND MUST BE PERPENDICULAR TO DIRECTION OF TRAFFIC |

| |

|16.6 - Handicap areas |

| |

|50% OF BEDROOMS AND TOILETS MUST BE HANDICAP ACCESSIBLE |

| |

|16.7 - Wheelchair Space Requirements |

| |

|CLEAR WIDTH IS 36” CONTINUOUSLY AND 32” AT ANY ONE POINT |

|Width for wheel chair passage is 60” |

|Wheelchair turning space is 60” |

|High forward reach from a wheelchair is 48” |

|Side reach from a wheelchair is between 9” – 54” off the floor |

| |

| |

|16.8 - Doors |

| |

|DOORS ON AN ACCESSIBLE ROUTE MUST BE A MINIMUM OF 32” WIDE |

| |

|16.9 - Parking Spaces |

| |

|MINIMUM NUMBER OF HANDICAP PARKING SPACES IS A 1:25 RATIO: |

| |

|1-25 = 1 space |

|26-50= 2 spaces |

|51-75= 3 spaces |

|76-100 = 4 spaces |

|101-150 = 5 |

| |

|The minimum width of a parking space is 96” wide with an accessible lane 60”wide |

|2 handicap parking spaces can shared by one handicap access aisle |

|A van space must be provided |

|A handicap parking sign must be high enough not to be obscured by a parked car |

|A passenger loading zone must be 60” wide and 20 feet long adjacent and parallel |

| |

|16.10 - Ramps |

| |

|A RAMP IS ANY PART OF AN ACCESSIBLE ROUTE WITH A SLOPE GREATER THAN 1:20 |

|The maximum slope of a ramp is 1:12 |

|The maximum rise of a ramp is 30” |

|The cross slope of ramp cannot exceed 1:50 |

| |

|16.11 - Stairs |

| |

|LANDINGS ARE REQUIRED AT THE TOP AND BOTTOM OF EACH STAIRWAY RUN |

|Landings must have a minimum width of 60” |

|Stair nosing must project no more than 1 ½” |

| |

|16.12 – Handrails (See Exhibit A – Page 18 below) |

| |

|HANDRAIL RISER HEIGHTS AND TREAD WIDTHS MUST BE UNIFORM |

|Staircase tread or step must be no less than 11” apart |

|Stair risers must be a maximum of 7” high |

|The top handrail must be mounted between 34’ and 38” above the stair nosing |

|The ends of the handrails must be rounded or end into a wall |

|Must not be able to rotate handrails in their fittings |

| |

|16.13 - Doors |

| |

|DOORS MUST HAVE A CLEAR WIDTH OF 32” AT OPENING AND AT A 90 DEGREE ANGLE TO AN ACCESSIBLE ROUTE |

|Must space two doors in a row at least 48 inches apart |

|A door threshold cannot exceed ¾ “ in height for exterior sliding doors and ½ “ for all others |

|Door handles must be shaped to grasp in one had and easy to open |

|Door handles must be no more than 48” from the floor |

|The pressure to open a door cannot exceed 5 lbs |

|Automatic and power assisted doors must be slow opening and low powered |

|Must not operate a door back to back faster than 3 seconds |

|Doors must not require more than 15 lbs to stop doors from opening and closing |

| |

| |

| |

| |

|16.14 - Fountains/Coolers |

| |

|FOUNTAINS MUST BE NO HIGHER THAN 36” FROM THE FLOOR |

|The water spout cannot be higher than 4 inches |

|Fountain controls must be located at the front or near the front of the fountain |

|Fountains must be operable with one hand and require no more than 5 lbs to use |

| |

|16.15 - Water Closet/Bathrooms |

| |

|MUST HAVE TOILETS BETWEEN 17-19” HIGH |

|Must have grab bars on walls mounted no higher than 33-36” off the floor |

|Toilets must require no more than 5 lbs to flush |

|Water closets may have a right or left hand approach |

| |

|16.16 - Toilet Stalls |

| |

|MUST HAVE GRAB BARS AND IF LESS THAN 60” IN DEPTH, PROVIDE 9” TOE CLEARANCE |

| |

|16.17 - Urinals |

| |

|MAY BE WALL HUNG OR SLING TYPE WITH RIM NO MORE THAN 17” FROM FLOOR |

|Clear floor space 30x48 inches |

|Flush lever must require no more than 5 lbs of pressure |

|Flush lever must be no more than 44” off the floor |

| |

|16.18 - Lavatories |

| |

|LAVATORY RIMS/COUNTERS MAY NOT BE HIGHER THAN 34” OFF THE FLOOR |

|Must have clearance of 29 inches above the finished floor |

|Faucets must require no more than 5 lbs of pressure |

| |

|16.19 - Medicine cabinets |

| |

|THE USABLE SHELF MAY BE NO HIGHER THAN 44” ABOVE THE FLOOR |

| |

|16.20 - Sinks |

| |

|MUST BE MOUNTED WITH A RIM NO HIGHER THAN 34 INCHES OFF THE FLOOR |

|Must have knee clearance at least 27” high, 30” wide, 19” deep |

|Water depth must be a max of 6 ½ “ deep |

|Need clear floor space of 30” x 48” |

|Faucets must not need more than 5 lbs of pressure |

|19 inches of knee clearance and 9 inches of toe clearance |

| |

|16.21 - Storage |

| |

|NEED CLEAR FLOOR SPACE OF 30X48 INCHES |

|Clothes rods must be a maximum of 54” above the floor |

| |

|16.22 - Handrails/Grab bars |

| |

|HANDRAILS AND GRAB BARS MUST HAVE A WIDTH OF 1 ¼” TO 1 ½” OF GRIPPING SERVICE |

|Wall mounted rails or grab bars must have at least 1 ½” of space between the grab bar and wall |

|Railings and grab bars must be able to bear a minimum of 250 lbs or more of weight |

|The maximum radius of the edge of a rail is 1/8” |

| |

|16.23 - Mirrors |

| |

|A MIRROR CANNOT BE MOUNTED MORE THAN 40” FROM THE FLOOR |

| |

| |

|16.24 - Tubs |

| |

|TUBS MUST HAVE A TUB SEAT |

|Tubs need grab bars |

|Tubs must have water controls |

|Tubs must require no more than 5 lbs pressure to operate the faucet |

|Tubs must have a hand held sprayer with 60” hose |

| |

|16.25 - Shower stall |

| |

|SHOWER STALLS MUST HAVE A TUB SEAT |

|Shower stalls must have grab bars |

|Water controls (must not require more than 5lbs of pressure) |

|Must have a hand held sprayer with a 60” hose |

|Shower stalls must have handrails and grab Bars |

| |

|16.26 - Audible Alarms |

| |

|AUDIBLE ALARMS MUST EXCEED ROOM NOISE LEVEL BY 15 DECIBELS |

|The maximum decibel level is 120 |

| |

|16.27 - Visual alarms |

| |

|MUST HAVE: |

| |

|Xenon strobe |

|2 second max pulse duration |

|Minimum 75 candle intensity |

|Flash rate must be a min1 hz and a max 3 hz |

|80” above highest floor level |

|6” below ceiling |

|Must be visible no more than 50 feet from any point in room |

|No more than 100 feet in large room |

|Visual alarms must be a maximum of 50 feet apart in hallways/corridors |

| |

|16.28 - Auxiliary Alarms |

| |

|AUXILIARY ALARMS ARE REQUIRED IN SLEEPING ROOMS AND MUST BE CONNECTED TO AN EMERGENCY ALARM SYSTEM AND VISIBLE TO ALL AREAS OF THE ROOM |

| |

|16.29 - Detectable warnings |

| |

|WARNINGS ARE REQUIRED ON HAZARDOUS VEHICULAR AREAS WITHOUT CURBS AND AT THE EDGES OF REFLECTING POOLS WITHOUT RAILS OR CURBS |

|On walking surfaces in 0.9 “ diameter and 0.2 inch in height and 2.35 “ spacing |

| |

|16.30 - Signage |

| |

|LETTERS MUST HAVE A WIDTH-TO-HEIGHT RATIO BETWEEN 3:5 AND 1:1 AND A STROKE WIDTH-TO-HEIGHT RATIO OF BETWEEN 1:5 AND 1:10 |

|Character height must be at least 3 “ |

| |

|16.31 - Dining and Resident Activity Areas |

| |

|DINING AND RESIDENT ACTIVITY AREAS MUST BE WELL LIT AND VENTILATED |

|Smoking and non smoking areas must be clearly identified |

|The space used for these areas should be functional with sufficient space so wheelchairs can maneuver |

| |

| |

|16.32 - Telephones |

| |

|TELEPHONE SEATING: CLEAR FLOOR SPACE 30X48” |

|Phones mounted between 15” to 48”; highest reach 54” |

|Phones must have hearing and volume controls (volume level between 12 and 18 decibels) |

|Phone directories are required on 29” cord |

| |

|16.33 - Tables/Counters |

| |

|KNEE SPACE UNDER TABLE IS 27”H, 30”WIDE, 19” DEEP |

|Table tops must be between 28” to 34” above the floor |

| |

|16.34 – Electrical Switches |

| |

|1. Electrical switches must be located on walls at a minimum of 15 inches above the floor |

|Section 17 - KEY TO EFFECTIVE MAINTENANCE PROGRAM |

| |

|17.1 – Key to Effective Maintenance Program |

|MUST DOCUMENT DEFICIENCIES, ENVIRONMENTAL ISSUES AND INCIDENTS |

|Must respond to urgent issues |

|Must document findings, recommendations and the action taken |

|Section 18 - Policies and Procedures |

| |

|18.1 – Policies and Procedures |

| |

|THE FACILITY MUST HAVE POLICIES AND PROCEDURES REGARDING THE PHYSICAL ENVIRONMENT AND ATMOSPHERE |

|Recommended polices are reviewed every six months |

|All facility policies should be reviewed annually |

| |

|Section 19 – QUALITY ASSURANCE AND ASSESSMENT COMMITTEE |

| |

|19.1 – Quality Assuranace and assessment committee |

| |

|THE FACILITY MUST HAVE A QUALITY ASSURANCE AND ASSESSMENT COMMITTEE |

|The committee must meet at least quarterly |

|The committee members must consist of the director of nursing, a physician and at least three other staff members |

| |

|Section 20 – MISCELLANEOUS TERMS |

| |

|Term |Definition |

| | |

|Acuity Levels |Acuity (level care required by residents) determines appropriate staffing levels. You can staff per min state staffing |

| |levels and still get cited for insufficient care if resident needs are not met |

|Aging |Aging is highly individualized and each person ages differently |

|Air Temperature |Measured just off the floor or 3 feet off the surface of the floor |

|Building Fire Rating |The fire rating of a building is established by the life safety code |

|Clean linen |Need to wash 11 pounds of laundry per resident per day. |

|Cleaning a Hallway |Must clean one side of a hallway, pathway or sidewalk and keep a safe corridor on the other half to allow safe passage. |

|Fire Drills |12 per year, 3 per quarter on all shifts, the number of drills is determined by the Life Safety Code |

|Fire Extinguishers |Class A - Fire and wood Class B|

| |- Flammable liquids (kerosene and grease) Class C - Electrical |

| |Class D - Metals (magnesium) |

|Fire Rating of building |determined by the Life Safety Code |

|Housekeeping hours |Should staff one hour for each 1000 sq feet of space in a facility. A 20,000 square foot facility would |

| |need 60 hours of housekeeping staff time per day or 2 people full time (8 hours per person) and 1 part time |

| |person working 4 hours) |

|Laundry |Must schedule 1 hour of housekeeping time per 1000 square feet (i.e. A 80,000 S.F. facility) would require |

| |80 hours of housekeeping time per day to stay clean or 10 house keepers working 8 hr shifts |

|Medications |Internal and external medication must be kept in separate areas. They are usually stored in separate |

| |drawers in the med cart |

|Mopping Hallways |Must mop one side of hallway and leave a safe pathway down the other half gor people to get by |

|NIOSH |Stands for the National Institute of Occupational Safety and Health |

|Nursing Staffing Hours |Remember that the key criteria, ultimately, as to how many hours you need to staff for nurses and nursing |

| |aides is determined by the acuity or severity of the medical condition of your residents and not the minimum|

| |state staffing hours. Also if residents feel their needs are not being met then you will be cited for |

| |insufficient staff |

|OSHA Record Keeping |Must maintain employee health records and incident reports during the course of employment of an individual |

| |and then 30 years thereafter |

|Topical medications |Applied to the outer layer of the skin |

|Utilization Review (UR) |Every facility has a utilization Review meeting where nursing, therapy, social services, business office and|

| |MDS coordinator get together to discuss progress of resident's being skilled and ensure they get the |

| |benefits and care they are entitled to and determine rug rates |

|Waste Management |Waste materials are monitored by OSHA |

|Water Temperature |Resident water cannot be hotter than 110 degrees F. The Kitchen has a heat booster to boost the water |

| |coming from the hot water tanks from from 110 degrees to 180 degrees |

|Water Temperature |To prevent scalding, must maintain resident hot water at 110 degrees and below |

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LEFT INTENTIONALLY BLANK

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TREAD OR STEP (min 11 inch deep)

RISER (min 4 and

max 7 in high)

EXHIBIT A

Stair Nosing

Edge of handrail must extend 12 inches beyond bottom tread for safety

Handrail

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