Alabama Administrative Code
Title 420 - ALABAMA STATE BOARD OF HEALTH
Chapter 420-5-10 - NURSING FACILITIES
Section 420-5-10-.18 - Physical Plant

1. Nursing facilities in existence at the time of current code adoption shall comply with the code requirements for an existing building.

2. New nursing facilities, additions or alterations shall comply with the currently adopted code requirement for a new building.

1. Water under pressure of not less than 15 lbs. per square inch is piped within the building to all sinks, toilets, lavatories, tubs and other fixtures requiring water.

2. An adequate supply of hot water for resident and service uses is available at all times. Temperature of hot water used by residents is automatically regulated by tempering valves and shall not exceed 110 degrees Fahrenheit.

3. In the laundry, provision shall be made to increase the water temperature to 160 degrees Fahrenheit unless manufacturer documentation can be provided for the chemical being used at a lower temperature.

4. There shall be procedures established to ensure that water can be provided for all essential services in the event of loss of the normal water supply.

1. Plumbing is so sized, installed and maintained to carry adequate quantities of water to required locations throughout the facility, to prevent contamination of the water supply, and to properly convey sewage and liquid wastes from the establishment to the sewerage or sewage disposal system, in such a manner and so that it does not constitute a source of contamination or create an unsanitary condition or nuisance.

2. Solid, non-infectious wastes are kept in leak proof, non-absorbent containers which shall be kept covered with tight fitting lids, and are disposed of in a manner approved by the Alabama Department of Public Health or its appropriate designated agency.

3. Solid wastes which are potentially infectious shall be burned on the premises in an incinerator approved by the Alabama Department of Public Health or disposed of in a manner approved by the Alabama Department of Public Health or its appropriate designated agency.

1. Lighting in nursing facilities shall meet the requirement as in the Illuminating Engineers Society (IES) Lighting Handbook Application volume.

2. Night lights shall be provided in bedrooms, hallways, toilet rooms and bathrooms. Glowing toggle switches are acceptable in toilet rooms and bathrooms.

1. Hardware on all toilet and bathroom doors shall be operable from outside the room.

2. Bedroom doors shall not be equipped with hardware that will permit a resident to lock himself within the room.

3. Bedroom doors shall open into the bedroom.

4. To avoid danger of a resident falling and blocking the swing of a door, all doors to residents' central baths and toilets shall swing out or be double-acting and equipped with an emergency stop release.

1. Resident bedrooms shall be ventilated in such a manner as to supply fresh air and to prevent accumulation of objectionable odors.

2. All service areas shall be ventilated as permitted by codes.

1. Existing nursing facilities shall have an electrical nurse call system at the side of each bed which will provide an initial audible signal and a visual signal on an annunciator panel at the nurses' station until deactivated. (Nursing facilities licensed after the effective date of theses rules, both audible and visual signals must function until deactivated in the resident room.)

2. Nursing facilities licensed after December 26, 1988, shall have an electrical nurse call station at each bed and a light over the door to the bedrooms on the corridor.

3. An electrical nurse call system shall be provided in each resident toilet and bathroom and in additions to existing buildings and in remodeling after the effective date of these rules. This signal shall be distinct from the regular nurse call signal and turned off only at the emergency calling station.

4. On new call systems, additional visible signals shall be installed at corridor intersections or in main corridor area where rooms are recessed if patient room call lights are not visible from the nurses' station area.

1. New facilities with residents on one or more floors above the first floor shall be equipped with at least one automatic elevator of a size sufficient to carry a resident on a stretcher.

2. If an elevator is not installed in the existing nursing facility due to exits on each floor, each floor shall have a dining room, living room, and sunroom.

3. Annual inspections shall be made of elevators by qualified inspection service personnel and inspection documents maintained in the facility.

1. Necessary accommodations shall be made to meet the needs of persons with semi-ambulatory disabilities, sight and hearing disabilities, disabilities of coordination, as well as other disabilities in accordance with the American National Standard Institute (ANSI), A117.1 - 1992, American National Standard for Buildings and Facilities - Providing Accessibility and Usability for Physically Handicapped People.

2. In nursing facilities existing prior to these rules, provisions shall be made to accommodate the handicapped.

1. Must be of non-combustible material.

2. Must have a railing or guard at least four feet high on each unenclosed side.

3. Wall openings adjacent to fire escapes are protected with fire resistive doors and protected windows.

4. Doors leading to fire escapes shall open in the direction of exit and be provided with panic hardware.

1. Nursing facilities and additions to nursing facilities constructed after October 20, 1967, shall have an emergency generator.

2. Nursing facilities and additions to nursing facilities constructed prior to October 20, 1967, may have an automatic battery-powered system which will provide the emergency power required for at least 1 1\2 hours. An emergency generator shall be provided if life support equipment systems are used.

3. As a minimum, emergency power shall be provided to the following:

1. All doors in line of exit travel shall be hinged and shall swing in the line of travel.

2. All exit doors serving residents including doors to stairs shall be as a minimum 44 inches wide.

3. Doors to toilets used by residents in additions or new facilities shall be at least 34 inches wide.

4. Where rated doors are required by code, a permanent label from an independent testing laboratory shall be attached to the door.

1. The handrails shall have a circular grip, a clearance of 1 1\2 inch from the wall and be mounted 30-34 inches from the floor to the top of the rail.

2. Handrails shall return to the wall at all terminations.

3. Handrails may be omitted where service corridors are not part of a required exit from resident areas, the corridor is not a path of circulation from one resident area to another and cross corridor doors are installed. These doors shall separate resident corridors from service corridors and shall normally remain closed.

1. Each nursing unit shall have:

2. On a nursing unit, no residents' bedroom door shall be more than 150 feet from the nurses' station.

1. All bedrooms shall have window(s) with the windowsills not more than three feet above the floor. Windows shall not be below grade.

2. The window area shall not be less than one-tenth of the floor area.

3. Residents' bedrooms shall be located so as to minimize the entrance of odors, noise and other nuisances.

4. Residents' bedrooms shall be directly accessible from the main corridor of the nursing unit. Existing resident bedrooms may be accessible from any public space other than the dining room. In no case shall a resident's bedroom be used for access to another resident's room.

5. The capacity of any new room shall not exceed two residents, and the capacity of existing rooms shall not exceed four residents.

6. The minimum floor area of bedrooms, exclusive of toilets, closets, wardrobes, alcoves, or vestibules in facilities and additions to existing facilities constructed after October 20, 1967, shall be as follows:

Private Room 100 Square Feet

Multi-Resident Room 80 Square Feet Per Resident

7. There shall be sufficient space to permit nursing procedures to be performed and to permit the placing of beds at least three feet apart, and three feet from the wall at the foot of the bed. Sides of beds shall maintain a minimum clearance of 12 inches from electrical outlets in walls, unless electrical outlet and plug protection is maintained.

1. Residents shall be provided with a standard or adjustable bed.

2. Chair and bedside table.

3. Storage space for clothing, toilet articles and personal belongings.

4. Bedside electrical call system for summoning aid.

5. Waste paper receptacle.

6. A headwall bed light must be mounted so that it is operable by the resident from the bed.

7. Nursing facilities or additions to nursing facilities constructed after November 16, 1988, shall provide hand washing lavatory in each bedroom. It may be omitted from bedroom when a lavatory is provided in an adjoining toilet or bathroom.

1. Isolation rooms shall be provided at the rate of not less than one private bedroom per 50 beds or major fraction thereof for the isolation of residents suffering from infectious diseases as defined by the Centers for Disease Control (CDC). The bedroom shall meet all of the requirements for bedrooms as previously stated in these regulations. Isolation bedrooms may be used to provide for the special care of residents who develop acute illnesses, have personality problems, or residents in terminal phases of illness. If central heating/cooling is provided, the air from the room shall be exhausted directly to the outside.

2. Isolation rooms in nursing facilities shall have a lavatory within the room or within a private toilet.

1. Annunciator board for receiving residents' calls.

2. Cabinet space.

3. Storage space for current residents' charts.

4. Working space and accommodations for recording and charting purposes by facility staff.

5. Medicine preparation room. The room at each nurses' station shall have, as a minimum, 80 square feet of floor space with an additional square foot for each bed in excess of 50 beds per unit. This requirement pertains to any construction or renovation after November 16, 1988. If medication carts are utilized, sufficient storage space for the carts and over-the-counter stock medications must be provided in lieu of a medication preparation room.

1. The clean utility room shall contain as a minimum:

2. The soiled utility room shall contain as a minimum:

3. In nursing facilities constructed prior to December 26, 1988, each nursing unit shall have at least a clean/soiled utility room, but it is recommended that a separate clean and soiled utility room be provided.

1. For all resident bedrooms, which do not have adjoining toilet and bath facilities, plumbing fixtures shall be provided within the nursing unit, according to the following ratio:

Bathtubs or Showers 1 per 25 Beds

Lavatories 1 per 6 Beds

Toilets (water closets) 1 per 6 Beds

2. Non-skid mats, or equivalent and grab bars shall be provided at tubs and showers. Grab handles on soap dishes are not acceptable for grab bars.

3. Grab bars shall be provided at each water closet.

1. Nursing units in facilities and additions to facilities constructed after August 23, 1996, shall have a nourishment room containing a work counter, refrigerator, storage cabinet, and a sink for serving nourishments between meals. Ice for residents' consumption shall be provided by icemaker units. The nourishment room shall include space for trays and dishes used in non-scheduled meal service.

2. Existing facilities shall provide a nourishment room in accordance with the above paragraph when the nursing unit is remodeled or expanded.

3. Nourishment room shall be separated from corridor by wall and door.

1. The total area set aside for these purposes shall be at least 20 square feet per bed for new facilities and for expanded facilities.

2. As a minimum, facility shall include two separate recreation/sitting areas and a dining area.

3. Each nursing unit shall contain at least one recreation/sitting area.

4. A minimum of at least one porch and/or glass enclosed sun parlor shall be provided for the use of residents.

1. The existing laundry room, or storage and counting area shall be located so that soiled linens are not carried through the food service area.

2. Laundries built, renovated, or added to after August 23, 1996, shall provide the following rooms and shall comply with the additional requirements:

1. Administrator's office.

2. Business office.

3. Public lobby or waiting room.

4. Public toilets.

5. For facilities constructed after August 23, 1996, or when existing lobbies are renovated, handicapped public toilets accessible from the lobby/waiting room shall be provided.