Code of Massachusetts Regulations
105 CMR - DEPARTMENT OF PUBLIC HEALTH
Title 105 CMR 150.000 - Standards for Long-Term Care Facilities
Section 150.017 - Construction and Equipment
Universal Citation: 105 MA Code of Regs 105.150
Current through Register 1531, September 27, 2024
(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.
(2) 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 occupancy rooms, 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.
(4)
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.
(6)
Activity Areas.
All facilities shall provide on every floor and for every unit a comfortable,
pleasant, convenient, well-lit and ventilated sitting room, day room, 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 110°F
and 120°F.
(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
sanitary storage 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 140°F 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 by the 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%.
(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.
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