Current through Register 1531, September 27, 2024
(A)
General
Requirements.
(1) A home-like
environment is encouraged for design of DSCU. The design and environment of a
unit shall assist residents in their activities of daily living, enhance their
quality of life, reduce tension, agitation and problem behaviors, and promote
their safety.
(2) The DSCU must
encompass the entirety of a nursing care unit, as defined by
105
CMR 150.020: Skilled Nursing Care
Facility (Level II) and Supportive Nursing Care Facility (Level III)
and 150.310: Required Supporting Elements - Nursing Care
Units.
(3) A DSCU shall
meet the requirements listed in 105 CMR 150.029(B) through (K) in addition to
the requirements set forth in
105 CMR
150.017.
(B)
Access. The
design of the DSCU shall not require visitors or staff to pass through the unit
to reach other areas of the facility.
(C)
Outdoor Recreation
Space.
(1) A DSCU shall have
secured outdoor space and walkways allowing residents to ambulate, with or
without assistive devices such as wheelchairs or walkers, but that prevent
undetected egress.
(2) Such outdoor
space and walkways shall be wheelchair accessible.
(3) Residents shall have access to the
secured outdoor space and walkways during reasonable times with supervision
appropriate to each resident.
(4)
Outdoor recreation space shall have fencing or barriers that prevent injury and
elopement.
(D)
Lighting.
(1) The
DSCU shall provide adequate and evenly distributed lighting that minimizes
glare and shadows and is designed to meet the specific needs of the
residents.
(2) Artificial lighting
shall meet the lighting requirements of the Guidelines for Design and
Construction of Residential Health, Care and Support Facilities from the
Facility Guidelines Institute.
(E)
Finishes.
(1) Finishes shall include high visual
contrasts between floors and walls and between doorways and walls in resident
use areas. Except for fire exits, door and access ways not in resident use
areas may be designed to minimize contrast to obscure or conceal areas the
residents should not enter.
(2)
Floors, walls and ceilings shall be non-reflective to minimize glare.
(3) Flooring shall not include contrasted
visual patterns.
(F)
Resident Centered Environment. The DSCU shall promote
a resident centered environment that includes the following:
(1) Freedom of movement within the DSCU for
the residents including to common areas and to their personal spaces, including
bedrooms, at all times;
(2)
Assistive equipment that maximizes the independence of individual
residents;
(3) Comfortable seating
in the common use areas;
(4)
Bedroom decoration and furnishings that include residents' personal items based
on the resident's needs, preferences and appropriateness;
(5) In addition to the requirement of
105 CMR
150.015(F)(3), individual
identification of each resident's bedroom based on the resident's cognitive
level to assist residents in locating their bedrooms, and to permit them to
differentiate their bedroom from the bedrooms of other residents; and
(6) Corridors and passageways through
common-use areas kept free of objects that may cause falls, or obstruct passage
by physically impaired individuals.
(G)
Noise Control.
(1) The DSCU shall have acoustical ceilings
in corridors, dining areas and activity areas to reduce noise levels.
(2) No overhead paging system shall be used
in the DSCU except in the case of an emergency.
(3) The sound signal for the nurses call
system shall be adjustable so as to minimize disruption of residents and
resident activities.
(H)
Egress Control.
(1)
The facility shall develop policies and procedures to ensure the safety of
residents who may wander. The procedures shall include actions to be taken to
prevent elopement and actions in case a resident elopes.
(2) Locking devices shall be used on exit
doors, as approved by the local building inspector and fire department having
jurisdiction over the facility. The locking devices shall be electronic and
release when the following occurs:
(a)
activation of the fire alarm or sprinkler system;
(b) loss of electrical power; or
(c) use of a keypad located at each locked
door for routine staff access. The electronic locking devices shall be
connected to the emergency power circuits.
(3) If the DSCU uses keypads to lock and
unlock exits, then directions for their operation shall be posted on the
outside of the door to allow individuals access to the unit. However, if the
DSCU is the entire nursing home, then directions for the operation of the locks
need not be posted on the outside of the door. The DSCUs shall not have
entrance and exit doors that are closed with non-electronic keyed locks, nor
shall a door with a keyed lock be placed between a resident and the
exit.
(I)
Safety.
(1) Windows
shall be operable and equipped with secure locks under the control of the DSCU
staff.
(2) In conjunction with
locked windows, the DSCU shall be equipped with a cooling system capable of
maintaining a maximum temperature of 75°F throughout resident areas at all
times at summer design temperatures. Temperatures must be maintained at a level
that ensures the comfort and health of residents.
(J)
Common Space. A
multipurpose room or rooms for dining, group and individual activities, and
family visits comply with the following licensure requirements for common space
shall be included in the DSCU. The floor areas of this multipurpose room or
rooms shall accommodate the licensure requirements of at least ten square feet
per bed for dining per
105 CMR 150.570:
Central Dining, at least eight square feet per bed for group
activities per
105 CMR
150.510: General and Special Activity
Areas and at least nine square feet per bed for day room per
105 CMR
150.360: Activity Area - Nursing Care
Units, for a total of at least 27-square feet per bed.
(K)
Implementation.
A facility may request additional time to implement physical plant
modifications necessary to meet the requirements of 105 CMR 150.029 pursuant to
Department guidelines.
