Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This rule establishes fire-safety and
emergency preparedness requirements for new and existing intermediate care and
skilled nursing facilities.
PUBLISHER'S NOTE: The secretary of state has
determined that the publication of the entire text of the material which is
incorporated by reference as a portion of this rule would be unduly cumbersome
or expensive. This material as incorporated by reference in this rule shall be
maintained by the agency at its headquarters and shall be made available to the
public for inspection and copying at no more than the actual cost of
reproduction. This note applies only to the reference material. The entire text
of the rule is printed here.
AGENCY NOTE: All rules relating to long-term care
facilities licensed by the Department of Health and Senior Services are
followed by a Roman Numeral notation which refers to the class (either class I,
II, or III) of standard as designated in section
198.085,
RSMo 2000.
(1) Definitions.
For the purpose of this rule, the following definitions shall apply:
(A) Accessible spaces-shall include all
rooms, halls, storage areas, basements, attics, lofts, closets, elevator
shafts, enclosed stairways, dumbwaiter shafts, and chutes;
(B) Area of refuge-a space located in or
immediately adjacent to a path of travel leading to an exit that is protected
from the effects of fire, either by means of separation from other spaces in
the same building or its location, permitting a delay in evacuation. An area of
refuge may be temporarily used as a staging area that provides some relative
safety to its occupants while potential emergencies are assessed, decisions are
made, and if applicable, evacuation has begun;
(C) Major renovation-shall include the
following:
1. Addition of any room(s),
accessible by residents, that either exceeds fifty percent (50%) of the total
square footage of the facility or exceeds four thousand five hundred (4,500)
square feet;
2. Repairs,
remodeling, or renovations that involve more than fifty percent (50%) of the
building;
3. Repairs, remodeling,
or renovations that involve more than four thousand five hundred (4,500) square
feet of a smoke section; or
4. If
the addition is separated by two-(2-) hour fire-resistant construction, only
the addition portion shall meet the requirements for an NFPA 13, 1999 edition,
sprinkler system, unless the facility is otherwise required to meet NFPA 13,
1999 edition; and
(D)
Concealed spaces-shall include areas within the building that cannot be
occupied or used for storage.
(2) General Requirements.
(A) All National Fire Protection Association
(NFPA) codes and standards cited in this rule: NFPA 10,
Standard for
Portable Fire Extinguishers, 1998 edition; NFPA 13,
Standard
for the Installation of Sprinkler Systems, 1999 edition; NFPA 96,
Standard for Ventilation Control and Fire Protection of Commercial
Cooking Operations, 1998 edition; NFPA 99,
Standard for Health
Care Facilities, 1999 edition; NFPA 101,
The Life Safety
Code, 2000 edition; NFPA 72,
National Fire Alarm
Code, 1999 edition; NFPA 25,
Standard for the Inspection,
Testing, and Maintenance of Water-Based Fire Protection Systems, 1998
edition; NFPA 253,
Standard Method of Test of Surface Burning
Characteristics of Building Materials, 2000 edition; NFPA 701,
Standard Methods of Fire Tests for Flame Propagation of Textiles and
Films, 1999 edition; NFPA 211,
Chimneys, Fireplaces, Vents and
Solid Fuel-Burning Appliances, 2000 edition; and NFPA 101A,
Guide
to Alternative Approaches to Life
Safety, 2001 edition, are incorporated by reference in this rule and
available for purchase from the National Fire Protection Agency, 1
Battery-march Park, Quincy, MA 02269-9101;
www.nfpa.org; by telephone at (617) 770-3000
or 1-800-344-3555. This rule does not incorporate any subsequent amendments or
additions to the materials listed above.
(B) This rule does not prohibit facilities
from complying with standards set forth in newer editions of the incorporated
by reference material listed in subsection (2)(A) of this rule if approved by
the department.
(C) The department
shall have the right of inspection of any portion of a building in which a
licensed facility is located unless the unlicensed portion is separated by two-
(2-) hour fire-resistant construction. I/II
(D) Facilities shall not use space under
stairways to store combustible materials. I/II
(E) No section of the building shall present
a fire hazard. I/II
(F) All
facilities shall notify the department immediately after the emergency is
addressed if there is a fire in the facility or premises and shall submit a
complete written fire report to the department within seven (7) days of the
fire, regardless of the size of the fire or the loss involved. II/III
(G) Following the discovery of any fire, the
facility shall monitor the area and/or the source of the fire for a
twenty-four- (24-) hour period. This monitoring shall include, at a minimum,
hourly visual checks of the area. These hourly visual checks shall be
documented. I/II
(H) All electrical
appliances shall be Underwriters' Laboratories (UL) or Factory Mutual
(FM)-approved, shall be maintained in good repair, and no appliances or
electrical equipment shall be used which emit fumes or which could in any other
way present a hazard to the residents. I/II
(3) All openings that could permit the
passage of fire, smoke, or both, between floors shall be fire-stopped with a
suitable noncom-bustible material. II/III
(4) Hazardous areas shall be separated by
construction of at least one- (1-) hour fire-resistant construction. Hazardous
areas may be protected by an automatic sprinkler system in lieu of a one- (1-)
hour rated fire-resistant construction. When the sprinkler option is chosen,
the areas shall be separated from other spaces by smoke-resistant partitions
and doors. The doors shall be self-closing or automatic closing. II
(5) The storage of any unnecessary
combustible materials in any part of a building in which a licensed facility is
located is prohibited. No section of the building shall present a fire hazard.
I/II
(6) Oxygen storage shall be in
accordance with NFPA 99, 1999 edition. Facilities shall use permanent racks or
fasteners to prevent accidental damage or dislocation of oxygen cylinders.
Safety caps shall remain intact except where a cylinder is in actual use or
where the regulator has been attached and the cylinder is ready for use.
Individual oxygen cylinders in use or with an attached regulator shall be
supported by cylinder collars or by stable cylinder carts. II/III
(7) Each nursing unit may maintain only one
(1) emergency-use oxygen tank in a readily accessible unit area. II
(8) Fire Extinguishers.
(A) Fire extinguishers shall be provided at a
minimum of one (1) per floor, so that there is no more than seventy-five feet
(75') travel distance from any point on that floor to an extinguisher.
I/II
(B) All new or replacement
portable fire extinguishers shall be ABC-rated extinguishers, in accordance
with the provisions of NFPA 10, 1998 edition. A K-rated extinguisher or its
equivalent shall be used in lieu of an ABC-rated extinguisher in the kitchen
cooking areas. II
(C) Fire
extinguishers shall have a rating of at least-
1. Ten pounds (10 lbs.), ABC-rated or the
equivalent, in or within fifteen feet (15') of hazardous areas as defined in
19 CSR
30-83.010; II and
2. Five pounds (5 lbs.), ABC-rated or the
equivalent, in other areas. II
(D) All fire extinguishers shall bear the
label of the UL or the FM Laboratories and shall be installed and maintained in
accordance with NFPA 10, 1998 edition. This includes the documentation and
dating of a monthly pressure check. II/III
(9) Facilities shall provide every cooking
range with a range hood and approved range hood extinguishing system installed,
tested, and maintained in accordance with NFPA 96, 1998 edition. The range hood
and its extinguishing system shall be certified at least twice annually in
accordance with NFPA 96, 1998 edition. II/III
(10) Complete Fire Alarm Systems.
(A) Facilities shall have a complete fire
alarm system installed in accordance with NFPA 101, Section 18.3.4, 2000
edition. The complete fire alarm system shall automatically transmit to the
fire department, dispatching agency, or central monitoring company. The
complete fire alarm system shall include visual signals and audible alarms that
can be heard throughout the building and a main panel that interconnects all
alarm-activating devices and audible signals in accordance with NFPA 72, 1999
edition. Manual pull stations shall be installed at or near each required
nurse/attendant's station and each required exit. Smoke detectors shall be
interconnected to the complete fire alarm system. Specific minimum requirements
relating to the interconnected smoke detectors are found in subsections (10)(I)
and (10)(J) of this rule. I/II
(B)
All facilities shall test and maintain the complete fire alarm system in
accordance with NFPA 72, 1999 edition. I/II
(C) All facilities shall have inspections and
written certifications of the complete fire alarm system completed by an
approved qualified service representative in accordance with NFPA 72, 1999
edition, at least annually. I/II
(D) The complete fire alarm system shall be
activated by all of the following: sprinkler system flow alarm, smoke
detectors, heat detectors, manual pull stations, and activation of the range
hood extinguishment system. II/III
(E) Facilities shall test by activating the
complete fire alarm system at least once a month. II/III
(F) Facilities shall maintain a record of the
complete fire alarm system tests, inspections and certifications required by
subsections (10)(B), (10)(C), and (10)(E) of this rule. III
(G) Upon discovery of a fault with the
complete fire alarm system, the facility shall correct the fault.
I/II
(H) When a complete fire alarm
system is to be out-of-service for more than four (4) hours in a twenty-four-
(24-) hour period, the facility shall immediately notify the department and the
local fire authority and implement an approved fire watch in accordance with
NFPA 101, 2000 edition, until the fire alarm system has returned to full
service. I/II
(I) All facilities
shall have smoke detectors interconnected to the complete fire alarm system in
all corridors and spaces open to corridors. Smoke detectors shall be no more
than thirty feet (30') apart with no point on the ceiling more than twenty-one
feet (21') from a smoke detector. I/II
(J) Facilities that have a sprinkler system
exemption shall have smoke detectors interconnected to the complete fire alarm
system in all accessible spaces within the facility as required by NFPA 72,
1999 edition. Smoke detectors shall be no more than thirty feet (30') apart
with no point on the ceiling more than twenty-one feet (21') from a smoke
detector. Smoke detectors shall not be installed in areas where environmental
influences may cause nuisance alarms. Such areas include, but are not limited
to, kitchens, laundries, bathrooms, mechanical air handling rooms, and attic
spaces. In these areas, heat detectors interconnected to the complete fire
alarm system shall be installed. Bathrooms not exceeding fifty-five (55) square
feet and clothes closets, linen closets, and pantries not exceeding twenty-four
(24) square feet are exempt from having any detection device if the walls and
ceilings are surfaced with limited-combustible or noncombustible material as
defined in NFPA 101, 2000 edition. Concealed spaces of noncombustible or
limited-combustible construction are not required to have detection devices.
These spaces may have limited access but cannot be occupied or used for
storage. I/II
(K) For each facility
not having a sprinkler system exemption, each resident room or any room
designated for sleeping shall be equipped with at least one (1) battery-powered
smoke alarm installed, tested, and maintained in accordance with manufacturer's
specifications. In addition, the facility shall be equipped with interconnected
heat detectors installed, tested, and maintained in accordance with NFPA 72,
1999 edition, with detectors in all areas subject to nuisance alarms,
including, but not limited to, kitchens, laundries, bathrooms, mechanical air
handling rooms, and attic spaces. I/II
1. The
facility shall maintain a written record of the monthly testing and battery
changes. The written records shall be retained for one (1) year. I/II
2. Upon discovery of a fault with any
detector or alarm, the facility shall correct the fault. I/II
(11) Sprinkler System.
(A) All facilities shall have inspections and
written certifications of the sprinkler system completed by an approved
qualified service representative in accordance with NFPA 25, 1998 edition. The
inspections shall be in accordance with the provisions of NFPA 25, 1998
edition, with certification at least annually by a qualified service
representative. I/II
(B) All
facilities licensed prior to August 28, 2007, that were not required to have a
complete sprinkler system in accordance with NFPA 13 shall have until December
31, 2012, to comply with NFPA 13, 1999 edition. I/II
1. Exemptions shall be granted if the
facility presents evidence in writing from a certified sprinkler system
representative or licensed engineer that the facility is unable to install an
approved NFPA 13, 1999 edition, system due to the unavailability of the water
supply. I/II
(C)
Facilities that have a sprinkler system installed prior to August 28, 2007,
shall inspect, maintain, and test these systems in accordance with the
requirements in effect for such facilities on August 27, 2007. I/II
(D) Facilities licensed on or after August
28, 2007, or any section of a facility in which a major renovation has been
completed on or after August 28, 2007, shall install and maintain a complete
sprinkler system in accordance with NFPA 13, 1999 edition. I/II
(E) When a sprinkler system is to be
out-of-service for more than four (4) hours in a twenty-four- (24-) hour
period, the facility shall immediately notify the department and the local fire
authority and implement an approved fire watch in accordance with NFPA 101,
2000 edition, until the sprinkler system has returned to full service.
I/II
(12) Each floor of
an existing licensed facility shall have at least two (2) unobstructed exits
remote from each other. One (1) of the required exits in an existing
multi-story facility must be an outside stairway or an enclosed stair that is
separated by one- (1-) hour construction from each floor and has an exit
leading directly outside at grade level. One (1) exit may lead to a lobby with
exit facilities to the ground level outside instead of leading directly to the
outside. The lobby shall have at least a one- (1-) hour fire-rated separation
from the remainder of the exiting floor. I/II
(13) If facilities have outside stairways,
they shall be substantially constructed to support residents during evacuation.
These stairways shall be protected or cleared of ice and snow. Stairways shall
be of sturdy construction using at least two-inch (2") lumber and shall be
continuous to ground level. All treads and risers shall be of the same height
and width throughout the entire stairway, not including landings.
II/III
(14) Fire escapes added to
existing buildings, whether interior or exterior, shall have at least a minimum
thirty-six-inch (36") width, eight-inch (8") maximum risers, a nine-inch (9")
minimum tread, no winders, a maximum height between landings of twelve feet
(12'), minimum landing dimensions of forty-four inches (44"), landings at each
exit door, and handrails on both sides. Exit(s) to fire escapes shall be at
least thirty-six inches (36") wide, and the fire-escape door shall swing
outward. All treads and risers shall be of the same height and width throughout
the entire stairway, not including landings. II/III
(15) Facilities with three (3) or more floors
shall comply with the provisions of Chapter 320, RSMo, which requires that
outside stairways be constructed of iron or steel. II
(16) Door locks shall be of a type that can
be opened from the inside by turning the knob or operating a simple device that
will release the lock, or shall meet the requirements of Section 19.2 of NFPA
101, 2000 edition. Only one (1) lock will be permitted on any one (1) door.
I/II
(17) All exit doors in
existing licensed facilities shall be at least thirty inches (30") wide.
II
(18) All exit doors in new
facilities shall be at least forty-four inches (44") wide. II
(19) In all facilities, all exit doors and
vestibule doors shall swing outward in the direction of exit travel.
II
(20) In all existing licensed
facilities, all horizontal exit doors in fire walls and all doors in smoke
barrier partitions may swing in either direction. These doors normally may be
open, but shall be automatically self-closing upon activation of the fire alarm
system. They shall be capable of being manually released to self-closing
action. II/III
(21) Facilities
shall maintain corridors to be free of obstruction, equipment, or supplies not
in use. Doors to resident rooms shall not swing into the corridor.
II/III
(22) Facilities shall place
signs bearing the word EXIT in plain, legible block letters at each required
exit, except at doors directly from rooms to exit corridors or passageways.
II
(23) Wherever necessary, the
facility shall place additional signs in corridors and passageways to indicate
the exit's direction. Letters on these signs shall be at least six inches (6")
high and principle strokes three-fourths inch (3/4") wide, except that the
letters of internally illuminated exit signs may be not less than four inches
(4") high. III
(24) Facilities
shall maintain all exit and directional signs to be clearly legible and
electrically illuminated at all times by acceptable means such as emergency
lighting when lighting fails. II
(25) Facilities shall have emergency lighting
of sufficient intensity to provide for the safety of residents and other people
using any exit, stairway, and corridor. The lighting shall be supplied by an
emergency service, an automatic emergency generator or battery lighting system.
This emergency lighting system shall be equipped with an automatic transfer
switch. In an existing licensed facility, battery lights, if used, shall be wet
cell units or other rechargeable-type batteries that shall be UL-approved and
capable of operating the light for at least one and one-half (1 1/2) hours.
Battery-operated emergency lighting shall be tested for at least thirty (30)
seconds every thirty (30) days, and an annual function test shall be conducted
for the full operational duration of one and one-half (1 1/2) hours. Records of
these tests shall be documented and maintained for review. II
(26) If existing licensed facilities have
laundry chutes, dumbwaiter shafts, or other similar vertical shafts, they shall
have a fire resistance rating of at least one (1) hour if serving three (3) or
fewer stories. Enclosures serving four (4) or more stories shall have at least
a two- (2-) hour fire-rated enclosure. These chute or shaft doors shall be
self-closing or shall have any other approved device that will guarantee
separation between floors. II
(27)
Existing licensed multistoried facilities shall provide a smoke separation
barrier between the basement and the first floor and the floors of resident-use
areas. At a minimum, this barrier shall consist of one-half inch (1/2") gypsum
board, plaster, or equivalent. There shall be a one and three-fourths inch (1
3/4") thick solid-core wood door, or equivalent, at the top or bottom of the
stairs. If the door is glazed, it shall be glazed with wired glass.
II
(28) Each floor accessed by
residents shall be divided into at least two (2) smoke sections with each
section not exceeding one hundred fifty feet (150') in length or width. If the
floor's dimensions do not exceed seventy-five feet (75') in length or width, a
division of the the floor into two (2) smoke sections will not be required.
II
(29) Each smoke section shall be
separated by one- (1-) hour fire-rated walls that are continuous from outside
wall-to-outside wall and from floor-to-floor or floor-to-roof deck. All doors
in this wall shall be at least twenty-(20-) minute fire rated or its
equivalent, self-closing, and may be held open only if the door closes
automatically upon activation of the fire alarm system. II
(30) Existing licensed facilities shall have
attached self-closing devices on all doors providing separation between floors.
If the doors are to be held open, they shall have electromagnetic hold-open
devices that are interconnected with either a smoke alarm or with other
smoke-sensitive fire extinguishment or alarm systems in the building.
II/III
(31) Smoking shall be
permitted only in designated areas. Areas where smoking is permitted shall be
directly supervised unless the resident has been assessed by the facility and
determined capable of smoking unassisted. At least annually, the facility shall
reassess those residents the facility has determined to be capable of smoking
unsupervised and shall also reassess such resident when changes in his or her
condition indicate the resident may no longer be capable of smoking without
supervision. The facility shall document this assessment in the resident's
medical record. II
(32) Designated
smoking areas shall have ashtrays of noncombustible material and of safe
design. The contents of ashtrays shall be disposed of properly in receptacles
made of noncombustible material. II/III
(33) Fire Drills and Emergency Preparedness.
(A) All facilities shall have a written plan
to meet potential emergencies or disasters and shall request consultation and
assistance annually from a local fire unit for review of fire and evacuation
plans. If the consultation cannot be obtained, the facility shall inform the
state fire marshal in writing and request assistance in review of the plan. An
up-to-date copy of the facility's entire plan shall be provided to the local
jurisdiction's emergency management director. II/III
(B) The plan shall include, but is not
limited to-
1. A phased response ranging from
relocation of residents to an immediate area within the facility; relocation to
an area of refuge, if applicable; or to total building evacuation. This phased
response part of the plan shall be consistent with the direction of the local
fire unit or state fire marshal and shall be appropriate for the fire or
emergency;
2. Written instructions
for evacuation of each floor including evacuation to areas of refuge, if
applicable, and floor plan showing the location of exits, fire alarm pull
stations, fire extinguishers, and any areas of refuge;
3. Evacuating residents, if necessary, from
an area of refuge to a point of safety outside the building;
4. The location of any additional water
sources on the property such as cisterns, wells, lagoons, ponds, or
creeks;
5. Procedures for the
safety and comfort of residents evacuated;
6. Staffing assignments;
7. Instructions for staff to call the fire
department or other outside emergency services;
8. Instructions for staff to call alternative
resource(s) for housing residents, if necessary;
9. Administrative staff responsibilities;
and
10. Designation of a staff
member to be responsible for accounting for all residents' whereabouts.
II/III
(C) The written
plan shall be accessible at all times and an evacuation diagram shall be posted
on each floor in a conspicuous place so that employees and residents can become
familiar with the plan and routes to safety. II/III
(D) A minimum of twelve (12) fire drills
shall be conducted annually with at least one (1) every three (3) months on
each shift. At least four (4) of the required fire drills must be unannounced
to residents and staff, excluding staff who are assigned to evaluate staff and
resident response to the fire drill. The fire drills shall include a simulated
resident evacuation that involves the local fire department or emergency
service at least once a year. II/III
(E) The fire alarm shall be activated during
all fire drills unless the drill is conducted between 9 p.m. and 6 a.m., when a
facility-generated predetermined message is acceptable in lieu of the audible
and visual components of the fire alarm. II/III
(F) The facility shall keep a record of all
fire drills including the simulated resident evacuation. The record shall
include the time, date, personnel participating, length of time to complete the
fire drill, and a narrative notation of any special problems. III
(34) Fire Safety Training
Requirements.
(A) The facility shall ensure
that fire safety training is provided to all employees:
1. During employee orientation;
2. At least every six (6) months;
and
3. When training needs are
identified as a result of fire drill evaluations. II/III
(B) The training shall include, but is not
limited to, the following:
1. Prevention of
fire ignition, detection of fire, and control of fire development;
2. Confinement of the effects of
fire;
3. Procedures for moving
residents to an area of refuge, if applicable;
4. Use of alarms;
5. Transmission of alarms to the fire
department;
6. Response to
alarms;
7. Isolation of
fire;
8. Evacuation of the
immediate area and building;
9.
Preparation of floors and facility for evacuation; and
10. Use of the evacuation plan required by
section (33) of this rule. II/III
(35) The use of wood- or gas-burning
fireplaces will be permitted only if the fireplaces are built of firebrick or
metal, enclosed by masonry, and have metal or tempered glass screens. The
chimneys shall be of masonry construction with flue linings that have at least
eight inches (8") of masonry separating the flue lining and the fireplace from
any combustible material. All fireplaces shall be installed, operated, and
maintained in a safe manner. Fireplaces not in compliance with these
requirements may be provided if they are for decorative purposes only or if
they are equipped with decorative-type electric logs or other electric heaters
which bear the UL label and are constructed of electrical components complying
with and installed in compliance with the National Electrical
Code, incorporated by reference in this rule. Fireplaces meeting
standards set forth in NFPA 211, 2000 edition, are considered in compliance
with this rule. II/III
(36) All
electric or gas clothes dryers shall be vented to the outside and the lint trap
cleaned regularly. II/III
(37) In
existing licensed facilities, all wall and ceiling surfaces shall be smooth and
free of highly-combustible materials. II/III
(38) All curtains in resident-use areas shall
be rendered and maintained flame-resistant in accordance with NFPA 701, 1999
edition. II/III
(39) All new floor
covering installed in buildings that do not have a sprinkler system shall be
Class I in accordance with NFPA 253, 2000 edition. II/III
(40) Trash and Rubbish Disposal Requirements.
(A) Only metal or UL- or FM-approved
wastebaskets shall be used for the collection of trash. II
(B) The facility shall maintain the exterior
premises in a manner as to provide for fire safety. II
(C) Trash shall be removed from the premises
as often as necessary to prevent fire hazards and public health nuisance.
II
(D) No trash shall be burned
within fifty feet (50') of any facility except in an approved incinerator
I/II
(E) Trash may be burned only
in a masonry or metal container The container shall be equipped with a metal
cover with openings no larger than one-half inch (1/2") in size.
II/III
(41) Minimum
Staffing for Safety and Protective Oversight to Residents.
(A) In a building that is of fire-resistant
construction or a building with a sprinkler system, minimum staffing shall be
the following:
|
Time
|
Personnel
|
Residents
|
| 7 a.m. to 3 p.m. (Day) |
1 |
3-10* |
| 3 p.m. to 11 p.m. (Evening) |
1 |
3-15* |
| 11 p.m. to 7 a.m. (Night) |
1 |
3-20* |
*One (1) additional staff person for every fraction after
that. I/II
(B) In a
building that is of nonfire-resistant construction or a building that has a
sprinkler system exemption, minimum staffing shall be the following:
|
Time
|
Personnel
|
Residents
|
| 7 a.m. to 3 p.m. (Day) |
1 |
3-10* |
| 3 p.m. to 11 p.m. (Evening) |
1 |
3-15* |
| 11 p.m. to 7 a.m. (Night) |
1 |
3-15* |
*One (1) additional staff person for every fraction after
that. I/II
*Original authority: 198.074, RSMo 2007 and 198.079, RSMo
1979, amended 2007.
