Header:
WISCONSIN ADMINISTRATIVE CODE
DEPARTMENT OF HEALTH SERVICES
CHAPTER DHS 131 HOSPICES
SUBCHAPTER V -- PHYSICAL ENVIRONMENT
Date:
02/18/2014
Document:
DHS 131.37 Physical plant
(1) GENERAL REQUIREMENTS. The building of a freestanding hospice shall be constructed and maintained so that it is functional for the delivery of hospice services, appropriate to the needs of the community and protects the health and safety of the patients. The provisions of this section apply to all new, remodeled and existing construction unless otherwise noted. Wherever a requirement in this section is in conflict with the applicable Life Safety Code under s. DHS 131.38, the Life Safety Code shall take precedence.
(2) APPROVALS. The hospice shall keep documentation of approvals on file in the hospice following all inspections by state and local authorities.
(3) PLANS FOR NEW CONSTRUCTION OR REMODELING. The hospice shall submit its plans and specifications for any new construction or remodeling to the department according to the following schedule:
(a) One copy of preliminary or schematic plans shall be submitted to the department for review and approval.
(b) One copy of final plans and specifications which are used for bidding purposes shall be submitted to the de-partment for review and approval before construction is started.
(c) If on-site construction above the foundation is not started within 12 months after the date of approval of the final plans and specifications, the approval under par. (b) shall be void and the plans and specifications shall be re-submitted for reconsideration of approval.
(d) Any changes in the approved final plans affecting the application of the requirements of this subchapter shall be shown on the approved final plans and shall be submitted to the department for approval before construction is undertaken. The department shall notify the hospice in writing of any conflict with this subchapter found in its review of modified plans and specifications.
(4) ADDITIONAL REQUIREMENTS FOR NEW CONSTRUCTION. (a) All newly constructed hospice facilities shall meet the relevant construction requirements affecting new construction found in chs. SPS 361 to 365 and this subsection.
(b) All newly constructed hospice facilities shall be built to meet the accessibility requirements of chs. SPS 361 to 365.
(c) All public spaces shall be accessible to persons who use wheelchairs.
(d) At least one wheelchair-accessible toilet room shall be provided in the facility.
(e) Electrical switches, receptacles and other devices shall be mounted at accessible heights and locations, but at least 18 inches above floor and no more than 42 inches above the floor.
(5) PATIENT BEDROOMS. (a) Design and location. 1. Patient bedrooms shall be designed and equipped for the comfort and privacy of the patient and shall be equipped with or conveniently located near toilet and bathing facilities.
2. Patient bedrooms shall be enclosed by full-height partitions and rigid, swing-type doors, may not be used to gain access to any other part of the facility or to any required exit, and may not be used for purposes other than sleeping and living.
3. Transoms, louvers and grills are not permitted in or above patient's bedroom door exiting to the corridor.
(b) Capacity. 1. A patient bedroom may accommodate no more than 3 patients except that in new construction a patient bedroom may accommodate no more than 2 persons. Patients of the opposite sex may not be required to occupy the same sleeping room.
2. The minimum floor area per bed shall be 80 square feet in multiple patient rooms and 100 square feet in single patient rooms. The distance between patient beds in multipatient rooms shall be at least 3 feet.
(c) Bed arrangements. 1. Beds shall be located the minimum distance from heat producing sources recommended by the manufacturer or 18 inches, whichever is greater, except that a bed may be closer than 18 inches to a forced air register but may not block it.
2. There shall be at least 3 feet between beds where the space is necessary for patient or staff access.
3. Visual privacy shall be provided for each patient in multibed patient rooms. In new or remodeled construction, cubicle curtains shall be provided.
(d) Semiambulatory and nonambulatory patients. For rooms with semiambulatory or nonambulatory patients, mobility space at the end and one side of each bed may not be not less than 4 feet. Adequate accessible space for storage of a patient's wheelchair or other adaptive or prosthetic equipment shall be provided and shall be readily ac-cessible to the patient. In this paragraph, "semiambulatory" means able to walk with difficulty or able to walk only with assistance of an aid such as crutches, a cane or a walker, and "nonambulatory" means not able to walk at all.
(e) Equipment and supplies. Each patient shall be provided with all of the following:
1. A separate bed of proper size and height for the convenience of the patient. Beds shall be at least 36 inches wide and shall be maintained in good condition.
2. Drawer space available in the bedroom for personal clothing and possessions.
3. Closet or wardrobe space with clothes racks and shelves in the bedroom. Closets or wardrobes shall have an enclosed space of not less than 15 inches wide by 18 inches deep by 5 feet in height for each patient.
(6) HABITABLE ROOMS. All habitable rooms shall have an average ceiling height of not less than 7 feet.
(7) WINDOWS. (a) Minimum size. Every living and sleeping room shall have one or more outside-facing windows with a total sash area of at least 8% of the floor area of the room. The openable area of a window shall be equal to not less than 4% of the floor area of the room.
(b) Openable bedroom window. At least one outside window in a bedroom shall be openable from the inside without the use of tools.
(c) Storm windows and screens. All windows serving habitable rooms shall be provided with storm windows in winter, except insulated windows, and openable windows serving habitable rooms shall be provided with insect-proof screens in summer.
(8) ELECTRICAL. (a) Every hospice facility shall be supplied with electrical service and shall have wiring, outlets and fixtures properly installed and maintained in good and safe working condition.
(b) All bathroom outlets and all outlets on the exterior of the facility and in the garage shall have ground fault in-terrupt protection.
(c) Outlets shall be located to minimize the use of extension cords.
(d) When extension cords are needed, they shall be rated appropriately for the ampere capacity of the appliance being used.
(e) An extension cord may not extend beyond the room of origin, may not be a substitute for permanent wiring, may not be located beneath rugs or carpeting and may not be located across any pathways.
(f) There shall be a switch or equivalent device for turning on at least one light in each room or passageway. The switch or equivalent device shall be located so as to conveniently control the lighting in the area.
(g) All electrical cords and appliances shall be maintained in a safe condition. Frayed wires and cracked or damaged switches, plugs and electric fixtures shall be repaired or replaced.
(9) PATIENT CALL SYSTEM. A reliable call mechanism shall be provided in every location where patients may be left unattended, including patient rooms, toilet and bathing areas and designated high risk treatment areas from which individuals may need to summon assistance.
(10) BEDDING AND LAUNDRY. There shall be separate clean linen and dirty linen storage areas.
(b) Each patient shall have available all of the following:
1. Sufficient blankets to keep warm.
2. A pillow.
3. Mattress and pillow covers as necessary to keep mattresses and pillows clean and dry.
Note: When plastic mattress covers are used, there shall be a mattress pad the same size as the mattress over the plastic mattress cover.
(c) Clean sheets, pillowcases, towels and washcloths shall be available at least weekly and shall be changed as necessary to ensure that at all times they are clean and free from odors.
(11) DAYROOM OR LOUNGE. At least one dayroom or lounge, centrally located, shall be provided for use of the patients.
(12) SIZE OF DINING ROOM. Dining rooms shall be of sufficient size to seat all patients at no more than 2 shifts. Dining tables and chairs shall be provided. Television trays or portable card tables may not be used as the primary dining tables.
(13) KITCHEN. The kitchen shall be located on the premises, or a satisfactory sanitary method of transportation of food shall be provided. If there is a kitchen on the premises, it shall meet food service needs and be arranged and equipped for proper refrigeration, heating, storage, preparation and serving of food. Adequate space shall be provided for proper refuse handling and washing of waste receptacles, and for storage of cleaning compounds.
(14) MULTIPURPOSE ROOM. If a multipurpose room is used for dining, diversional and social activities of patients, there shall be sufficient space to accommodate all activities and minimize their interference with each other.
(15) TOTAL AREA. (a) In existing facilities, the combined floor space of dining, recreation, and activity areas shall not be less than 15 square feet per bed. Solaria and lobby sitting space may be included, but shall not include required exit paths. A required exit path in these areas shall be at least 4 feet wide.
(b) In new construction, the combined floor space of dining, recreation, and activity areas shall not be less than 25 square feet per bed. Solaria and lobby areas, exclusive of traffic areas, shall be categorized as living room space.
(c) All required dining and living areas within the building shall be internally accessible to every patient of the hos-pice.
(d) Each habitable room shall contain furnishings appropriate to the intended use of the room. Furnishings shall be safe for use by patients, and shall be comfortable, clean and maintained in good repair.
(e) Adequate space and equipment shall be designated to meet the needs of the patients and family members for privacy and social activities.
(16) HEATING. (a) The facility shall have a heating system capable of maintaining a temperature of 72 [degrees] F. (20 [degrees] C.) during periods of occupancy. Temperatures during sleeping hours may be reduced to 68 [degrees] F. (18 [degrees] C.). Higher or lower temperatures shall be available upon request.
(b) The heating system shall be maintained in a safe and properly functioning condition.
(c) The use of portable space heaters is prohibited except for permanently wired electric heaters which have an automatic thermostatic control and are attached to a wall.
(17) BATH AND TOILET FACILITIES. (a) General. 1. Each hospice shall have at least one separate bath and one sep-arate toilet room or one combination bath and toilet room for the use of patients which is accessible from public, non-sleeping areas, except where private bath and toilet rooms are adjacent to each sleeping room.
2. Each floor in which patient sleeping, dining and living rooms are located shall have bath and toilet facilities or one combination bath and toilet room for use of patients which is accessible from public, non-sleeping areas, except where private bath and toilet rooms are adjacent to each bedroom.
3. All bath and toilet areas shall be well lighted. Bath and toilet rooms shall be provided with at least one electrical fixture to provide artificial light.
4. Toilets, bathtubs and showers used by residents shall provide for individual privacy. If door locks are used for privacy they shall be operable from both sides in an emergency.
5. All toilet and bathing areas, facilities and fixtures shall be kept clean, in good repair and in good working order.
(b) Number of fixtures. 1. Toilets and sinks shall be provided in the ratio of at least one toilet and at least one sink for every 4 residents and other occupants or a fraction thereof. At least one bathtub or shower shall be available for every 8 residents and other occupants or a fraction thereof.
2. Where fixtures are accessible only through a sleeping room, they may be counted as meeting the requirements for only the occupants of the sleeping room.
(18) WATER SUPPLY. (a) Each sink, bathtub and shower shall be connected to hot and cold water, and adequate hot water shall be supplied to meet the needs of the patients.
(b) Hot water at taps accessible to patients may not exceed 110 [degrees] F.
(c) Where a public water supply is not available, the well or wells shall be approved by the Wisconsin department of natural resources. Water samples from an approved well shall be tested at least annually at the state laboratory of hygiene or another laboratory approved under 42 CFR 493 (CLIA).
(d) The hospice shall make provision for obtaining emergency fuel and water supplies.
(19) SEWAGE DISPOSAL. (a) Discharge. If a municipal sewer system is available, all sewage shall be discharged into it. If a municipal sewer system is not available, the sewage shall be collected, treated, and disposed of by means of an independent sewer system approved under ch. SPS 383.
(b) Septic systems. If a septic system is used it shall meet the requirements of ch. SPS 383.
(c) Plumbing. The plumbing and drainage for the disposal of wastes shall be approved under chs. SPS 382 and 384.
(20) FACILITY MAINTENANCE. (a) The building shall be maintained in good repair and free of hazards such as cracks in floors, walls or ceilings, warped or loose boards, warped, broken, loose or cracked floor covering such as tile or linoleum, loose handrails or railings, and loose or broken window panes.
(b) All electrical, mechanical, water supply, fire protection and sewage disposal systems shall be maintained in a safe and functioning condition.
(c) All plumbing fixtures shall be in good repair, properly functioning and satisfactorily provided with protection to prevent contamination from entering the water supply piping.
(d) Rooms shall be kept clean, well ventilated and tidy.
(e) All furniture and furnishings shall be kept clean and maintained in good repair.
(f) Storage areas shall be maintained in a safe, dry and orderly condition. Attics and basements shall be free of accumulation of garbage, refuse, soiled laundry, discarded furniture, old newspapers, boxes, discarded equipment and similar items.
(g) Abrasive strips or nonskid surfaces to reduce or prevent slipping shall be used where slippery surfaces present a hazard.
(h) The grounds, yards, and sidewalks shall be maintained in a neat, orderly and safe condition.
(21) FLOORS AND STAIRS. Floors and stairs shall be maintained in a nonhazardous condition.
(22) EXITS. Sidewalks, doorways, stairways, fire escapes and driveways used for exiting shall be kept free of ice, snow and obstructions.
(23) DOOR LOCKS. The employee in charge of the facility on each work shift shall have a key or other means of opening all locks or closing devices on all doors in the facility.
(24) EMERGENCY PLAN. (a) Each hospice shall have a written plan posted in a conspicuous place which specifies procedures for the orderly evacuation of patients in case of an emergency. The plan shall include an evacuation dia-gram. The evacuation diagram shall in addition be posted in a conspicuous place in the facility.
(b) The licensee, administrator and all staff who work in the hospice facility shall be trained in all aspects of the emergency plan.
(c) The procedures for exiting or taking shelter in the event of a fire, tornado, flooding or other disaster to be fol-lowed for patient safety shall be clearly communicated by the staff to the patients within 72 hours after admission and practiced at least quarterly by staff.
(25) ZONING. A hospice site shall adhere to local zoning regulations, including flood plain management under ch. NR 116.
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