CHAPTER 204. PHYSICAL ENVIRONMENT AND EQUIPMENT STANDARDS FOR CONSTRUCTION, ALTERATION OR RENOVATION OF LONG-TERM CARE NURSING FACILITIES Sec.
204.1. Application of Guidelines for Design and Construction of Residential Health, Care and Support Facilities.
204.2. Building plans.
204.3. Buildings and grounds; general.
204.4. Basement.
204.5. Resident rooms.
204.6. Locks.
204.7. Laundry.
204.8. Utility room.
204.9. Bathing facilities.
204.10. Toilet facilities.
204.11. Equipment for bathrooms.
204.12. Toilet room equipment.
204.13. Linen.
204.14. Supplies.
204.15. Windows.
204.16. Dining.
204.17. Lounge and recreation rooms.
204.18. Storage.
204.19. Plumbing, heating, ventilation, air conditioning and electrical.
204.20. Airborne infection isolation room.Authority The provisions of this Chapter 204 added under sections 102, 201(12), 601, 801.1 and 803 of the Health Care Facilities Act (35 P.S. § § 448.102, 448.201(12). 448.601, 448.801a and 448.803); and section 2102(a) and (g) of The Administrative Code of 1929 (71 P.S. § 532(a) and (g)), unless otherwise noted.
Source The provisions of this Chapter 204 added December 23, 2022, effective July 1, 2023, 52 Pa.B. 8065, unless otherwise noted.
§ 204.1. Application of Guidelines for Design and Construction of Residential Health, Care and Support Facilities.
(a) In addition to the requirements set forth in this chapter, facility construction, alteration or renovation approved on or after July 1, 2023, shall comply with the 2018 edition of the Facility Guidelines Institute Guidelines for Design and Construction of Residential Health, Care, and Support Facilities.
(b) Facility construction, alteration or renovation approved before July 1, 2023, shall comply with the standards set forth in Chapter 205 (relating to physical environment and equipment standards for long-term care nursing facilities construction, alteration or renovation approved before July 1, 2023).
(c) Construction, alteration or renovation shall meet the requirements in effect on the date that the facility’s plans for construction, alteration or renovation are approved by the Department.
§ 204.2. Building plans.
(a) A licensee or prospective licensee shall submit its plans for construction, alteration or renovation to the department. The Department will post instructions for submissions on its public web site.
(b) A licensee or prospective licensee shall have the opportunity to present and discuss with the Department its purposes and plans concerning the requested changes indicated on architectural plans submitted under § 51.3(d) (relating to notification). If differences occur and cannot be resolved, an administrative hearing may be sought under 1 Pa. Code Part II (relating to General Rules of Administrative Practice and Procedure).
(c) Construction, alteration or renovation approved by the Department shall begin within 2 years of the Department’s approval and shall be completed within 5 years of the Department’s approval.
(d) A facility may seek an extension of the time periods under subsection (c) for beginning or completing an approved construction, alteration or renovation by written request to the Department. The Department may approve an extension for good cause shown.
(e) A facility shall obtain approval from the Department before using an area of the facility for resident care when that area has not been occupied or used by residents for 1 year or more.
§ 204.3. Buildings and grounds; general.
(a) A building to be used for and by residents shall be located in an area that is geographically and environmentally conducive to the health and safety of residents.
(b) No part of a building may be used for a purpose that interferes with or jeopardizes the health and safety of residents. Special authorization shall be given by the Department’s Division of Nursing Care Facilities if a part of the building is to be used for a purpose other than health care.
(c) Only residents, employees, the licensee, the administrator or members of the administrator’s immediate family may reside in the facility.
(d) Grounds shall be adequate to provide necessary service areas and outdoor areas for residents. A facility may provide rooftop or balcony areas if adequate protective enclosures are provided.
(e) A delivery area, service yard or parking area shall be located so that traffic does not cross an area commonly used by residents.
§ 204.4. Basement.
(a) A basement may be used for storage, laundry, kitchen, heat, electric and water equipment. Approval from the Department’s Division of Nursing Care Facilities shall be secured before any part of the basement may be used for other purposes, such as physical therapy, central supply and occupational therapy.
(b) A door to a basement may not be located in a resident room.
§ 204.5. Resident rooms.
(a) A bed for a resident may be placed only in a room approved by the Department as a resident room.
(b) The basement of a facility may not be used for resident rooms.
(c) The maximum number of residents who may be accommodated in a facility shall be indicated on the facility license. The number of resident rooms and the number of beds in a room may not exceed the maximum number approved by the Department.
(d) A resident shall have a choice in the placement of the resident’s bed in the room unless the placement presents a safety hazard.
(e) A bed may not be placed close to a radiator, heat vent, air conditioner, direct glare of natural light or draft unless the resident chooses to do so and the placement does not pose a safety hazard.
(f) A resident shall be provided with a drawer or cabinet in the resident’s room that can be locked.
§ 204.6. Locks.
A door into a room used by a resident may not be locked from the outside when the resident is in the room.
§ 204.7. Laundry.
Equipment shall be made available and accessible for residents desiring to do their personal laundry.
§ 204.8. Utility room.
The facility shall make provisions in each nursing unit for utility rooms. The nursing unit shall have separate soiled and clean workrooms. The rooms may not be more than 120 feet from the most remote room served.
§ 204.9. Bathing facilities.
(a) A facility shall provide a general bathing area in each nursing unit to serve resident rooms that do not have adjoining bathrooms with a bathtub or shower.
(b) Unless bathing fixtures are located in a separate room, there shall be compartments to permit privacy. Cubicle curtains may provide this privacy.
(c) Each bathing room shall include a toilet and lavatory. If more than one tub or shower is in the bathing room, privacy shall be provided at each bathing facility and at the toilet.
(d) The facility shall have at least one bathtub in each centralized bath area on each floor.
§ 204.10. Toilet facilities.
Toilets and lavatories, other than resident facilities, shall be provided for visitors in a facility.
§ 204.11. Equipment for bathrooms.
(a) Grab bars shall be installed as necessary at each tub and shower for safety and convenience. Grab bars, accessories and anchorage shall have sufficient strength to accommodate the residents’ needs.
(b) The general bathroom or shower room used by residents shall have one emergency signal bell located in close proximity to the tub or shower and which registers at the workstation. An emergency signal bell shall also be located at each toilet unless a signal bell can be reached by the resident from both the toilet and tub or shower.
(c) The facility shall make provisions to get residents in and out of bathtubs in a safe way to prevent injury to residents and personnel. The facility shall provide appropriate supervision and assistance to ensure the safety of all residents being bathed.
(d) A dressing area shall be provided immediately adjacent to the shower stall and bathtub. In the dressing area, there shall be provisions for keeping clothes dry while bathing.
(e) The facility shall ensure that water for baths and showers is at a safe and comfortable temperature before the resident is bathed.
§ 204.12. Toilet room equipment.
Each toilet used by residents shall be provided with handrails or assist bars on each side capable of accommodating the residents’ needs.
§ 204.13. Linen.
The facility shall have available at all times a quantity of linens essential for proper care and comfort of residents.
§ 204.14. Supplies.
Adequate supplies shall be available at all times to meet the residents’ needs.
§ 204.15. Windows.
(a) Each window opening in the exterior walls that are used for ventilation shall be effectively covered by screening.
(b) A room with windows opening onto light or air shafts, or onto an exposure where the distance between the building or an obstruction higher than the windowsill is less than 20 feet, may not be used for resident rooms.
§ 204.16. Dining.
The dining area shall be a minimum of 15 square feet per bed for the first 100 beds and 13 1/2 square feet per bed for beds over 100. This space is required in addition to the space required for lounge and recreation rooms.
§ 204.17. Lounge and recreation rooms.
A recreation or lounge room shall be a minimum of 15 square feet of floor space per bed provided for the first 100 beds and 13 1/2 square feet for all beds over 100. A facility shall provide recreation or lounge rooms for residents on each floor.
§ 204.18. Storage.
General storage space shall be provided for storage of supplies, furniture, equipment, residents’ possessions and the like. Space provided for this purpose shall be commensurate with the needs of the nursing facility but may not be less than 10 square feet per bed.
§ 204.19. Plumbing, heating, ventilation, air conditioning and electrical.
Building systems, such as plumbing, heating, ventilation, air conditioning and electrical must comply with all State and local codes.
§ 204.20. Airborne infection isolation room.
A facility shall have at least one airborne infection isolation room for isolating residents as necessary to prevent the spread of airborne infections. An airborne infection isolation room shall be in accordance with the 2018 edition of the Facility Guidelines Institute Guidelines for Design and Construction of Residential Health, Care, and Support Facilities.
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