The purpose of the proposed rule amendments is to delete the physical plant standards, including fire safety standards, in Rules 58A-2.0236, Residential Units, and 58A-2.025, Physical Plant Requirements (Inpatient Facility and Unit), F.A.C., which ...

 

DEPARTMENT OF ELDER AFFAIRS
Federal Aging Programs

RULE NO: RULE TITLE
58A-2.0236: Residential Units
58A-2.025: Physical Plant Requirements (Inpatient Facility and Unit)
58A-2.026: Comprehensive Emergency Management Plan
PURPOSE AND EFFECT: The purpose of the proposed rule amendments is to delete the physical plant standards, including fire safety standards, in Rules 58A-2.0236, Residential Units, and 58A-2.025, Physical Plant Requirements (Inpatient Facility and Unit), F.A.C., which are incorporated under the Florida Building Code, 2004 Edition, 2006 Supplements, Section 437; to incorporate changes in Section 400.610(1)(b)1., F.S., in accordance with Chapter No. 2006-71, Section 24, Laws of Florida, regarding the hospice’s responsibility to provide the same type and quantity of services to hospice patients in a special needs shelter that were being provided prior to evacuation; and to incorporate changes to the Hospice Comprehensive Emergency Management reporting form, incorporated by reference in the rule.

SUMMARY: Deletion of physical plant standards, including fire safety standards, for residential units and inpatient facilities and units, which are included under the Florida Building Code, 2004 Edition, 2006 Supplements, Section 437; the responsibility of hospices to provide the same type and quantity of services to hospice patients in special needs shelters that were being provided prior to evacuation; and changes in the Hospice Comprehensive Emergency Management Plan reporting form.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COST: No Statement of Estimated Regulatory Cost was prepared.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

SPECIFIC AUTHORITY: 400.605, 400.6051, 400.610(1)(b) FS., Chapter 2005-191, Laws of Florida.
LAW IMPLEMENTED: 400.605, 400.605(1)(i), 400.610, 553.73(2) FS., Chapter 2005-191, Laws of Florida.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW (IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: February 14, 2007, 9:30 a.m. – 11:00 a.m.

PLACE: Department of Elder Affairs, 4040 Esplanade Way, Conference Room 225F, Tallahassee, FL 32399-7000

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 72 hours before the workshop/meeting by contacting: Jim Crochet, Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, FL 32399-7000; telephone number [phone]; Email address: crochethj@ elderaffairs.org. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULES IS: Jim Crochet, Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, FL 32399-7000; telephone number [phone]; Email address: [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULES IS:

58A-2.0236 Residential Units.

(1) through (6) No change.

(7) Residential units shall comply with the requirements of Section 400.6051, F.S. and Section 553.73(2), F.S., which incorporates the Florida Building Code, 2004 Edition, 2006 Supplements, Section 437. following codes and standards:

(a) All new facilities and additions and renovations to existing facilities shall be in compliance with:

1. The Florida Building Code, as described in Chapter 3 of Section 311.2 (R4) as adopted by the Florida Building Commission and incorporated by reference in subsection 9B-3.047(1), F.A.C., dated December 16, 2001, by the Department of Community Affairs and obtainable from the Southern Building Code Congress International, Inc., 900 Montclair Road, Birmingham, Alabama 35213-1206;

2. The National Fire Protection Association Life Safety Code 101, Chapter 32, Residential Board and Care Occupancy and incorporated by reference in Rule 4A-3.012, F.A.C., dated November 6, 2001, by the Division of State Fire Marshal at the Department of Finance and obtainable from the National Fire Protection Association, 1 Batterymarch Park, P. O. Box 9101, Quincy, Massachusetts 02269-9101; and

3. Chapter 11, Section 11-6.1(1) of the Florida Building Code, as adopted by the Florida Building Commission and incorporated by reference in subsection 9B-3.047(1), F.A.C., dated December 16, 2001, by the Department of Community Affairs and obtainable from the Southern Building Code Congress International, Inc., 900 Montclair Road, Birmingham, Alabama 35213-1206.

(b) All existing facilities shall comply with National Fire Protection Association Life Safety Code 101, Chapter 33, Residential Board and Care Occupancy and incorporated by reference in Rule 4A-3.012, F.A.C., dated November 6, 2001, by the Division of State Fire Marshal at the Department of Finance and obtainable from the National Fire Protection Association, 1 Batterymarch Park, P. O. Box 9101, Quincy, Massachusetts, 02269-9101.

Specific Authority 400.605, 400.6051 FS., Chapter 2005-191, Laws of Florida. Law Implemented 400.605(1)(i), 553.73(2) FS., Chapter 2005-191, Laws of Florida. History–New 4-27-94, Formerly 59A-2.0236, Amended 6-5-97, 8-10-03,________.

 

58A-2.025 Physical Plant Requirements (Inpatient Facility and Unit).

(1) As used in this rule, “inpatient facility and unit” means the location where inpatient services are provided to hospice patients that are in need of hospice inpatient care.

(2) All new inpatient facilities and units, and additions or renovations to existing facilities and units shall be in compliance with the requirements of Section 400.6051, F.S. and Section 553.73(2), F.S., which incorporates the Florida Building Code, 2004 Edition, 2006 Supplements, Section 437 Codes and Standards.

(a) All new inpatient units and facilities, and additions or renovations to existing units and facilities shall be in compliance with the requirements for:

1. Institutional Occupancy – Group I, Unrestrained, of the Florida Building Code as described in Chapter 3 of Section 309.1 as adopted by the Florida Building Commission and incorporated by reference in subsection 9B-3.047(1), F.A.C., dated December 16, 2001, by the Department of Community Affairs and obtainable from the Southern Building Code Congress International, Inc., 900 Montclair Road, Birmingham, Alabama 35213-1206, after 8-10-03; and

2. The National Fire Protection Association Life Safety Code 101, Chapter 18, New Health Care Occupancy, as described in Rule 4A-3.012, F.A.C., Standards of the National Fire Protection Association and incorporated by reference in Rule 4A-3.012, F.A.C., dated November 6, 2001, by the Division of State Fire Marshal at the Department of Finance and obtainable from the National Fire Protection Association, 1 Batterymarch Park, P. O. Box 9101, Quincy, Massachusetts, 02269-9101, after 8-10-03.

All new inpatient facilities and units will be made accessible and shall comply with the requirements of the Florida Building Code, Chapter 11, as adopted by the Florida Building Commission and Section 11-6.1(1) of the Florida Building Code and incorporated by reference in subsection 9B-3.047(1), F.A.C., dated December 16, 2001, by the Department of Community Affairs and which is incorporated by reference and obtainable from the Southern Building Code Congress International, Inc., 900 Montclair Road, Birmingham, Alabama 35213-1206, after 8-10-03.

a. In renovations and additions to existing facilities, only that portion of the total facility affected by the project must comply with applicable sections of the codes for new facilities and units, after 8-10-03.

b. Existing portions of the facility that are not included in the renovation or addition but are essential to the functioning of the complete facility, as well as existing areas which receive less than substantial amounts of new work, shall comply with the applicable sections of the codes for existing inpatients facilities and units, after 8-10-03.

(b) All existing inpatient facilities and units licensed by the Agency for Health Care Administration before the date this rule is promulgated, shall be in compliance with National Fire Protection Association Life Safety Code 101, Chapter 19, Existing Health Care Occupancy, and incorporated by reference in Rule 4A-3.012, F.A.C., dated November 6, 2001, by the Department of Community Affairs and obtainable from the National Fire Protection Association, 1 Batterymarch Park, P. O. Box 9101, Quincy, Massachusetts 02269-9101, after 8-10-03.

(3) Construction Requirements. The following shall be provided in each inpatient facility and unit:

(a) The hospice shall be responsible for assuring that the planning and decoration of the facilities, both contractual arrangements and free-standing, shall be coordinated to provide a homelike atmosphere. For purposes of this rule, a “homelike atmosphere” means at a minimum, items typically found at home or in a residence that enhance quality of life. The following items are examples of a “homelike atmosphere”: window treatments, lamps, guest seating, and wall decorations. A hospital or nursing home room shall not be required to be in compliance with this section of the rule by the fact of its licensure.

(b) Each patient sleeping room shall have a minimum room area exclusive of toilet room, or permanently attached or built in closets, lockers or wardrobes, of one hundred (100) square feet (9.29 square meters) per bed for private rooms and eighty (80) square feet (7.70 square meters) per bed for double occupancy rooms.

(c) Each patient sleeping room shall have a window or door with a clear glass light in compliance with Chapter 12 of Section 1203, Light and Ventilation, of the Florida Building Code and incorporated by reference in subsection 9B-3.047(1), F.A.C., dated December 16, 2001, by the Department of Community Affairs and obtainable from the Department of Community Affairs, Building Codes and Standards, 2555 Shumard Oak Boulevard, Tallahassee, Florida 32399-2100, [phone] after 8-10-03. The window or door shall open directly to an atrium or to the outside of the building with a minimum of twenty (20) feet (6.10 meters) in clear and unobstructed vista measured perpendicularly from the window or door.

(d) Each patient sleeping room shall have a wardrobe, locker or closet suitable for hanging clothing of the patient.

(e) Other than a patient sleeping room located in a hospital or nursing home, each patient sleeping room shall have access to a toilet room without having to enter the general corridor area. One toilet room shall serve no more than four beds and no more than two resident rooms. The door shall be side hinged, swing out from the toilet room, and unless otherwise required by this code, be at least 32 inches (81.28 centimeters) wide. The toilet room shall contain a water closet with grab bars on both sides and an emergency nurse call station. The water closet shall be equipped with a bedpan-rinsing device.

(f) A hand washing facility shall be provided within each patient toilet room or within each patient bedroom.

(g) A nurses’ station, clean workroom and soiled workroom shall be provided. Access to these rooms shall be from a corridor.

(h) A charting space for clinical staff shall be provided at each nurses’ station.

(i) A hand washing facility shall be located in or near each nurses’ station.

(j) The clean workroom shall be provided with a work counter, hand wash facility, storage facilities and covered waste receptacle.

(k) The soiled workroom shall be provided with a service sink equipped with rinsing device, work counter, a hand washing facility, storage facilities, covered waste receptacle, and covered linen receptacle.

(l) A drug distribution system shall be provided with provisions for the locked storage of medications. Nothing in this section shall prohibit the use of the clean workroom for drug distribution.

(m) A clean linen storage room or closet shall be provided.

(n) A nourishment station with equipment for preparing or serving nourishments between scheduled meals shall be provided and shall be available for patient, family, volunteers, guests and staff use. Provisions shall be made for the use and storage of small appliances requiring less than 220 volts of service such as coffee makers or toasters.

(o) A nurse calling system accessible by the patient shall be provided.

(p) Storage for administrative supplies shall be provided.

(q) Parking for stretchers and wheelchairs in an area out of the path of normal traffic and of adequate size for the unit shall be provided.

(r) A janitor’s closet with a floor receptor and storage space for housekeeping equipment and supplies shall be provided.

(s) A multi-purpose lounge suitable and furnished for reception, recreation, dining, visitation, group social activities, and worship shall be provided.

(t) A conference or consultation room for patient and family use shall be provided.

(u) A washer and dryer for patients’ personal use shall be provided.

(4) Room furnishings for each patient shall include an adjustable frame hospital type bed with side rails, a bedside stand, an over-the-bed table, an individual reading light easily accessible to the patient, and a comfortable sitting chair.

(5) Room decor shall be non-institutional in design and function. Patients shall be permitted to bring personal items of furniture or furnishings into their rooms unless medically contraindicated.

(6) Details.

(a) Fixtures such as drinking fountains, public telephone, vending machines, and portable equipment shall not be located or stored so as to restrict corridor traffic or reduce the minimum required corridor width.

(b) Doors to patient tub rooms, showers, and water closets that swing into the room shall be equipped with reversible hardware that will allow the door to swing out in an emergency.

(c) Doors, except those to closets or spaces not subject to occupancy, shall not swing into the exit access corridors.

(d) Windows and outer doors, if used for ventilation, shall be equipped with insect screens.

(e) Thresholds and expansion joint covers shall be made flush with the floor surface.

(f) Grab bars shall be provided at all patient toilets, showers, and tubs. The bars shall have a clearance of 1-1/2 inches (38.1 millimeters) to the walls and shall be sufficiently anchored to sustain a concentrated applied load of not less than 250 pounds (113.4 kilograms).

(g) Single paper towel dispensers, soap dispensers and covered waste receptacles shall be provided at all hand washing facilities.

(h) Staff hand washing facilities shall be fitted with wrist blades and a gooseneck type spout.

(i) All hand washing facilities shall be securely anchored to withstand an applied vertical load of not less than two hundred and fifty pounds on the front of the fixture.

(7) Elevators. In new multistory units and facilities an elevator shall be provided in compliance with the requirements of Chapter 30 of the Florida Building Code, as adopted by the Florida Building Commission and incorporated by reference in subsection 9B-3.047(1), F.A.C., dated December 16, 2001, by the Department of Community Affairs and obtainable from the Southern Building Code Congress International, Inc., 900 Montclair Road, Birmingham, Alabama 35213-1206, after 8-10-03. In addition, a hospital-type elevator large enough to accommodate a bed and attending staff shall service all patient sleeping rooms and patient treatment areas located above the ground floor. The car shall be at least 5 feet 8 inches (1.73 meters) wide by 9 feet (2.74 meters) deep and the car doors shall have a clear opening of not less than 4 feet (1.22 meters) wide and 7 feet (2.13 meters) high.

(8) Mechanical System Requirements.

(a) Air conditioning, heating and ventilating systems.

1. All patient occupied areas shall be heated or cooled by individual or central units. Heating units shall be designed to provide a minimum of 72 degrees Fahrenheit (22.22 Celsius) ambient indoor temperature and air conditioning units shall be designed to provide a minimum of 78 degrees Fahrenheit (25.55 Celsius) ambient indoor temperature.

2. All air-supply and air-exhaust systems shall be mechanically operated. Fans serving exhaust systems shall be located at the discharge end of the system.

(b) Plumbing and other piping systems. Water distribution systems shall be arranged to provide hot water at each hot water outlet at all times. Hot water at shower, bathing, and hand washing facilities for patients’ personal use shall not exceed 110 degrees Fahrenheit (43.3 degrees Celsius).

(9) Electrical System Requirements.

(a) Lighting.

1. All spaces occupied by people, machinery, and equipment within the building, approaches to building, and parking areas shall have electric lighting.

2. All patients’ rooms shall have general lighting and night lighting. General room luminaries shall be switched at the entrance to the patient room.

(b) Receptacles. All patient rooms shall have hospital grade duplex grounding type receptacles.

(10) Emergency Electrical System.

(a) A Type 1 essential electrical system shall be provided in all hospice facilities as described in National Fire Protection Association Life Safety Code 99, “Health Care Facilities”, and incorporated by reference in Rule 4A-3.012, F.A.C., dated November 6, 2001, by Division of State Fire Marshal at the Department of Finance and obtainable from the National Fire Protection Association, 1 Batterymarch Park, P. O. Box 9101, Quincy, Massachusetts 02269-9101, after 8-10-03. The emergency power for this system shall meet the requirements of a Level 1, type 10, Class 48 generator as described in National Fire Protection Association Life Safety Code 110, “Emergency Standby Power Systems”, and incorporated by reference in Rule 4A-3.012, F.A.C., dated November 6, 2001, and obtainable from the National Fire Protection Association, 1 Batterymarch Park, P. O. Box 9101, Quincy, Massachusetts 02269-9101, after 8-10-03.

(b) In new construction, the normal main service equipment shall be separated from the emergency distribution equipment by locating it in a separate room. Transfer switches shall be considered emergency distribution equipment for this purpose.

(c) Switches for critical branch lighting shall be completely separate from normal switching. The devices or cover plates shall be of a distinctive color. Critical branch switches are permitted to be adjacent to normal switches. Switches for life safety lighting are not permitted except as required for dusk-to-dawn automatic control of exterior lighting fixtures.

(e) A minimum of one elevator per bank serving any patient use floor shall be connected to the equipment branch of the essential electric system and arranged for manual or automatic operation during loss of normal power. Elevator cab lighting, controls, and communication and signal systems shall be connected to the life safety branch.(d) There shall be selected life safety lighting provided at a minimum of 1 footcandle and designed for automatic dusk-to-dawn operation along the travel paths from the exits to the public way or to safe areas located a minimum of 30 feet (9.14 meters) from the building.

(f) There shall be a dedicated low fuel alarm for the day tank supplying the emergency generator driver. A manual pump shall also be provided for the day tank. The alarm shall be located at the generator derangement panel.

(g) Transfer switch contacts shall be of the open type and shall be accessible for inspection and replacement.

(h) If required by the facility’s emergency food plan, there shall be power connected to the equipment branch of the essential electrical system for kitchen refrigerators, freezers and range hood exhaust fans. Selected lighting within the kitchen and dry storage areas shall be connected to the critical branch of the essential electrical system.

Specific Authority 400.605, 400.6051 FS., Chapter 2005-191, Laws of Florida. Law Implemented 400.605(1)(i), 553.73(2) FS., Chapter 2005-191, Laws of Florida. History–New 8-10-03, Amended_______.

 

58A-2.026 Comprehensive Emergency Management Plan.

(1) Pursuant to Section 400.610(1)(b), F.S., each hospice shall prepare and maintain a comprehensive emergency management plan, hereinafter referred to as “the plan,” in accordance with the “Comprehensive Emergency Management Planning (CEMP) Format Criteria for Hospices,” DOEA Form H-001001H, 2007 October 2001, which is incorporated by reference. This document is available from through the Agency for Health Care Administration, Licensed Home Health Programs Unit, 2727 Mahan Drive, Mail Stop 34, Tallahassee, Florida, 32308, or the agency Web site at http://ahca.myflorida.com under “Licensing and Certification”, “Hospices”, and shall be included as part of the hospice’s comprehensive emergency management plan.

(2) The plan shall be submitted electronically for review to the local cCounty hHealth dDepartment in each county that the hospice is licensed to serve. Any method other than electronic submission of the form shall be expressly approved by the local county health department or by the Department of Health pursuant to Section 400.610(1)(b), F.S., in those counties where the Department of Health receives funding for such reviews, pursuant to Section 381.0303(7), F.S.

(a) Upon approval of the plan by the local County Health Department or the Department of Health, in counties where the Department has authority to approve the plan, the hospice shall provide a copy of the plan to the local emergency management agency in each county served by the hospice.

(3) The hospice shall report cChanges in the after-hours emergency telephone number and address of those staff who are coordinating the hospice’s emergency response shall be reported by the hospice to the hospice’s local emergency management agency and county health department. The telephone numbers must include all numbers where the coordinating staff can be contacted outside the hospice’s regular office hours. All hospices must report these changes, whether the plan has been previously reviewed or not, as defined in subsection (2) above.

(4) Upon a change of ownership, the new owner shall submit a new plan identifying any substantive changes, including facility renovations, and changes noted in subsection (3) above. Those hospices, which previously have had the plan reviewed by the local cCounty hHealth dDepartment or by the Department of Health, as defined in subsection (2) above, shall report any substantive changes to the reviewing entity.

(5) The plan shall describe:

(a) Procedures to ensure adequate preparation of hospice patients for potential or imminent emergencies and disasters.

(b) Procedures for annual review of the plan and for the governing body to incorporate making substantive changes to the plan by the governing body.

(6) In the event of an emergency or disaster, the hospice shall implement the hospice’s plan in accordance with Section 400.610, F.S.

(7) On admission, each hospice patient and, where applicable, home hospice caregiver shall be informed of the hospice plan and of the special-needs registry maintained by the local emergency management agency, pursuant to Section 252.355, F.S. The hospice shall document in the patient’s file if:

(a) If Tthe patient plans to evacuate the patient’s home or the hospice facility;

(b) If during the emergency Tthe caregiver can take responsibility for services normally provided by the hospice during the emergency or disaster to the home patient; or

(c) If Tthe hospice needs to arrange for alternative caregiver services for the patient.

(8) Upon imminent threat of an emergency or disaster, the hospice shall confirm each patient’s plan during and immediately following an emergency or disaster.

(9) When the hospice is unable to provide services during an emergency or disaster, the hospice shall make all reasonable efforts to inform, where applicable, those facility and home patients whose services will be interrupted during the emergency or disaster, including patients sheltering in place;, and shall inform when services are anticipated to be restored.

(10) Each hospice shall contact each the local emergency management agency in counties each county served by that hospice to determine procedures for registration of special-needs registrants as referenced in Section 252.355, F.S.

(11) Upon admission of a patient, eEach hospice shall collect upon admission registration information for special-needs registrants who will require continuing care or services during a disaster or emergency, consistent with Section 252.355, F.S. This registration information shall be submitted, when collected, to the local emergency management agency, or on a periodic basis as determined by the local emergency management agency.

(12) The hospice shall educate patients registered with the special-needs registry that services provided by the hospice in special-needs shelters shall meet the requirements of Section 400.610(1)(b), F.S. re an option of last resort and that services may not be equal to those received in the hospice programs.

(13) The hospice shall maintain a current list of patients clients who are special-needs registrants, and shall forward this list to the local emergency management agency upon imminent threat of disaster or emergency and in accordance with the local emergency management agency procedures.

(14) Each hospice patient record for patients who are listed in the special-needs registry established pursuant to Section 252.355, F.S., shall include a description of how care or services will be continued in the event of an emergency or disaster pursuant to Section 400.610(1)(b), F.S. The hospice shall discuss the emergency provisions with the patient and the patient’s caregiver, including where and how the patient is to evacuate, procedures for notifying the hospice in the event that the patient evacuates to a location other than the shelter identified in the patient record, and advance directives., and the hospice shall make arrangements to make the list of medications, supplies, and equipment available to each patient in the event of an evacuation.

(15) The hospice shall maintain for each patient who is a special-needs patient registrant a list of client-specific medications, supplies, and equipment required for continuing care and service, should the patient be evacuated. If the hospice provides services to home patients, the hospice shall make arrangements to make the list of medications, supplies, and equipment available to each special-needs registrant in the event of an evacuation. The hospice shall notify the patient registrant that he/she the registrant is responsible for maintaining a supply of medications in the home. The list of medication shall include the names of all medications, dose, frequency, times, and any other special considerations for administration, any allergies, names of physicians and telephone numbers, and name and telephone number of the patient’s pharmacy. If the patient gives consent, the list may also include the patient’s diagnosis.

Specific Authority 400.605, 400.610(1)(b) FS. Law Implemented 400.605, 400.610 FS. History–New 8-6-02, Amended________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Jim Crochet

NAME OF SUPERVISOR OR PERSON WHO APPROVED THE PROPOSED RULE: Charles T. Corley, Interim Secretary
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: December 15, 2006

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: November 22, 2006