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Physical Environment - Facility Wide

 

Description of Federal Requirements
Comparison of State Requirements
Table Comparing States

Complete Transcript of State Requirements on Physical Environment - Facility Wide (PDF)

Federal Regulations & Related F-tags Applicable Federal Regulation
Life safety from fire | F454
Emergency power | F455
Space and equipment | F456
Dispose of Garbage | F372
Adequate Ventilation | F467
Comfortable Temperature | F257
Comfortable sound levels | F258
Comfortable light levels | F256

Environment (Quality of Life 483.15) | F252 - F258
Toilet Facilities | F462
Resident call system | F463
Dining and resident activities | F464
Direct access to exit corridor | F459
Handrails on corridor walls | F468
Other environmental conditions | F465 - F469
Posting of contact information of advocacy groups, State survey, State licensure, ombudsman, protection and advocacy network, Medicaid fraud | F156
483.70 Physical Environment
483.15 Quality of Life
483.10 Resident Rights

Description of Federal Requirements    (TOP)    (NEXT)

The Federal Regulations on Physical Environment (483.70) deals with an assortment of topics related to life safety from fire, required space and equipment, minimal standards for resident rooms and other environment conditions. The umbrella requirement for the physical environment is that “the facility must be designed, constructed, equipped, and maintained to protect the health and safety of residents, personnel and the public.”

Part (c) pertains to space and equipment and requires the facility to: (1) provide sufficient space and equipment in dining, health services, recreation, and program areas to enable staff to provide residents with needed services and as identified in resident’s care plan; and (2) maintain essential mechanical, electrical and care equipment in safe operating condition.

Part (g) pertains to dining and resident activities and requires the facility to provide one or more rooms designated for resident dining and activities and these rooms must be well lighted.

Part (h) pertains to other environmental conditions and requires the facility to provide a safe, functional, sanitary, and comfortable environment for residents, staff and the public that: ensures water is available when there is a loss of normal water supply; that there is outside ventilation by means of windows or mechanical equipment; handrails are firmly secured on each side of the corridor; and there is an effective pest control programs and the facility is free of pests and rodents.

Requirements for signage are briefly mentioned under resident rights and include: “a posting of names, addresses, and telephone numbers of all pertinent State client advocacy groups, such as the State survey and certification agency, the State licensure office, the State ombudsman program, the protection and advocacy network, and the Medicaid fraud unit.” 483.10(b) (7) (iii)
“The facility must prominently display in the facility written information . . . about how to apply for and use Medicare and Medicaid benefits, and how to receive refunds for previous payments covered by such benefits. 483.10(b) (10)

No federal regulations refer to the quality of these signs and no references are made at all to signage to help residents or others locate a resident's rooms, signs on the room, or other general signage to assist with way-finding.

Under Quality of Life 483.15 (h) Environment. The facility must provide:
(2) Housekeeping and maintenance services necessary to maintain a sanitary, orderly and comfortable interior.
(5) Adequate and comfortable lighting levels in all areas.
(6) Comfortable and safe temperature levels. Facilities initially certified after October 1, 1990 must maintain a temperature range of 71-81degrees F.

Comparison of State Requirements    (TOP)    (NEXT)

Arkansas has created new state regulations relevant to the Green House™  and Home Style model. The intent of the regulations is that Green House™  facilities are an attempt to enhance residents’ quality of life through the use of a non-institutional facility model resulting in a residential-style physical plant and specific principles of staff interaction. The Greenhouse model is defined as utilizing small, free­standing, self-contained homes surrounding or adjacent to a central administration unit, each housing between ten (10) and twelve (12) private rooms, each with full bathrooms.  The residents’ rooms are constructed around a central, communal, family-style open space that includes a hearth, dining area, and residential-style kitchen. All residents’ room entrances are visible from the central communal area. Each home is built to blend architecturally with neighboring homes. The intent of these regulations is to create a framework that encourages the construction and operation of Green House™ facilities. To be designated by the Office of Long Term Care as a Green House™ facility, the facility meet the minimum standards, and have approval to use the Green House™ service mark, issued by the Green House™ Project and NCB Capital Impact at the time of designation and at all times thereafter. Facilities designated by the Office of Long Term Care as Green House™ facilities shall employ the same staffing ratios and otherwise comply with Section 520 of these regulations; provided, however, that CNAs utilized in Green House™ facilities may act as universal workers. For purposes of this regulation, universal worker means a Certified Nurse Assistant (CNA) who, in addition to performing CNA duties, performs dietary, laundry, housekeeping and other services to meet the needs of residents.

The construction and operation of Home Style facilities is a pilot project of the State of Arkansas to determine the efficacy of an alternative long-term care model. Facilities participating in the project will be required to maintain detailed medical and social records of residents. The records will contain an initial assessment of the medical and social conditions and needs of residents at the time of admission which will form a baseline measure. The baseline will be compared by the Office of Long Term Care or its designees with subsequent records maintained by the facility to determine the level of functioning, social interaction, and medical conditions of residents to determine whether Home Style facilities result in improvements in those areas, including but not limited to the type and dosage amounts and frequency of medications. Further, facilities will be required to maintain detailed financial records.

Housekeeping, Laundry and Maintenance  (TOP)    (NEXT)

Housekeeping regulations are addressed by few states. Alabama requires that each facility provide space to accommodate routine maintenance appropriate to the needs. Arkansas requires that janitors’ closets be provided for each unit and the closets shall have hot and cold running water, a floor receptor or service sink, and shelves for the storage of janitorial equipment and supplies. The closets shall be mechanically ventilated to the outside and be locked. In Connecticut, one janitor’s closet may serve a 50-bed unit on each floor. Minnesota requires ceilings, walls, and floors to be of a type or finish to permit good maintenance including frequent washing, cleaning, or painting. Connecticut requires that floors be easily cleanable and have wear resistance appropriate for location. Floors in kitchens shall be waterproof and greaseproof and in areas subject to wetting shall have a non-slip finish. Walls to be washable and wall bases in dietary areas are to be free of spaces that can harbor insects. Ceilings shall be washable or easily cleanable, except in boiler rooms, mechanical and building equipment rooms, shops and similar space. Also required is a refuse area that is located in an outside, fenced area or a separate room for holding trash and garbage prior to disposal. It must be located convenient to the service entrance and be sized to accommodate the refuse volume and the chosen type of disposal system. Washington requires equipment and casework be designed, manufactured and installed for ease of proper cleaning and maintenance, and suitable for the functions of each area.

Laundry requirements are addressed in most states. In Florida if the household design model for person centered care is utilized and if required by the functional program, resident laundry facilities including washing and drying equipment shall be provided for staff, family or individual resident use for the laundering only of a resident’s personal items. If these laundry facilities are provided, they shall be readily accessible from each resident household without requiring the user to enter another resident unit, or floor and may be shared between two resident households.

Corridors, Floors and Signage  (TOP)    (NEXT)

Corridors regulations are covered extensively in the Life Safety Codes (K17, K18, K19,K22), and American Disability Act Accessibility Guidelines. Many states duplicate the language of those regulations in their state regulatory language. Other states include additional  general language.  For example For example, Arizona requires that the corridors are equipped with handrails on each side that are firmly attached to the wall and are not in need of repair, and Connecticut requires that hazards such as sharp corners shall be avoided and floors shall be easily cleanable. Arkansas and Iowa have specific state regulations related to hand rails: In Arkansas, corridors in facilities licensed prior to 1973 shall be at least 6 feet wide. Standard handrails shall be provided one each side of the corridor in all areas used by patients; however a 6-foot passageway must be maintained. For 6-foot corridors, a handrail shall be required only on one side. In Iowa, handrails shall be provided on both sides of corridors and stairways used by residents. There shall be a clear distance of 1-½ inches between handrail and wall. Many states have regulations that forbid the storage of items in the corridor. In Alabama, corridors shall not be used to store or hold soiled linen or clean linen carts at any time of the day. In Georgia, corridors in areas used by patients shall not be less than 8 feet in clean width. Handrails may project into corridors, but drinking fountains, desk or other projections or obstructions may not reduce the 8-foot minim dimension.

Rules about floor treatments typically relate to carpet: In New Jersey, scatter rugs shall not be permitted and floors shall be coated with slip-resistant floor finish. Carpeting shall be kept clean and odor free and shall not be frayed, worn, torn, or buckled. In Wisconsin, scatter rugs and highly polished, slippery floors are prohibited, except for non-slip entrance mats. Arkansas is quite specific about where carpet is permitted. Provided carpet meets the following requirements: flame spread rating of 75 or less, a smoke density of 100 or less, when the carpet is treated in accordance with NFPA 253 flooring radiant panel test it is permitted in offices, corridors, chapels, and day rooms. No pad will be permitted under the carpet, the carpet is to be glued directly to the floor and prior approval by the Division is required before the carpet is installed.  Utah guidelines for carpets include microbial resistance ratings. In Washington, the nursing home must ensure that the Department of Health, construction review approves of all carpet installation. Carpets may be used in all areas except: toilet rooms, bathrooms, kitchen, laundry, utility rooms, medication rooms, maintenance, isolation rooms and areas subject to high moisture or flooding. Specifications for acceptable carpeting include: pile yarn fibers are easily cleanable; pile is looped texture in all resident use areas. Cut pile may be used in non-resident use areas; average pile density of 5,000 ounces per cubic yard in resident use areas and 4,000 ounces per cubic yard in nonresident areas. (The formula for calculating the density of the carpet is: Yarn weight in ounces times 36, divided by pile height in inches equals ounces per cubic year of density); and a maximum pile height of .255 inches in resident use areas and .312 inches in nonresident use areas. Carpets must be cemented to the floor, have edges covered and t op set base with toe at all wall junctures. When re-carpeting, the safety of residents must be assured during and after re-carpeting installation within the room or area. Finally, in an unusual detail on floor maintenance, in Wyoming, “household straw brooms” shall be used only at entrances and exits of the building.

Signage regulatory language is addressed in very few states. In Oregon, all resident rooms shall be clearly identified by room number, room numbers shall be no less than one inch high and shall contrast with their background (light characters on dark background or dark characters on light background). Such signs shall be located in order to be easily readable to all residents, including those in wheelchairs. In California, each patient room shall be labeled with a number, letter or combination of the two for identification. In Connecticut, each resident room shall be numbered, and the number, together with the licensed capacity of each room shall be posted by each door. In New Mexico, each bedroom shall be identified with a unique number placed on or near the door. In Utah, signs shall be provided as follows: general and circulation direction signs in corridors; identification at each door and emergency directional signs. In Washington new construction, the facility must ensure rooms and service areas are identified by visible and tactile signs. [NH Regs Plus Comment: The reference to tactile signs (such as raised letters to be used by a blind person) is unusual. Note that for tactile signs to be useful to all residents, they must be accessible at wheelchair height.]

[NH Regs Plus Comment: In a 40-facility quality of life study funded by CMS with an environmental component, University of Minnesota researchers found multiple problems with signage in nursing homes, and subsequently we have paid attention to issues with signage. Some of these concerned the utility of the signs in terms of their size, height, and general legibility. In our opinion, other signage problems relate to meeting the federal requirements for dignity. Hastily prepared signs on torn or soiled paper were common, as were out of date announcements. Other highly visible signs for Diapers or Soiled Linen seem to violate resident dignity. Very commonly we found toilet rooms in public areas with signs that connoted Resident Keep Out. Occasionally we have noticed bulletin boards with signs meant for staff members that use demeaning language about either staff or residents. Signage would be fruitful area for study to identify the strategies that work well for residents and visitors in terms of wayfinding while minimizing the impersonality that excessive signage would create.]

Lighting, Noise, Temperature and Odors  (TOP)    (NEXT)

Lighting is addressed in most states. Iowa, Washington and Oregon have created very extensive lighting requirements that could be used as guidelines for other states while other states such as Arizona require only that there is lighting for tasks performed by a resident or a staff member. All states require lighting at the bedside but contrary to common belief very few states (e.g., Alabama and Florida ) specify that the bedside light be mounted over bed on the headwall. Hawaii requires artificial light adequate for reading at bedside. Louisiana requires that the resident be provided with a bedside light or over-the-bed light capable of being operated from the bed. Illinois requires a satisfactory reading lamp, or equivalent, shall be provided for each bed. In Iowa, wall-mounted lights with flexible or extension arms shall not be used. In New Mexico, a properly shaded reading light in working condition shall be installed over or at each bed.
Night-lights are a common requirement. In Colorado, plug in types of night-lights are approved. In Connecticut, night-lights shall be switched at the nursing station.

Other variations on lighting regulations are described below: In Arkansas, each patient's room shall have natural lighting during the day and have general lighting at night. Natural lighting shall be augmented when necessary by artificial illumination. In California all patient rooms shall have a minimum of 30 foot candles of light delivered to reading or working surfaces and not less than 20 foot candles of light in the rest of the room. Indiana provides a table of required foot candles for separate areas and also requires that each facility have natural lighting augmented by artificial illumination, when necessary, to provide light intensity and to avoid glare and reflective surfaces that produce discomfort. Iowa requires at least one recessed light fixture for night lighting installed no higher than 18 inches above the floor in each resident room, which shall have a switch at the entrance. Maine provides foot-candle guidelines and also forbids the use of candles, courtesy oil lanterns and other open-flame methods of illumination are prohibited. In New Hampshire, increased lighting shall be available to allow resident to participate in activities such as needlework or handicrafts, which require more lighting. In Wisconsin, no candles, oil lanterns, or other open flame method of illumination may be used. Massachusetts uses bulb wattage rather than foot-candles in its guidelines. The State requires that no electric bulb under 60 watts shall be used for illumination for resident's use. Night-lights for hallways, stairways and bathrooms shall have at least 15-watt bulbs. Oregon and Washington require that windows and skylights shall be utilized to minimize the need for artificial light and to allow residents to experience the natural daylight cycle. The use of windows and skylights is especially important near entrances/exits, in order to avoid difficulty in adjusting to light levels when entering or leaving the facility.

Noise is addressed in Quality of Life Federal regulations with the requirement that the facility must provide for the maintenance of comfortable sound levels. Iowa has the most comprehensive rules requiring that partition, floor and ceiling construction in resident areas shall comply with noise reduction criteria set forth in American Society for Testing and Materials (ASTM) Standard E90 and ASTM Standard E413. Mississippi requires that resident bedrooms shall be located so as to minimize the entrance of excessive noise. In Oklahoma, recreation rooms, exercise rooms, and similar spaces where impact noise may be generated shall not be located directly over resident bed areas unless special provisions are mode to minimize such noise while in Washington, all nursing homes must maintain comfortable sound levels to include minimizing the use of the public address system and taking reasonable precautions with noisy services so residents are not disturbed, particularly during their sleeping times. In new construction, nursing homes are required to utilize an alternative to the public address system for non-emergency communication that best serves the residents' needs.

Temperature is addressed in most states but in many different ways. In Arizona, the temperature can't exceed 84 degrees F. In Delaware the minimum temperature in each room used by patients is 73 degrees F. In Georgia, the heating equipment shall be capable of maintaining a temperature of 75 degrees F in all habitable rooms and corridors. The heating system should provide warm floors. In Kansas the system shall be designed to maintain a year-round indoor temperature range in resident care areas of 7degrees F to 85 degrees F. The winter outside design temperature of the facility shall be 10F dry bulb, and the summer outside design temperature of the facility shall be 100F dry bulb. In Maryland, space heaters and portable heaters may not be used. In Massachusetts adequate heating shall be provided in all rooms in order to maintain a minimum temperature of 75 degrees F at winter temperatures for the hours between 6:00AM and 10:00PM and a minimum temperature of 70 degrees F at winter temperature for the same hours. In Minnesota, variations of the temperatures required are allowed if the variations are based on “documented resident preferences.” In New Jersey, the facility shall establish a written heat emergency action plan which specifies procedures to be followed in the event that the indoor air temperature is 82 degrees F or higher for a continuous period of 4 hours or longer. Rhode Island requires an air-conditioned room or rooms in a residential section(s) of the facility to provide relief to patients when the outdoor temperature exceeds 80 degrees F. Energy conservation is addressed in Oregon by requiring that special design considerations should be given to energy conservation in accordance with section 53 of the Oregon Structural Specialty Code (effective 1/1/92 ).

Odors specific regulations are found in only four States. In Alabama, resident bedrooms shall be ventilated to supply fresh air and prevent accumulation of objectionable odors. In Mississippi bedrooms shall be located so as to minimize the entrance of unpleasant odors. The other references are to covering up odors. In Arkansas, deodorants shall not be used to cover up odor while in Texas if deodorant is used for air-freshening purposes, the following procedures must apply: deodorants or air fresheners are permitted provided the dispensing device is located where it is inaccessible to residents, products are not used to cover odors resulting from poor housekeeping practices; products are not used in excess, there is no contra-indication indicating the product should not be used in presence of aged or ill persons, and devices such as ozone generators, and smoke eliminators must be approved by the DHS.

Body Holding Room  (TOP)    (NEXT)

Body Holding Rooms are seldom included in State regulations. Two states, Maryland and Connecticut require body holding rooms for the handling of the bodies of residents who die in the nursing home. In Maryland new facilities, if a body holding room is provided it shall be located to facilitate quiet and unobtrusive ingress and egress of bodies, convenient to the elevator and with an isolated exit. If a body holding room is not provided, a holding area shall be designated which are similar to the conditions for a body holding room. In existing facilities a method for holding which minimizes the psychological effect on other patients is required. Connecticut expands on describing the characteristics of the body holding room by requiring that when a patient ceases to breathe and has no detectable pulse or blood pressure, the body shall be moved promptly to an otherwise unoccupied room in the same institution pending pronouncement of death by a physician who has personally viewed the body. The facility shall provide a room for the dignified holding of the body where it will not be exposed to the view of patients or visitors. The room so designated may be used for other purposes when not required for this purpose. [NH Regs Plus Comment: Both of the identified examples emphasize the reducing the supposed trauma on other residents and visitors of seeing the body of a deceased resident by using isolated areas. The Connecticut language also emphasizes the “dignified holding of the body.” Some of the practices in facilities devoted to culture change, in contrast to the emphasis on isolating, entail leaving the body in the bed where death occurred, holding impromptu brief services, providing for laying in state and visitation, and using shrouds and special coverings.]

Outdoor Space  (TOP)    (NEXT)

Outdoor space is not addressed in the Federal regulations and the majority of state regulations do not address it as well, except in requirements for new construction and/or  Dementia specific units. Washington provides a good example of comprehensive outdoor guidelines for outdoor recreation space and walkways in new construction. The facility must ensure the outdoor area has: shaded and sheltered areas; accessible walking surfaces which are firm, stable and free from cracks and abrupt changes with a maximum of one inch between sidewalk and adjoining landscape areas; sufficient space and outdoor furniture with flexibility in arrangement to accommodate residents who use wheelchairs and mobility aids; shrubs, natural foliage and trees; and if used as a resident courtyard, the outdoor area must not be used for public or service deliveries. [NH Regs Plus Comment: Studies of quality of life undertaken at University of Minnesota show that large numbers of residents, a third or more, do not get out of doors at all in a month, and that residents value being outdoors. Post-occupancy evaluation studies of outdoor spaces in both nursing homes and assisted living reveal common problems in exposure to excessive sun or wind, lack of strategic seating, poorly placed plantings, and terrain that is difficult to navigate. We think this is an important area for nursing homes to innovate, and one where they have no federal rules to either restricted them or ensure minimum access to open outdoors.]

Colorado, requires any facility that has an outside area or yard that residents in the non-secure areas of the facility may use shall establish a secure outside area for residents of the secure unit. Connecticut makes a distinction between porch or paved patio areas and open outdoor space. Ten square feet per resident shall be provided for porches or paved patio areas and 100 square feet per resident for outdoor space that includes lawn and plantings. In Iowa, 40 square feet per licensed bed is required after 1990 for outdoor activities. Open-air porches and decks may be included in meeting this requirement. In Nebraska, the outdoor area must be equipped and situated to allow “for resident safety and abilities.” North Carolina requires outdoor space to be handicap accessible. In Pennsylvania, any facility with site limitations that makes outdoor areas impossible may provide rooftop or balcony areas. [NH Regs Plus Comment: Although absent prohibitions, nursing homes are free to develop rooftop areas or upper story balconies, the Pennsylvania specification that they “may” do so encourages facilities and reduces the likelihood of failure to act in case regulators would object. This capacity seems important for facilities in many urban areas.]

New Construction    (TOP)    (NEXT)

New Construction - Housekeeping, Laundry and Maintenance    (TOP)    (NEXT)

Arkansas and Maryland require that new facilities provide complete separation (a partition) between soiled and clean laundry areas. Maryland also requires that, "hot water temperatures in laundries shall conform to applicable standards of the International Fabric Care Institute for laundry water supply." In South Dakota, "the laundry department must be capable of processing 10 pounds (4.54 kilograms) of soiled linen for each bed during a normal work day." Texas requires that, "a sufficient number of janitors' closets must be provided throughout the facility to maintain a clean and sanitary environment."

New Construction - Corridors, Floors and Signage    (TOP)    (NEXT)

New facilities in California must have corridors that are a minimum of eight feet wide and have ceilings at least eight feet high. In Minnesota, newly constructed "ceilings in corridors, storage rooms, resident toilet rooms, and other minor rooms must not be less than seven feet, six inches." Mississippi requires that, "generally the walls and ceilings should be painted a light color." Oklahoma requires that, "ceilings throughout shall be easily cleanable." South Dakota provides a variety of regulations about floors, including that, "adjacent dissimilar floor materials must be flush with each other to provide a level floor surface." Texas regulations stipulate that, "hazards such as sharp corners and edges and unexpected steps must be avoided." Washington includes very specific regulations about where carpeting is allowed in facilities and, in those areas, what type of carpet can be used. For example, "average pile density of five thousand ounces per cubic yard in resident use areas and four thousand ounces per cubic yard in nonresident areas."

New Construction - Lighting, Noise, Temperature, HVAC and Odors    (TOP)    (NEXT)

Newly constructed facilities in Idaho are provided with strict guidance around temperature control: "For normal comfort the design temperature for all occupied areas shall provide a minimum of sixty-eight degrees (68) and a maximum of eighty degrees (80) Fahrenheit." Newly constructed facilities in Mississippi must provide heating and cooling so that a minimum of 75 degrees and maximum of 80 degrees may be maintained. Nebraska regulations state, "Openings to the heating and cooling system must not be located where subject to wet cleaning methods or body fluids."

Iowa includes specific regulations about the installation of noise reduction partitions. Guidelines include the stipulation that, the "location of electrical receptacles, grills, duct work, other mechanical items, and blocking and sealing of partitions at floors and ceilings shall not compromise the sound isolation required." Similarly, in New York, "acoustical treatment shall be provided between corridors in resident areas, nurse's stations, dayrooms, recreation rooms, dining areas and waiting areas and resident rooms to reduce ambient noise in resident living and sleeping areas."

Many states also include specific regulations about lighting requirements. For example, in South Carolina, "artificial light shall be provided to include sufficient lighting for reading, observation, and activities. There shall be a minimum of thirty-five (35) foot-candles in areas used for reading, study, or close work. Lighting in work areas and medication preparation areas shall not be less than thirty (30) foot-candles."

New Construction - Outdoor Space    (TOP)    (NEXT)

Few states explicitly address new construction of outdoor areas. Washington is an exception, with several very specific regulations about what may or may not be included in outdoor areas. For example, facilities must provide "shrubs, natural foliage, and trees" and "accessible walking surfaces which are firm, stable, and free from cracks and abrupt changes with a maximum of one inch between sidewalk and adjoining landscape areas." And, West Virginia requires that, "the grounds are maintained in a presentable condition free from rubbish and other health hazards of a similar nature."

New Construction - Amenities    (TOP)    (NEXT)

Minnesota requires that newly constructed facilities provide both barber and beauty shop facilities for residents. Minnesota also requires that, "refrigerated drinking fountains must be provided in resident areas, the recreational or activities area, and in or near the dining area." Missouri includes regulations about fireplaces, stating, "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." However, "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."

New Construction - Alternate Models    (TOP)    (TABLE)

Arkansas presents guidelines for construction of two alternate models of nursing homes: Green House and HomeStyle homes. For HomeStyle facilities, Arkansas explains that, "the construction and operation of HomeStyle facilities is a pilot project of the State of Arkansas to determine the efficacy of an alternative long-term care model." Alternatively, "Green House™ facilities are an attempt to enhance residents' quality of life through the use of a non-institutional facility model resulting in a residential-style physical plant and specific principles of staff interaction." Florida provides guidance for the building of household design model facilities for person-centered care, which includes the following regulations about laundry facilities: "If the household design model for person centered care is utilized and if required by the functional program, resident laundry facilities including washing and drying equipment shall be provided for staff, family or individual resident use for the laundering only of a resident's personal items."

Table Comparing States   (TOP)

Note: If the States in this table are not hyper-linked, their provisions do not appear to address the topic, and therefore, do not alter the Federal Regulatory scope.  The Table summarizes content on Physical Environment - Facility Wide by State (with a link to each State's specific language).  

Link to a downloadable PDF document containing all State requirements on Physical Environment - Facility Wide.

483.70 Physical Environment

Facility Wide
(Note: Certain sections of 483.15, Quality of Life and 483.10 Resident Rights may also apply.)
State Goes beyond Federal Regulations? Subjects Addressed: How State Differs From or Expands On Federal Regulations
Alabama Yes Corridor width, exits, handrails, floor finish, risers, ramps, code compliance, night lights, switches, fixed light, ventilation and fresh air required, parking, access, resident activity space
Alaska Yes Housekeeping; laundry; Compliance with Health and Safety Codes
Arizona Yes Housekeeping;  handrails; temperature range; task lighting; Green House; HomeStyle; Housekeeping; Laundry; Utility Rooms; Equipment and Supplies
Arkansas Yes Housekeeping; laundry; bedpan cleaning room; corridor width; floor finish; carpets; cleanings; fixed light; glare; switches; deodorants shall not be used to cover up odors; parking to be dust free and bed ratio for parking spaces; Intensive Care Unit; Call System; Nurses' Station
California Yes Laundry; housekeeping; room ID; minimum foot candles; Corridors; Storage; Administrative Offices; Fire Alarm; Ceilings, Walls, and Floors; Water Cooler
Colorado Yes Housekeeping; laundry; door fire resistance; door swings; night light; switches, secure area for residents on secure unit
Connecticut Yes Laundry; corridor widths; floor finish; carpets; cleaning; unit determination; room ID; heat; hot water temperature; ventilation; reading light; switches; receptacles; square feet of outdoor space per resident; landscaping requirements; body holding room
Delaware Yes Laundry; floor surfaces shall not be slippery and be kept in good repair. If rugs are used they should be large enough so as not to slip nor curl up at the edges; temperature easily controlled; minimum foot candles; receptacles; low windows; open porches; changes in floor level and danger areas on the grounds shall be protected
District of Columbia Yes Laundry; sewage disposal; 1996 BOCA building code for ramps; stairs; corridors; temperature 71-78 range; minimum foot candles; electrical systems; acoustical insulation and noise reduction; no steps shall be included in outdoor design
Florida Yes Laundry; plant maintenance and housekeeping in accordance with rule 59A-4.049FAChousehold model laundry requirements; reading light; receptacles; Household Design Model for Person-Centered Care; Ducts; Smoke Partitions; Equipment
Georgia Yes Housekeeping; warm floors; stairway width; landing; door swings; floor finish; exits; entrances; handrail specifics; ramps; ceiling light; night light; reading light; switches; receptacles; emergency lighting
Hawaii Yes Locked janitor space; corridor width; handrails; floor finish; humidity controls; ceiling lights; night light; reading light; switches; receptacles; emergency lighting
Idaho Yes Laundry; pest control; janitor's closet; linen service; Housekeeping; Rehabilitation Services; Personal Care; Administrative and Public Areas; Engineering and Equipment; Details and Finishes; Construction Finishes; Lighting
Illinois Yes Housekeeping; laundry; reading lamp
Indiana Yes Pest control; laundry; heating and air conditioning; glare; minimum foot candles
Iowa Yes Soiled workroom; laundry; floor finish; corridor width; obstructions; door width; door swings; door width; code compliance; extension cords; electrical systems; door alarms; switches; minimum foot candles; reading lights; receptacles; emergency plan and equipment; noise reduction criteria; areas of facility with noise reduction; square feet of outdoor space per resident; Partition, Floor, and Ceiling; Sound Transmission; Public Areas; Service Areas; Doors; Plastic; Thresholds
Kansas Yes Waste processing; laundry; janitor's closet; temperature range; night light; reading light; switches; receptacles; minimum foot candles
Kentucky Yes Laundry; janitor's closet; storage for laundry; comfortable and safe temperature
Louisiana Yes Clean linen; water temperature; temperature range; bedside/over the bed light; minimum foot candles
Maine Yes Laundry; housekeeping; handrail specifics; floor finish; cleaning; central heating plant; alternate heating systems; minimum foot candles; activity-specific lighting; reading lamps; outdoor space free from undue noises; smoke; dust; always be accessible; Staff and Visitor Bathrooms
Maryland Yes Housekeeping; temperature range; minimum foot candles; night lights; body holding room
Massachusetts Yes Laundry; housekeeping; temperature range per time of day; switches; code compliance; wattage
Michigan No Michigan regulations do not address this topic.
Minnesota Yes Housekeeping; Handrails; air changes; humidity; variation in temperature permitted if residents agree; switches; rheostats; glare; residential appearance; distortion; night light; receptacles; new construction must provide outdoor space; Housekeeping; Laundry; Storage; Refuse; Mechanical and Electrical; Handrails and Corridors; Drinking Fountains; Barber and Beauty Shop; Dumbwaiters; Elevators; Floors; Piping; Ceilings and Walls; Heating and Cooling; Ventilation; Lighting; Fire Alarm
Mississippi Yes Disposal of liquid and human wastes; location and space requirements for laundry; minimum temperature; minimum foot candles; night lights; locate resident rooms to minimize the entrance of excessive noise; minimize odors; Soundness and Repair; Temperature; Lighting; Screens; Floors; Walls and Ceilings; Handrails; Ramps; Trash Chutes; Housekeeping
Missouri Yes Housekeeping; washable finishes; date specific temperature requirements; inspection schedule; code compliance electric only; night lights; reading lights; extension cords; Doors; Floors; Walls and Ceilings; Heating; Ventilation; Plumbing; Fixtures; Equipment; Electrical Systems; Elevators; Fire Alarms and Sprinklers; Stairways; Fireplaces; Storage; Housekeeping
Montana Yes Housekeeping and maintenance; laundry; pest control
Nebraska Yes Laundry; housekeeping room; corridor width; handrails; must provide outdoor spaces supportive of safety and abilities; Floors; Temperature; Air Distribution; Ventilation; Outlets; Emergency Power
Nevada Yes Maintain sanitary conditions; comfortable noise levels in all areas
New Hampshire Yes Sanitation; variation in temperature permitted if residents agree; code compliance; specific tasks
New Jersey Yes Mattresses and mattress pads maintained floor finish; rugs; cleaning; written heat emergency action plan; variances permitted if resident agree; glare
New Mexico Yes Poison; garbage; linens; room ID; Variation in temperature permitted if residents agree; glare; reading light; prohibitions; facility kept clean and free from offensive odors; accumulations of dirt; rubbish; dust; and safety hazards
New York Yes Janitor's closet; linens; laundry; Construction Requirements and Standards; Details and Finishes
North Carolina Yes Soiled linen room; must provide outdoor space that is accessible; Additions; Horizontal Exits
North Dakota Yes Soiled linen room; must provide outdoor space that is accessible; Site of Facility; Boiler Rooms
Ohio Yes Clean and soiled laundry; individual controls of temperature where possible; written policies for outside range; repairs; bedside light
Oklahoma Yes Linen services; obstructions; ventilation systems; electrical requirements; reading light; flexible light arms; switches; night lights; receptacles; consider locating recreation rooms; exercise rooms and similar spaces to lessen impact of noise; Corridor Traffic; Doors and Windows; Grab Bars; Details and Finishes; Ceilings and Walls
Oregon Yes Laundry services; corridor width; obstructions; handrail specifics; exceptions; room ID; other signage requirements, energy conservation; electrical system; glare; energy consumption; natural light; reflectance value; switches; reading light
Pennsylvania Yes Laundry and janitor's closet; handrail specifics; electric only glare; night lights; receptacles; reading light; must provide outdoor space; Heating; Plumbing and Piping; Ventilation; Electrical Requirements
Rhode Island Yes Housekeeping; laundry service; recyclable waste; handrails; lighting; safety; heat relief; air condition; temperature range; outdoor space to be accessible
South Carolina Yes Utility room; janitor's closet; corridor width; corridor height; switches; minimum foot candles; reading light; night lights; receptacles; Construction and Installation; Hazardous Elements; Fire Protection; Water Supply/Hygiene; Electrical System; Heating, Ventilation, and Air Conditioning
South Dakota Yes Laundry; janitor's closet; obstructions; handrail specifics; minimum foot candles; night lights; switches; Engineering Service and Equipment Areas; Corridors; Ceilings; Insulation; Fire Extinguishers; Floors; Finishes; Elevators; Water Supply and Drainage; Ventilation; Plumbing; Electrical System; Lighting; Soil Treatment; Laundry; Incinerators
Tennessee Yes Water Supply; Sewage; Alarms; Elevators
Texas Yes Laundry; resident use laundry requirements; corridor width; glare; reading light; code compliance; flashlight; minimum foot candles; limitations on deodorant use; Heating, Ventilation, and Air Conditioning; Electrical Systems; Lighting; Space and Equipment; Provisions for Persons with Disabilities; Plumbing; Location and Site; Finishes; Storage; Doors; Smoke Barriers and Fire Protection; Hazardous Areas; Structural Requirements; Mechanical Requirements; Elevators; Housekeeping
Utah Yes General services; waste standards; signs; floor specifics; sound control carpet specifics; signage; code compliance; emergency lighting; heating equipment; receptacles; Mechanical Standards
Vermont Yes Provide clean environment
Virginia Yes Handrails
Washington Yes Linen storage; janitor's closet; pest control; equipment and case work designed, manufactured and installed for ease of proper cleaning and maintenance. Handrails; floor finish; carpets; room ID visible and tactile; light shields; minimum foot candles; night lights; switches; outlets; new construction to utilize an alternative to public address system; outdoor spaces to be provided that are accessible, with landscaping; Walls, Ceilings, and Floors; Accessibility; Lighting; Switches; Electrical Systems; Elevators; Entrances and Exits; Lobbies; Outdoor Areas; Finishes; Accessories; Heating and Cooling; Ventilation; Handwashing Sinks; Drinking Fountains; Plumbing; Housekeeping
West Virginia Yes Establish maintenance program; Accessibility; Parking Areas; Maintenance Program
Wisconsin Yes Maintenance; cleaning; floor finish; cleaning; time of day temperature requirements; reading light; glare; prohibitions; Fire Protection
Wyoming Yes Pest control; cleaning; floor finish; brooms; Line Safety from Fire; Hand Rub Dispensers; Emergency Power; Space and Equipment; Environmental Conditions; Ventilation

 

Complete Transcript of State Requirements on Physical Environment - Facility Wide    (TOP)