10.07.02.27

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=160 BGCOLOR="#006699" TEXT="#080000" background="16d00a03.jpg"> <div> <I><B>V</B></I><FONT SIZE="6" COLOR="#000080" FACE="Verdana" ><I><B>oices</B></I></FONT><FONT SIZE="6" COLOR="#000080" FACE="TimesRoman" ><I><B> </B></I></FONT><FONT SIZE="5" COLOR="#000080" FACE="Verdana" ><I><B>for Quality Care (LTC), Inc.</B></I></FONT></div> <bR> <div> <B>P.O. Box 2251, Leonardtown, MD 20650</B></div> <div> <B>1-888-600-2375</B></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" background="178cae83.jpg"> <div> <B> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="177" BORDERCOLORLIGHT="#000099" BORDERCOLORDARK="#000099" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 640 WIDTH="165"><div> <B>Website Navigation Panel</B></div> <div> Click on the text below to go to other pages in our website<FONT SIZE="2" COLOR="#000000" FACE="Arial" ><B>.</B></FONT></div> <div> <A HREF="index.htm" TARGET="_top" TITLE="Voices for Quality Care"><U><B>Home</B></U></A></div> <div> <A HREF="id45.htm" TARGET="_top" TITLE="About Voices"><U><B>About Voices</B></U></A></div> <div> <A HREF="id59.htm" TARGET="_top" TITLE="Culture Change"><U><B>Culture Change</B></U></A></div> <div> <A HREF="id72.htm" TARGET="_top" TITLE="Beth Bakers Book"><U><B>Beth Baker's Book</B></U></A></div> <div> <A HREF="id49.htm" TARGET="_top" TITLE="Nursing Home Staffing in Maryland"><U><B>Nursing Home Staffing in Maryland</B></U></A></div> <div> <A HREF="id48.htm" TARGET="_top" TITLE="Washington,DC Nursing Home Data"><U><B>Washington, DC Nursing Home Data</B></U></A></div> <div> <A HREF="id180.htm" TARGET="_top" TITLE="Star Ratings"><U><B>Nursing Home Star Ratings</B></U></A></div> <div> <A HREF="id56.htm" TARGET="_top" TITLE="Laws and Regulations"><U><B>Laws and Regulations</B></U></A></div> <div> <A HREF="id47.htm" TARGET="_top" TITLE="Related Websites"><U><B>Related Websites</B></U></A></div> <div> <A HREF="id43.htm" TARGET="_top" TITLE="Contact Us"><U><B>Contact Us</B></U></A></div> <div> <A HREF="id46.htm" TARGET="_top" TITLE="Membership Application"><U><B>Membership Application</B></U></A></div> <div> <A HREF="id53.htm" TARGET="_top" TITLE="Directions to Our Meetings"><U><B>Directions to Our Meetings</B></U></A></div> <div> <A HREF="id52.htm" TARGET="_top" TITLE="Voices ByLaws"><U><B>Voices ByLaws</B></U></A></div> <div> <A HREF="id54.htm" TARGET="_top" TITLE="Terms of Service"><U><B>Terms of Service</B></U></A></div> <div> <A HREF="id55.htm" TARGET="_top" TITLE="Privacy Policy"><U><B>Privacy Policy</B></U></A></div> <div> <A HREF="id176.htm" TARGET="_top" TITLE="Maryland Ombudsman Program"><U><B>MD Ombudman Program</B></U></A></div> <div> <A HREF="id178.htm" TARGET="_top" TITLE="Assisted Living Choices"><U><B>Assisted Living Choices</B></U></A></div> <div> <A HREF="id181.htm" TARGET="_top" TITLE="FamilyCouncil"><U><B>Family Councils</B></U></A></div> <div> <A HREF="id76.htm" TARGET="_top" TITLE="Donation"><U><B>Donate to Voices</B></U></A></div> </tD> </tR> </TABLE></B></div> <bR> </td> <td valign="top" height=320 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <B>10.07.02.27</B></div> <div> <B>.27 Nursing Care Unit.</B></div> <div> <B>A. Size. Nursing care units may not exceed 60 beds. The Department may specify the numbers and types of personnel for each unit which exceeds 40 beds.</B></div> <div> <B>B. Service Areas Required in New Construction or for New Facilities.</B></div> <div> <B>(1) Nurses' Station. The nurses' station shall be centrally located in relation to beds served and shall provide easy view of corridors outside of rooms. The Department may specify the location and size of a nurses' station which serves a nursing care unit exceeding 40 beds. A nursing care unit also shall include:</B></div> <div> <B>(a) A toilet, within the care unit, for the use of personnel, a handwashing sink equipped with 4 inch wrist blades, goose-neck spout, and separate soap dispensers and towel dispensers.</B></div> <div> <B>(b) Medicine storage cabinet with locks. Schedule II drugs shall be kept in separately locked, securely fixed boxes or drawers in a cabinet, under two locks, keyed differently; medicine storage and preparation area with illumination of 100 footcandles at the work counter; preparation area shall include a small sink set into the counter or with drain boards; biological refrigerator. Spaces housing medicine storage cabinet, medicine preparation area, and biological refrigerator shall be under the direct visual control of the nursing or pharmacy staff.</B></div> <div> <B>(c) Nurses' call system.</B></div> <div> <B>(d) Charting desk and supplies.</B></div> <div> <B>(e) Storage space for miscellaneous medical supplies which shall be protected from contamination.</B></div> <div> <B>(f) Sufficient space and equipment for medical records which enables personnel to function in an effective manner and to maintain records on all patients so they are easily accessible.</B></div> <div> <B>(2) Nurses' Station-Existing Facility. Each care unit shall have a nurses' station provided with a medicine storage cabinet and preparation counter or table having adequate lighting overhead. A handsink with hot and cold running water shall be convenient to the nurses' station.</B></div> <div> <B>(3) Because specific temperatures are often required for the safe storage of drugs, the storage facilities shall provide for the following conditions when prescribed:</B></div> <div> <B>(a) Cold-Any temperature not exceeding 8 degrees C (46 </B><B>degrees </B><B>F). A refrigerator is a cold place in which the temperature is maintained thermostatically between 2 </B><B>degrees </B><B>C and 8 </B><B>degrees </B><B>C (46 </B><B>degrees</B><B> and 59 </B><B>degrees </B><B>F). A freezer is a cold place in which the temperature is maintained thermostatically between -20 </B><B>degrees </B><B>C and -10 </B><B>degrees </B><B>C (-4 </B><B>degrees</B><B> and -14 </B><B>degrees </B><B>F).</B></div> <div> <B>(b) Cool-Any temperature between 8 </B><B>degrees </B><B>C and 15 </B><B>degrees </B><B>C (46 </B><B>degrees</B><B> and 59 </B><B>degrees </B><B>F). An article for which storage in a cool place is directed may, alternatively, be stored in a refrigerator, unless otherwise specified in the individual monograph.</B></div> <div> <B>(c) Room Temperature-The temperature prevailing in a working area. Controlled room temperature is a temperature maintained thermostatically between 15 degrees C and 30 degrees C (59 degrees and 86 degrees F).</B></div> <div> <B>(d) Warm-Any temperature between 30 degrees C and 40 degrees C (86 degress and 104 degrees F).</B></div> <div> <B>(e) Excessive Heat-Any temperature above 40 degrees C (104 degrees F).</B></div> <div> <B>(f) Protection from Freezing. When, in addition to the risk of breakage of the container, freezing subjects a product to loss of strength or potency, or to destructive alteration of the dosage form, the container label bears an appropriate instruction to protect the product from freezing.</B></div> <div> <B>(g) Storage under Non-specific Conditions. When no specific storage directions or limitations are provided in the individual monograph, it is to be understood that the storage conditions include protection from moisture, freezing, and excessive heat.</B></div> <div> <B>(4) Space for Storage of Linen-New Construction and Existing Facilities. Capacity shall be provided for storage of at least two complete changes per bed. Clean linen shall be stored separately from non-clean items.</B></div> <div> <B>(5) Janitors' Closet-New Construction. Each nursing unit shall contain at least one janitors' closet containing a floor receptor or service sink and storage space for housekeeping equipment and supplies. The janitors' closet shall be equipped for handwashing.</B></div> <div> <B>(6) Utility Rooms-New Construction.</B></div> <div> <B>(a) There shall be separate clean and soiled utility rooms in each nursing unit, accessible to the patient area, no more than 120 feet to the most remote patient bedroom. There shall be a separate entrance into each room.</B></div> <div> <B>(b) The clean utility room shall contain:</B></div> <div> <B>(i) Wall and base cabinets with stain resistant counter top;</B></div> <div> <B>(ii) A small sink set into the counter, or with drainboards; sink shall be equipped with gooseneck spout and wrist blades;</B></div> <div> <B>(iii) Adequate storage and work counter space for storage and assembly of supplies for nursing procedures;</B></div> <div> <B>(iv) Provision for storing and transporting clean linen in covered container. Clean linen may also be stored in closed linen carts or rooms exclusively provided for this purpose, if approved by the Department.</B></div> <div> <B>(c) The soiled utility room shall contain:</B></div> <div> <B>(i) Work counter with sink, gooseneck faucet, and wrist blades;</B></div> <div> <B>(ii) A separate wall-hung hand sink for handwashing, equipped with wrist blades and soap and towel dispensers;</B></div> <div> <B>(iii) Space for waste receptacles and soiled linen receptacles; provision for storing and transporting soiled linen in covered leakproof containers;</B></div> <div> <B>(iv) Equipment, approved by the Department, to clean and sanitize bedpans, urinals, and basins.</B></div> <div> <B>(7) Utility Rooms-Existing Facility. In existing facilities service areas shall be provided for patient care items which are acceptable to the Department.</B></div> <div> <B>C. Call System-New Construction. A call system shall be installed and maintained in operating order in all nursing units. Call systems shall be maintained in a manner that will provide visible and audible signal communication between nursing personnel and patients. The minimum requirements are:</B></div> <div> <B>(1) A call station or stations providing detachable extension cords to each patient's bed in the patients' rooms. These extension cords shall be readily accessible to patients at all times.</B></div> <div> <B>(2) A visible signal in the corridor above the corridor door of each patient's bedroom, visible from all parts of the corridor.</B></div> <div> <B>(3) An audible signal and a nurses' call enunciator indicating the room from which the call originates or an alternate system approved in writing by the Department, shall be located at the nurses' station. The sounding of the audible signal shall be continuous or intermittent until answered. The audible signal may not be turned off at the nursing station.</B></div> <div> <B>(4) A call system shall be provided in each patient's toilet room, bathroom, and shower stall in locations easily accessible to the patients. The call system shall enable patients in the rehabilitation area to summon rehabilitation staff.</B></div> <div> <B>(5) The nurses' call system shall be so designed as to require resetting at the station where the call originates.</B></div> <div> <B>D. Call System-Existing Facilities. Existing facilities (those facilities licensed at the time this regulation becomes effective) shall provide some method/means of a patient summoning aid that shall include as minimum a combined visual and audible signal that is audible at the nurses' station and simultaneously activates a light located in the hall, outside of and adjacent to the patient's room. The activating device for those signals shall be located in each patient's room and each and every bathing compartment and toilet room or compartment used by patients. Exceptions may be made in part at the discretion of the Department for an individual facility only when the facility can demonstrate compliance with the intent of this section by showing an effective patient call system to provide quality patient care.</B></div> <div> <B>E. Drinking Fountains. One public drinking fountain shall be provided one each floor, usable from a wheelchair.</B></div> <bR> </td> </tr></table></body>