CHAPTER 61
MINIMUM PHYSICAL STANDARDS FOR
NURSING FACILITIES
[Prior to 7/15/87, Health Department[470] Ch 61]
481—61.1(135C) Definitions. Definitions in rules 481—58.1(135C) and 481—59.1(135C) are incorporated by reference as part of this chapter.
481—61.2(135C) Variances. Procedures for requesting a variance in rules 481—58.2(135C) and 481—59.2(135C) are incorporated by reference as part of this chapter. Certain resident populations, conditions in the area, or the site may justify variances. In specific cases, variances to the rules may be granted by the director after the following conditions are met:
	1.	The design and planning for the specific property shall offer improved or compensating features which provide equivalent desirability and utility;
	2.	Alternate or special construction methods, techniques, and mechanical equipment shall offer equivalent durability, utility, safety, structural strength and rigidity, sanitation, odor control, protection from corrosion, decay and insect attack, and quality of workmanship;
	3.	The health, safety or welfare of any resident shall not be endangered;
	4.	Variations are limited to the specific project under consideration and shall not be construed as establishing a precedent for similar acceptance in other cases;
	5.	Occupancy and function of the building shall be considered; and
	6.	Type of licensing shall be considered.
481—61.3(135C) General requirements. Nursing facilities shall contain the elements described in this chapter and shall be built in accordance with these construction requirements. Elements available through affiliation with a connected hospital need not be duplicated. (III)
	61.3(1) This chapter covers both new and existing construction, except as noted in paragraphs “a” through “f” below. In various sections of the rules, specific provisions for existing structures which differ from those for new construction are indicated by a notation at the end of the rule as follows:
	a. 	(Exception 1): Rule does not pertain to facilities built before 1957;
	b. 	(Exception 2): Rule does not pertain to facilities built before 1972;
	c. 	(Exception 3): Rule does not pertain to facilities built according to plans approved by the department prior to January 1, 1977;
	d. 	(Exception 4): Rule does not pertain to facilities built according to plans approved by the department prior to November 21, 1990;
	e. 	(Exception 5): Rule does not pertain to facilities built according to plans approved by the department prior to May 6, 1992;
	f. 	(Exception 6): Rule does not pertain to facilities built or renovated according to pans approved by the department and designated as a person directed care environment.
	61.3(2) The rules apply to renovations, additions, functional alterations, or change of space utilization to existing facilities which are completed after November 21, 1990. Conversion of a building or any of the parts not currently licensed as a nursing facility must meet the rules governing construction of new facilities. (III)
	61.3(3) The building site is subject to departmental approval.
	a. 	An 8½- by 11-inch vicinity map shall be submitted which indicates the site location and address. If possible, a city map should also be included. (III)
	b. 	The neighborhood environment shall be free from excessive noise, dirt, polluted or odorous air. (III)
	c. 	There shall be an area available for outdoor activities. Open air porches and decks may be included in meeting this requirement. (III)
	d. 	The outdoor area shall be 40 square feet per licensed bed. (III) (Exception 4)
	e. 	Each facility shall have on-site parking space for residents, employees, staff and visitors. (III)
The following minimum parking spaces shall be provided:
	(1)	In facilities of 20 or more beds, one space for each 5 beds, plus one space for each day-shift employee. (III) (Exception 4)
	(2)	In facilities of 19 or fewer beds, one space for each 3 beds, plus one space for each day-shift employee. (III) (Exception 4)
	(3)	Handicapped parking as appropriate, or a minimum of one space. (III) (Exception 4)
	f. 	Accessibility shall be provided for emergency and delivery vehicles. (III) (Exception 3)
	61.3(4) When new construction, an addition, functional alteration, or conversion of an existing building is contemplated, the licensee or applicant for license shall:
	a. 	File a detailed and comprehensive program of care as set forth in rules 481—58.3(135C) and 481—59.3(135C) which includes a description of the specific needs of the residents to be served, and any other information the department may require. (III)
	b. 	Submit a preliminary site plan and floor plan. The design shall meet the requirements of all applicable state statutes, fire codes, federal regulations and local ordinances. The most stringent standards shall apply in resolving conflicts. (III)
	c. 	Submit legible working drawings and specifications showing all elements of construction, fixed equipment, and mechanical and electrical systems to the department and to the state fire marshal. These construction documents shall be prepared by or under the direct supervision of a registered architect or engineer. The architects or engineers shall be working within their field of registration and shall be licensed to practice in Iowa. All construction documents shall be certified by and bear the seal of the architect or engineer responsible for the project. Each project shall be evaluated for its impact on the facility. Projects not affecting primary structural elements may, at the discretion of the department, be excluded from this rule. (III)
	d. 	Receive written approval from the department and the state fire marshal’s office before starting construction. If on-site construction above the foundation is not started within 12 months of the date of final approval of the working drawings and specifications, the approval shall be void and the plans and specifications shall be resubmitted. (III)
	e. 	Have plans and specifications approved in writing by the department and the state fire marshal’s office before a change in the building is made. The applicant is responsible for ensuring that construction proceeds according to approved plans and specifications. (III)
	61.3(5) For new construction, an addition, functional alteration or conversion of an existing building, it is the responsibility of the owner or an agent to notify the department at all of the following intervals and wait for inspection by the department before proceeding:
	a. 	At least 30 days before commencement of construction on the premises; (III)
	b. 	At least 30 days before pouring the concrete floor slab; (III)
	c. 	After completion of the mechanical or electrical rough-in and 30 days before enclosing walls; (III)
	d. 	Thirty days before the completion of the project. (III)
	61.3(6) Rescinded IAB 12/6/06, effective 1/10/07.
	61.3(7) The facility shall be made accessible to and usable by persons with physical handicaps in accordance with the requirements of the American National Standards Institute (ANSI) document A117.1-1986 except where more stringent requirements are specified in these rules. (II, III) (Exception 3)
	61.3(8) No room in a basement shall be occupied for living purposes unless the room meets all the requirements of the department and is approved by the department as fit for human habitation. (III)
	61.3(9) A foundation drainage system shall be installed around any portion of a building containing a basement. (III) (Exception 4)
	a. 	The foundation drainage system shall be installed at a slope so the water will run to a low point and then run into a sump pit in the basement, into a storm sewer system, or out to surface drainage. (III) (Exception 4)
	b. 	The foundation drainage system shall not be connected to the sanitary sewer system. (III) (Exception 4)
	c. 	The high point of the flow line shall be 4 inches below the elevation of the basement floor slab. (III) (Exception 4)
	61.3(10) Projects involving alterations of and additions to existing buildings shall be programmed and phased so that on-site construction will minimize disruptions of living functions. Access, exits and fire protection shall be maintained so that the safety of the occupants is not jeopardized during construction. (II, III)
	61.3(11) If a resident exit is below the outside grade level, at least one exit from that level shall include an approved ramp. (III) (Exception 4)
	61.3(12) Any equipment found to be hazardous, or which fails to meet the purposes for which it is intended, shall be repaired, removed or replaced. (III)
	61.3(13) Upon completion of the contract, the department shall be provided a complete set of approved record drawings, specifications, and addenda which show all construction, fixed equipment, mechanical and electrical systems. (III) (Exception 4)
481—61.4(135C) Typical construction. This rule contains construction requirements that are typical in all areas of the building.
	61.4(1) Details and finishes shall provide a high degree of safety for the occupants by minimizing the opportunity for accidents. Hazards such as sharp corners shall be avoided. (III)
	61.4(2) Minimum exit corridor widths shall be 8 feet in new construction and not less than 4 feet for renovated facilities or as approved by the department. Corridors in adjunct areas not intended for the housing of or use by residents may be a minimum of 6 feet in width. (III) Handrails may project into corridors.
	61.4(3) Drinking fountains, telephone booths, vending machines or similar items shall not project into the required width of any corridor. (III)
	61.4(4) Minimum width doors to all rooms which need access for beds or stretchers shall be at least 3 feet 8 inches. Doors to resident toilet rooms and other rooms which need access for wheelchairs shall have a minimum clear opening width of at least 32 inches. (III)
	61.4(5) Handrails shall be provided on both sides of corridors and stairways used by residents. There shall be a clear distance of 1½ inches between handrail and wall. (III)
	a. 	Handrails shall be mounted with the top surfaces 31 to 34 inches above the finished floor. (III) (Exception 2)
	b. 	The end of handrails shall return to the wall. (III) (Exception 2)
	61.4(6) Stairs, stair landings, balconies, ramps and aisles located along the edge of open-sided floors and mezzanines shall have guards to prevent falls over the open side. (III)
	a. 	The heights of guards shall be at least 42 inches. (Exception 4)
	b. 	Open guards shall have intermediate rails or an ornamental pattern so a sphere 6 inches in diameter cannot pass through. (Exception 4)
	61.4(7) Landings shall be provided at the top and the bottom of each stair run. There shall be an approved landing which complies with 5-2.2.4.3 of the 1985 Life Safety Code between the top step and the doorway regardless of the direction of the door swing. (III) (Exception 2)
	61.4(8) Toilet and bath facilities shall have an aggregate outside window area of at least 4 square feet. Facilities which have a system of mechanical ventilation are exempt from this regulation. (III)
	61.4(9) No doors shall swing into the exit corridor except doors to spaces such as small closets which are not subject to entry, resident bedroom doors as indicated in subrule 61.5(7), paragraph “j,” or those required by the state fire marshal. (III)
	61.4(10) All doors, except elevator doors, opening from corridors shall be swing-type. (III)
	61.4(11) Mirrors shall be provided in toilet rooms and resident bathrooms.
	a. 	Mirrors in resident bathrooms or toilet rooms shall be arranged for convenient use by residents in wheelchairs as well as by residents in a standing position. (III)
	b. 	The bottom of the mirror shall be no more than 40 inches above the floor. (III) (Exception 3)
	61.4(12) All lavatories shall have paper towel dispensers. (III)
	61.4(13) Screens of 16 mesh per square inch shall be provided at all exterior openings and in any exterior door that is normally left open. (III)
	61.4(14) Screen doors shall swing outward and be self-closing. At the discretion of the state fire marshal, screens for fire doors may swing in. (III)
	61.4(15) Fire escape or porch railings and protected barrier enclosures shall be designed to resist a horizontal thrust of 50 pounds per running foot of railing. (III)
	61.4(16) Exposed heating pipes, hot water pipes, or radiators in rooms and areas used by or within reach of residents shall be covered or protected to prevent injury or burns. (II, III)
	61.4(17) All fans located within 7 feet of the floor shall be approved by Underwriters’ Laboratories Inc.	(UL) and shall have a guard with no greater than ½-inch spacing in one direction. (III)
	61.4(18) Finishes shall be as follows:
	a. 	Floors shall be easy to clean and shall have wear resistance appropriate to the location involved. Floors in kitchens and related spaces shall be waterproof and nonabsorbent. In all areas where floors are subject to wetting, they shall have a slip-resistant finish. (III)
	b. 	Ceilings shall be washable or easy to clean. (III) This requirement does not apply to boiler rooms, mechanical and building equipment rooms, shops or similar spaces.
	c. 	Ceilings in the dietary and food preparation areas shall be cleanable and have a finished covering over all pipe and duct work. (III) (Exception 2)
	d. 	Ceilings shall be acoustically treated in nursing areas, day rooms, dining rooms, recreation areas, waiting areas and corridors in resident areas. (III)
	e. 	Wall assemblies shall present cleanable and continuous surfaces to the interior of resident rooms and corridors. (III) (Exception 4)
	61.4(19) Partition, floor and ceiling construction in resident areas shall comply with noise reduction criteria in the following table. The requirements set forth in this table assume installation methods which will not appreciably reduce the efficiency of the assembly as tested. 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. (III)
Table 1

(Exception 2)	Airborne Sound Transmission Class
(STC)*	
 	Partitions	Floors	
Resident’s room to resident’s room	35	35	
Corridor to resident’s room	35	35	
Public space to resident’s room**	40	40	
Service areas to resident’s room***	50	50	
*Sound transmission (STC) shall be determined by tests in accordance with methods set forth in American Society for Testing and Materials (ASTM) Standard E 90 and ASTM Standard E 413.
**Public space includes lobbies, dining rooms, recreation rooms, treatment rooms and similar places.
***Service areas include kitchens, elevators, elevator machine rooms, laundries, garages, maintenance rooms, boiler and mechanical equipment rooms, and similar spaces of high noise. Mechanical equipment located on the same floor or above residents’ rooms, offices, nurses’ stations, and similar occupied spaces shall be effectively isolated from the floor.
	61.4(20) The following ceiling heights are required:
	a. 	Corridors, storage rooms, residents’ toilet rooms, and other minor rooms—not less than 7 feet 6 inches; (III) (Exception 2)
	b. 	Boiler room—not less than 2 feet 6 inches above the main boiler header and connecting piping with adequate headroom under piping for maintenance and access; (III) (Exception 2)
	c. 	All other rooms—not less than 8 feet; (III) (Exception 2)
	d. 	Ceiling-mounted equipment, luminaries, suspended tracks, or rails and pipes located in the path of normal traffic shall be not less than 6 feet 8 inches above the floor; (III) (Exception 3)
	e. 	Boiler rooms, food preparation centers, and laundries shall be insulated and ventilated to prevent any floor surface above from exceeding 10°F above the ambient room temperatures. (III)
	61.4(21) Doors, sidelights, and windows in which the glazing extends below 31 inches from the floor shall have a horizontal mullion or railing 31 to 34 inches above the finished floor. Those shall be safety glass, plastic glazing material, or wire glass when required by the state fire marshal. (III) (Exception 4) All replacement glass shall meet this standard. (III)
	61.4(22) All sheet plastic and molded plastic insulation in living spaces, attics, and crawl spaces shall be covered with an approved thermal barrier. The thermal barrier shall be constructed of materials with no less than the fire protection qualities of ½-inch fire-resistant gypsum board or as accepted by Uniform Building Code (UBC) Sec.	1712(b)2, 1985 Edition. (III)
	61.4(23) Thresholds shall be low profile, and expansion joint covers shall be flush with the floor surface to facilitate the use of wheelchairs and carts. (III)
481—61.5(135C) Nursing care unit.
	61.5(1) A nursing care unit shall include or have access to the following areas: (III)
	a. 	Nurses’ space,
	b. 	Clean work area,
	c. 	Medication storage,
	d. 	Resident rooms,
	e. 	Resident toilets and baths,
	f. 	Soiled work area, and
	g. 	Enclosed clean linen storage.
	61.5(2) There shall be a secure place or method for storing resident information and supplies. (III)
	61.5(3) A clean work area for storage and assembly of clean supplies shall contain a work counter and sink. (III)
	61.5(4) Lockable medication storage including the storage of Schedule II drugs shall be provided. (III)
	61.5(5) and 61.5(6) Rescinded IAB 12/6/06, effective 1/10/07.
	61.5(7) Resident rooms shall meet at least the following requirements:
	a. 	Bedrooms shall open directly into a corridor or common living area and shall not be used as a thoroughfare. (III)
	b. 	The minimum room area, exclusive of closets, toilet rooms, lockers, wardrobes, vestibules, and corridor door swings shall be at least 100 square feet in one-bed rooms and 80 square feet per bed in multibed rooms. Usable floor space shall be no less than 8 feet in any direction. All resident rooms shall be designed with a minimum of 3 feet of space between beds, lateral walls or room furnishings. (III) (Exception 4)
	c. 	Each resident room shall be provided with light and ventilation by means of a window or windows with a minimal net glass area equal to at least 10 percent of the total floor area. The windows shall open without the use of tools. Provisions for locking windows must be approved by the state fire marshal. The window sill shall not be higher than 3 feet above the floor. (III)
	d. 	There shall be a wardrobe or closet in each resident’s room. The minimum clear dimensions shall be 1 foot 10 inches deep by 2 feet 6 inches wide of clear hanging space for each resident. A clothes rod and shelf shall be provided. See subrule 61.7(9). (III) (Exception 2)
	e. 	In a shared closet, segregated portions shall be established. Each wardrobe and closet in each resident room shall have a door. (III) (Exception 4)
	f. 	No bedroom shall have the floor on the window wall more than 2 feet 6 inches below the adjacent grade level. (III)
	g. 	Fixtures or storage shall be provided to hold individual towels and washcloths. (III)
	h. 	No part of any room shall be enclosed, subdivided or partitioned unless that part is separately lighted and ventilated and meets such other requirements dictated by usage and occupancy. Closets used for the storage of resident’s clothing are excepted. (III)
	i. 	Each resident bedroom shall have a door. The door shall be the swing type and shall swing in, unless fully recessed. (III)
	j. 	Resident rooms shall be designed to permit no more than two beds. (III) (Exception 4)
	k. 	Each resident bedroom shall be designed so the head of the bed is not in front of a window, heat register, or radiator. (III)
	l. 	One lavatory shall be provided in each resident room. The lavatory may be omitted from a room when a lavatory is located in a connecting toilet room, which serves not more than two beds. (III) (Exception 4)
	m. 	Full visual privacy for each resident shall be provided in multibed rooms. Portable screens are not acceptable. (III)
	n. 	Each resident 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 rooms. (III) (Exception 3)
	o. 	No resident room shall be located more than 150 feet from an exit. (III)
	61.5(8) Resident toilet rooms shall be provided according to the following standards:
	a. 	Each resident toilet room shall have a swing or sliding door. There shall be a minimum clear opening of 32 inches. (II, III) (Exception 2)
	b. 	The door shall not be a pocket door or swing into the toilet room. (III) (Exception 4)
	c. 	Toilets shall be accessible to and usable by residents with handicaps. (III) (Exception 3)
	d. 	All toilet rooms shall have mechanical exhaust ventilation. (III) (Exception 2)
	e. 	Grab bars shall be provided at all toilets. (III)
	f. 	Water closets shall be 17 to 19 inches high measured to the top of the seat. (III) (Exception 4)
	61.5(9) Each facility must provide bathing systems that meet the needs of the residents. Bathing facilities shall be provided according to the following standards:
	a. 	There shall be at least one bathing unit for each wing on each floor of a facility with a minimum of one unit for each 20 residents or part of 20. In facilities licensed for 15 or fewer beds, at least one bathing unit shall be provided for each five residents. (III)
	b. 	Every bathing unit shall have a toilet and sink which are accessible to and functional for persons with physical disabilities. (III) (Exception 2)
	c. 	Privacy for dressing and bathing shall be provided in bathrooms. (III)
	d. 	All bathrooms shall have mechanical ventilation. (III) (Exception 2) See subrule 61.11(3), paragraph “c.”
	e. 	Showers shall be at least 4 feet by 5 feet without curbs, and designed to permit use from a wheelchair. All tubs and shower floors shall have slip-resistant surfaces. (III) (Exception 4)
	f. 	Bathing areas shall have a swinging door which swings into the area. (III)
	g. 	Lavatories intended for use by residents shall be securely anchored to withstand an applied vertical load of not less than 250 pounds on the front of the fixture and shall be usable by people in wheelchairs. (III)
	h. 	Hot water and drain pipes under lavatories shall be insulated or shielded per ANSI standard A117.1-1986. (III) (Exception 4)
	i. 	Soap holders shall be provided at showers and bathtubs. Soap holders in showers shall be recessed. (III) (Exception 2)
	j. 	All toilet, bath and shower facilities shall be equipped with grab bars and adequate safety devices. The bars shall have a diameter of 1¼ to 1½ inches and have a 1½-inch clearance to walls, shall be anchored with sufficient strength to sustain a concentrated load of 250 pounds, and shall meet the requirements of the ANSI document A117.1-1986. (II, III)
	k. 	Raised toilet seats shall be available for residents as needed. (III)
	l. 	Showers shall be equipped with a shower head on the end of a flexible hose. (III) (Exception 2)
	61.5(10) The soiled work area shall contain a clinical flush-rim service sink, a work counter, waste and soiled linen receptacles and a two-compartment sink. One compartment of the double sink shall be at least 10 inches deep for cleaning and sanitizing equipment such as bedpans, urinals and wash basins. Clinical flush-rim service sinks shall have an integral trap in which the upper portion of the water surface shall provide a visible trap seal. (III) (Exception 3)
	61.5(11) Enclosed clean linen storage shall be separate from the clean work area. (III) (Exception 4)
	61.5(12) A seclusion room may be used in an intermediate care facility for persons with mental illness. When a seclusion room is used, it must meet the following standards. A seclusion room shall:
	a. 	Be located where direct care staff can provide direct supervision; (I, II, III)
	b. 	Have only one door which swings out but does not swing into a corridor; (II, III)
	c. 	Have only locking devices that are approved by the state fire marshal; (I, II, III)
	d. 	Have unbreakable, fire-safe vision panels arranged to permit observation of the resident. The arrangement shall ensure resident privacy and prevent casual observation by visitors or other residents; (I, II, III)
	e. 	House only one resident at a time; (I, II, III)
	f. 	Have an area of at least 60 square feet, but not more than 100 square feet; (II, III)
	g. 	Be constructed to protect against the possibility of hiding, escape, injury and suicide; (I, II, III)
	h. 	Have construction of the room area, including floor, walls, ceilings, and all openings approved in writing by the state fire marshal prior to construction or alteration of a room. Padding materials, if used, shall be approved in writing by the state fire marshal; (I, II, III)
	i. 	Contain only vandal- and tamper-resistant fixtures and hardware; (I, II, III)
	j. 	Contain no electrical receptacles; (I, II, III)
	k. 	Have exterior windows or a second exit for fire safety; (I, II, III)
	l. 	Have security screens with tamper-resistant locks on exterior windows. The locks must be approved in writing by the state fire marshal. Privacy of the resident shall be ensured; (I, II, III)
	m. 	Contain an exhaust ventilation system with a fan located at the discharge end of the system; (II, III)
	n. 	Have electrical switches for the light and exhaust ventilation systems installed outside the room; (I, II, III)
	o. 	Have an emergency call system for staff located outside the room near the observation window; (II, III) and
	p. 	Be built with materials that are easily maintained and sanitized. (III)
481—61.6(135C) Facility support area.
	61.6(1) Each facility shall include or provide for the following:
	a. 	Living area,
	b. 	Dining area,
	c. 	Personal care area,
	d. 	Equipment storage area,
	e. 	Therapy area, and
	f. 	An isolation area or method for isolating a resident, if necessary.
The size of a facility support area shall depend upon the number of licensed beds. (III)
	61.6(2) Where space is provided for multipurpose dining, activities, or recreational purposes, the area shall total at least 30 square feet per licensed bed for the first 100 beds and 27 square feet per licensed bed for all beds in excess of 100. An open area of sufficient size shall be provided to permit group activities such as religious meetings or presentation of demonstrations or entertainment. (III)
	61.6(3) Where space is provided to be used only for activities and recreational purposes, the area shall be at least 15 square feet per licensed bed. At least 50 percent of the required area must be in one room. (III) (Exception 4)
	a. 	The activity area shall be readily accessible to wheelchair and ambulatory residents.
	b. 	The activity area shall be of sufficient size to accommodate necessary equipment and to permit unobstructed movement of wheelchairs, residents and personnel responsible for instructing and supervising residents.
	c. 	Space to store recreational equipment and supplies for the activities program shall be within, or convenient to, the area or areas. Locked storage shall be available for potentially dangerous items such as scissors, knives and toxic materials. (II, III)
	61.6(4) Where the dining and recreation areas are separated, each area shall have:
	a. 	A minimum of 180 square feet of usable floor space and be at least 10 feet in any one direction. (III)
	b. 	An area of at least 15 square feet per licensed bed when the area is used for dining only. (III) (Exception 4)
	61.6(5) Access to a personal care area with barber and beauty shop facilities shall be provided. (III) (Exception 4)
	61.6(6) An equipment storage area shall be available for each nursing unit for immediate storage of walkers, wheelchairs, bed rails, intravenous stands, inhalators, air mattresses and similar bulky equipment. (III)
	61.6(7) An alcove or area shall be provided for parking stretchers and wheelchairs. (III) (Exception 2)
	61.6(8) Rescinded IAB 12/6/06, effective 1/10/07.
	61.6(9) A therapy area shall contain a lavatory or sink, a full-length mirror, a storage facility, a work counter, or space for the appropriate equipment and shall have a minimum floor area of 180 square feet. (III) (Exception 3)
	61.6(10) Plans and methods for the isolation of residents, if necessary, shall be provided. (III)
481—61.7(135C) Service area.
	61.7(1) A service area shall contain the following rooms or areas:
	a. 	Dietetic service area;
	b. 	Laundry area;
	c. 	General storage area;
	d. 	Mechanical room, electrical, maintenance areas and janitor’s closets.
The size of a service area shall depend upon the number of licensed beds. (III)
	61.7(2) The construction and installation of equipment of the dietetic service area shall comply with, or exceed, the minimum standards set forth in the 1999 Food Code, U.S. Public Health Service, Food and Drug Administration, Washington, DC 20204. (III) (Exception 4)
	a. 	Detailed layout plans and specifications of equipment shall be submitted to the department for review and approval before the new construction, alterations or additions to existing kitchens begin. (III)
	b. 	A dining area for residents and staff shall be provided outside of the food preparation area. (III)
	c. 	The dishwashing area shall have mechanical dishwashing equipment designed to handle racks that are coordinated with mobile dish storage equipment. (III) Either conventional or chemical dishwashing equipment may be used.
	(1)	Water temperature requirements for conventional dishwashing equipment are found in 61.11(4)“c”(8), Table 3. (III)
	(2)	A three-compartment pot and pan sink shall be provided for soaking and washing utensils. It must be large enough for sanitizing all sizes of utensils used and must provide easy access to the dishwasher. (III) (Exception 1) (Exception 6)
	(3)	Machines using chemicals for sanitation may be used provided that:
	1.	The temperature of the wash water is not less than 120° F. (III)
	2.	The wash water is kept clean. (III)
	3.	Chemicals added for sanitation purposes are automatically dispensed. (III)
	4.	Utensils and equipment are exposed to the final chemical sanitizing rinse in accordance with manufacturers’ specifications for time and concentration. (III)
	5.	The chemical sanitizing rinse water temperature is not less than 75° F nor less than the temperature specified by the machine’s manufacturer. (III)
	d. 	The dietetic service area shall be designed to separate clean and dirty areas in accordance with the 1999 Food Code, U.S. Public Health Service, Food and Drug Administration, Washington, DC 20204. (III)
	e. 	A hand-washing lavatory without mirror shall be provided in the dietetic service area. (III) (Exception 2)
	f. 	There shall be refrigerated storage for at least a three-day supply of perishable food. (III)
	g. 	There shall be available storage for at least a seven-day supply of staple food. (III)
	h. 	No less than 2½ square feet of shelving per resident bed shall be provided for staple food storage. (III)
	i. 	A storage area for carts shall be provided. (III)
	j. 	Provisions for sanitary waste disposal and storage of waste shall be provided on the premises. (III)
	k. 	A toilet room with lavatory conveniently accessible for the dietary staff shall be provided. The toilet room shall not open directly into the dietary area. (III)
	l. 	There shall be an outside service entrance to the food service area which does not open directly into the food preparation area. (III) (Exception 6)
	m. 	The food service area shall be at least 10 square feet per resident bed. Variances to this rule may be granted on the basis of equipment and serving methods used. (III) (Exception 4) (Exception 6)
	n. 	Where meals are provided by a health care facility or by a commercial food service, the preparation, storing and serving of the food and the utensil sanitizing procedures shall meet the requirements of these rules. (III)
	o. 	Mechanical ventilation shall be provided as required in subrule 61.11(3), paragraph “i.” (III)
	61.7(3) A janitor’s closet shall be provided for storage of housekeeping supplies and equipment. The closet shall contain a floor receptor or service sink. The door to the janitor’s closet shall be equipped with a lock. Locked storage shall be provided for chemicals. (III)
	61.7(4) Where linen is processed on site, the following shall be provided:
	a. 	A clean, dry, well-lighted laundry processing room;
	b. 	A soiled linen holding area;
	c. 	A clean linen area;
	d. 	Linen cart storage;
	e. 	Lockable storage for laundry supplies; (Exception 4) and
	f. 	One janitor’s closet or alcove in the immediate vicinity of the laundry. (III) (Exception 2)
	61.7(5) In the laundry, a work-flow pattern shall be established in which soiled linen is not transported through the clean area to the soiled area. Two distinct areas physically separated, not necessarily by a wall, are required. (III)
	61.7(6) A handwashing lavatory shall be located between the soiled area and the clean area. (III) (Exception 4) In facilities licensed for 15 or fewer beds, a handwashing lavatory located in the laundry area may meet this requirement.
	61.7(7) The laundry room in any facility not using off-site processing which serves more than 20 residents shall contain at least 125 square feet of available floor space. (III)
	61.7(8) Where linen is processed off the site, a soiled linen holding room and a clean linen receiving and storage area shall be provided. (III)
	61.7(9) General storage areas totaling not less than 14 square feet per bed shall be provided. If each resident has a 4-foot wide closet in the bedroom, the general storage area per bed may be reduced from 14 square feet to 10 square feet per resident. (III) (Exception 4) Storage areas are not required to be located in only one room.
	a. 	Storage areas for linens, janitor’s supplies, sterile nursing supplies, activities supplies, library books, office supplies, kitchen supplies and mechanical plant accessories shall not be included as part of the general storage area and are not required to be located in the same area. (III)
	b. 	Thirty percent of the general storage area may be provided in a building outside the facility easily accessible to personnel. (III)
	61.7(10) A mechanical room and electrical equipment room which may include a maintenance area in facilities of less than 100 beds shall be provided. (III)
	a. 	This room may be used for storage of noncombustible material. (II, III)
	b. 	Noncombustible material shall not be stored close to or hinder access to any fuel-fired equipment, or electrical panels. (III)
	c. 	These areas shall not be included in calculating the general storage areas required by subrule 61.7(9), paragraph “a.” (III)
	(1)	There shall be a maintenance shop in facilities of 100 or more beds. (III) (Exception 2)
	(2)	Yard equipment storage may be provided in a separate room or building. This shall not be included in the general storage area. (III)
	(3)	No portable fuel-operated equipment shall be housed inside a facility unless it is separated by at least a two-hour fire separation which has been approved by the state fire marshal’s office. (III)
481—61.8(135C) Administration and staff area. An administration and staff area shall contain space for the following:
	1.	Administrator’s area;
	2.	Business area;
	3.	Social service area; (Exception 4)
	4.	Storage space for office equipment and supplies; (Exception 3)
	5.	Conference or training area; (Exception 3)
	6.	Staff lounge;
	7.	Staff toilet room with lavatory and water closet;
	8.	Activity director’s area; (Exception 4)
	9.	Director of nurses’ area; (Exception 2)
	10.	Food service supervisor’s area; (Exception 4)
	11.	Reception and information counter or desk, which may be combined in the business area; and
	12.	An area for the safekeeping of coats and personal effects of staff. (III)
The size and location of an administration and staff area shall depend upon the number of licensed beds within the nursing unit. (Exception 6)
481—61.9(135C) Public area.
	61.9(1) Every facility shall provide a separate toilet for the public with a lavatory and water closet. (III)
	a. 	Public toilets shall be accessible to and usable by people who have a physical handicap. Equipment shall meet the ANSI document A117.1-1986. (III) (Exception 3)
	b. 	In facilities over 15 beds, there shall be public toilet rooms for both men and women. (III) (Exception 4)
	c. 	Public toilets shall contain a 60-inch by 60-inch clear floor area, free from obstructions. (III) (Exception 3)
	61.9(2) A telephone shall be accessible to residents within the facility to make personal calls. The telephone shall be accessible to and functional for people who have a physical handicap. (III)
481—61.10(135C) Elevator requirements. (All provisions in this rule are subject to Exception 2.) All facilities where either resident beds or other facilities for residents are not located on the first floor shall have electric or electrohydraulic elevators as specified in this rule. Facilities for residents include, but are not limited to, diagnostic, recreation, resident dining or therapy rooms. The first floor is the floor first reached from the main front entrance. Elevators shall comply with division of labor services regulations as promulgated under Iowa Code chapter 89A and 347—Chapters 71 to 78. (III)
	61.10(1) At least one elevator which complies with subrule 61.10(5), paragraph “b,” shall be installed where 1 to 59 resident beds are located on any floor other than the first, or where any facilities for residents are located on a floor other than the first. (III)
	61.10(2) At least two elevators, one of which complies with subrule 61.10(5), paragraph “b,” shall be installed where 60 to 200 resident beds are located on a floor other than the first, or where any facilities for residents are located on a floor other than the first. (III)
	61.10(3) At least three elevators, one of which complies with subrule 61.10(5), paragraph “b,” shall be installed where 201 to 350 resident beds are located on a floor other than the first, or where any facilities for residents are located on a floor other than the first. (III)
	61.10(4) For facilities with more than 350 beds, the number of elevators shall be determined from a study of the facility plan and the estimated vertical transportation requirements. (III)
	61.10(5) The following rules apply to cars and platforms:
	a. 	Elevator cars and platforms shall be constructed of noncombustible material, except that fire-retardant-treated material may be used if all exterior surfaces of the car are covered with metal; (II, III)
	b. 	Elevators used to transport a resident in a bed shall have inside dimensions that will accommodate the resident’s bed and attendants. The dimensions shall be at least 5 feet wide by 7 feet 6 inches deep. Car doors shall have a clear opening of at least 3 feet 8 inches. (II, III)
481—61.11(135C) Mechanical requirements.
	61.11(1) Steam and hot water heating and domestic water heating systems shall comply with the following:
	a. 	Boilers shall be installed to comply with the division of labor services rules promulgated under Iowa Code chapter 89 and 875—Chapters 90 to 96, Iowa Administrative Code. (III)
	b. 	Boiler feed pumps, condensate return pumps, fuel oil pumps and hot water heating pumps shall be connected and installed to provide standby service if any pump malfunctions. (III)
	c. 	Supply and return mains and risers of cooling, heating, and steam systems shall have valves which isolate various sections of each system. Each piece of equipment shall have a valve at the supply and return ends. (III) (Exception 2)
	61.11(2) Insulation shall be provided for the following within the building: (Exception 3)
	a. 	Steam supply and condensate return pipe; (III)
	b. 	Pipe above 125° F, if it is exposed to contact by residents; (II, III)
	c. 	Chilled water, refrigerant, and other process pipe and equipment operating with fluid temperatures below ambient dew point; (III)
	d. 	Water supply and roof drainage pipe on which condensation may occur; (III)
	e. 	Boilers, smoke-breaching and stacks; (III)
	f. 	Hot water pipe above 180° F, and all hot water boilers, heaters, and pipe; and (III)
	g. 	Other pipes, ducts, and equipment as necessary to maintain the efficiency of the system. (III)
Insulation including finishes and adhesives on the interior surface of ducts, pipes, and equipment, shall have a flame-spread rating of 25 or less, and a smoke-develop rating of 50 or less. This shall be determined by an independent testing laboratory in accordance with National Fire Protection Association (NFPA) Standard 255, 1984 Edition. (III) (Exception 3)
Insulation on cold surfaces shall include an exterior vapor barrier. (III)
	61.11(3) The heating system shall be capable of maintaining a temperature of 78° F. (II, III)
The cooling system shall be designed to maintain all living spaces within the comfort zone. The comfort zone is defined in the ANSI/American Society of Heating, Refrigeration and Air Conditioning Engineers (ASHRAE) Standard 55-1981 or the 1985 ASHRAE Fundamentals Handbook. (III) (Exception 4)
	a. 	All air-supply and air-exhaust systems shall be mechanically operated and shall have ducts from a central system to and from each room. All fans serving exhaust systems shall be located at the discharge end of the system. The ventilation rates shown in Table 2 are minimum acceptable rates, and shall not preclude higher ventilation rates. (III) (Exception 2)
	b. 	The bottoms of ventilation openings shall be not less than 3 inches above the floor of any room. (III) (Exception 3)
	c. 	All central systems designed to heat and cool the building with recirculation of air shall be equipped with a minimum 2-inch deep, 8- to 11-pleat per foot, class 2 Underwriters’ Laboratories, self-extinguishing, nonwoven, cotton, downstream, or final filter with a minimum efficiency of 25 to 30 percent and average arrestance of 90 percent, tested in accordance with ASHRAE Standard 52-76. This does not preclude the additional use of a prefilter upstream of the air-handling equipment to extend the service life of the downstream, or final filter. (III) (Exception 5)
	d. 	Evaporative cooling shall not be substituted for direct expansion refrigeration in the air-conditioning system. (III) (Exception 4)
	e. 	Any alternate ventilation system designed to attain an equivalent degree of odor control and purity of air to resident areas shall be considered for approval under conditions in rules 481—58.2(135C) and 481—59.2(135C). (III)
	f. 	Mechanical ventilation over cooking equipment and dishwashing equipment shall be designed to remove hot air and inhibit cold air above hot food or dishes. (III) (Exception 3)
	g. 	Mechanical ventilation shall be provided in food storerooms to maintain temperature and humidity for the type of food being stored. (III) (Exception 4) Facilities built before November 21, 1990, shall provide mechanical ventilation if freezers, refrigerators or compressors are located in the storeroom.
	h. 	Outdoor ventilation air intakes shall be at least 25 feet from the exhaust outlets of any ventilating system, combustion equipment stacks, or noxious fumes. The bottom of outdoor intakes serving central air systems shall be located as high as practical, but not less than 6 feet above grade level, or, if installed through the roof, 3 feet above roof opening. (III) (Exception 3)
	i. 	The ventilation system shall be designed and balanced to provide the general pressure relationship to adjacent areas shown in the Pressure Relationship and Ventilation Table 2. Through-the-wall air-conditioning units will not be used to calculate make-up air. (III) (Exception 2)
	j. 	Corridors, attics or crawl spaces shall not be used as a plenum to supply air to or exhaust air from any rooms. (III) (Exception 3)
	k. 	The air system for resident rooms, between smoke-stop partitions, shall be operated with common switches. (III) (Exception 3)
	l. 	If the fire alarm system is activated, the air distribution system shall shut down. (III)
	m. 	Air-handling duct systems shall meet the requirements of 1987 NFPA Standards 90A and 90B. Supply and return registers shall not be at the same level and shall be designed to inhibit stratification. (III) (Exception 4)
	n. 	Fire and smoke dampers shall be constructed, located and installed in accordance with the requirements of 1987 NFPA Standard 90A, 90B and 101.
	o. 	Range and dishwasher exhaust hoods in food preparation centers shall have a minimum exhaust rate of 60 cubic feet per minute per square foot of hood face area. Face area is the open area from the exposed perimeter of the hood to the average perimeter of the cooking surfaces. (Exception 4)
	(1)	All hoods over cooking ranges shall be equipped with grease filters, a fire extinguishing system, and heat-activated fan controls.
	(2)	Openings for cleaning shall be provided every 20 feet in horizontal exhaust duct systems serving hoods.
	(3)	Conditioned air shall be supplied to balance exhausted air.
	(4)	Special hood designs shall be evaluated. (III) (Exception 4)
	p. 	Rooms containing fuel-fired heating units or other fuel-fired equipment shall be provided with sufficient outdoor air to maintain combustion rates of equipment and reasonable temperatures in the room and in adjoining areas. (III) (Exception 3)
	q. 	Filter beds shall be located upstream of the air-conditioning equipment unless a prefilter is employed. A prefilter shall be upstream of the equipment. The main filter bed may then be located farther downstream.
	(1)	Filter frames shall be durable and carefully dimensioned and shall provide an airtight fit within enclosing duct work.
	(2)	All joints between filter segments and the enclosing duct work shall have gaskets or be sealed to provide a positive seal against air leakage. (III) (Exception 2)
	r. 	All perimeter duct work under the slab shall be encased in lightweight or insulating concrete and sloped to a plenum low point. (III) (Exception 3)
	s. 	Laundry rooms shall be supplied with sufficient conditioned outside air to balance the amounts exhausted or used for combustion. (III) (Exception 3)
	t. 	The amounts of air and pressure relationship set forth in Table 2 shall be provided. (III) (Exception 3)
	u. 	Condensate piping from cooling coils shall be a minimum of ¾ of an inch inside diameter and provided with openings for cleaning every 10 feet. (III) (Exception 4)
	v. 	Attics or crawl spaces shall not be used to house heating or cooling equipment. (III) (Exception 3)
	w. 	Rooms used for heating and cooling equipment must be accessible through a swinging door. (III) (Exception 3)
Table 2
PRESSURE RELATIONSHIPS AND VENTILATION OF CERTAIN
AREAS OF NURSING FACILITIES

Area Design	Pressure
Relationship to Adjacent Areas	Minimum Air Changes of
Outdoor Air Per Hour Supplied to Room	Minimum Total
Air Changes Per Hour
Supplied to Room	All Air
Exhausted
Directly to
Outdoors	
Resident Room	E	2	2	Opt. (#1)	
Resident Area Corridor	E	2	2	Opt. (#3)	
Physical Therapy	N	2	6	Opt. (#1)	
Soiled Work Area or Soiled Holding	N	2	10	Yes	
Toilet Room	N	Opt. (#1)	10	Yes	
Bathroom	N	Opt. (#3)	10	Yes	
Housekeeping Closet	N	Opt. (#3)	10	Yes	
Food Preparation Area	E	2	10	Yes	
Warewashing Room	N	Opt. (#2)	10	Yes	
Laundry, General	E	2	10	Opt. (#4)	
Soiled Linen Sorting and Storage Area	N	Opt. (#4)	10	Yes	
Employees’ Lounge	N	2	6	Yes	
Lounge	N (#5)	2	6	Yes (#5)	
*Designated Smoking Areas	N	2	6	Yes	

P = Positive	N = Negative	E = Equal	Opt. = Optional	
#1 Room may be exhausted through adjoining toilet room.
#2 Make-up air may be supplied through kitchen.
#3 Corridor may be exhausted through adjoining service areas.
#4 Laundry may be exhausted through the soiled area.
#5 Pressure relationships in lounges are subject to Exception 4.
*Exception 4
	61.11(4) Every facility shall have a complete interior plumbing system. (I, II, III)
	a. 	All plumbing and other pipe systems shall be installed in accordance with the requirements of the Iowa state plumbing code and applicable provisions of local ordinances. (II, III)
	b. 	All pipes below grade or in concrete slabs shall be type K, soft copper. There shall be no joints below the slab.
	c. 	Water supply systems shall meet the following requirements:
	(1)	All facilities shall have a potable water source from a city water system or a private source which complies with the regulations and is approved by the department of natural resources. (I, II, III)
	(2)	Systems shall be designed to supply water to the fixtures and equipment at a minimum pressure of 15 pounds per square inch during maximum demand periods. (III)
	(3)	Plumbing fixtures in janitors’ rooms and soiled workrooms shall be provided with hot water. (III)
	(4)	Each water service main and branch main shall have valves. Stop valves shall be provided at each fixture. Bathtubs or showers shall be equipped with screwdriver stop valves. (III) (Exception 2)
	(5)	Backflow preventers (vacuum breakers) shall be installed on hose bibbs, janitors’ sinks, bedpan flushing attachments, hair care sinks, and on all other threaded fixtures to which hoses or tubing can be attached. (I, II, III)
	(6)	Water softeners shall not supply cold water to the kitchen, drinking fountains, or ice machines. (III) (Exception 4)
	(7)	Hot water distribution systems shall provide hot water as specified at each hot water outlet at all times. (See Table 3) A circulating pump in a hot water system shall meet these requirements. A circulating pump is not required in facilities licensed for 15 or fewer beds. (III)
	(8)	The hot water system shall be designed to supply 110° F to 120° F water to all resident lavatories, tubs and showers. (II, III)
Table 3
HOT WATER USE

 	Resident
Areas	Dietary	Laundry	
 	 	 	 	
Gallons per hr. per bed**	3	2	2	
Temperature (°F)	110	120*	 	
*Provisions shall be made to provide 180°F rinse water at dishwasher. (May be provided by a separate booster heater.)
**Quantities indicated for design demand of hot water are for general reference minimums and shall not substitute for accepted engineering design procedures using actual number and types of fixtures to be installed. Design shall also be affected by temperatures of cold water used for mixing, length of run, and insulation relative to heat loss or other factors. As an example, the total quantity of hot water needed will be less when the temperature available at the outlet is very nearly that of the source tank and the cold water used for tempering is relatively warm.
	(9)	Rescinded IAB 10/7/09, effective 11/11/09.
	d. 	Drainage systems shall meet the following requirements:
	(1)	Sewage shall be collected and disposed of in a manner approved by the department. Disposal into a municipal system meets this requirement. (III)
	(2)	Private sewage systems shall conform to rules promulgated by the department of natural resources. (III)
	(3)	Drainage pipes which pass above food preparation, serving, and food storage areas shall be enclosed. (III)
	(4)	Plastic pipe may be used in any drain-waste-vent system in accordance with the state plumbing code 641—Chapter 25. (III)
	(5)	Openings for pipe cleaning shall be no more than 50 feet apart in a horizontal drain line. (III) (Exception 2)
	(6)	Floor drains with appropriate grates shall be provided for all mechanical equipment rooms, laundries, kitchens, dishwashing areas, soiled utility rooms, basement floors, any other area where water may collect on the floor, shower stalls and in front of showers or bath units. (III) (Exception 4)
	(7)	Foundation drains shall be provided in accordance with subrule 61.3(9). (III) (Exception 4)
	61.11(5) Before completion of the contract for new construction and final acceptance of the facility, the contractor shall certify that all mechanical systems have been tested and balanced, and that the installation and performance of these systems conform to plans and specifications.
	61.11(6) Upon completion of the contract, the owner shall be furnished with a complete set of manufacturer’s operating, maintenance, and preventive instructions. A parts list with numbers and descriptions for each piece of equipment shall be included. The owner shall be instructed in the operational use of systems and equipment as required. (III) (Exception 3)
[ARC 8189B, IAB 10/7/09, effective 11/11/09]
481—61.12(135C) Electrical requirements. All materials, including equipment, conductors, controls and signaling devices, shall be installed to provide a complete electrical system with the necessary characteristics and capacity necessary to supply the electrical needs shown in the specifications or indicated on the plans. All materials shall be listed by Underwriters’ Laboratories, Inc., or other similarly recognized laboratories. (III)
	61.12(1) Electrical systems and equipment shall meet the minimum requirements of the “National Electrical Code, 1990 edition.” (III)
	61.12(2) Drop cords, extension cords or any type of flexible cord shall not be used as a substitute for fixed or hard wiring. Surge protectors may be used for computers and related devices, facsimile, photocopying and scanning machines, and other consumer electronic devices in a resident’s room and other locations in a facility provided the surge protector is of metal construction and approved by Underwriters Laboratories, Inc., or other similarly recognized laboratories. Only fixed supplementary electric heating shall be installed. (III)
	61.12(3) Electrical metallic tubing or rigid heavy wall conduit shall be used throughout the interior of the facility. In areas used for patient care, the grounding terminals of all receptacles and all non-current-carrying conductive surfaces of fixed electrical equipment likely to become energized that are subject to personal contact shall be grounded by a green insulated copper conductor. The grounding conductor shall be sized in accordance with the requirements of the “National Electrical Code” and installed in electrical metallic tubing with the branch-circuit conductors supplying these receptacles or fixed equipment. (III) (Exception 3)
	61.12(4) Electrical wiring systems shall not be surface mounted in resident-occupied areas. (II, III) (Exception 4)
	61.12(5) An exit door alarm system shall be installed on all designated fire exit doors. (I, II, III)
	61.12(6) Panel boards which serve lighting and appliance circuits shall be located on the same floor as the circuits they serve. All circuits shall be identified on the panel door. (III) This requirement does not apply to emergency system circuits which can be centrally located.
	61.12(7) All spaces occupied by people, machinery, or equipment within buildings, parking lots, and approaches to buildings shall have electric lighting. (III)
	a. 	All rooms in resident-occupied areas shall have general lighting. Switches for general lighting shall be at the entrance to the room. (III)
	b. 	Light shall be provided in the areas of the building as required in Table 4. Light in the resident care area, reading area, activities task area and dining area may be reduced to 30 foot-candles measured at the floor surface when tasks are not being performed in that area. (II, III) (Exception 4)
Table 4

Area	Measured
Site	Required
Foot-candles	
Resident Rooms:	 	 	
General	floor	30	
Resident care area	bed surface	50	
Task lighting	task surface	100	
Night light	floor below fixture	5	
Staff Areas:	 	 	
Nursing station	task surface	100	
Medication room	task surface	100	
Activities task area	task surface	75	
Dining area	task surface	50	
Corridor, stairway
and hazardous area:	 	 	
General	floor	30	
Night light	floor below fixture	10	
	c. 	Light fixtures shall be equipped to prevent glare and hazards. (III)
	d. 	There shall be 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. (III) (Exception 3)
	e. 	Night lights shall be provided in corridors, at stairways, attendant’s stations and hazardous areas. They shall be recessed if the bottom of the fixture is less than 6 feet 8 inches above the floor. (III)
	f. 	Reading lights or lamps shall be provided for each resident in the resident’s room. (III)
	g. 	Wall-mounted lights with flexible or extension arms shall not be used. (Exception 4)
	61.12(8) Each resident room shall have duplex grounding type receptacles as follows: one located on each side of the head of each bed; one for television, where used; and one on another wall. For parallel adjacent beds, only one receptacle is required between the beds. Each resident room or resident toilet room shall have one duplex ground fault interrupter outlet beside a lavatory and mirror. (III) (Exception 4) (III) (Exception 3)
	a. 	Duplex receptacles for general and emergency use shall be installed a maximum of 50 feet apart in all corridors and within 25 feet of ends of corridors. (III) (Exception 2)
	b. 	All receptacles within 6 feet of sinks, tubs, or showers and those installed outside the building shall be protected by a local ground fault circuit interrupter. (III) (Exception 4)
	61.12(9) In general resident areas, each room shall be served by at least one calling station. Each bed shall be provided with a call device. Two call devices serving adjacent beds may be served by one calling station. (II, III) (Exception 4)
	a. 	After November 21, 1990, pull string call devices will not be acceptable. The call device shall be electrically operable from the bed or chair. (II, III) (Exception 4)
	b. 	All calls shall activate an audible and visible signal in each area. There shall be a visible signal in the public area at the resident’s door. (II, III) (Exception 4)
	c. 	In multicorridor units, additional visible signals shall be installed at corridor intersections. (II, III)
	d. 	Nurses’ calling systems which provide two-way voice communication shall be equipped with a light at each calling station which lights and remains lighted as long as the voice circuit is operating. (II, III)
	e. 	A nurses’ call emergency device shall be provided at each resident’s toilet, bath, and shower room. (II, III)
	f. 	The emergency call device in the resident’s toilet, bath and shower room shall have a distinguishable audible signal at the nurses’ station. (II, III) (Exception 4)
	g. 	As an alternative to a hardwired nurse calling station with a visible signal in the corridor at a resident’s room, a wireless calling system that provides an acceptable means of identifying the origin or location of a call is acceptable.
	h. 	A wireless calling system shall be connected to an emergency power source to ensure operation during a power outage.
	i. 	Pagers used as part of a wireless calling system shall have a self-diagnostic system to alert the user of a low battery.
	j. 	For wireless calling systems utilizing two-way communication devices, a visible indicator shall be placed in a resident’s room to indicate when the system is operable and conversations may be heard.
	61.12(10) Emergency electric service shall provide electricity during an interruption of the normal electric supply which could affect the resident care or the safety of the occupants. Facilities of 19 or fewer beds are exempt from this requirement. (III) (Exception 3)
	a. 	The source of the emergency electric service shall be from an emergency generating set. (III)
	b. 	The required emergency generating set, including the prime mover, shall not be powered solely by natural gas or cooled solely by domestic water. (III) (Exception 4)
	c. 	The emergency generator set shall supply all lighting and power load demands of the emergency system and shall be located on the premises. (III)
	d. 	Emergency electric service shall be provided to the distribution system for light as follows:
	(1)	Exits and all necessary ways of approach to exits, including exit signs and exit direction signs, exterior of exits, exit doorways, stairways, and corridors; (II, III)
	(2)	Egress as required in NFPA Standard 101; (II, III)
	(3)	Dining and recreation rooms; (III)
	(4)	Nurses’ work area; (III)
	(5)	Generator set location; (III)
	(6)	Switch-gear location; (III)
	(7)	Boiler room; (III) and
	(8)	Elevator. (III)
	e. 	Emergency electric service shall be provided to the distribution system for equipment essential to life safety and to protect vital equipment or materials as follows:
	(1)	Call board; (III)
	(2)	Alarm systems, including fire alarm activated at manual stations; water flow alarm devices or sprinkler systems, where electrically operated; fire detection and smoke detection systems; paging or speaker systems intended for issuing instructions during emergency conditions; and alarms required for nonflammable medical gas systems, where installed; (III)
	(3)	Sewage and sump lift pump, where installed; (III)
	(4)	All required duplex receptacles in resident areas; (III)
	(5)	One elevator, if required for emergency service; (III)
	(6)	Burners and pumps necessary for operation of one or more boilers and their necessary auxiliaries and controls required for heating; (III) and
	(7)	Equipment necessary for maintaining telephone service. (III)
	f. 	Emergency electric service shall be provided to the distribution system for heating as follows:
	(1)	Where electricity is the only source of power normally used for space heating, the emergency service shall provide heating for resident rooms or an area approximately 30 square feet per bed within the facility to accommodate all of the residents for the duration of the emergency; (III)
	(2)	Emergency heating shall not be required if the facility is supplied by at least two service feeders. Each shall be supplied by separate sources from an integrated transmission distribution system. Each shall be capable of supplying required service, and each so routed, connected and protected that a fault any place between the utility energy source and the facility will not cause an interruption of more than one of the electric service feeders. (III)
	g. 	The emergency electrical system shall be brought to full voltage and frequency and be connected within ten seconds through one or more primary automatic transfer switches. Power to pumps and burners may be brought to full power through the use of manual switches. (III)
	h. 	Receptacles connected to the emergency system shall be distinctively marked for identification. (III)
	i. 	Storage-battery-powered lights, provided to augment emergency light or for continuity of light during the interim of transfer switches, shall not be used as a substitute for the requirements of a generator. (III)
481—61.13(135C) Specialized unit or facility for persons with chronic confusion or a dementing illness (CCDI unit or facility). This unit or facility shall be designed so that residents, staff and visitors will not pass through the unit in order to reach exits or other areas of the facility. (III)
	61.13(1) If the unit or facility is to be a locked unit or facility, all locking devices shall meet the life safety code and any requirements of the state fire marshal. If the unit or facility is to be unlocked, a system of security monitoring is required. (I, II, III)
	61.13(2) The outdoor activity area as required by rule 61.5(135C) shall be secure for the unit or facility. Nontoxic plants shall be used in the secured outdoor activity area. (I, II)
	61.13(3) Within the unit or facility there shall be no steps or slopes. (III)
	61.13(4) Dining and activity areas for the unit or facility required by rule 61.6(135C) shall be located within the unit or facility and shall not be used by other facility residents. (III)
	61.13(5) An area shall be provided to allow nurses to prepare daily resident reports. (III)
	61.13(6) If the lounge and activity areas are not adjacent to resident rooms, there shall be one unisex resident toilet room for each ten residents in clear view of the lounge and activity area. (III)
	61.13(7) The area shall be designed to minimize breakable objects within the unit or facility. (III)
481—61.14(135C) Codes and standards. Nothing in the rules shall relieve anyone from compliance with building codes, ordinances and regulations which are enforced by city, county or state jurisdictions. Where codes, ordinances and regulations are not in effect, the sponsor shall consult one of the national building codes, provided the requirements of the code are not less stringent than the minimum standards set in this chapter. (III)
Any alterations, or any installation of new equipment, shall be accomplished as nearly as practical in conformance with all applicable codes, ordinances, regulations and standards required for new construction. Alterations shall not diminish the level of compliance with any codes, ordinances, regulations or standards below that which existed prior to the alterations. Any feature which does not meet the requirement for new buildings but exceeds the requirement for existing buildings shall not be further diminished. Features which exceed requirements for new construction need not be maintained. In no case shall any feature be less than that required for existing buildings. (III)
Note:  The following codes and standards have been used in whole or in part in these rules:
American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) Handbooks.
American Society for Testing and Materials (ASTM) Standard E 84, Method of Test for Surface Burning Characteristics of Building Material.
International Conference of Building Officials (ICBO) Uniform Building Code.
Iowa State Building Code.
Iowa State Plumbing Code.
Labor Services Division, Department of Employment Services.
National Fire Protection Association (NFPA) Standard 70, National Electrical Code.
National Fire Protection Association (NFPA) Standard 90A & 90B, Installation of Air Conditioning and Ventilating Systems.
National Fire Protection Association (NFPA) Standard 101, Life Safety Code.
Food Service Sanitation Manual (DHEW Publication (FDA) 8-2081).
Underwriters’ Laboratories, Inc.	lists.
American National Standards Institute (ANSI) Standard A 117.1-1986, American Standard Specifications for Making Buildings and Facilities Accessible to, and Usable by, the Physically Handicapped.
Copies of nongovernment publications can be obtained from the various agencies at the addresses listed:
American Society for Testing and Materials
1916 Race Street
Philadelphia, Pennsylvania 19103
Iowa State Building Code
Department of Public Safety
Wallace State Office Building
Des Moines, Iowa 50319
Iowa State Plumbing Code
Department of Public Health
Lucas State Office Building
Des Moines, Iowa 50319
National Fire Protection Association
Batterymarch Park
Quincy, Massachusetts 02269
Underwriters Laboratories, Inc.
33 Pfingsten Road
Northbrook, Illinois 66062
American National Standards Institute
1430 Broadway
New York, New York 10018
International Conference of Building Officials (ICBO)
Uniform Building Code
5360 South Workman Mill Road
Whittier, California 90601
American Society of Heating, Refrigeration, and Air Conditioning Engineers (ASHRAE)
1791 Tullie Circle N.E.
Atlanta, Georgia 30329
Except as noted in the list, copies of government publications can be purchased from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402.
These rules are intended to implement Iowa Code sections 135C.14 to 135C.17 and 135C.36.
[Filed 8/6/76, Notice 4/19/76—published 8/23/76, effective 9/27/76]
[Filed without Notice 10/4/76—published 10/20/76, effective 11/24/76]
[Filed emergency 12/21/76—published 1/12/77, effective 1/12/77]
[Filed 8/18/77, Notice 3/9/77—published 9/7/77, effective 10/13/77]
[Filed without Notice 10/14/77—published 11/2/77, effective 12/8/77]
[Filed 1/20/78, Notice 12/14/77—published 2/8/78, effective 3/15/78]
[Filed 11/9/78, Notice 6/28/78—published 11/29/78, effective 1/3/79]
[Filed emergency 6/25/87—published 7/15/87, effective 6/25/87]
[Filed 9/28/90, Notice 5/16/90—published 10/17/90, effective 11/21/90]
[Filed 3/12/92, Notice 12/11/91—published 4/1/92, effective 5/6/92]
[Filed 1/15/93, Notice 11/25/92—published 2/3/93, effective 3/10/93]
[Filed 5/16/95, Notice 3/15/95—published 6/7/95, effective 7/12/95]
[Filed 1/21/97, Notice 8/14/96—published 2/12/97, effective 3/19/97]
[Filed 7/11/97, Notice 4/23/97—published 7/30/97, effective 9/3/97]
[Filed 7/17/03, Notice 6/11/03—published 8/6/03, effective 9/10/03]
[Filed 11/16/05, Notice 10/12/05—published 12/7/05, effective 1/11/06]
[Filed 11/15/06, Notice 10/11/06—published 12/6/06, effective 1/10/07]
[Filed 3/21/07, Notice 2/14/07—published 4/11/07, effective 5/16/07]
[Filed ARC 8189B (Notice ARC 7989B, IAB 7/29/09), IAB 10/7/09, effective 11/11/09]