Unless otherwise stated these guidelines apply to all types of facilities, namely:

 

• Home For Senior Citizens
• Nursing Home/Infirmary
• Adult Day Centre
• Psychiatric Nursing Homes
• Homes Of Charitable Organisation
• Convalescent Homes

Definitions

 

Home For Senior Citizens:

 

Any facility where the operator provides boarding with or without food service two or more adults who are not related by blood or marriage

 

Nursing Home/Infirmary:

 

A care facility providing basic nursing services in additional to domiciliary and custodial care. The operator has a satisfactory agreement with a physician for medical coverage

 

ADULT DAY CENTRE

 

A non-residential facility offering social activities during the day, for senior citizens and the mentally challenged

 

Ambulatory Resident:

 

A resident who is able to move from place to place either unaided or by use of ambulatory devices and can respond to an emergency with minimal human assistance.

 

Chemical Restraint

 

A psychopharmacologic drug that is given to control movement and to treat such medical symptoms.

 

Physical restraint

 

Any device or material that the individual cannot remove easily and which restricts freedom of movement or normal access to the person’s own body e.g. arm and leg restraint, hand mitts and tightly tucked bed sheets.

 

Registration of Nursing Homes

The steps in registering a Nursing Home may be found in the document below:

DOWNLOAD HERE:

Steps in Registering a Nursing Home (50 kB)

 

Guidelines in Setting up a Nursing Home

 

1. Administration

1.1 All facilities shall maintain a chronological listing of all residents administered and discharged;

1.2 A written statement of policies and procedure shall be developed for each facility prior to being granted registration. They shall include:

(a) A description of the services provided, including emergency medical and dental care of residents;

(b) Policies and procedures for maintaining confidentiality of residents personnel records;

(c) Procedures for handling acts committed by staff or residents, which are inconsistent with the policies of the facility;

(d) Policy on in-service training for staff;

(e) Policy and procedure for reporting incidents;

1.3 The domestic routine of the facility shall as far as possible meet the needs and preferences of residents as well as the administration;

1.4 Staff shall be assigned duties consistent with their position, training and experience. Written job descriptions shall be available for each member of staff;

1.5 A work schedule shall be posted indicating adequate coverage for all shifts;

1.6 Each facility shall have a written and regularly rehearsed disaster preparedness plan consistent with the local disaster plan and made readily available to the staff of the facility;

2.0 Requirements for Residents

· A home shall be so constructed, arranged and maintained as to provide adequately for the health, safety, access and well-being of the residents;

· Residents who are not independently ambulant shall have their living quarters located on the ground floor or a floor with access to the ground level. A home shall provide separate and distinct living and sleeping areas;

(a) A living room, dining room, hallway or other room not ordinarily used for sleeping shall not be used as such by residents, family or staff;

(b) No residents room will be so located as to make it a thoroughfare for other residents and staff;

(c) Space in the bedroom shall be so arranged that each resident has a small area that is seen as his/hers;

(d) Supportive devices, excluding physical restraints, such as handrails and grab bars shall be installed to enable residents to achieve a greater degree of mobility and safety;

· At least one ramp (moveable) shall be available for wheelchair convenience;

· There must be at least one centrally located living room for the free access to and informal use of the resident and visitors;

· At least one current calendar and one working clock shall be placed in the common living area of each home;

· A home shall provide laundering facilities on the premises for residents’;

· Personal laundry;

· There shall be no smoking in the bedrooms or communal area and an area shall be designated for smoking;

3.0 minimum floor plan requirements (residential homes)

3.1 The following minimum standards for resident bedrooms must be met

(a) Bedrooms shall have at least 5.57 sq.m (60sq.ft) of usable space per resident. Usable flow space is defined as that floor space under ceiling at least 2.13m (7feet) in height. Each bed shall be at least 1.2m (4ft.) apart;

(b) There shall be well ventilated and maintained at a comfortable temperature;

(c) Doorways of bedrooms occupied by residents shall be equipped with side-hinged;

(d) Permanently mounted doors that can be opened by a single

motion. For bedrooms that have locks on doors, both the

occupant and on-site manager must be provided with keys to

ensure entry and exit;

(e) No bedroom shall open into any place or room where food is stored or prepared;

3.2 The following minimum standards apply to bathroom facilities

(a) At least one functional toilet and at least one bathing or showering facility shall be provided for each eight residents living in the home;

(b) The height of the bath from the floor shall be of such to allow access to the residents who have difficulty lifting their legs;

(c) Grab bars and nonskid strips shall be installed in all showers and bath areas;

(d) Bath seats shall be provided;

(e) All shower stalls shall be at least 1.2mx1.2sq.m and must have handrails on two sides, be equipped with curtains and designed for wheelchair use. Thresholds to showers must be flush with the floor. The floor of the shower shall be designed to drain properly;

(f) Bathrooms and toilet facilities without windows shall have forces ventilation to the outside;

(g) Toilets, baths and showers shall provide for individual privacy;

(h) All plumbing and bathroom fixtures shall be maintained in good working order at all times and shall present a bleach and sanitary appearance;

(i) No toilet shall open into any place or room where food is stored or prepared;

3.3 All facilities with stairways and ramps shall have sturdy and securely fastened handrails. Exterior decks and porches shall have handrails on the open sides;

3.4 Any hazard that may cause tripping shall be removed e.g. scatter rugs, frayed carpets. Rugs may be placed on top of rubber mats to prevent slipping;

3.5 All areas including hallways and stairs shall be lighted sufficiently (60 watt bulb)

3.6 Entrance exits and escape routes shall be clearly marked and maintained free of all impediments to full instant use;

3.7 The yard area shall be kept free from all hazards, nuisances, refuse and litter;

4.0 Furnishings and fixtures

4.1 Furnishing and housekeeping standards shall be such that the facility present a clean and orderly appearance;

4.2 Resident bedroom furnishing shall include the following

(a) Adequate closet space;

(b) A dresser or the equivalent and at least one chair per resident in each room;

(c) A mirror appropriate for grooming;

(d) An individual bed with comfortable springs and mattress, clean and in good condition;

(e) Bedding for each resident that includes two sheets, a pillow, a pillowcase, and a minimum of one blanket;

4.3 A home shall maintain a linen supply for not less than twice the bed capacity.

4.4 Bed linen shall be changed at least weekly or more often if soiled.

4.5 All mattresses shall be covered with waterproof material and placed under protective bed clothing. Rubber sheeting and mattresses shall receive special deodorizing attention when the resident is incontinent.

5.0 Physical plant

5.1 The location of the facility shall be well landscaped and aesthetic free from excessive noise, dust and nuisances and conducive to peace and good mental health.

5.2 Each facility shall be in compliance with fire and safety rules of the fire department. This should include fire drills and knowledge of how to operate the fire extinguishers. In the absence of or in addition to any local ordinances, the following requirements must be met;

(a) Wall type electric outlets and lamps or light fixtures shall be maintained in a safe operating condition;

(b) Each home must have at least 4.5kg(10lb) multipurpose abc fire extinguishers on each occupied floor. These extinguishers shall be checked and tagged annually to ensure they remain in operable condition;

(c) Exterior doors shall be equipped with locks that do not require keys to open them from the inside or at least two persons with copies of keys for locks. A wall mounted key-box is recommended for emergency access;

5.3 Water and sewage systems shall meet applicable local standards and/or regulations.

5.4 Floors, walls and ceilings shall be kept clean in good repair.

5.5 Kitchen and bathroom areas shall be cleaned with disinfectant at least daily and maintained to ensure cleanliness and sanitation.

5.6 The storage and disposal of bio-medical and hazardous waste shall comply with applicable local standards.

5.7 Solid waste shall be stored in vermin-proof, leak-proof, non-absorbent containers with close fitting covers until removed. Waste shall be removed from the kitchen at least daily and from the premises at least weekly.

5.8 Mesh screening of all areas is desirable and essential for the kitchen.

5.9 An insect, rodent or pest control programme shall be maintained and conducted in a manner that continually protects the health of residents and shall be in consultation with the local health department.

5.10 The following evacuation requirements must be met:

(a) Residents who need assistance with ambulation shall be assigned bedrooms that have a ground-level exit to the outside;

(b) There shall be an established procedure and mechanism for alerting and caring for residents in case of emergencies and evacuating then to safety;

(c) A facility serving persons dependent upon wheelchair for mobility shall have a clearly accessible route for emergencies throughout the common areas of the facility and at least one fully accessible bathroom;

5.11 Employees and visitors shall not use bathrooms provided for residents, washrooms with soap and paper towels shall be provided near to the nurses’ station and the waiting room.

5.12 Food service facilities shall be in compliance with public health food handling regulations.

6.0 Services

6.1 Each home shall provide room, meals, and personal services to the residents of the facility, which are commensurate with the needs of the individual residents.

6.2 Each home shall provide as a minimum books, newspapers and games for leisure time activities. Each home shall encourage and offer assistance to residents who wish to participate in recreational, cultural and religious activities available in the home and in the community.

6.3 The routine of the home shall be such that a resident may spend the majority of his or her waking hours out of the bedroom, if he or she chooses.

6.4 At no time (other than when health and/or safety are jeopardized) may a home restrict a resident’s free access to the common areas of the home or lock the resident into or out of the resident’s bedroom.

Adult day centres shall provide a place for rest for an individual who may require this during the course or a particular day.

7.0 Staffing

7.1 The facility shall have as many employers on duty at all times as may be needed to properly safeguard the health, safety and welfare of the residents, as required by the regulations. Employees are expected to be alert during the hours on duty. As minimum the following shall be observed.

(a) At least on administrator, on-site manager, or a trained staff persons shall be on the premises twenty-four (24) hours per day;

(b) Residents shall not be left unsupervised;

(c) A minimum on site staff to resident ratio shall be one (1) staff persons per fifteen (15) residents during working hours and one (1) staff persons per twenty-five (25) residents during non-waking hours (not applicable to nursing homes);

(d) There shall be one (1) staff person for every four (4) residents (nursing homes);

(e) All homes must maintain a written work schedule for all employees, including relief workers, showing adequate coverage for each day and night;

7.2 A registered nurse or medical practitioner shall supervise the facility, the registered nurse being on duty at least twelve hours weekly. The remaining hours shall be covered by a registered nurse on call;

7.3 Sufficient staff time shall be available to ensure that each resident

(a) Receives treatments, medications and diet as prescribed;

(b) Receives proper care to prevent decubitus ulcers and contractures;

(c) Is kept comfortable and clean;

(d) Is treated with dignity, kindness, consideration and respect;

(e) Is protected from physical and verbal abuse;

(f) Is protected from injury and infection;

(g) Is given prompt, unhurried assistance if she/he requires help with eating and

(h) Is given assistance, if needed with daily hygiene, including baths and oral care;

8.0 Personnel

8.1 All persons employed to the home shall be at least 18 years of age and of good character;

8.2 The administrator or on-site manager shall be responsible for ensuring that any persons working in the facility and an employee receives work-related training acceptable to the ministry of health within the first sixty days of employment. Such training shall at a minimum include the following:

(a) Current certification in emergency first aid except where the staff persons is a currently licensed health care professional;

(b) Emergency evacuation procedures;

(c) Medical and social needs and characteristic of the resident population;

(d) Resident’s rights;

8.3 At least on staff persons having completed the minimum training requirements of section 7.2 (a) of this rule shall be present in the home at all times.

8.4 Kitchen staff and all staff attending to the physical needs of residents in the home shall possess valid food handlers’ permits.

8.5 All persons, including the administrator or on-site manager, who offer direct care to the residents, shall be responsible for maintaining awareness of each resident’s normal appearance and shall be capable of intervening if a resident’s state of health appears to be in jeopardy.

8.6 The administrator, on-site manager, and each employee shall have received a physical examination by a licensed physician four weeks prior to employment to ensure that the employee is free of disease communicable within the scope of employment and is physically qualified to work. A licenses physician shall conduct follow-up examinations on each administrator or staff persons to determine readiness to return to work following a significant illness or injury.

8.7 An employment history for each persons working in the home must be verified by the administrator or on-site manager and on file in the home. These files shall be made available for inspection by the appropriate enforcement authorities. The confidentiality of the information contained shall be otherwise maintained.

8.8 No administrator, on-site manager, or staff person shall be under the influence of alcohol, controlled substances or any illegal drug while at the home.

8.9 An active in-service nursing education programme shall be in effect for all nursing personnel. This programme shall be developed and conducted by a health care professional.

9.0 Admission

9.1 The nursing assessment of each resident on admission to the facility shall include an assessment of his/her functional capacity.

9.2 No home shall admit or retain a resident who needs care beyond which the facility is permitted to provide.

9.3 The applicant shall be required to provide the home with a licensed physician’s report of a physical examination dated within 7 days prior to the date of admission.

9.4 At least one staff person having completed the minimum training requirements of section (2) of this rule shall be present in the home at all times.

9.5 Routine medical examinations shall be performed on each resident at least every three months.

9.6 Criteria for admission to a home for senior citizens, adult day centre, are as follows:

(a) Persons must be at least 18 years of age;

(b) The facility shall admit or retain only ambulatory residents;

(c) The facility shall not admit or retain persons who require the use of physical or chemical restraints, isolation or confinement for behaviourhal control;

(d) Persons admitted to the facility may not be confined to bed and may not require continuous medical or nursing care and treatment;

(e) Home for senior citizens: medical, nursing, health or supportive services required on a periodic basis, or for short-term illnesses;

9.7 Criteria for admission to a nursing home/infirmary, convalescent home and psychiatric homes

(a) The administrator or on-site manager of the home shall conduct an interview with the application and/or representative or legal surrogate, if any, of the applicant to ascertain if the home can meet the applicant’s needs;

(b) Each resident who has an acute condition shall be under the continuing care of a physician;

10.0 Resident Files

10.1 Each resident shall have a file maintained by the administrator or on-site manager. Personal information shall be treated as confidential and shall not be disclose except to the resident and his or her representative or legal surrogate, or any, an unauthorized agent of the ministry of health, and others to who written authorization is given by the resident or his representative or legal surrogate.

10.2 Each resident file shall include the following information:

(a) Identifying information including name, age, sex and previous address;

(b) Name address and telephone number of next of kin, legal guardian and/or representative or legal surrogate, if any;

(c) Name, address and telephone number of any persons providing additional services to the resident;

(d) Date of admission, prior address of resident, referral source;

(e) The name, address and telephone number of a physician, hospital and pharmacy of the resident’s choice;

(f) A record of all monetary transactions conducted on behalf of the resident with itemized receipts of all disbursements and deposits;

(g) Health information including all health appraisals, diagnoses, prescribed diets, medications and physician’s instructions;

(h) An inventory off all personal items brought to the home by the resident to be documented and updated at anytime after admission;

(i) A signed copy of the resident’s rights form;

(j) A signed copy of the admission agreement;

Medications

11.1. All medication required by a resident in a home for senior citizens shall be self-administered by the resident except when a resident, although generally capable of self-administration, requires supervision for administering oral or topical medication. A functionally literate staff shall then provide this, persons trained by a registered nurse or pharmacist. Injectable medication, except for insulin, may only be administered by an appropriately licensed health professional, under established medical protocol;

11.2 Responsibility for initial acquisition and refilling of prescribed medications shall be specifically assigned in the admission agreement to either the resident, his/her representative or legal surrogate, if any, or the administrator, or on-site manager.

11.3 Medications shall be stored in a locked cupboard at all times except when required to be kept by a resident on his/her persons due to the need for frequent or emergency use, as determined by the resident’s physician. The persons in charge shall keep the keys to the medication cupboard.

11.4 Medications shall be kept in original containers with original containers with original labels intact.

11.5 An accurate record of administered medication shall be kept.

11.6 Expired drugs shall be removed from the medicine cabinet and destroyed in an appropriate manner.

12.0 Dietary Services

12.1 A minimum of three regularly scheduled, well-balanced meals shall be assured seven days a week. Meals shall be of sufficient quantity, proper form, consistency and temperature and shall be served at a minimum of five (5) hours apart during the day with no longer than fourteen (14) hours between the evening meal and breakfast. Between meal and bedtime, snacks may be offered each resident.

12.2 All perishable foods shall be stored at such temperatures as will protect against spoilage.

12.3 All foods while being stored, prepared or served shall be protected against contamination and be safe for human consumption.

12.4 Dry stores shall be elevated at least 15.24cm (6in.) off floor.

12.5 A facility shall have properly equipped kitchen to prepare regularly scheduled, well-balanced meals.

12.6 A facility shall maintain a three-day supply of non-perishable foods for emergency needs.

12.7 A minimum of one individual qualified by training or by experience and performance shall be responsible for food preparation. Such a person shall be appropriately clad with clean clothing, nails and appearance.