<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".47" citation="COMAR 10.07.02.47" title_num="10" subtitle_num="07" chapter_num="02" heading="Nursing Care Unit.">
  <paragraph num="A.">
    <text>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.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Common Space. The nursing home shall provide a living room for residents’ use with a sufficient number of reading lamps, tables, and comfortable chairs or sofas.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Service Areas Required.</text>
    <paragraph num="(1)">
      <text>Nurses’ Work Area.</text>
      <paragraph num="(a)">
        <text>The nurses’ work area shall be located on the unit and within easy view of corridors outside of residents’ rooms.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The Department may specify the location and size of a nurses’ work area which serves a nursing care unit exceeding 40 beds.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Nursing Care Unit.</text>
      <paragraph num="(a)">
        <text>A nursing care unit, regardless of size, including special care units, shall be equipped as described in this regulation.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A nursing care unit bathroom shall include:</text>
        <paragraph num="(i)">
          <text>A toilet, within the care unit, for the use of personnel; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A hand-washing sink equipped with goose-neck spout, separate soap dispenser, and disposable paper towel dispenser.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>A nursing care unit’s medicine shall be stored in accordance with the following procedures:</text>
        <paragraph num="(i)">
          <text>Shall be stored in a cabinet with locks;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Schedule II drugs shall be kept in a separately locked, securely fixed box or drawer in the medicine storage cabinet under two locks, keyed differently;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>The medicine storage and preparation area shall be illuminated with at least 100 foot-candles at the work counter;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>The preparation area shall include a small sink set into the counter or with drain boards and a biological refrigerator; and</text>
        </paragraph>
        <paragraph num="(v)">
          <text>The medicine storage cabinet, medicine preparation area, and biological refrigerator shall be under the direct visual control of the nursing or pharmacy staff.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>Nurses' call system.</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Charting desk and supplies.</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Storage space for miscellaneous medical supplies which shall be protected from contamination.</text>
      </paragraph>
      <paragraph num="(g)">
        <text>A nursing care unit shall have sufficient space and equipment for medical records so that personnel can function effectively and maintain easily accessible records for all residents.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Medication Storage in Nursing Home.</text>
      <paragraph num="(a)">
        <text>The storage facility shall provide for the conditions listed in §C(3)(b)—(g) of this regulation when prescribed.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Cold — Any temperature at or below 46°F or 8°C. A refrigerator is a cold place in which the temperature is maintained thermostatically between 46°F and 59°F or 8°C and 15°C. A freezer is a cold place in which the temperature is maintained thermostatically between -4°F and -14°F or -20°C and -26°C.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Cool — Any temperature between 46°F and 59°F or 8°C and 15°. 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.</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Room Temperature — The temperature prevailing in a working area. Controlled room temperature is a temperature maintained thermostatically between 59°F and 86° F or 15°C and 30°C.</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Warm — Any temperature between 86°F and 104°F or 30°C and 40°C.</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Excessive Heat — Any temperature above 104°F or 40°C.</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Protection from Freezing. The container label bears appropriate instructions to protect the product from freezing when freezing it may subject a product to:</text>
        <paragraph num="(i)">
          <text>Loss of strength or potency;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Risk of breakage of the container; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Destructive alteration of the dosage form.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(h)">
        <text>Storage under Non-specific Conditions. When no specific storage directions or limitations are provided in the individual monograph, the storage conditions shall include protection from moisture, freezing, and excessive heat.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Space for Storage of Linen. Capacity shall be provided for storing of at least two complete linen changes per bed. Clean linen shall be stored separately from unclean items.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Janitor Closet — New Construction.</text>
      <paragraph num="(a)">
        <text>A nursing unit shall contain at least one janitor closet containing a floor receptor or service sink and storage space for housekeeping equipment and supplies.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The janitor closet shall be equipped for hand washing.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The janitor closet shall be connected to mechanically operated exhaust ventilation.</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The plumbing fixture for the utility or service sink within a janitor closet shall be provided with a back-flow prevention device.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>Utility Rooms.</text>
      <paragraph num="(a)">
        <text>There shall be separate clean and soiled utility rooms in each nursing unit:</text>
        <paragraph num="(i)">
          <text>Accessible to the resident area;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Each having separate entrances; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>No more than 120 feet to the most remote resident bedroom.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>The clean utility room shall contain:</text>
        <paragraph num="(i)">
          <text>A small sink equipped with gooseneck spout and wrist blades;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Soap and individual paper towels in a dispenser;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Adequate storage and work counter space for storage and assembly of supplies for nursing procedures; and</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Clean linen stored and transported in covered containers, closed linen carts, or rooms exclusively provided for this purpose.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>The soiled utility room shall contain:</text>
        <paragraph num="(i)">
          <text>Work counter with sink, gooseneck faucet, and wrist blades;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A small sink equipped with soap and individual paper towels in a dispenser;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Space for waste receptacles and soiled linen receptacles; provision for storing and transporting soiled linen in covered leakproof containers;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Equipment to clean and sanitize bedpans, urinals, and basins; and</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Equipment for the disposal of liquid and semi-solid wastes and bodily fluids via the nursing home’s sanitary sewer connection or on-site sewage disposal system.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>Culture Change Nursing Home. In a culture change nursing home, service areas shall be provided for resident care needs as approved by the Department. The culture change nursing home shall be required to have service areas that meet the specifications in this chapter for:</text>
      <paragraph num="(a)">
        <text>Clean storage;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Soiled holding;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Laundry;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Janitorial services; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Medication storage.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Drinking Fountains. One public drinking fountain or comparable equipment as preapproved by the Department shall be provided on each floor, usable from a wheelchair. Alternative means to provide drinking water to residents, staff, and the general public may be used as approved by the Department.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Automated External Defibrillator.</text>
    <paragraph num="(1)">
      <text>A nursing home shall possess a functioning automated external defibrillator (AED).</text>
    </paragraph>
    <paragraph num="(2)">
      <text>As of July 1, 2020, a nursing home shall install a functioning AED unit.</text>
    </paragraph>
  </paragraph>
</regulation>