This week on the CMSCG Blog, we are looking at some additional Ftags that comprise the Physical Environment regulatory group. While these Ftags may not be frequently cited, there are a significant number of regulations related to the resident’s room including F915 Resident Room Window, F916 Resident Room Floor Above Grade, F917 Resident Room Bed/Furniture/Closet and F918 Bedrooms Equipped/Near Lavatory/Toilet.
F915 Resident Room Window
As the name of this Ftag indicates, resident bedrooms in nursing homes must have an outside window or outside door in every sleeping room. For buildings that were constructed after July 5, 2016, the windowsill height may not exceed 36 inches above the floor. Windows in outdoor atrium walls are considered outside windows under the regulatory requirement, but windows that face an interior atrium are not. The Interpretive Guidance (IG) for this regulation reminds providers of the importance of creating a homelike environment for residents, and that windows are an important aspect of that.
F916 Resident Room Floor Above Grade
F916 requires that resident room floors are at or above the surrounding exterior ground level, which means that resident rooms in basements are not allowed. This is infrequently cited, but when it has been cited, resident rooms have often experienced water damage from storms.
F917 Resident Room Bed/Furniture/Closet
The regulation at F917 covers three aspects of the resident’s room:
- Closet – Each resident must have private closet space in the resident room where each resident’s clothing is kept separate from his/her roommate. This does not require installed closets, but may also include the use of wardrobes or detached storage furniture. Surveyors will check to see if there is individual closet space with racks and shelves that are accessible to the resident. They will also check if a resident can get to and reach his/her clothing as well as items on shelves if the resident is able to use a closet. If the resident is unable to use the closet, the facility needs to provide the resident with assistance to access clothing or alternative storage space that provides access for the resident.
- Bed – Each resident must have his/her own bed that is the proper size and height for the resident that has a clean, comfortable mattress and weather/climate-appropriate bedding on it. Surveyors are guided to check if residents who use wheelchairs are able to safely transfer to the bed if they are able to, based on whether the bed is positioned at an appropriate height.
- Functional furniture – Functional furniture is
defined by CMS as room furniture that “contributes to the resident attaining or
maintaining his or her highest practicable level of independence and
well-being.” Residents should be able to have their clothing put away in an
organized manner that protected it from casual access from others. Rooms should
also have somewhere to put personal effects, such as a bedside table, and
should have furniture that is “suitable for the comfort of the residents and
visitors (e.g., a chair).”
- This has been cited on survey when there was no physical separation in the closets for residents sharing rooms, when a surveyor interviewed a resident did not have anywhere to sit down due a chair not being in the room, and when non-functioning furniture, such as drawers off their tracks, was observed.
F918 Bedrooms Equipped/Near Lavatory/Toilet
The regulation at F918 requires nursing homes to ensure each resident’s room is either equipped with bathroom and toilet facilities or is located near them. Facilities have been cited under this regulation mainly related to accessibility of toilet facilities. One facility was cited for failing to provide unobstructed access to a hallway bathroom that residents in wheelchairs needed to use since the bathrooms in their rooms did not allow wheelchair access. Another facility was cited for not having enough showers to meet resident needs when surveyors identified that two units did not have any bathrooms, including showers. Upon interviewing the residents, they also identified that there was not sufficient hot water for residents either.
When the RoPs were revised, language related to new construction post-Phase 1 (after 11/28/16) required that each room was built with at least a toilet and sink in it. The proposed rule published by CMS this week includes some changes regarding new construction that you can read about in our blog post here.