AUTHORITY: Alternative Health Care Delivery Act [210 ILCS 3].

SOURCE: Adopted at 26 Ill. Reg. 4712, effective March 31, 2002; emergency amendment at 27 Ill. Reg. 7920, effective April 30, 2003, for a maximum of 150 days; emergency expired September 26, 2003; amended at 27 Ill. Reg. 18053, effective November 12, 2003; amended at 30 Ill. Reg. 866, effective January 9, 2006; Subchapter c recodified at 48 Ill. Reg. 17403.

SUBPART A: GENERAL PROVISIONS

 

Section 225.100  Definitions

 

The following terms have the meaning ascribed to them here whenever the term is used in this Part.

 

Abuse – any physical or mental injury or sexual assault inflicted on a participant other than by accidental means in a facility.  Abuse means:

 

Physical abuse – the infliction of physical injury on a participant that occurs other than by accidental means and that requires (whether or not actually given) medical attention.

 

Mental injury – non-physical injury arising from the following types of conduct:

 

Verbal abuse – the use by a licensee, employee or agent of oral, written or gestured language that includes disparaging and derogatory terms to residents or within their hearing or seeing distance, regardless of their age, ability to comprehend or disability.

 

Mental abuse – includes, but is not limited to, humiliation, harassment, threats of punishment or deprivation, or offensive physical contact by a licensee, employee or agent.  Sexual harassment or sexual coercion perpetrated by a licensee, employee or agent.

 

Sexual assault.

 

Act – the Alternative Health Care Delivery Act [210 ILCS 3].

 

Alzheimer's disease – a progressive, degenerative disease that attacks the brain and results in impaired memory, thinking and behavior.

 

Alzheimer's Disease Management Center Model or Model – a designated site that provides a safe and secure setting for care of persons diagnosed with Alzheimer's disease.  (Section 35(5) of the Act)

 

Board – the State Board of Health.  (Section 10 of the Act)

 

Caregivers – family members, other relatives or friends who are involved in caring for the resident.

 

Charitable care – the intentional provision of free or discounted services to persons who cannot afford to pay for them.

 

Chemical restraint – any drug that is used for discipline or convenience and is not required to treat medical symptoms or behavior manifestations of mental illness.

 

Comparable health care providers – other providers of care for individuals with Alzheimer's disease.

 

Comprehensive care plan – a plan of care developed specifically for an individual resident, based on the resident assessment.

 

Demonstration Program or Program – a program to license and study alternative health care models authorized under the Act.  (Section 10 of the Act)

 

Department – the Illinois Department of Public Health.  (Section 10 of the Act)

 

Dietician – a person who is a licensed dietician as provided in the Dietetic and Nutrition Services Practice Act [225 ILCS 30].

 

Director – the Director of Public Health or designee.  (Section 10 of the Act)

 

Emergency – a situation, physical condition or one or more practices, methods or operations that present imminent danger of death or serious physical or mental harm to residents of a facility.

 

Facility – same as Alzheimer's Disease Management Center Model.

 

Inspection – any survey, evaluation, or investigation of the Alzheimer's Disease Management Center Model's compliance with the Act and this Part by the Department or designee.

 

Licensee – the person or entity licensed to operate the Alzheimer's Disease Management Center Model.

 

Medical director – the physician who is responsible for advising the provost on the overall medical management of the residents in the Model.

 

Neurologist – a physician who is Board certified in neurology.

 

Occupational therapist, registered (OTR) – a person who is registered as an occupational therapist under the Illinois Occupational Therapy Practice Act [225 ILCS 75].

 

Operator – the person responsible for the control, maintenance and governance of the Model, its personnel and physical plant.

 

Owner – the individual, partnership, corporation, association or other person who owns the Model.

 

Physical restraint – any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident's body, which the individual cannot remove easily and which restricts freedom of movement or normal access to one's body.

 

Physical therapist – a person who is registered as a physical therapist under the Illinois Physical Therapy Act [225 ILCS 90].

 

Physician – a person licensed to practice medicine in all its branches under the Medical Practice Act of 1987 [225 ILCS 60].

 

Provost – the person responsible for directing the care of residents in the Model.

 

Registered nurse – a person who is licensed as a registered professional nurse under the Nursing and Advanced Practice Nursing Act [225 ILCS 65].

 

Resident – a person who resides in an Alzheimer's Disease Management Center Model.

 

Resident's representative – a person authorized by the resident or by law to act on behalf of the resident.

 

Social worker – a person who is a licensed social worker or a licensed clinical social worker under the Clinical Social Work and Social Work Practice Act [225 ILCS 20].

 

State Fire Marshal – the Office of the State Fire Marshal, Division of Fire Protection.

 

Substantial compliance – meeting requirements except for variance from the strict and literal performance, which results in unimportant omissions or defects given the particular circumstances involved.

 

Unit – a physically identifiable residence area.

 

Section 225.200  Incorporated and Referenced Materials

 

a)         The following private and professional association standards are incorporated in this Part:

 

1)         American National Standards Institute:  Standard No. A177.1-R1971, Specifications for Making Buildings and Facilities Accessible to, and Usable by, the Physically Handicapped, which may be obtained from the American Society of Mechanical Engineers, United Engineering Center, 325 East 47^th Street, New York, New York  10017.

 

2)         American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE), Handbook of Fundamentals (1997), which may be obtained from the National Association of American Society of Heating, Refrigerating, and Air Conditioning Engineers, Inc., 1791 Tullie Circle, N.E., Atlanta, Georgia 30329.

 

3)         American Society for Testing and Materials (ASTM) Standard No. E90-1975: Recommended Practice for Laboratory Measurement of Airborne Sound Transmission Loss of Building Partitions, which may be obtained from the American Society for Testing and Materials, 1916 Race Street, Philadelphia, Pennsylvania 19103.

 

4)         BOCA International Building Code (1996), which may be obtained from Building Officials and Code Administrators International, Inc., 4051 Flossmoor Road, Country Club Hills, Illinois 60478-5795.

 

5)         National Fire Protection Association (NFPA) Standard No. 101: Life Safety Code, Chapter 33 (2000), which may be obtained from the National Fire Protection Association, 1 Batterymarch Park, Quincy, Massachusetts 02269.

 

6)         Underwriters Laboratories, Inc. (UL), which may be obtained from Underwriters Laboratories, Inc., 333 Pfingsten Rd., Northbrook, Illinois 60062:

 

A)        Fire Resistance Directory (2001 Edition),

 

B)        Building Material Directory (2001 Edition), and

 

C)        Automotive Burglary Protection Mechanical Equipment Directory (2001 Edition).

 

7)         Dietary Guidelines for Americans, 2000, 5th Edition, which may be obtained from the Food and Nutrition Information Center, National Agricultural Library, U.S. Department of Agriculture, 10301 Baltimore Ave., Beltsville, Maryland 20705.

 

b)         All incorporations by reference of the standards of nationally recognized organizations refer to the standards on the date specified and do not include any additions or deletions subsequent to the date specified.

 

c)         The following State statutes and regulations are referenced in this Part:

 

1)         State of Illinois statutes:

 

A)        Alternative Health Care Delivery Act [210 ILCS 3]

 

B)        Dietetic and Nutrition Services Practice Act [225 ILCS 30]

 

C)        Illinois Occupational Therapy Practice Act [225 ILCS 75]

 

D)        Illinois Physical Therapy Act [225 ILCS 90]

 

E)        Medical Practice Act of 1987 [225 ILCS 60]

 

F)         Nursing and Advanced Practice Nursing Act [225 ILCS 65]

 

G)        Health Care Worker Background Check Act [225 ILCS 46]

 

H)        Nursing Home Care Act [210 ILCS 45]

 

I)         Criminal Code of 1961 [720 ILCS 5]

 

J)         Illinois Controlled Substances Act [720 ILCS 570]

 

K)        Cannabis Control Act [720 ILCS 550]

 

L)        Clinical Social Work and Social Work Practice Act [225 ILCS 20]

 

2)         State of Illinois rules:

 

A)        Office of the State Fire Marshal, Boiler and Pressure Vessel Safety Code (41 Ill. Adm. Code 120)

 

B)        Capital Development Board, Illinois Accessibility Code (71 Ill. Adm. Code 400)

 

C)        Department of Public Health:

 

i)          Control of Communicable Diseases Code (77 Ill. Adm. Code 690)

 

ii)         Control of Tuberculosis Code (77 Ill. Adm. Code 696)

 

iii)        Food Service Sanitation Code (77 Ill. Adm. Code 750)

 

iv)        Illinois Plumbing Code (77 Ill. Adm. Code 890)

 

v)         Private Sewage Disposal Code (77 Ill. Adm. Code 905)

 

vi)        Drinking Water Systems Code (77 Ill. Adm. Code 900)

 

vii)       Rules of Practice and Procedure in Administrative Hearings (77 Ill. Adm. Code 100)

 

Section 225.300  Demonstration Program Elements

 

a)         There shall be an authorized Alzheimer's Disease Management Center Alternative Health Care Model in the demonstration program.  The Alzheimer's Disease Management Center shall be located in Will County, owned by a not-for-profit entity, and endorsed by a resolution approved by the county board before June 16, 2000.  (Section 30(a-20) of the Act)

 

b)         The Model shall be a facility separate from any other facility licensed by the Department under the Act or any other Act. (Section 35(5) of the Act)

 

c)         The Model shall have no more than 100 residents. (Section 35(5) of the Act)

 

d)         The Model shall be licensed pursuant to this Part to be considered a participant in the Program.

 

e)         At the midpoint and end of the Program, the Board shall evaluate and make recommendations to the Governor and the General Assembly, through the Department, regarding the Program, in accordance with Section 20(b) of the Act.  (Section 20(b) of the Act)

 

f)         The Department shall deposit all application fees, renewal fees and fines collected under the Act and this Part into the Regulatory Evaluation and Basic Enforcement Fund in the State Treasury.  (Section 25(d) of the Act)

 

Section 225.400  Application for and Issuance of a License to Operate an Alzheimer's Disease Management Center Model

 

a)         Applications for a license to operate an Alzheimer's Disease Management Center Model shall be in writing on forms provided by the Department.  The application shall be made under oath and shall contain the following:

 

1)         The name of the proposed Model;

 

2)         The address of the proposed Model;

 

3)         A precise description of the site of the proposed Model;

 

4)         The number of beds;

 

5)         The name and address of the registered agent or other individual authorized to receive Service of Process for the Model licensee;

 

6)         The name, address and Illinois license number of the following persons:

 

A)        Medical director,

 

B)        Supervisor of nursing services, and

 

C)        Provost;

 

7)         The Model's admission protocol and transfer criteria as required by Section 225.1010;

 

8)         Information regarding any conviction of the owner or operator of the proposed Model of a felony or of any other crime under the laws of any state or of the United States arising out of or in connection with the operation of a health care facility; and

 

9)         Information regarding any encumbrance on a health care license issued in Illinois or any other state to the owner or operator of the proposed Model.

 

b)         An application for initial and renewal licensure shall be accompanied by an application fee of $500 plus $100 for each Model bed.

 

c)         Upon receipt and review of a complete application for licensure, the Department shall conduct an inspection to determine compliance with the Act and this Part.

 

d)         If the proposed Model is found to be in substantial compliance with the Act and this Part, the Department shall issue a license for a period of one year.  (Section 30 of the Act) The license shall not be transferable; it is issued to the licensee and for the specific location and number of beds identified in the application.

 

e)         An application for license renewal shall be filed with the Department 90 to 120 days prior to the expiration of the license, on forms provided by the Department.

 

1)         The renewal application shall comply with the requirements of subsections (a) and (b) of this Section; and

 

2)         Upon receipt and review of a complete application for license renewal, the Department may conduct a survey.  The Department shall renew the license in accordance with subsection (d) of this Section.

 

f)         The Department may issue a provisional license to any Model that does not substantially comply with the provisions of the Act and this Part:

 

1)         A provisional license may be issued only if the Department finds that:

 

A)        The Model has undertaken changes and corrections which upon completion will render the Model in substantial compliance with the Act and this Part; and

 

B)        The health and safety of the residents in the Model will be protected during the period for which the provisional license is issued.  (Section 30(c) of the Act)

 

2)         The Department shall advise the applicant or licensee of the conditions under which the provisional license is issued, including:

 

A)        The manner in which the Model fails to comply with the provisions of the Act and this Part;

 

B)        The changes and corrections that shall be completed;

 

C)        The time within which the necessary changes and corrections shall be completed (Section 30(c) of the Act); and

 

D)        The interim actions that are necessary to protect the health and safety of the residents.

 

g)         The Model license or provisional license shall be prominently displayed in an area accessible to the public.

 

Section 225.500  Obligations and Privileges of an Alzheimer's Disease Management Center Model

 

a)         An Alzheimer's Disease Management Center Model shall, within 30 days after licensure, seek certification under Titles XVIII and XIX of the Federal Social Security Act.  (Section 30(d) of the Act)

 

b)         The Model shall provide charitable care consistent with that provided by comparable health care providers in the geographic area.  (Section 30(d) of the Act)

 

c)         A licensed Model that continues to be in substantial compliance after the conclusion of the demonstration program shall be eligible for annual license renewals unless and until a different licensure program for that type of health care model is established by legislation.  (Section 30(c) of the Act)

 

Section 225.600  Inspections and Investigations

 

a)         The Department shall perform licensure inspections of the Alzheimer's Disease Management Center Model, as deemed necessary, to ensure compliance with the Act and this Part. (Section 25(c) of the Act)

 

b)         The Model to which this Part applies shall be subject to and shall be deemed to have given consent to all inspections by properly identified personnel of the Department, or by other such properly identified persons as the Department might designate.  In addition, representatives of the Department shall have access to and may reproduce or photocopy any books, records, and other documents maintained by the Model or the licensee to the extent necessary to carry out the Act and this Part.

 

c)         The Department shall investigate an applicant or licensee whenever it receives a verified complaint in writing of any person setting forth facts which, if proven, would constitute grounds for the denial of an application for a license, refusal to renew a license, or suspension or revocation of a license.  (Section 50 of the Act)

 

d)         The Department may also investigate an applicant or licensee on its own motion or based upon complaints received by mail, telephone, or in person.  (Section 50 of the Act)

 

Section 225.700  Notice of Violation and Plan of Correction

 

a)         Upon determination that the licensee or applicant is in violation of the Act or this Part, the Department shall issue a written Notice of Violation and request a plan of correction. The notice shall specify the violations, and shall instruct the licensee or applicant to submit a plan of correction to the Department within 10 days after receipt of the Notice.

 

b)         Within the ten-day period, a licensee or applicant may request additional time for submission of the plan of correction.  The Department may extend the period for submission of the plan of correction for an additional 30 days, when the Department finds that corrective action by the Model to abate or eliminate the violations will require substantial capital improvement.  The Department will consider the extent and complexity of necessary physical plant repairs and improvements and any impact on the health, safety, or welfare of the residents of the Model in determining whether to grant a requested extension.

 

c)         Each plan of correction shall be based on an assessment by the Model of the conditions or occurrences that are the basis of the violations and an evaluation of the practices, policies, and procedures that have caused or contributed to the conditions or occurrences. Evidence of such assessment and evaluation shall be maintained by the Model. Each plan of correction shall include:

 

1)         A description of the specific corrective action the Model is taking, or plans to take, to abate, eliminate, or correct the violations cited in the Notice;

 

2)         A description of the steps that will be taken to avoid future occurrences of the same and similar violations; and

 

3)         A specific date by which the corrective action will be completed.

 

d)         Submission of a plan of correction shall not be considered an admission by the Model that the violation has occurred.

 

e)         The applicant or licensee may submit additional information in response to the Notice of Violation that it believes will clarify the condition or alleged violations. The Department will consider the information in reviewing the applicant's or licensee's response and the plan of correction.

 

f)         The Department shall review each plan of correction to ensure that it provides for the abatement, elimination, or correction of the violation.  The Department shall reject a submitted plan only if it finds any of the following deficiencies:

 

1)         The plan does not address the conditions or occurrences that are the basis of the violation and an evaluation of the practices, policies, and procedures that have caused or contributed to the conditions or occurrences.

 

2)         The plan is not specific enough to indicate the actual actions the Model will be taking to abate, eliminate, or correct the violation.

 

3)         The plan does not provide for measures that will abate, eliminate, or correct the violation.

 

4)         The plan does not provide steps that will avoid future occurrences of the same and similar violations.

 

5)         The plan does not provide for timely completion of the corrective actions, considering the seriousness of the violation, any possible harm to the participants, and the extent and complexity of the corrective action.

 

g)         The Department shall notify the licensee or applicant if the plan of correction is rejected, including specific reasons for the rejection of the plan.  The Model shall submit a modified plan that addresses the requirements of subsection (c) of this Section within five days after receipt of notice of rejection.

 

h)         If a licensee or applicant fails to make a timely submission of a modified plan of correction, or such modified plan is not acceptable to the Department, a plan of correction shall be specified and imposed by the Department.

 

i)          The Department shall verify the completion of the corrective action required by the plan of correction within the specified time period during subsequent investigations, surveys, and evaluations of the Model.

 

Section 225.800  Adverse Licensure Action

 

a)         Before denying a license application, refusing to renew a license, suspending a license, revoking a license, or assessing an administrative fine, the Department shall notify the applicant or the licensee in writing.  The notice shall specify the charges or reasons for the Department's contemplated action, and shall provide the applicant or licensee an opportunity to file a request for a hearing within 10 days after receiving the notice. (Section 50 of the Act)

 

1)         A failure to request a hearing within 10 days shall constitute a waiver of the applicant's or licensee's right to a hearing.  (Section 50 of the Act)

 

2)         The hearing shall be conducted by the Director or an individual designated in writing by the Director as an Administrative Law Judge, and shall be conducted in conformance with the Department's Rules of Practice and Procedure in Administrative Hearings (77 Ill. Adm. Code 100) and Section 65 of the Act. (Section 55 of the Act)

 

b)         A license may be denied, suspended, or revoked, or the renewal of a license may be denied or administrative fine assessed, for any of the following reasons:

 

1)         Violation of any provision of the Act or this Part.

 

2)         Conviction of the owner or operator of the Alzheimer's Disease Management Center Model of a felony or of any other crime under the laws of any state or of the United States arising out of or in connection with the operation of a health care facility.  The record of conviction or a certified copy of it shall be conclusive evidence of conviction.

 

3)         An encumbrance on a health care license issued in Illinois or any other state to the owner or operator of the Model.

 

4)         Revocation of any facility license issued by the Department during the previous five years or surrender or expiration of the license during the pendency of action by the Department to revoke or suspend the license during the previous five years, if the prior license was issued to the individual applicant or a controlling owner or controlling combination of owners of the applicant or any affiliate of the individual applicant or controlling owner of the applicant or affiliate of the applicant was a controlling owner of the prior license.  (Section 45 of the Act)

 

c)         An action to assess an administrative fine may be initiated in conjunction with or in lieu of other adverse licensure action.

 

d)         The amount of an administrative fine shall be determined based on consideration of the following:

 

1)         The nature and severity of the violations;

 

2)         The Model's diligence in correcting the violations;

 

3)         Whether the Model had been previously cited for similar violations;

 

4)         The number of violations;

 

5)         The duration of uncorrected violations; and

 

6)         The impact or potential impact of the violations on resident health and safety.

 

e)         The administrative fine shall be calculated in relation to the number of days the violation existed, or continues to exist, if it has not been corrected.  The total amount of the fine assessed shall fall within the following parameters:

 

1)         For a violation that occurred as a single event or incident – between $100 and $5,000 per violation.

 

2)         For a violation that was or is continuing beyond a single event or incident – between $100 and $500 per day per violation.

 

Section 225.900  Waivers

 

a)         The Department may grant a waiver from this Part at the time of the on-site review if the licensee or applicant can demonstrate that an alternative is available to ensure the residents' health, safety, and welfare.

 

b)         An applicant or licensee shall submit a written request for a waiver on a Department-provided form that includes:

 

1)         The applicant's or licensee's name;

 

2)         The name, address, and license number, if applicable, of the facility;

 

3)         The specific Section of this Part for which the applicant is requesting a waiver;

 

4)         The reason or reasons why an applicant is not able to comply with the requirement; and

 

5)         An alternative that ensures that the health, safety, and welfare of residents are protected.

 

c)         The Department shall evaluate a request for a waiver as follows:

 

1)         Review the written request;

 

2)         Verify the submitted documentation;

 

3)         If the requested waiver involves a physical plant requirement, inspect the establishment; and

 

4)         If applicable, discuss the waiver with the facility's provost or provost's designee, residents or representatives, or any individual the Department determines is necessary to evaluate the request.

 

d)         If the Department issues a waiver, the Department shall provide a written notice to the applicant or licensee within 90 days after receipt of the request for a waiver.

 

e)         The Department shall issue a notice of denial within 90 days if the Department determines that the proposed alternative does not ensure that the health, safety and welfare of the residents are protected.

 

f)         The Department shall withdraw a waiver if:

 

1)         A licensee does not comply with the conditions of the waiver as approved by the Department;

 

2)         The Department determines that the health, safety, or welfare of residents is not protected by the waiver;

 

3)         The condition of the physical plant has deteriorated or its use substantially changed so that the basis upon which the waiver was issued is materially different; or

 

4)         The establishment is renovated or remodeled in such a way as to permit compliance.

 

g)         The Department may limit the time period that a waiver is in effect.

SUBPART B: POLICIES

 

Section 225.1000  Policies and Procedures

 

a)         The licensee shall have policies and procedures that implement and are consistent with the provisions of this Part.

 

b)         The licensee shall have infection control policies and procedures that shall include at least the following:

 

1)         Compliance with the Department's Control of Communicable Diseases Code (77 Ill. Adm. Code 690);

 

2)         The use of universal precautions and isolation techniques;

 

3)         A continuing program of instruction for all personnel on the mode of spread of infections; and

 

4)         Posted handwashing techniques.

 

c)         The licensee shall provide for the registration and disposition of complaints without threat of discharge or other reprisal against any employee, volunteer, resident or resident's representative.

 

d)         The licensee shall develop, with the approval of the medical director, policies and procedures to be followed during various medical emergencies.  The types of medical emergencies addressed should be based on the needs of the residents being served and may include, but are not limited to, foreign body aspiration, poisoning, allergic reactions, asthma, convulsions, insulin reaction, and acute respiratory distress.

 

e)         The licensee shall develop policies and procedures concerning the handling of resident's funds.  These policies and procedures shall be at least as stringent as those set forth in Section 2-201 of the Nursing Home Care Act [210 ILCS 45/2-201].

 

f)         The licensee shall develop policies and procedures concerning the role and level of supervision of students and interns in the operation of the Model and the care of residents.

 

Section 225.1010  Admission, Transfer and Discharge Policies

 

a)         No resident determined by professional evaluation to be in need of services not readily available in the facility, or through arrangement with a qualified outside resource, shall be admitted to or kept in the facility.

 

b)         No resident shall be admitted to or kept in the facility:

 

1)         Who is psychiatrically disturbed, in need of psychiatric therapy, and at risk because the person is reasonably expected to self-inflict serious physical harm or to inflict serious physical harm on another person in the near future as a result of the mental aberration, as determined by professional evaluation.

 

2)         Who is or may be destructive of property, himself or herself, or others.

 

c)         The licensee shall establish admission criteria that provide for:

 

1)         The admission of clients who can be served by the facility; and

 

2)         Nondiscrimination against clients based on disability, race, religion, sex, source of payment, and any other basis recognized by applicable State and federal laws.

 

d)         Prior to admission, each client shall have a complete neurological examination with a Mini-mental Screening Test.  The screening test shall be performed by a neurologist or an associate with recognized skill.

 

e)         Persons with communicable, contagious, or infectious diseases may be admitted under the conditions and in accordance with the procedures specified in the Control of Communicable Diseases Code.

 

f)         A Model shall not admit more residents than the number authorized by the license issued to it.

 

g)         Physician orders for medications (if necessary) and information concerning any other immediate medical care needs shall be submitted to the licensee at the time of the resident's admission, with appropriate signature of the physician.

 

h)         A Model shall not refuse to discharge or transfer a resident when requested to do so by the resident or, if the resident is incompetent, by the resident's guardian.

 

i)          A resident may be voluntarily discharged from a facility after he or she gives the provost, a physician, or a nurse of the facility written notice of his or her desire to be discharged. The resident shall be discharged upon written consent of the resident's representative.  In such cases, upon the resident's discharge, the facility is relieved from any responsibility for the resident's care, safety, or well-being.

 

j)          A facility may only involuntarily transfer or discharge a resident for one or more of the following reasons:

 

1)         For medical reasons;

 

2)         For the resident's physical safety;

 

3)         For the physical safety of other residents, the facility staff or facility visitors; or

 

4)         For either late payment or nonpayment for the resident's stay.  If payment is not received within 45 days after submission of a bill, the facility may send a notice to the resident and responsible party requesting payment within 30 days.  If payment is not received within 30 days the facility may institute transfer or discharge proceedings by sending a notice of transfer or discharge to the resident and responsible party by registered or certified mail.  The notice shall state that the responsible party has the right to pay the amount of the bill in full up to the date the transfer or discharge is to be made, and then the resident shall have the right to remain in the facility.  Such payment shall terminate the transfer or discharge proceedings.

 

k)         Prior to a planned involuntary discharge, the facility shall provide at least a 21-day written notice to the resident, the resident's representative and the Department.  The notice shall state the reason for the discharge and shall offer assistance in finding another living arrangement.

 

Section 225.1020  Medical Care Policies

 

a)         A medical director shall be responsible for advising the provost on the overall medical management of the residents and the staff of the facility.

 

b)         Every resident shall be under the care of a physician.

 

c)         All residents, or their guardians, shall be permitted their choice of a physician.

 

d)         The facility shall notify the resident's physician of any accident, injury, or significant change in a resident's condition that threatens the health, safety or welfare of a resident, including, but not limited to, the presence of incipient or manifest decubitus ulcers or a weight loss or gain of five percent or more within a period of 30 days.  The facility shall obtain and record the physician's plan of care for the care or treatment of the accident, injury or change in condition at the time of notification.

 

e)         Review of medication orders:  The staff pharmacist or consultant pharmacist shall review the medical record, including physician orders and laboratory test results, at least monthly and, based on his/her clinical experience and judgment, determine if there are irregularities that would cause potential adverse reactions, allergies, contraindications, or ineffectiveness.  This review shall be done at the facility.  Documentation of this review must be entered in the clinical record.  Any irregularities noted shall be reported to the attending physician, the medical director, and the provost.

 

Section 225.1030  Personnel Policies

 

a)         An Alzheimer's Disease Management Center Model shall develop and maintain written personnel policies that are followed in the operation of the facility.

 

b)         Employee Records

 

1)         Each employee shall complete an employment application form, which shall be kept on file in the facility and shall be available for review by Department personnel.

 

2)         Individual personnel files for each employee shall contain the employee's date of employment, date of birth, home address, educational background, and experience, including: types of employment; where the employee was previously employed; type of position employed to fill in this facility; last day employed (if no longer in present facility); and reasons for leaving.

 

3)         Individual personnel files for each employee shall contain health records, including the initial health evaluation, and documentation of the tuberculin skin test.

 

4)         Individual personnel records for each employee shall contain records of evaluation of performance.

 

c)         Prior to employing any individual in a position that requires a State license, the facility shall contact the Illinois Department of Professional Regulation to verify that the individual's license is authorized and in good standing.  A copy of the license shall be placed in the individual's personnel file.

 

d)         All personnel shall have either training or experience, or both, in the job assigned to them.

 

e)         All new employees shall complete an orientation program covering, at a minimum, the following:  general facility and resident orientation; job orientation, emphasizing allowable duties of the new employee; resident safety, including fire and disaster and emergency care; and understanding and communicating with the type of residents being cared for in the facility.  In addition, all new direct care staff shall complete an orientation program covering the facility's policies and procedures for resident care services before being assigned to provide direct care to residents.  This orientation program shall include material regarding the prevention and treatment of decubitus ulcers, which shall be devised and taught by a wound care specialist, and the importance of nutrition in general health care.

 

f)         Employees shall only be assigned duties that are directly related to their job functions, as identified in their job descriptions.  Exceptions may be made in emergencies.

 

g)         Nothing in this Section shall prohibit the use of a universal worker, if all other requirements are met.

 

h)         Personnel policies shall include a plan to provide personnel coverage for regular staff when one or more are absent.

 

i)          The Model shall have a current, dated weekly employee time schedule posted in a convenient place where employees may refer to it.  This schedule shall contain the employee's name, job title, shift assignment, hours of work, and days off.  The schedule shall be kept on file in the facility for one year after the week for which the schedule was used.

 

Section 225.1040  Health Evaluations for Employees

 

a)         Each employee shall have an initial health evaluation, which shall be used to ensure that employees are not placed in positions that would pose undue risk of infection to themselves, other employees, residents or visitors.

 

b)         The initial health evaluation shall be performed by a physician Board Certified in Internal Medicine or Family Practice and shall be completed not more than 30 days prior to the employee's first day of employment.

 

c)         The initial health evaluation shall include the following:

 

1)         A health inventory from the employee, including an evaluation of the employee's immunization status.

 

2)         A physical examination, which shall include:

 

A)        Any procedures needed to detect any unusual susceptibility to infection and any conditions that would increase the likelihood of the transmission of disease to residents, other employees, or visitors;

 

B)        Any procedures needed to determine that the employee appears to be physically able to perform the job functions that the Model intends to assign to the employee.

 

3)         Tuberculin testing in accordance with the Control of Tuberculosis Code (77 Ill. Adm. Code 696), which shall be done at the time of the physical examination.

 

Section 225.1050  Health Care Worker Background Check

 

A facility shall comply with the Health Care Worker Background Check Act [225 ILCS 46] and the Health Care Worker Background Check Code (77 Ill. Adm. Code 955).

 

(Source:  Amended at 30 Ill. Reg. 866, effective January 9, 2006)

 

Section 225.1060  Disaster Preparedness

 

a)         For the purpose of this Section only, "disaster" means an occurrence, as a result of a natural force or mechanical failure such as water, wind or fire, or a lack of essential resources such as electrical power, that poses a threat to the safety and welfare of residents, personnel, and others present in the facility.

 

b)         The facility shall have policies covering disaster preparedness, including a written plan for staff, residents and others to follow.  The plan shall include, but not be limited to, the following:

 

1)         All personnel employed on the premises shall be properly instructed in the use of fire extinguishers.

 

2)         A diagram of the evacuation route shall be posted and made familiar to all personnel employed on the premises.

 

3)         A written plan shall be developed for moving residents to safe locations within the facility in the event of a tornado warning or severe thunderstorm warning.

 

4)         There shall be an established means of facility notification when the National Weather Service issues a tornado or severe thunderstorm warning that covers the area in which the facility is located.  The notification mechanism must be other than commercial radio or television.  Approved notification measures include being within range of local tornado warning sirens, an operable National Oceanic and Atmospheric Administration weather radio in the facility or arrangements with local public safety agencies (police, fire, ESDA) to be notified if a warning is issued.

 

c)         Fire drills shall be held at least quarterly for each shift of facility personnel.  Disaster drills for other than fire shall be held twice annually for each shift of facility personnel. Drills shall be held under varied conditions to:

 

1)         Ensure that all personnel on all shifts are trained to perform assigned tasks;

 

2)         Ensure that all personnel on all shifts are familiar with the use of the fire fighting equipment in the facility; and

 

3)         Evaluate the effectiveness of disaster plans and procedures.

 

d)         Fire drills shall include simulation of evacuation of residents to safe areas during at least one drill each year on each shift.

 

e)         There shall be special provisions for the evacuation of  physically handicapped persons, including those who are hearing or sight impaired.

 

f)         Where the welfare of the residents precludes an actual evacuation of an entire building, there must be drills involving the evacuation of successive portions of the building under such conditions as to assure the capability of evacuating the entire building with the personnel usually available, should the need arise.

 

g)         A written evaluation of each drill shall be submitted to the facility administrator and shall be maintained for one year.

 

h)         A written plan shall be developed for temporarily relocating the residents for any disaster requiring relocation and any time the temperature in residents' bedrooms falls below 55Ί F for 12 hours or more.

 

i)          Reporting of Disasters

 

1)         Upon the occurrence of any disaster requiring hospital service, police, fire department or coroner, the facility administrator or designee must provide a preliminary report to the Department either by using the Central Complaint Registry or by directly contacting the Department during business hours.  This preliminary report shall include, at a minimum:

 

A)        name and location of facility;

 

B)        type of disaster;

 

C)        number of injuries or deaths to residents;

 

D)        number of beds not usable due to the occurrence;

 

E)        estimate of the extent of damages to the facility;

 

F)         type of assistance needed, if any; and

 

G)        other State or local agencies notified about the problem.

 

2)         If the disaster will not require direct Departmental assistance, the facility shall provide the preliminary report within 24 hours after the occurrence. Additionally, the facility shall submit a full written account to the Department within seven days after the occurrence, which includes the information specified in subsection (i)(1) of this Section and a statement of actions taken by the facility after the preliminary report.

 

j)          The facility shall establish and implement policies and procedures in a written plan to provide for the health, safety, welfare and comfort of all residents when the heat index/apparent temperature (see Section 225.Table A), as established by the National Oceanic and Atmospheric Administration, inside the residents' living, dining, activities, or sleeping areas of the facility exceeds a heat index/apparent temperature of 80Ί F.

 

Section 225.1070  Restraints

 

a)         The facility shall have written policies controlling the use of physical restraints. Adaptive equipment is not considered a physical restraint.  Wrist bands or devices on clothing that trigger electronic alarms to warn staff that a resident is leaving a room do not, in and of themselves, restrict freedom of movement and should not be considered as physical restraints.  The policies shall be followed in the operation of the facility.  These policies shall be developed by the medical director and by nursing and administrative personnel.

 

b)         No physical restraints with locks shall be used.

 

c)         Physical restraints shall not be used on a resident for the purpose of discipline or convenience.

 

d)         The use of chemical restraints is prohibited.

 

Section 225.1080  Abuse and Neglect

 

a)         An owner, licensee, employee or agent of a facility shall not abuse or neglect a resident.

 

b)         A facility employee or agent who becomes aware of abuse or neglect of a resident shall immediately report the matter to the provost.

 

c)         A provost who becomes aware of abuse or neglect of a resident shall immediately report the matter by telephone and in writing to the resident's representative.

 

d)         A facility employee or agent who becomes aware of abuse or neglect of a resident shall also report the matter to the Department.

 

e)         When an investigation of a report of suspected abuse of a resident indicates, based upon credible evidence, that an employee of the facility is the perpetrator of the abuse, that employee shall immediately be barred from any further contact with residents of the facility, pending the outcome of any further investigation, prosecution or disciplinary action against the employee.

 

f)         When an investigation of a report of suspected abuse of a resident indicates, based upon credible evidence, that another resident of the facility is the perpetrator of the abuse, that resident's condition shall be immediately evaluated to determine the most suitable therapy and placement for the resident, considering the safety of that resident as well as the safety of other residents and employees of the facility.

SUBPART C: PERSONNEL

 

Section 225.2000  General Requirements

 

a)         The facility shall provide adequate, properly trained and supervised staff to meet each resident's comprehensive care.  Services shall be provided by a coordinated care team.

 

b)         The facility shall define, through job descriptions, necessary education and experience requirements for all regular staff, consultants, and contract staff providing services to the Alzheimer's Disease Management Center Model.

 

c)         The facility shall provide an initial orientation and routine, pertinent training to all staff.

 

d)         The facility shall designate a provost, whose minimum qualifications shall include:

 

1)         Graduate education with degree, and with experience in health services administration, management, providing continuing education and in-service training, and the use of innovative assessment tools;

 

2)         Knowledge of the diverse manifestations of brain illnesses, especially the Alzheimer's type; and

 

3)         Knowledge of basic concepts to foster and develop harmonious relationships with understanding toward residents and personnel.

 

e)         A registered nurse shall be responsible for managing the day-to-day health needs of every resident under his/her direct care.

 

f)         A registered nurse shall be on duty in the facility 24 hours per day, seven days per week.

 

g)         A registered nurse shall be designated as Supervisory Nurse, who shall:

 

1)         Promote the competency, numbers, and staff levels of nursing personnel appropriate to meet the complex needs of the persons served;

 

2)         Identify and implement a nursing program and structure such that the persons served will receive coordinated services; and

 

3)         Provide ongoing monitoring of compliance with nursing standards.

 

h)         Care managers shall be employed to organize the provision of services to residents.  Minimum qualifications shall include:

 

1)         Two years of experience working with individuals with dementia; and

 

2)         Ability to:

 

A)        Prepare a comprehensive care plan with guidance;

 

B)        Recognize emerging conditions for each resident;

 

C)        Adjust the care plan to accommodate changes in a resident's condition;

 

D)        Monitor the performance of care givers;

 

E)        Address present and future care needs of the residents; and

 

F)         Promote an optimal quality of life for the Alzheimer's resident.

 

i)          A social worker shall be employed to direct the social services provided by the Model.

 

Section 225.2010  Staff Training

 

a)         All staff shall have necessary training to care for all stages of Alzheimer's Disease. (Section 35(5) of the Act)  Programmed courses shall be provided.

 

b)         All employees shall attend in-service training programs pertaining to their assigned duties at least annually.  These in-service training programs shall include material regarding the facility's policies, skill training, and ongoing education carried out to enable all personnel to perform their duties effectively.  The in-service training sessions regarding personal care, nursing and restorative services shall include material concerning prevention and treatment of decubitus ulcers.  In-service training concerning dietary services shall include material concerning effects of diet in treatment of various diseases or medical conditions and the importance of laboratory test results in determining therapeutic diets.  Written records of program content for each session and of personnel attending each session shall be kept.  In-service training shall be held at three-month intervals.

 

c)         In-service training may include demonstration, one-on-one training, small group exercises, or lectures.  All training shall be documented with:

 

1)         date,

 

2)         starting and ending time,

 

3)         instructors,

 

4)         short description of content, and

 

5)         staff member's written signature.

 

Section 225.2020  Nursing Assistants

 

a)         A facility shall not employ an individual as a nursing assistant unless the facility has inquired of the Department as to information in the Nurse Aide Registry concerning the individual.

 

b)         The facility shall ensure that each nursing assistant is included on the Nurse Aide Registry as having met training or equivalency requirements and not having a disqualifying criminal conviction.

 

c)         Each person employed by the facility as a nursing assistant shall meet each of the following requirements:

 

1)         Be at least 18 years of age, of good moral character, honest, reliable, and trustworthy;

 

2)         Be able to speak and understand the English language or a language understood by a substantial percentage of the facility's residents;

 

3)         Provide evidence of prior employment or occupation, if any, and residence for two years prior to present employment as a nursing assistant; and

 

4)         Have a valid high school diploma or equivalent.

 

d)         The facility shall certify that each nursing assistant employed by the facility meets the requirements of this Section.  Such certification shall be retained by the facility as part of the employee's personnel record.

 

e)         During inspections of the facility, the Department may require nursing assistants to demonstrate competency in the principles, techniques, and procedures covered by the basic nursing assistant training program curriculum described in 77 Ill. Adm. Code 395, and other training required by this Part, when possible problems in the care provided by nursing assistants or other evidences of inadequate training are observed.  The State-approved manual skills evaluation testing format and forms will be used to determine competency of a nursing assistant when appropriate.  Failure to demonstrate competency of the principles, techniques and procedures shall result in the provision of in-service training to the individual by the facility.  The in-service training shall address the basic nursing assistant training principles and techniques relative to the procedures in which the nursing assistants are found to be deficient during inspection (see 77 Ill. Adm. Code 395).

SUBPART D: RESIDENT CARE SERVICES

 

Section 225.3000  Resident Assessment

 

a)         The facility shall establish policies and procedures defining the assessment process.

 

b)         Prior to admission, each prospective resident shall receive a complete physical examination with specific laboratory testing as follows:

 

1)         Vitamin B12 and Folate levels;

 

2)         Thyroid stimulating hormone level;

 

3)         Complete blood count and blood parameters;

 

4)         Electrocardiogram, 12 lead;

 

5)         Chest radiologic study; and

 

6)         Magnetic Resonance Imaging (MRI) study of the brain, when possible.

 

c)         Within two weeks after admission, each resident shall be assessed by a neurologist, a registered nurse, a psychiatrist and a care manager.  A family member or other individual with knowledge about the resident shall participate in the assessment.

 

d)         The neurologist, with input from the registered nurse, shall determine the resident's need for evaluation by a dietician or for other specialized medical evaluations. The assessment shall be coordinated with the pre-admission assessment to the extent possible to avoid duplicative testing.

 

e)         The assessment shall be used, along with the pre-admission assessment, to develop the resident's comprehensive care plan.  At four-week intervals, the resident's status shall be reviewed by the facility's nursing, social service and activities and recreation staff.

 

f)         In addition to the assessments required in subsections (c) and (d) of this Section, an Alzheimer's Disease Management Center shall conduct and document an assessment of each resident every six months.  The assessment conducted shall include an evaluation of the following:

 

1)         daily functioning,

 

2)         cognitive status, and

 

3)         behavioral problems.  (Section 35(5) of the Act)

 

g)         Assessment outcomes shall be reported to appropriate personnel and to the resident and/or resident's representative.

 

Section 225.3010  Resident Comprehensive Care Plan

 

a)         An Alzheimer's Disease Management Center shall develop and implement an ongoing treatment plan for each resident.  The treatment plan shall have defined goals. (Section 35(5) of the Act)

 

b)         The comprehensive care plan shall be implemented within 24 hours after the resident's admission to the facility based on the pre-admission assessment.

 

c)         The comprehensive care plan shall be revised as needed based on assessments conducted in accordance with Section 225.3000 of this Part.

 

d)         The comprehensive care plan shall include, at a minimum:

 

1)         Staging of the resident based on cognitive study;

 

2)         Assignment to a care manager;

 

3)         Dietary prescription; and

 

4)         Activities provided throughout the day and evening.

 

e)         The facility shall define the members of the care team who will develop and review the plan.  The members of the team shall include, at a minimum:

 

1)         The resident;

 

2)         Resident representative, if he/she chooses to participate, and any other persons chosen by the resident;

 

3)         A person assigned to coordinate services for the person (care manager);

 

4)         A nurse; and

 

5)         Persons providing services for the resident, based on the assessment.

 

f)         The care team shall meet at least every 30 days to implement and modify the care plan as needed.  The care manager shall ensure that the comprehensive care plan is implemented and that the appropriate services are coordinated to ensure that the comprehensive care plan is followed.

 

Section 225.3020  Resident Care and Treatment Services

 

a)         The Alzheimer's Disease Management Center shall treat behavioral problems and mood disorders using nonpharmacologic approaches such as:

 

1)         environmental modification;

 

2)         task simplification; and

 

3)         other appropriate activities.  (Section 35(5) of the Act)

 

b)         The Center shall provide education and support for residents and caregivers.  The education and support shall include referrals to support organizations for educational materials on community resources, support groups, legal and financial issues, respite care, and future care needs and options. (Section 35(5) of the Act)

 

c)         The education and support required by subsection (b) of this Section shall also include a discussion of the resident's need to make advance directives and to identify surrogates for medical and legal decision making.  (Section 35(5) of the Act)

 

d)         The facility shall provide access to appropriate emergency and specialty medical services.  A care manager shall be designated for each resident.  A care manager may serve one or more residents.  The provision of services for each resident shall be organized through the care manager, who shall:

 

1)         Assume responsibility for implementation of the care plan;

 

2)         Assist the resident in becoming oriented to his/her program;

 

3)         Enable the program to proceed in an orderly, purposeful, and goal-oriented manner;

 

4)         Promote the program's responsiveness to the needs and preferences of the resident;

 

5)         Participate consistently in care team conferences concerning the resident; and

 

6)         Maintain communication with family members, resident representative (if designated), and funding source of the resident.

 

e)         The licensee shall provide adequate auxiliary and support services to meet each resident's comprehensive care plan.

 

f)         The facility shall provide other services as necessary to implement and support the resident's comprehensive care plan and overall needs, including provisions for:

 

1)         Case management;

 

2)         Fostering resident independence;

 

3)         Protection of resident rights, privacy and dignity; and

 

4)         Assisting the resident and resident's representative in understanding and adjusting to the resident's current condition, prognosis and future needs.

 

g)         Services shall be delivered in the least restrictive or intrusive manner.

 

Section 225.3030  Activity Program

 

a)         The facility shall provide an ongoing program of activities to meet the interests and preferences and the physical, mental and psychosocial well-being of each resident, in accordance with the resident's comprehensive assessment.  The activities shall be coordinated with other services and programs to make use of both community and facility resources and to benefit the residents.

 

b)         Activity personnel shall be provided to meet the needs of the residents and the program.

 

1)         Activity staff time each week shall total not less than 45 minutes multiplied by the number of residents in the facility.  This time shall be spent in providing activity programming as well as planning and directing the program.  The time spent in the performance of other duties not related to the activity program shall not be counted as part of the required activity staff time.

 

2)         Activity personnel shall have the background and education necessary to be able to implement drama, music, and art therapeutic technique.

 

c)         Activity personnel working under the direction of the activity director shall have a minimum of 10 hours of in-service training per calendar or employment year, directly related to recreation/activities.  In-service training may be provided by qualified facility staff and/or consultants, or may be obtained from college or university courses, seminars and/or workshops, educational offerings through professional organizations, similar educational offerings or any combination of these sources.

 

d)         Activity Director

 

1)         A trained staff person shall be designated as activity director and shall be responsible for planning and directing the activities program.  This person shall be regularly scheduled to be on duty in the facility at least four days per week.

 

2)         The activity director shall be a certified Therapeutic Recreation Specialist.

 

3)         The activity director shall have a minimum of 10 hours of continuing education per year pertaining to activities programming.

 

e)         Written permission, with any contraindications stated, shall be given by the resident's physician if the resident participates in the activity program.  Standing orders will be acceptable with individual contraindications noted.

 

f)         Activity program staff shall participate in the assessment of each resident, which shall include the following:

 

1)         Background information, including education level, cultural/social issues, and spiritual needs;

 

2)         Current functional status, including communication status, physical functioning, cognitive abilities, and behavioral issues; and

 

3)         Leisure functioning, including attitude toward leisure, awareness of leisure resources, knowledge of activity skills, and social interaction skills and activity interests, both current and past.

 

g)         The activity staff shall participate in the development of an individualized plan of care addressing needs and interests of the residents, including activity/recreational goals and/or interventions.

 

h)         The facility shall provide a specific, planned program of individual (including self-initiated) and group activities that are aimed at improving, maintaining, or minimizing decline in the resident's functional status, and at promoting well-being.  The program shall be designed in accordance with the individual resident's needs, based on past and present lifestyle, cultural/ethnic background, interests, capabilities, and tolerance. Activities shall be daily and shall reflect the schedules, choices, and rights of the residents (e.g., morning, afternoon, evenings and weekends).  The residents shall be given opportunities to contribute to planning, preparing, conducting, concluding and evaluating the activity program.

 

i)          The activity program shall be multifaceted and shall reflect each individual resident's needs and be adapted to the resident's capabilities.  The activity program philosophy shall encompass programs that provide stimulation or solace; promote physical, cognitive and/or emotional health; enhance, to the extent practicable, each resident's physical and mental status; and promote each resident's self-respect by providing, for example, activities that support self-expression and choice.  Specific types of activities may include:

 

1)         Physical activity (e.g., exercise, fitness, adapted sports);

 

2)         Cognitive simulation/intellectual/educational activity (e.g., discussion groups, reminiscence, guest speakers, films, trivia, quizzes, table games, puzzles, writing, spelling, newsletter);

 

3)         Spiritual/religious activity (e.g., religious services, spiritual study groups, visits from spiritual support groups);

 

4)         Service activity (e.g., volunteer work for the facility, other individuals and/or the community);

 

5)         Sensory stimulation (e.g., tactile, olfactory, auditory, visual and gustatory);

 

6)         Community involvement (e.g., community groups coming into the facility for intergenerational programs, special entertainment and volunteer visits; excursions outside the facility to museums, sporting events, entertainment, parks);

 

7)         Expressive and creative arts/crafts (adapted to the resident's capabilities), music, movement/dance, horticulture, pet-facilitated therapy, drama, literary programs, art, cooking;

 

8)         Family involvement (e.g., correspondence, family parties, holiday celebrations, family volunteers); and

 

9)         Social activity (e.g., parties and seasonal activities).

 

j)          Residents' participation in and response to the activity program shall be documented at least quarterly and included in the clinical record.  The facility shall maintain current records of resident participation in the activity program.

 

Section 225.3040  Volunteer Program

 

a)         If the facility has a volunteer or auxiliary program, a staff person shall direct the program.  Community groups such as Boy Scouts and Girl Scouts, church groups and civic organizations that may occasionally present programs, activities, or entertainment in the facility shall not be considered volunteers for the purposes of this Section.

 

b)         Volunteers shall complete a standard orientation program, in accordance with their responsibilities and with the facility's policies and procedures governing the volunteer program.  The orientation shall include, but not be limited to:

 

1)         Residents' rights;

 

2)         Confidentiality;

 

3)         Disaster preparedness (i.e., fire, tornado);

 

4)         Emergency response procedures;

 

5)         Safety procedures/precautions;

 

6)         Infection control; and

 

7)         Body mechanics.

 

c)         Volunteers shall respect all aspects of confidentiality.

 

d)         Volunteers shall be informed of and shall implement medical and physical precautions related to the residents with whom they work.

 

e)         Volunteers shall not take the place of qualified staff (e.g., activity professionals, nursing assistants, or case workers).

 

Section 225.3050  Residential Services

 

a)         Twenty-four hour supervision shall be provided in each living environment. At least one staff member shall be present in each living environment at all times when residents are present.

 

b)         An emergency response system shall be provided.

 

c)         Twenty-four hour access to assistance shall be provided in each environment.

 

d)         The facility shall have policies and procedures in place to guide decisions regarding the necessary level of supervision each resident requires in the facility.

 

Section 225.3060  Medication Administration

 

a)         Except for medications allowed in subsection (c) of this Section, the only medications allowed in the facility are those for particular individual residents. The medication of each resident shall be kept and stored in the original container received from the pharmacy or as packaged by the nurse, when preparing unit dose packages from multidose containers.

 

1)         Each multidose medication container shall indicate the resident's name; physician's name; prescription number, name, strength and quantity of drug; date the container was last filled; the initials of the pharmacist filling the prescription; the identity of the pharmacy; the refill date; and any necessary special instructions.

 

2)         Each single unit or unit dose package shall contain the proprietary and nonproprietary name of the drug and the strength of the dose.  The name of the resident and the physician do not have to be on the label of the package, but they must be identified with the package in such a manner as to assure that the drug is administered to the correct resident.

 

b)         All oral medication packaged in multidose containers, prescribed medication given through a feeding tube, and all parenteral medication must be administered by a registered nurse or physician.

 

c)         A small supply of medications regularly available without prescription at a commercial pharmacy may be stocked in the facility, such as:  noncontrolled cough syrups, laxatives, and analgesics.  These shall be given to a resident only upon the order of a physician.

 

d)         Each living area shall have a first aid kit that contains items appropriate to treat minor cuts, burns, and abrasions.

 

e)         All medications shall be properly stored in a secured location not accessible to unauthorized individuals.

SUBPART E: RESIDENTS' RIGHTS

 

Section 225.4000  Residents' Rights

 

a)         No resident shall be deprived of any rights, benefits, or privileges guaranteed by law based on his/her status as a resident of the Model.

 

b)         A resident has the right to be free from abuse, neglect or restraint.

 

c)         A resident shall be permitted to retain and use or wear personal property in his/her immediate living quarters, unless deemed medically inappropriate by a physician and so documented in the resident's clinical record.

 

d)         If clothing is provided to the resident by the facility it shall be of a proper fit.

 

e)         The facility shall provide adequate and convenient storage space for the personal property of the resident.

 

f)         The facility shall make reasonable efforts to prevent loss and theft of residents' property. Those efforts may include, but are not limited to, staff training and monitoring, labeling property, and frequent property inventories.

 

g)         The facility shall develop procedures for investigating complaints concerning theft of residents' property and shall promptly investigate all such complaints.

 

h)         The provost shall ensure that married residents residing in the facility are allowed to reside in the same room unless there is no room available or it is deemed medically inadvisable by the residents' attending physician and so documented in the residents' medical records.

 

i)          A resident's room shall not be used as access to any other area of the building.

 

j)          Children under 16 years of age who are related to employees or owners of a facility shall be restricted to quarters reserved for family or employee use except during times when such children are part of a group visiting the facility as part of a planned program, or similar activity.

 

k)         A resident shall be permitted the free exercise of religion.  Upon a resident's request, and if necessary at his/her expense, the administrator shall make arrangements for a resident's attendance at religious services of the resident's choice.  However, no religious beliefs or practices, or attendance at religious services, may be imposed upon any resident.

 

l)          The facility shall immediately notify the resident's next of kin, representative and physician of the resident's death or when the resident's death appears to be imminent.

 

m)        The facility shall also immediately notify the resident's family, guardian, representative, conservator and any private or public agency financially responsible for the resident's care whenever unusual circumstances, such as accidents, sudden illness, disease, unexplained absences, extraordinary resident charges, billings, or related administrative matters, arise.

SUBPART F: RESIDENT RECORDS

 

Section 225.5000  Resident Record Requirements

 

The facility shall maintain resident records that are accessible to service providers. Confidentiality of residents' medical records shall be ensured.  Records shall include, but are not limited to:

 

a)         Medical records;

 

b)         Preadmission screening results;

 

c)         Resident initial and ongoing assessment results;

 

d)         Records pertaining to residents' property; and

 

e)         Comprehensive care plan.

SUBPART G: FOOD SERVICE

 

Section 225.6000  Director of Food Services

 

a)         A full-time person, qualified by training and experience, shall be responsible for the total food services of the facility.  This person shall be on duty a minimum of 40 hours each week.

 

1)         This person shall be either a dietician or a dietetic service supervisor.

 

2)         The person responsible for the food service may assume some cooking duties, but only if these duties do not interfere with the responsibilities of management and supervision.

 

b)         If the person responsible for food service is not a dietician, the person shall have frequent and regularly scheduled consultation from a dietician.  Consultation, given in the facility, shall include training, as needed, in areas such as menu planning and review, food preparation, food storage, food service, safety, food sanitation, and use of food equipment.  Clinical management of therapeutic diets shall also be included in consulting, covering areas such as tube feeding; nutritional status and requirements of residents, including weight, height, hematologic and biochemical assessments; physical limitations; adaptive eating equipment; and clinical observations of nutrition, nutritional intake, resident's eating habits and preferences, and dietary restrictions.

 

Section 225.6010  Meal Planning

 

Each resident shall be served food to meet the resident's needs and to meet physician's orders. The facility shall use this Section to plan menus and purchase food in accordance with the following and the Dietary Guidelines for Americans of the U.S. Department of Agriculture:

 

a)         Milk and Milk Products Group:  16 ounces or more of Grade A whole or low fat pasteurized milk where milk is used for fluid consumption.  Calcium equivalents for eight ounces of milk:

 

1)         1½ ounces natural cheese;

 

2)         2 ounces processed cheese;

 

3)         1 cup yogurt, or one cup frozen yogurt;

 

4)         1 cup cottage cheese; or

 

5)         1½ cups ice cream or ice milk.

 

b)         Meat Group:  A total of 6 ounces (by weight) of good quality protein to provide 38 to 42 grams of protein daily.  To ensure variety, food items repeated within the same day shall not be counted as meeting a required serving.  The following are examples of one serving:

 

1)         3 ounces (excluding bone, fat and breading) of any cooked meat such as whole or ground beef, veal, pork or lamb; poultry; organ meats such as liver, heart, kidney; prepared luncheon meats.

 

2)         3 ounces (excluding skin and breading) of cooked fish or shell fish or ½ cup canned fish.

 

3)         3 ounces of natural or processed cheese or Ύ cup cottage cheese.

 

4)         3 eggs (minimum weight 21 ounces per dozen, considered a medium egg).

 

            AGENCY NOTE:  If one egg is served at a meal, a protein food of good quality may be reduced from 6 to 5 ounces for the remaining meals.  If 2 eggs are served at a meal, a minimum of 2 ounces of good quality protein shall be served at each of the remaining meals.

 

5)         1½ cups cooked dried peas or beans, 6 tablespoons of peanut butter, or 1 cup nuts, not more than twice a week and provided that eggs, milk or lean meat is served at the same meal.

 

6)         3 ounces of soy protein containing not less than 21 grams of protein or in combination with other sources of quality protein to equal 21 grams of protein, provided that it is acceptable to the resident population.

 

7)         Combinations of all above examples are acceptable, provided that the minimum standard of 6 ounces of a good quality protein food is served daily and provided that the combinations do not conflict with eye appeal or palatability.

 

8)         The content of meat alternative products shall be listed on the menu.

 

c)         Vegetable and Fruit Group:  5 or more servings of fruits or vegetables.

 

1)         A serving consists of:

 

A)        ½ cup chopped raw, cooked, canned or frozen fruit or vegetables;

 

B)        Ύ cup fruit or vegetable juice; or

 

C)        1 cup raw leafy vegetable.

 

2)         The 5 or more servings shall consist of:

 

A)        Sources of vitamin C

 

i)          1 serving of a good source of vitamin C (containing at least 60 mg of vitamin C); or

 

ii)         2 servings of a fair source of vitamin C.  This may be more than one food item and shall contain a total of at least 50-100 mg of vitamin C.

 

B)        1 serving of a good source of vitamin A at least 3 times a week supplying at least 1000 micrograms retinol equivalent (RE) of vitamin A.

 

C)        Other fruits and vegetables, including potatoes, which may be served in ⅓ cup or larger portions.

 

3)         To ensure variety, food items repeated within the same day shall not be counted as meeting a required serving.

 

d)         Bread, Cereal, Rice and Pasta Group:  6 or more servings of whole grain, enriched or restored products.  One serving equals:

 

1)         1 slice of bread;

 

2)         ½ cup of cooked cereal, rice, pasta, noodles, or grain product;

 

3)         Ύ cup of dry, ready-to-eat cereal;

 

4)         ½ hamburger or hotdog bun, bagel or English muffin;

 

5)         1 4-inch diameter pancake;

 

6)         1 tortilla;

 

7)         3 to 4 plain crackers (small);

 

8)         ½ croissant (large), doughnut or danish (medium);

 

9)         ¹/₁₆ cake;

 

10)         2 cookies; or

 

11)         ¹/₁₂ pie (2-crust, 8").

 

e)         Butter or Margarine:  To be used as a spread and in cooking.

 

f)         Any orders for a change in salt usage in food preparation shall define the gram total.  The normal salt intake shall be 10 grams.

 

g)         Other foods shall be served to round out meals, satisfy individual appetites, improve flavor, and meet the individual's nutritional and caloric needs.

 

h)         Meals for the day shall be planned to provide a variety of foods, variety in texture and good color balance.  The following meal patterns shall be used.

 

1)         Three meals a day plan:

 

A)        Breakfast:  Fruit or juice, cereal, meat (optional, but 3 to 4 times per week preferable), bread, butter or margarine, milk, and choice of additional beverage.

 

B)        Main Meal (may be served noon or evening):  Soup or juice (optional), entree (quality protein), potato or potato substitute, vegetable or salad, dessert (preferably fruit unless fruit is served as a salad or will be served at another meal), bread, butter or margarine, and choice of beverage.

 

C)        Lunch or Supper:  Soup or juice (optional), entree (quality protein), potato or potato substitute (optional if served at main meal), vegetable or salad, dessert, bread, butter or margarine, milk, and choice of additional beverage.

 

2)         Other meal plans may be used if the facility is able to meet residents' needs using such plans.

 

Section 225.6020  Menus and Food Records

 

a)         Menus, including menus for "sack" lunches and between meal or bedtime snacks, shall be planned at least one week in advance.  Food sufficient to meet the nutritional needs of all the residents shall be prepared for each meal.  When changes in the menu are necessary, substitutions shall provide equal nutritive value and shall be recorded on the original menu, or in a notebook marked "Substitutions", which is kept in the kitchen.  If a notebook is used to document substitutions, it shall include the date of the substitution; the meal at which the substitution was made; the menu as originally written; and the menu as actually served.

 

b)         The menu for the current week shall be dated and available in the kitchen. Upon the request of the Department, sample menus shall be submitted for evaluation.

 

c)         Menus shall be different for the same day of consecutive weeks and adjusted for seasonal differences.

 

d)         All menus as actually served shall be kept on file at the facility for not less than 30 days.

 

e)         Food label information for purchased prepared food, listing food composition and, when available, nutrient content, shall be kept on file in the facility for the current menu cycle.

 

f)         Supplies of staple foods for a minimum of a one week period and of perishable foods for a minimum of a two day period shall be maintained on the premises. These supplies shall be appropriate to meet the requirements of the menu.

 

g)         Records of all food purchased shall be kept on file in the facility for not less than 30 days.

 

Section 225.6030  Diet Orders

 

a)         Two or more copies of a current diet manual shall be available and in use. One copy shall be located in the kitchen for use by dietary personnel.  Other copies shall be located at each nurses' station for use by physicians when prescribing diets.

 

b)         Physicians shall write a diet order, in the medical record, for each resident indicating whether the resident is to have a general or a therapeutic diet. The diet shall be served as ordered.

 

c)         A written diet order shall be sent to the food service department when each resident is admitted and each time that the resident's diet is changed. Each change shall be ordered by the physician.  The diet order shall include, at a minimum, the following information:  name of resident, room and bed number, type of diet, consistency if other than regular consistency, date diet order is sent to the dietary department, name of physician ordering the diet, and the signature of the person transmitting the order to the food service department.

 

d)         The resident shall be observed to determine acceptance of the diet, and these observations shall be recorded in the medical record.

 

e)         A therapeutic diet means a diet ordered by the physician as part of a treatment for a disease or clinical condition, to eliminate or decrease certain substances in the diet (e.g., sodium) or to increase certain substances in the diet (e.g., potassium), or to provide food in a form that the resident is able to eat (e.g., mechanically altered diet).

 

f)         All therapeutic diets shall be medically prescribed and shall be planned or approved by a dietician.

 

g)         The kinds and variations of prescribed therapeutic diets shall be available in the kitchen.  If separate menus are not planned for each specific diet, diet information for each specific type, in a form easily understood by staff, shall be available in a convenient location in the kitchen.

 

h)         All oral liquid diets shall be reviewed every 48 hours.  Medical soft diets, sometimes known as transitional diets, shall be reviewed every three weeks. All other therapeutic and mechanically altered diets, including commercially prepared formulas that are in liquid form and blenderized liquid diets, shall be reviewed as needed, or at least every three months.

 

i)          The resident's physician, the food service director, the charge nurse, and the nursing assistants shall be made aware of any resident's feeding difficulties.

 

j)          Each resident shall be weighed every two weeks, and the resident's weight shall be recorded in the medical chart.

SUBPART H: PHYSICAL PLANT

 

Section 225.7000  Codes and Standards

 

a)         The facility shall comply with the applicable provisions of the following codes and standards.  Incorporations in this Section refer to the codes and standards on the dates specified in Section 225.200 of this Part.

 

1)         State of Illinois rules

 

A)        Illinois Plumbing Code (77 Ill. Adm. Code 890), Department of Public Health

 

B)        Illinois Accessibility Code (77 Ill. Adm. Code 400), Capital Development Board

 

C)        Food Service Sanitation Code (77 Ill. Adm. Code 750), Department of Public Health

 

D)        Boiler and Pressure Vessel Safety Code (41 Ill. Adm. Code 120), Office of the State Fire Marshal

 

2)         Nationally recognized codes and standards

 

A)        National Fire Protection Association (NFPA) Standard No. 101: Life Safety Code (New Health Care Occupancies), and all appropriate references under Chapter 33

 

B)        Underwriters' Laboratories, Inc. (UL):

 

i)          Fire Resistance Directory

 

ii)         Building Material Directory

 

iii)        Automotive Burglary Protection Mechanical Equipment Directory

 

C)        American Society for Testing and Materials (ASTM) Standard No. E90-1975: Recommended Practice for Laboratory Measurement of Airborne Sound Transmission Loss of Building Partitions

 

D)        American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE):  Handbook of Fundamentals

 

E)        BOCA International Building Code

 

F)         American National Standards Institute (ANSI):  Standard No. A177.1-R1971, Specifications for Making Buildings and Facilities Accessible to, and Usable by, the Physically Handicapped

 

b)         In addition to compliance with the standards set forth in this Section, all building codes, ordinances and regulations that are enforced by city, county or other local jurisdictions in which the facility is, or will be, located must be observed.

 

c)         Where no local building code exists, the recommendations of the BOCA International Building Code shall apply.

 

d)         The local building code or the recommendations of the BOCA International Building Code shall apply insofar as such recommendations are not in conflict with the standards set forth in this Part, or with the National Fire Protection Association Standard No. 101: Life Safety Code.

 

Section 225.7010  Site

 

a)         The facility shall be located so that the building or buildings can comply with all applicable local zoning ordinances, building restrictions and fire safety requirements. The Department may have additional requirements if the proposed location of the building or buildings on the site would result in a hazard to or be detrimental to the health, welfare, or safety of the residents in the facility.  These additional requirements shall include, but are not limited to fences, stairs, and other types of barriers to prevent residents from injury.

 

b)         The facility shall be served by a potable water supply in compliance with the Drinking Water Systems Code.

 

c)         The distance from the fire station, the accessibility of the facility, and capability of the fire department must be approved in writing by the Office of the State Fire Marshal.

 

d)         The facility shall have at least one municipal or private fire hydrant, located within 300 feet of every point on the perimeter of the building and satisfactory for use by the equipment of the fire department serving the building, or have an acceptable equivalent. Additional hydrants may be required if needed to properly protect the residents from fire hazards.  Evaluation and written approval must be obtained from the Office of the State Fire Marshal.

 

Section 225.7020  Administration and Public Areas

 

a)         Facilities for persons with physical disabilities (public, staff and residents) shall be provided in administration and public areas as well as in resident areas.

 

b)         The lobby shall include a reception and information counter or desk, waiting space, and public telephones.  Drinking fountains and toilet facilities for staff and visitors shall be provided in accordance with the Illinois Plumbing Code.

 

c)         The offices shall have sufficient space to accommodate the following functions: Administrative, Business/Financial Transactions, Professional Staff (Supervisory Nurse, Food Service Supervisor, Activity Director, Social Service Director), and Professional Consultants (Medical Director, Pharmacist, Dietician, Social Worker).

 

d)         A multipurpose room shall be provided for conferences, meetings, interviews, and educational purposes.

 

e)         Adequate space for recording, reviewing and storing resident records shall be provided.

 

Section 225.7030  Nursing Units

 

a)         The number of resident beds in a nursing unit shall not exceed 20 beds.

 

1)         All of the resident beds shall be in one- or two-bed rooms.

 

2)         Not less than 40 percent of the total number of the beds in the facility shall be located in single bed rooms with a private bath, water closet and lavatory.

 

b)         General Requirements for Bedrooms

 

1)         Resident bedrooms shall have an entrance directly off a corridor with an entrance door that swings into the room.

 

2)         Resident bedrooms shall have adequate and satisfactory artificial light and be equipped in accordance with Section 225.8050.

 

3)         Residents shall have access to a toilet room without entering the general corridor area.

 

4)         The facility shall provide a closet or wardrobe of at least four square feet for each resident.

 

5)         Resident bedroom floors shall be at or above grade level.

 

6)         Each room used as a resident bedroom shall have at least one outside window, and a total window area to the outside equal to at least one-tenth the floor area of the room.

 

7)         A wireless call system shall be provided in accordance with Section 225.8050.

 

8)         Complete visual privacy shall be provided for each resident in multibed rooms. Design for privacy shall not restrict resident access to the entry, lavatory, or toilet.

 

9)         No resident bedroom shall be located more than 120 feet from the nurses' station, clean utility room, and soiled utility room.

 

c)         Resident Bedrooms

            Single resident bedrooms shall contain at least 100 square feet.  Multiple resident bedrooms shall contain at least 80 square feet per bed.  Minimum usable floor area shall be exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, vestibules, or clearly definable entryways.

 

d)         Special Care Room

 

1)         The facility shall provide a special care room for each nursing unit.

 

2)         This room shall be provided with a private toilet room containing water closet, lavatory, bathtub or shower, and all other necessary facilities to meet the resident's needs.

 

3)         This room shall be located to allow direct visual supervision from the nurses' station.

 

4)         This room shall be included in the authorized maximum bed capacity for the facility.

 

e)         Nurses' Station

 

1)         The facility shall provide a minimum of one nursing station per unit with direct access to the corridor for each nursing unit.  The location of this station shall allow visual control of each resident sleeping corridor without the use of mirrors. Separation shall be provided from the utility rooms.

 

2)         One or more nursing units may be combined at a central nursing station if sufficient space is provided for all nursing functions.

 

3)         A substation shall be provided near or adjacent to the central nurses' station, which shall include a computer network modem and a small staff office.

 

4)         A lounge with toilet room shall be provided near each station for nursing staff. Lockers for safekeeping of coats and personal effects may be provided within this space or in a convenient central location.

 

f)         Bath and Toilet Rooms

 

1)         The resident bedroom toilet room shall serve no more than two resident rooms. The toilet room shall contain a water closet and a lavatory.  The lavatory may be omitted from the toilet room when the resident room contains a lavatory.

 

2)         The facility shall provide one wheelchair resident toilet room for each gender residing in a nursing unit.  The room shall be accessible from the corridor. This room shall contain a water closet and lavatory.

 

3)         Wheelchair resident toilet rooms are not required when all resident toilet rooms can accommodate wheelchair residents.

 

4)         The facility shall provide one training toilet room on each nursing floor, which is accessible from the corridor.  Three-foot clearance at the front and both sides of the water closet shall be provided.  This room shall contain a lavatory accessible for wheelchair use.

 

5)         The facility shall provide one bathtub or shower for each ten resident beds per nursing unit that are not served by bathing or showering facilities in resident rooms.

 

6)         All shower stalls for residents not needing assistance shall be at least three feet square and shall have no curb.

 

7)         The facility shall provide at least one bathtub for assisted bathing per nursing unit.  There shall be a clear area at least three feet wide at both sides and one end of the tub.

 

8)         The facility shall provide at least one shower stall for assisted showering per nursing unit.  The shower stall shall be at least four feet square with no curb.

 

9)         The facility shall provide a toilet room with a water closet and lavatory, accessible to the assisted bathtub and shower without entering the general hallway.  This room may be arranged to serve as the training toilet facility.

 

10)         Grouped bathing and toilet facilities shall be partitioned or curtained for privacy.

 

g)         Utility Rooms

 

1)         The clean utility room shall have direct access to a corridor, or access may be through the nurses' station entrance.  This room shall contain work counters, single or double compartment sink with integral drainboard, storage cabinets, and an autoclave.  (The autoclave may be waived in lieu of other methods if sterilization is approved by Department.)

 

2)         A clean linen storage room or closet within the clean utility room shall be provided.  If a closed cart system is used, storage may be in an alcove.

 

3)         The soiled utility room shall have direct access to a corridor.  This room shall contain work counters, storage cabinets, and a clinical rim flush sink.  The room shall also contain a three compartment sink with integral drainboard if a utensil sanitizer is not used.

 

4)         The charging room for a linen chute shall be large enough to unload the collecting cart with the door closed.

 

h)         Medication Facilities

 

1)         A medication station shall be provided for 24-hour distribution of medicine to residents.  The medicine preparation room shall be under the nursing staff's visual control and shall contain a work counter, refrigerator, and locked storage for biologicals and drugs.  A sink for handwashing and preparation of medication shall be provided in the medication preparation room.

 

2)         If medicine dispensing carts are used, a specific storage space for the cart shall be provided, which may be located in the nurses' station or in an alcove or other space under the direct control of the nursing staff.  A sink for hand washing and preparation of medication shall be provided in the nurses' station.

 

i)          A nourishment station shall be provided with a handwashing sink and equipment, including refrigerator and storage cabinets for serving nourishment between scheduled meals.  Ice for residents' use shall be provided only by icemaker dispenser units.

 

j)          A room for examination and treatment of residents shall be provided and shall have a minimum floor area of 100 square feet, excluding space for vestibule, closets and work counters (whether fixed or movable).  The minimum room dimension shall be 10 feet. The room shall contain a lavatory or sink equipped for hand washing; a work counter; storage facilities; and a desk, counter, or shelf space for writing.

 

k)         An equipment storage room shall be provided for storage of equipment such as I.V. stands, inhalators, air mattresses, walkers, and wheelchairs.

 

l)          Parking space for wheelchairs shall be provided and shall be located out of the path of normal traffic.

 

Section 225.7040  Dining, Living, and Activities Rooms

 

a)         The combined area of these rooms shall not be less than 25 square feet per resident bed.

 

b)         A minimum of one dining room with at least 20 square feet per resident bed shall be provided.  Facilities to allow individual feeding of residents shall be provided in the nursing unit if they are not able to feed themselves.  Dining area provided for this function may be included in the required area.

 

c)         A comfortably furnished living room shall be provided, with a total window area of at least one-tenth of the floor area.

 

d)         An activities room shall be provided based on program requirements.

 

e)         Dining, living, and activities rooms shall be located so that they are not an entrance vestibule from the outside.

 

Section 225.7050  Therapy and Personal Care Rooms

 

a)         Physical and occupational therapy facilities shall be provided as may be required.

 

b)         A separate room shall be provided with appropriate equipment for hair care and grooming needs of the residents.

 

Section 225.7060  Service Departments

 

a)         Dietary facilities shall comply with the Food Service Sanitation Code. Food service facilities may consist of an on-site conventional food preparation system, a convenience food service system, or a combination of the two.

 

b)         The kitchen, consisting of food preparation, cooking and serving areas, shall be approximately 10 square feet per resident bed with a minimum area of at least 200 square feet.  It shall be properly located for efficient food service, and be large enough to accommodate the equipment and personnel needed to prepare and serve the number of meals required.

 

c)         The following facilities shall be provided as required to implement the type of food service selected:

 

1)         A control station shall be provided for receiving food supplies.

 

2)         Storage space shall be adequate to provide normal and emergency supply needs, approximately two and one-half square feet per resident bed, for bulk and daily food storage, located in a room convenient to the kitchen.

 

3)         Conventional food preparation facilities systems require space for cooking and baking.  Convenience food service systems such as frozen prepared meals, bulk packaged entrees, and individual packaged portions, or systems using contractual commissary service require space and equipment for thawing, portioning, heating, cooking, or baking.

 

4)         Hand-washing facilities shall be located in the food preparation area. Antibacterial soap shall be provided.

 

5)         Residents' meal service facilities shall be provided as required for tray assembly and distribution.

 

6)         Ware-washing space shall be located in a room or an alcove separate from food preparation and serving areas.  Commercial dishwashing equipment shall be provided.  Space shall also be provided for receiving, scraping, sorting, stacking and loading soiled tableware and for transferring clean tableware to the using areas.  A hand-washing lavatory and antibacterial soap shall be provided.

 

7)         Pot-washing facilities shall be located conveniently for washing and sanitizing cooking utensils.

 

8)         Storage areas shall be provided for cans, carts, and mobile tray conveyors.

 

9)         Waste storage facilities shall be located in a separate room easily accessible to the outside for direct pickup or disposal.

 

10)         An office or desk space shall be provided for the dietician or dietary service manager.

 

11)         Toilets shall be accessible to the dietary staff.  Hand-washing facilities and antibacterial soap shall be immediately available.

 

12)         A janitors' closet for the exclusive use of the food preparation areas shall be located within the dietary department.  It shall contain a floor receptor or service sink and storage space for housekeeping equipment and supplies.

 

13)         Self-dispensing icemaking facilities shall be provided.

 

14)         Adequate can, cart and mobile tray washing facilities shall be provided as required.

 

d)         Linen Service

 

1)         A laundry room with commercial equipment designed to meet the needs of the facility shall be provided unless a commercial laundry service is used.

 

2)         The laundry facilities shall be designed to provide for the processing of linens from soiled linen receiving/sorting through washing, through drying, through clean linen inspection, folding and storage, maintaining a separation between soiled and clean functions.

 

3)         Storage space for laundry supplies and carts shall be provided.

 

4)         If washers and dryers are provided for personal use of residents, they shall be located in a room separate from the facility's laundry room.

 

e)         Housekeeping and Storage

 

1)         Sufficient janitors' closets shall be provided throughout the facility to maintain a clean and sanitary environment.  Each shall contain a floor receptor or service sink and storage space for housekeeping equipment and supplies.  Space for large housekeeping equipment and for back-up supplies may be centrally located.

 

2)         A total area of approximately 10 square feet per resident bed shall be provided for the storage areas designated in this service department.  This does not include closets or wardrobes in residents' rooms.  Separate storage space with provisions for locking and security control shall be provided for residents' personal effects that are not kept in residents' bedrooms.

 

3)         Storage rooms for maintenance supplies and yard equipment shall be provided.

SUBPART I: FACILITY DESIGN AND CONSTRUCTION

 

Section 225.8000  Applicability

 

a)         When construction is contemplated, either for new buildings or additions or major alterations (those that are not defined as minor alterations in subsection (e) of this Section) to existing buildings coming within the scope of these standards, design development drawings and outline specifications shall be submitted to the Department for review.  Approval will be based on compliance with this Part.  Approval of design development drawings and specifications shall be obtained from the Department prior to starting final working drawings and specifications. Comments or approval will be provided within 30 days after receipt by the Department.

 

b)         The final working drawings and specifications shall be submitted to the Department for review and approval prior to beginning of construction.  For final approval to remain valid, contracts must be signed within one year after the date of final approval.  Alternate methods of design development and construction such as fast track shall be acceptable if equivalency can be proved.  Comments or approval will be provided within 30 days after receipt by the Department.

 

c)         Any contract modifications that affect or change the function, design, or purpose of a facility shall be submitted to the Department for approval prior to authorizing the modifications.  Comments or approval will be provided within 30 days after receipt by the Department.

 

d)         The facility shall notify the Department at least 30 days before construction has been completed.  The Department will then complete a final inspection.  Deficiencies noted during the final inspection must be corrected before occupancy will be allowed.

 

e)         Minor alterations or remodeling changes that do not affect the structural integrity of the building, that do not change functional operation, that do not affect fire safety, and that do not add beds or facilities over those for which the Model is licensed need not be submitted for drawing approval.

 

f)         No system of water supply, plumbing, sewage, garbage or refuse disposal shall be installed, nor any such existing system materially altered or extended until complete plans and specifications for the installation, alteration or extension have been submitted to the Department and have been reviewed and approved.

 

Section 225.8010  General Building Requirements

 

a)         Chair Rails and Grab Bars

 

1)         Wooden chair rails shall be provided on both sides of all hallways and ramps used by residents.

 

2)         Wooden chair rails on stairs used by residents shall be provided on both sides of the stairs, including the platforms and landings.

 

3)         Chair rail dimensions and details shall conform to the Illinois Accessibility Code (71 Ill. Adm. Code 400).  It is recommended that chair rails be installed at a height of 32 inches measured vertically from the floor surface.

 

4)         Grab bars shall be provided for all resident use toilets, showers, and tubs.

 

5)         The ends of chair rails and grab bars shall return to the wall.

 

b)         Ceiling Heights

 

1)         All rooms occupied or used by residents shall have ceilings with a height of not less than eight feet.

 

2)         Corridors, storage rooms, toilet rooms and other minor rooms shall have ceilings with a height of not less than seven feet, eight inches.

 

3)         Suspended tracks, rails and pipes located in the path of traffic shall be no less than six feet, eight inches above the floor.

 

4)         The boiler room shall have ceiling clearances not less than two feet, six inches above the main boiler header and connecting piping.

 

c)         Doors and Windows

 

1)         All required doors shall swing outward and be provided with door closers and panic hardware, where required.

 

2)         All exterior doors shall be equipped with a signal that will alert the staff if a resident leaves the building.  Any exterior door that is supervised during certain periods may have a disconnect device for part-time use.  All exterior doors shall be equipped with coded switches known only to the staff.

 

3)         Resident toilet rooms shall open directly into a corridor or into a resident bedroom.

 

4)         The doors for the toilet rooms used by residents shall have a minimum door width of 3 feet.

 

5)         No toilet or bathroom door shall be provided with hardware that could allow a resident to become locked in the room.  All toilet or bathroom doors and hardware shall be designed to permit emergency ingress to the room.

 

6)         Doors and windows shall fit snugly and be weather tight, yet open and close easily.

 

7)         Outside doors, other than required exits, and operable windows shall be equipped with tight-fitting 16-mesh screens.  Screen doors shall be equipped with self-closing devices.

 

8)         All doors shall be wide enough to accommodate a wheelchair or other transporting vehicle.

 

d)         Floors

 

1)         Floors shall be smooth, free from cracks and finished so that they can be easily and properly cleaned.  Floors shall be covered wall to wall with water-resistant material in wet areas, including but not limited to bathrooms, kitchens, utility rooms.

 

2)         Thresholds and expansion joints shall be flush with the floor to facilitate use of wheelchairs and carts.

 

e)         Mirrors shall be installed above all lavatories except hand-washing lavatories in food preparation areas, or in clean and sterile supply areas or at the nurses' hand-washing sink.

 

f)         Paper towel dispensers and waste receptacles or electric hand dryers shall be provided at all lavatories.

 

g)         Rooms containing heat-producing equipment (such as boiler or heater rooms and laundry rooms) shall be insulated and ventilated to prevent any floor surface above from exceeding a temperature of l0Ί F above the ambient room temperature.

 

h)         Recreation rooms and exercise rooms, and similar spaces where impact noises may be generated, shall not be located directly over resident bed areas unless special provisions are made to minimize such noise.

 

i)          Hazardous Areas and Fire Extinguishers

 

1)         Interior finish flame spread ratings shall be in accordance with the National Fire Protection Association Standard 101: Life Safety Code, Standards for Flame Spread and Smoke Emission Ratings.

 

2)         At least one approved fire extinguisher shall be located in all basements, furnace rooms, kitchens, laundry rooms and beauty shops.  In addition, extinguishers shall be located so that a person will not have to travel more than 50 feet from any point to reach one.  They shall be inspected annually and recharged when necessary.  The date of checking and recharging shall be recorded on a tag attached to the extinguisher.

 

3)         Containers with proper covers shall be provided for daily storage of rubbish.

 

4)         Housekeeping throughout the building, including basements, attics, and unoccupied rooms, shall be performed to minimize all fire hazards.

 

5)         The facility shall comply with any reasonable additional fire protection measures recommended by the Department or the Office of the State Fire Marshal if conditions in and around the building, including its location, indicate that such additional protection is needed.  Additional fire protection measures shall include, but are not limited to, the institution of a fire watch, installation of a sprinkler system, and installation of smoke detectors.

 

j)          No other business not related to health care shall be conducted in the building that would constitute a hazard or annoyance to the residents.  In any case, the business shall be in a segregated portion of the building and shall have a separate entrance.

 

Section 225.8020  Structural Requirements

 

a)         General Design

 

1)         The buildings and all parts thereof shall be of sufficient strength to support all dead, live, and lateral loads without exceeding the working stresses permitted for the materials of their construction in generally accepted good engineering practice.

 

2)         Special provision shall be made for loads that have a greater load than the specified minimum live load, including partitions that are subject to change of location.

 

b)         Construction shall be in accordance with the requirements of National Fire Protection Association Standard l0l: Life Safety Code and the minimum requirements contained in this Section.

 

1)         Foundations shall rest on natural solid ground and shall be carried to a depth of not less than one foot below the estimated frost line or shall rest on leveled rock or load-bearing piles or caissons when solid ground is not encountered. Footings, piers, and foundation walls shall be protected against deterioration from the action of ground water.  It is recommended that soil test borings be taken to establish proper soil-bearing values for the soil at the building site.

 

2)         Assumed live loads shall be in accordance with the BOCA International Building Code.

 

c)         Provisions for Natural Disasters

 

1)         Earthquakes:  In regions where earthquakes have caused loss of life or extensive property damage, buildings and structures shall be designed to withstand the force assumptions specified in the BOCA International  Building Code.

 

2)         Tornadoes and Floods:  Special provisions shall be made in the design of buildings, including structural design, in regions where local experience shows loss of life or damage to buildings resulting from tornadoes or floods.

 

Section 225.8030  Mechanical Systems

 

a)         General Requirements

 

1)         Mechanical systems shall be tested, balanced, and operated to demonstrate that the installation and performance of these systems conform to the requirements of this Part.

 

2)         Upon the completion of the contract, the owner shall be furnished with a complete set of manufacturer's operating and preventative maintenance instructions, parts list with numbers and descriptions for each piece of equipment, and a copy of the air-balance report.  A complete set of these documents shall be kept on the premises.

 

3)         The owner shall be provided with instructions in the operational use of the systems and equipment as required.

 

b)         Thermal and Acoustical Insulation

 

1)         Insulation shall be provided for the following:

 

A)        Boilers, smoke breeching, and stacks;

 

B)        Steam supply and condensate return piping;

 

C)        Hot water piping above l80Ί F and all hot water heaters, generators, and convertors;

 

D)        Hot water piping above l25Ί F that is exposed to contact by residents;

 

E)        Chilled water, refrigerant, other process piping and equipment operating with fluid temperatures below ambient dew point;

 

F)         Water supply and drainage piping on which condensate may occur;

 

G)        Air ducts and casings with outside surface temperatures below ambient dew point; and

 

H)        Other piping, ducts, and equipment as necessary to maintain the efficiency of the system.

 

2)         Insulation may be omitted from hot water and steam condensate piping not subject to contact by residents when such insulation is not necessary for preventing excessive system heat loss or excessive heat gain.

 

3)         Insulation, including finishes and adhesives on exterior surfaces of ducts, pipes, and equipment, shall have a flame spread rating of 25 or less and a smoke developed rating of l50 or less as determined by an independent testing laboratory. Exception:  Duct, pipe and equipment coverings shall not be required to meet these requirements where they are located entirely outside of a building, do not penetrate a wall or roof, or do not create an exposure hazard.

 

4)         Access for filter changing shall be provided within equipment rooms.

 

c)         Steam and Hot Water Systems.  Supply and return mains and risers for cooling, heating and process steam systems shall be valved to isolate the various sections of each system. Each piece of equipment shall be valved at the supply and return ends.

 

d)         Thermal Hazards.  Any surface exceeding a temperature of 140Ί F (such as radiators, hot water or steam pipes, baseboard heaters, or therapy equipment) that is accessible to residents shall be provided with partitions, screens, shields, or other means to protect residents from injury.  Any protective device shall be designed and installed so that it does not present a fire or safety hazard or adversely affect the safe operation of the equipment.

 

e)         Heating, Cooling, and Ventilating Systems

 

1)         A design temperature of 75Ί F for both summer and winter design conditions shall be provided for all resident use areas, including hallways.

 

2)         All ventilation supply, return and exhaust systems shall be mechanically operated.

 

3)         Outdoor air intakes shall be located as far as practical but not less than l5 feet from the exhaust outlets of ventilation systems, combustion equipment stacks, plumbing vent stacks, or from areas that may collect vehicular exhaust and other noxious fumes.  The bottom of outdoor air intakes serving central systems shall be located as high as practical but not less than six feet above ground level, or if installed above the roof, three feet above roof level.

 

4)         The ventilation systems shall be designed and balanced to provide the pressure relationships and ventilation rates as required by National Fire Protection Association Standard 101.

 

5)         A manometer shall be installed across each filter bed serving central air systems.

 

6)         Air conditioning and ventilation systems shall be designed, installed and maintained as required by National Fire Protection Association Standard 101.

 

7)         The hood and duct system for cooking equipment used in processes producing smoke or grease-laden vapors shall be in conformance with National Fire Protection Association Standard 101.  That portion of the fire extinguishment system required for protection of the duct system may be omitted when all cooking equipment is served by a grease extractor listed by Underwriter's Laboratory or other independent testing laboratories.

 

8)         The ventilation of the medical gas storage room shall conform to the requirements of National Fire Protection Association Standard 101.

 

9)         Boiler rooms and other rooms having combustion equipment shall be provided with sufficient outdoor air to maintain combustion rates of equipment and limit temperatures to 97Ί F.  Effective temperature shall be as defined by the American Society of Heating, Refrigerating and Air Conditioning Engineers Handbook of Fundamentals.

 

10)         Rooms containing heat-producing equipment, such as boiler rooms, heater rooms, food preparation centers, laundries, and sterilizer rooms shall be insulated and ventilated to prevent any floor surface above from exceeding a temperature of l0Ί F above the ambient temperature.

 

Section 225.8040  Plumbing Systems

 

a)         All plumbing systems shall be designed and installed in accordance with the requirements of the Illinois Plumbing Code (77 Ill. Adm. Code 890), except that the number of resident required water closets, lavatories, bathtubs, showers, and other fixtures shall be as required by this Part and the facility program.

 

b)         Plumbing Fixtures

 

1)         Plumbing fixtures shall be of non-absorptive acid-resistant materials.

 

2)         The water supply spout for lavatories and sinks required for filling pitchers by nursing staff and for food handlers' hand washing shall be mounted so that its discharge point is a minimum distance of five inches above the rim of the fixture.

 

3)         Hand-washing lavatories used by nursing staff and food handlers shall be trimmed with valves that can be operated without the use of hands.  When blade handles are used for this purpose, the blade handles shall not exceed four and one half inches in length, except the handles on clinical sinks shall not be less than six inches in length.

 

4)         Clinical rim flush sinks shall have an integral trap in which the upper portion of the trap seal provides a visible water surface.

 

5)         The pot-washing sink shall be a three compartment sink with one compartment at least l4 inches deep.

 

6)         Shower bases and tub bottoms shall be designed with nonslip surfaces.

 

c)         Water Supply Systems

 

1)         Water supply systems shall be designed to supply water at sufficient pressure and volume to operate all fixtures and equipment during maximum demand periods.

 

2)         Each water service main, branch main, riser and branch to a group of fixtures shall be valved.  Stop valves shall be provided at each fixture.

 

3)         Flush valves installed on plumbing fixtures shall be of a quiet operating type, equipped with silencers.

 

4)         Hot water distribution systems shall be arranged to provide hot water of at least 100Ί F at each hot water outlet at all times.

 

5)         Hot water available to residents at shower, bathing and hand-washing facilities shall not exceed 110Ί F.

 

6)         Each hot water system serving resident areas shall include at least one of the following equipment requirements to ensure that the water temperature does not exceed 110Ί F:

 

A)        A thermostatically controlled mixing valve, or

 

B)        An aquastat that limits the water temperature in the water heater to a maximum temperature of 110Ί F and a solenoid operated shut-off valve activated by a sensing element in the water line that shuts off the water and activates an alarm at the nurses' station when the water temperature exceeds 110Ί F.

 

d)         Water Heaters and Tanks

 

1)         Capacity and Temperature Requirements

 

A)        The water heating equipment shall have sufficient capacity to supply water at the temperature and quantities in the following areas:

 

	Resident Service	Dietary	Laundry
gallons/hour/bed	6/1/2	4/1/1	4/1/2
Temperature (Ί F)	110	140*	180

 

*180Ί F water required at dishwasher and pot and pan sink.

 

B)        Water temperatures to be taken at the point of use or discharge of the hot water or inlet to processing equipment.

 

2)         Water storage tanks shall be fabricated of corrosion-resistant metal or lined with noncorrosive material.

 

e)         Drainage Systems.  Insofar as possible, drainage piping shall not be installed above the ceiling or installed in an exposed location in food preparation centers, food serving facilities, food storage areas, and other critical areas.  Special precautions shall be taken to protect these areas from possible leakage or condensation from necessary overhead piping systems.

 

f)         Fire Extinguishing Systems

 

1)         A complete automatic sprinkler system shall be installed throughout all facilities regardless of construction type.

 

2)         All sprinkler and other fire extinguishing systems shall be designed and installed in accordance with National Fire Protection Association Standard 101.

 

3)         All sprinkler systems shall be maintained in accordance with National Fire Protection Association Standard 101.

 

Section 225.8050  Electrical Systems

 

a)         General Requirements

 

1)         All material, including equipment, conductors, controls, and signaling devices, shall be installed to provide a complete electrical system with the necessary characteristics and capacity to supply the electrical facilities required by this Part. All materials shall be listed as complying with the standards of Underwriters' Laboratories, Inc. or other similarly established standards.

 

2)         All electrical installations and systems shall be tested to show that the equipment is installed and operates as planned or specified and be in accordance with the standards specified in subsection (a)(1).

 

3)         The installation shall meet all the requirements of the National Fire Protection Association Standard 101.

 

b)         Switchboards and Power Panels.  Circuit breakers or fusible switches that provide disconnecting means and overcurrent protection for conductors connected to switchboards and panelboards shall be enclosed or guarded to provide a dead-front type of assembly.  The main switchboard shall be located in a separate enclosure accessible only to authorized persons.  The switchboard shall be convenient for use, readily accessible for maintenance, clear of traffic lanes, and in a dry ventilated space free of corrosive fumes or gases.  Overload protective devices shall be suitable for operating properly in ambient temperature conditions.

 

c)         Panelboards.  Panelboards serving lighting and appliance circuits shall be located on the same floor as the circuits they serve.  This requirement does not apply to emergency system circuits.

 

d)         Lighting

 

1)         All spaces occupied by people, machinery, and equipment within buildings, approaches to and exits from buildings, and parking lots shall have lighting.

 

2)         Residents' rooms shall have general lighting.  A reading light shall be provided for each resident.  At least one light fixture shall be switched at the entrance to each resident room.  All switches for control of lighting in residents' sleeping areas shall operate quietly.

 

3)         Any electrical outlet not in use in a resident's room shall have a plastic plug.

 

e)         Receptacles (Convenience Outlets)

 

1)         Each resident bedroom shall have duplex grounding type receptacles as follows: One located each side of the head of each bed; one for television if used; and one on another wall.  Receptacles are to be located between l2 to 30 inches above the finished floor.

 

2)         Resident bathrooms shall have at least one duplex receptacle.

 

3)         Duplex receptacles shall be installed approximately 50 feet apart in all corridors and within 25 feet of ends of corridors.

 

f)         Door Alarm System.  Each exterior door shall be equipped with a signal that will alert staff if a resident leaves the building.  Any exterior door that is supervised during certain periods may have a disconnect device for part-time use.

 

g)         Nurses' Calling System

 

1)         Each resident room shall be served by at least one calling station, and each bed shall be provided with a call station.  One call station may serve two adjacent beds.  Calls shall register at the nurses' station and shall activate a visible signal in the corridor at the resident's door and in the nurses' station.  In multicorridor nursing units, additional visible signals shall be installed at corridor intersections. In rooms containing two or more calling stations, identifying lights shall be provided at the nurses' station.

 

2)         A nurses' call station shall be provided for residents' use at each resident's toilet, bath, and shower location.  The cord shall be long enough to reach within six inches of the floor.

 

h)         Fire Alarm System

 

1)         A manually and automatically operated fire alarm system shall be installed.

 

2)         Automatic smoke detectors shall be installed in all resident sleeping rooms and at 30 feet on center in all corridors other than sleeping area corridors.

 

i)          Emergency Electrical System

 

1)         To provide electricity during an interruption of the normal electric supply, an emergency source of electricity shall be provided and connected to certain circuits for lighting and power.  The emergency system shall consist of the life safety branch and the critical branch.

 

2)         The source of this emergency electrical service shall be an emergency generating set or an approved dual source of normal power.

 

3)         Life Safety Branch, Automatic Transfer 10 Seconds.

 

A)        Illumination of means of egress as necessary for corridors, passageways, stairways, landings and exit doors, and all ways of approach to and through exits.

 

B)        Exit signs and exit directional signs.

 

C)        Sufficient lighting in dining room and recreation areas to provide illumination to exit ways.

 

D)        Fire alarms activated at manual stations, by electric water flow alarm devices in connection with sprinkler systems, and by all automatic detection systems.

 

E)        Communication systems, where these are used for issuing instructions during emergency conditions.

 

F)         Task illumination and selected receptacles at the generator set location.

 

4)         Critical Branch, Automatic Transfer 10 Seconds

 

A)        Task illumination and selected receptacles in the nurses' station, including the medication preparation area.

 

B)        Sump pumps and other equipment required to operate for the safety of major apparatus, including associated control systems and alarms.

 

C)        Nurses' call system.

 

5)         Critical Branch, Automatic or Manual Systems Heating Equipment to Provide Heating for Patient Rooms.  Exception:  Where the facility is served by two or more electrical services supplied from separate generators or a utility distribution network having multiple power input sources and arranged to provide mechanical and electrical separation so that a fault between the facility and the generating sources is not likely to cause an interruption of more than one of the facility service feeders.

 

6)         Details

 

A)        The life safety and critical branch shall be in operation within 10 seconds after the interruption of normal electric power supply.

 

B)        Receptacles connected to emergency power shall be distinctively marked.

 

C)        The emergency generator shall not be solely dependent upon a public utility gas system for the fuel supply.  Means shall be provided for automatically transferring from one fuel supply to another where dual fuel supplies are used.

 

D)        Where fuel storage facilities are provided on the site, the fuel tank shall have minimum capacity for 24 hour operation of the generator.

SUBPART J: QUALITY ASSESSMENT AND IMPROVEMENT

 

Section 225.9000  Quality Assessment and Improvement

 

a)         The licensee shall develop and implement a quality assessment and improvement program designed to meet at least the following goals:

 

1)         Ongoing monitoring and evaluation of the quality of services provided by the program, including but not limited to:

 

A)        Accomplishment of outcome goals;

 

B)        Accomplishment of program goals;

 

C)        Resident satisfaction; and

 

D)        Quality of life.

 

2)         Routine review of quality indicators to ensure identification of problem areas.

 

3)         Identification and implementation of corrective action to address problem areas.

 

b)         The licensee shall have a written quality assessment plan, which shall include but is not limited to:

 

1)         A statement of its mission and philosophy;

 

2)         A statement of its goals;

 

3)         Measurable objectives; and

 

4)         Identification of the persons responsible for administering the program.

 

c)         The Department shall have access to any materials or documents generated pursuant to the facility's quality assessment and improvement or that pertain to utilization and satisfaction, and financial viability of the facility.  This information shall be used by the Department to evaluate and assess the facility in relation to the requirements of the Act and shall be confidential.







Section 225.TABLE A   Heat Index Table/Apparent Temperature

 

	70	75	80	85	90	95	100	105	110	115	120	125	130	135
5	64	69	74	79	84	88	93	97	102	107	111	116	122	128
10	65	70	75	80	85	90	95	100	105	111	116	123	131
15	65	71	76	81	86	91	97	102	108	115	123	131
20	66	72	77	82	87	93	99	105	112	120	130	141
25	66	72	77	83	88	94	101	109	117	127	139
30	67	73	78	84	90	96	104	113	123	135	148
35	67	73	79	85	91	98	107	118	130	143
40	68	74	79	86	93	101	110	123	137	151
45	68	74	80	87	95	104	115	129	143
50	69	75	81	88	96	107	120	135	150
55	69	75	81	89	98	110	126	142
60	70	76	82	90	100	114	132	149
65	70	76	83	91	102	119	138
70	70	77	85	93	106	124	144
75	70	77	86	95	109	130
80	71	78	83	97	113	136
85	71	78	87	99	117
90	71	79	88	102	122
95	71	79	89	105