PURPOSE: This rule establishes fire-safety requirements for new and existing intermediate care and skilled nursing facilities.

PUBLISHER’S NOTE: The publication of the full text of the material that the adopting agency has incorporated by reference in this rule would be unduly cumbersome or expensive. Therefore, the full text of that material will be made available to any interested person at both the Office of the Secretary of State and the office of the adopting agency, pursuant to section 536.031.4, RSMo. Such material will be provided at the cost established by state law.

PUBLISHER’S NOTE: All rules relating to long-term care facilities licensed by the Division of Aging are followed by a Roman Numeral notation which refers to the class (either class I, II or III) of standard as designated in section 198.085.1, RSMo 1994.

1. (1) All openings that could permit the passage of fire, smoke, or both, between floors shall be fire-stopped with a suitable noncombustible material. II/III
2. (2) Hazardous areas shall be separated by construction of at least one (1)-hour fireresistant construction. Hazardous area may be protected by an approved automatic fire detection or automatic sprinkler system in lieu of one (1)-hour fire-resistant construction. II
3. (3) The division prohibits the storage of any unnecessary combustible materials in any part of a building in which a licensed facility is located. No section of the building shall present a fire hazard. I/II
4. (4) The division shall have the right to inspect any portion of a building in which a licensed facility is located unless the unlicensed portion is separated by two (2)-hour fire-resistant construction. Facilities shall not use space under stairways to store combustible materials. II/III
5. (5) Facilities shall store oxygen cylinders in a separate room or area free of combustible materials. If oxygen is stored in excess of fifteen hundred (1500) cubic feet in total, it shall be located in a room vented to the outside. I/II
6. (6) Facilities shall use permanent racks or fasteners to prevent accidental damage or dislocation of oxygen cylinders. Safety caps shall remain intact except where a cylinder is in actual use or where the regulator has been attached and the cylinder is ready for use. Individual oxygen cylinders in use or with an attached regulator shall be supported by cylinder collars or by stable cylinder carts. II/III
7. (7) Each nursing unit may maintain only one
8. (1) emergency-use oxygen tank in a readily accessible unit area. II
9. (8) All new or replacement portable fire extinguishers shall be ABC-type extinguisher. II
10. (9) In or immediately adjacent to hazardous areas, the facility shall maintain an extinguisher of at least ten (10)-pound dry powder, or the equivalent. II
11. (10) In other areas, the facility shall maintain an extinguisher of at least five (5)-pound dry powder. II
12. (11) The facility shall provide a minimum of one (1) fire extinguisher per floor, so that there is no more than a one hundred foot (100') travel distance from any point on that floor to an extinguisher. I/II
13. (12) All fire extinguishers shall be installed and maintained in accordance with the National Fire Protection Association NFPA
14. 10. Facilities with plans approved on or before December 31, 1998, shall comply with the requirements of the 1978 NFPA 10, Standard for Portable Fire Extinguishers. Facilities with plans approved on or after January 1, 1999, shall comply with the requirements of the 1994 NFPA 10, incorporated by reference in this rule. This includes the documentation and dating of a monthly pressure check. II/III
15. (13) Unless there is an approved sprinkler system, facilities shall provide every cooking range with a range hood and approved automatic class BC or ABC range hood extinguishing system which shall also have the capability of being manually operated. II
16. (14) The facility shall install the range hood extinguishing system and maintain it in accordance with the NFPA 96. Facilities with plans approved on or before December 31, 1998, shall comply with the requirements of NFPA 96 referenced in the 1967 Life Safety Code, and facilities with plans approved on or after January 1, 1999, shall comply with the requirements of the 1994 NFPA 96, incorporated by reference in this rule. III
17. (15) Every existing licensed facility with plans approved after April 8, 1972 and prior to January 1, 1999, shall install and maintain a fire alarm system in compliance with the provisions of the 1967 Life Safety Code, NFPA 101. Facilities with plans approved on or after January 1, 1999, shall comply with the requirements of the 1996 NFPA 72, National Fire Alarm Code, incorporated by reference in this rule. I/II
18. (16) Every existing licensed facility with plans approved before April 8, 1972 shall comply with the 1967 Life Safety Code or shall have an electrically-supervised fire alarm system with a manual pull station provided at, or near, each required exit and at, or near, each nurses’ station; either batteries or a generator for emergency power; and alarm bells or other sounding devices that shall be audible in all areas of the building. II/III
19. (17) In addition to the manual pull stations, at least one (1) of the following must also activate every fire alarm system: a flow alarm on a complete sprinkler system; smoke detectors located in every resident room or every fifty feet (50') of the corridor and at every smoke door; or a complete heat detector system. II
20. (18) The facility shall test every fire alarm system at least once a month. II
21. (19) Facilities shall maintain a record of these fire alarm tests. III
22. (20) Upon its discovery, the facilities shall promptly correct any fault with the fire alarm. I/II
23. (21) A fire alarm service representative or electrical contractor shall inspect every alarm system at least once annually. This inspector shall test and certify in writing to the division that the system is operating in accordance with the National Fire Alarm Code, NFPA 72. Facilities with plans approved on or before December 31, 1998, shall comply with the requirements of NFPA 72 referenced in the 1967 Life Safety Code, and facilities with plans approved on or after January 1, 1999, shall comply with the requirements of the 1996 NFPA 72, National Fire Alarm Code, incorporated by reference in this rule. II/III
24. (22) All existing licensed facilities not of fire-resistant construction housing residents above the first floor who require personal assistance or assistive devices other than canes shall install and maintain an approved automatic sprinkler system throughout the facility according to the applicable edition of the NFPA 13, which was required to be met at the time of installation. Facilities with plans approved on or after January 1, 1999, shall comply with the requirements of the 1996 NFPA 13, Installation of Sprinkler Systems, incorporated by reference in this rule. I/II
25. (23) All existing licensed facilities not of fire-resistant construction housing residents above the second floor shall install and maintain an approved automatic sprinkler system throughout the facility according to the applicable edition of the NFPA 13, which was required to be met at the time of installation. Facilities with plans approved on or after January 1, 1999, shall comply with the requirements of the 1996 NFPA 13, Installation of Sprinkler Systems, incorporated by reference in this rule. I/II
26. (24) Plans approved on or after January 1, 1999, for all new facilities and all additions to existing facilities that contain resident sleeping rooms, regardless of construction type, shall have a complete sprinkler system installed and maintained according to the 1996 NFPA 13, incorporated by reference in this rule. Facilities whose plans were approved on or after June 11, 1981, and before December 31, 1998, shall have complete sprinkler systems installed and maintained in accordance with the applicable edition of NFPA 13 that was in effect at the time of initial plan approval. I/II
27. (25) Each floor of an existing licensed facility shall have at least two (2) unobstructed exits remote from each other. One (1) of the required exits in an existing multi-story facility must be an outside stairway or an enclosed stair that is separated by one (1)-hour construction from each floor and has an exit leading directly outside at grade level. One
28. (1) exit may lead to a lobby with exit facilities to the ground level outside instead of leading directly to the outside. I/II
29. (26) If facilities have outside stairways, they shall be substantially constructed to support residents during evacuation. These stairways shall be protected or cleared of ice and snow. Fire escapes added to existing buildings, whether interior or exterior, shall have at least a minimum thirty-six inch (36") width, eight-inch (8") maximum risers, a nine-inch (9") minimum tread, no winders, a maximum height between landings of twelve feet (12'), minimum landing dimensions of forty-four inches (44"), landings at each exit door and handrails on both sides. Stairways shall be of sturdy construction using at least two-inch (2") lumber and shall be continuous to ground level. Exit(s) to fire escapes shall be at least thirty-six inches (36") wide and the fire-escape door shall swing outward. II/III
30. (27) Facilities with three (3) or more floors shall comply with the provisions of Chapter 320, RSMo which requires that outside stairways be constructed of iron or steel. II
31. (28) If it is necessary to lock exit doors or resident room doors, the locks shall be of a type that can be opened from the inside by turning the knob or by operating a simple device that will release the lock. Only one (1) lock will be permitted on any one (1) door. I/II
32. (29) All exit doors in existing licensed facilities shall be at least thirty inches (30") wide. II
33. (30) All exit doors in new facilities shall be at least forty-four inches (44") wide. II
34. (31) In all facilities, all exit doors and vestibule doors shall swing outward in the direction of exit travel. II
35. (32) In all existing licensed facilities, all horizontal exit doors in fire walls and all doors in smoke barrier partitions may swing in either direction. These doors normally may be open, but shall be automatically self-closing in case of smoke or fire. They shall be capable of being manually released to selfclosing action. II/III
36. (33) Facilities shall maintain corridors to be free of permanent obstruction or equipment or supplies not in use. Doors to resident rooms shall not swing into the corridor. II/III
37. (34) Facilities shall place signs bearing the word EXIT in plain, legible block letters at each required exit, except at doors directly from rooms to exit corridors or passageways. II
38. (35) Wherever necessary, the facility shall place additional signs in corridors and passageways to indicate the exit’s direction. Letters on these signs shall be at least six inches (6") high and three-fourths inches (3/4") wide, except that the letters of internally illuminated exit signs may be not less than four and one-half inches (4 1/2") high. III
39. (36) Facilities shall maintain all exit and directional signs to be clearly legible by electric illumination or acceptable means such as emergency lighting when natural light fails. II
40. (37) If existing licensed facilities have laundry chutes, dumbwaiter shafts or other similar vertical shafts, they shall have a fire resistance rating of at least one (1) hour. These chute or shaft doors shall be self-closing or shall have any other approved device that will guarantee separation between floors. II
41. (38) Existing licensed multistoried facilities shall provide a smoke separation barrier 13 CSR 15-14

between the basement and the first floor and the floors of resident-use areas. At a minimum, this barrier shall consist of one-half inch (1/2") gypsum board, plaster or equivalent. There shall be a one and three-fourths inch (1 3/4") thick solid-core wood door, or equivalent, at the top or bottom of the stairs. If the door is glazed, it shall be glazed with wired glass. II

1. (39) Existing licensed facilities shall have attached self-closing devices on all doors providing separation between floors. If the doors are to be held open, they shall have electromagnetic hold-open devices that are interconnected with either a smoke alarm or with other smoke-sensitive fire extinguishment or alarm systems in the building. II/III
2. (40) Facilities shall have emergency lighting of sufficient intensity to provide for the safety of residents and other people using any exit, stairway and corridor. The lighting shall be supplied by an emergency service, an automatic emergency generator or battery lighting system. This emergency lighting system shall be equipped with an automatic transfer switch. In an existing licensed facility, battery lights, if used, shall be wet cell units or other rechargeable-type batteries that shall be Underwriters’ Laboratory (UL)- approved and capable of operating the light for at least one and one-half (1 1/2) hours. II
3. (41) All facilities shall notify the division immediately if there is a fire involving death or harm to a resident which requires medical attention by a physician or causes substantial damage to the facility. The division shall be notified in writing within seven (7) days in the event of any other fire, regardless of the size of the fire or the loss involved. II/III
4. (42) Smoking shall not be permitted in sleeping quarters except when direct supervision is provided. Areas where smoking is permitted shall be designated as such and shall be directly supervised. II
5. (43) All facilities shall develop a written plan for fire drills and evacuation and annually shall request consultation and assistance from a local fire unit, if available, to review the plan. If the consultation cannot be obtained, the facility shall inform the division immediately in writing and request assistance in review of the plan. The plan shall include, at a minimum, written instructions for evacuation of each floor and a floor plan indicating the location of exits, fire alarm stations and extinguishers. The written plan shall show the location of any water sources on the property or adjacent property such as cisterns, wells, lagoons, ponds or creeks. The plan shall provide for the safety and comfort of residents evacuated. The facility shall post the written plan and evacuation diagram on each floor in a conspicuous place so that employees and residents can become familiar with the plan and routes to safety. II/III
6. (44) Fire drills shall be conducted at least every three (3) months on each shift with a minimum of twelve (12) drills annually. Staff shall be trained how to proceed in the event of a fire, that is, who to call, how to evacuate injured residents, which residents will need special assistance in evacuation and how to operate fire alarm and extinguishing equipment. II/III
7. (45) All fire drills shall be recorded including the date, time, participating personnel and special problems. II/III
8. (46) The use of woodor gas-burning fireplaces will be permitted only if the fireplaces are built of firebrick or metal, enclosed by masonry and have metal or tempered glass screens. The chimneys shall be of masonry construction with flue linings that have at least eight inches (8") of masonry separating the flue lining and the fireplace from any combustible material. All fireplaces shall be installed, operated and maintained in a safe manner. Fireplaces not in compliance with these requirements may be provided if they are for decorative purposes only or if they are equipped with decorative-type electric logs or other electric heaters which bear the UL label and are constructed of electrical components complying with and installed in compliance with the National Electrical Code, incorporated by reference in this rule. II/III
9. (47) Electric or gas clothes dryers shall be vented to the outside and the lint trap cleaned regularly. II/III
10. (48) In existing licensed facilities, all wall and ceiling surfaces shall be smooth and free of highly combustible materials. II/III
11. (49) All curtains in resident-use areas shall be rendered and maintained flame-resistant. II/III
12. (50) All new floor covering installed in new and existing licensed facilities on or after January 1, 1999, shall be Class I in nonsprinklered buildings and Class II in sprinklered buildings. Class I shall have a critical radiant flux of zero point forty-five (0.45) or more watts per square centimeter when tested according to the 1995 NFPA 253, which is incorporated by reference in this rule. Class II shall have a critical radiant flux of zero point twenty-two (0.22) or more watts per square centimeter when tested according to the standards stated in the 1995 NFPA 253. Those facilities who installed new floor covering on or before December 31, 1998, shall comply with the requirements of the 1978 edition of the NFPA 253. II/III
13. (51) Only metal or UL- or Factory Mutual (FM)-approved wastebaskets shall be used for the collection of trash. II
14. (52) All electrical appliances shall be UL- approved, shall be maintained in good repair and no appliances or electrical equipment shall be used which emit fumes or which could in any other way present a hazard to the residents. I/II
15. (53) The facility shall maintain the exterior premises in a manner as to provide for fire safety. II
16. (54) Trash shall be removed from the premises as often as necessary to prevent fire hazards and public health nuisance. II
17. (55) No trash shall be burned within fifty feet (50') of any facility except in an approved incinerator. I/II
18. (56) Trash may be burned only in a masonry or metal container. The container shall be equipped with a metal cover with openings no larger than one-half inch (1/2") in size. II/III

19. (57) Minimum staffing for safety and protective oversight to residents shall be—

    1. (A) In a fire-resistant or sprinklered building—

Time Personnel Residents 7 a.m. to 3 p.m. 1 3–10* (Day) 3 p.m. to 11 p.m. 1 3–15* (Evening) 11 p.m. to 7 a.m. 1 3–20* (Night)

*One (1) additional staff person for every fraction after that; or I/II

1. (B) In a nonfire-resistant, nonsprinklered building—

Time Personnel Residents 7 a.m. to 3 p.m. 1 3–10* (Day) 3 p.m. to 11 p.m. 1 3–15* (Evening) 11 p.m. to 7 a.m. 1 3–15* (Night) *One (1) additional staff person for every fraction after that. I/II

AUTHORITY: section 198.079, RSMo 1994.* Original rule filed July 13, 1983, effective Oct. 13, 1983. Amended: Filed Sept. 12, 1984, effective Dec. 13, 1984. Amended: Filed Aug. 1, 1988, effective Nov. 11, 1988. Amended: Filed May 11, 1998, effective Dec. 30, 1998. Emergency amendment filed May 12, 1999, effective May 22, 1999, expired Feb. 24, 2000. Amended: Filed July 13, 1999, effective Jan. 30, 2000. *Original authority: 198.079, RSMo 1979.