(b) Thermal insulation and acoustical insulation (if applicable) shall be provided on the following fixtures and equipment in the nursing home facility and shall comply with the following:

1. (1) boilers, smoke breeching and stacks;
2. (2) steam supply and condensate return piping;
3. (3) hot water piping above 180°F and all hot water heaters, generators and converters;
4. (4) hot water piping above 125°F which is exposed to contact by residents;
5. (5) chilled water, refrigerant, other process piping and equipment operating with fluid temperatures below ambient dew point;
6. (6) water supply and drainage piping on which condensation may occur;
7. (7) air ducts and casings with outside surface temperatures below ambient dew point; and
8. (8) other piping, ducts, and equipment as necessary to maintain the efficiency of the system;
9. (9) insulation may be omitted from hot water and steam condensate piping not subject to contact by residents when such insulation is unnecessary for preventing excessive system heat loss or excessive heat gain.

(c) Steam and hot water systems shall comply with the following:

1. (1) Boilers shall have the capacity to supply the normal requirements of all systems and equipment. Boilers shall have the capacity, based on the net ratings published by the Hydronics Institute or another generally accepted national standard approved by the commissioner, which is adequate to assure resident safety and comfort, to supply not less than 70 percent of the normal requirements of all systems and equipment. Their number and arrangements shall accommodate facility needs despite the breakdown or routine maintenance of any one boiler. The capacity of the remaining boiler(s) shall be sufficient to provide hot water service for clinical, dietary, and resident use; steam for dietary purposes, and heating for general resident rooms. However, reserve capacity for facility space heating is not required in geographic areas where a design dry-bulb temperature of 25°F (-4°C) or more represents not less than 99 percent of the total hours in any one heating month.
2. (2) Boiler feed pumps, heating circulating pumps, condensate return pumps and fuel oil pumps shall be connected and installed to provide normal and standby service.
3. (3) Supply and return mains and risers of 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) Heating, cooling and ventilating systems for resident occupied areas of the facility shall comply with the following minimum standards except where other minimum standards are shown on Table 8 of this subdivision:

1. (1) Heating systems shall provide for a minimum temperature of 75°F at design temperature. Cooling systems shall be designed to permit a maximum temperature of 80°F at design temperature.

2. (2) All air-supply and air-exhaust systems shall be mechanically operated. All fans serving exhaust systems shall be located at the discharge end of the system. The ventilation rates shown in Table 8 of this subdivision shall be considered as minimum acceptable rates and shall not be construed as precluding the use of higher ventilation rates provided such higher rates do not result in undesirable air velocity in resident-use areas. TABLE 8 PRESSURE RELATIONSHIPS AND VENTILATION OF NURSING HOME FACILITIES TABLE 9 FILTER EFFICIENCIES FOR CENTRAL VENTILATION AND AIR CONDITIONING SYSTEMS IN NURSING HOME FACILITIES *

   1. (i) Outdoor air intakes shall be located as far as practical, but not less than 25 feet, from exhaust outlets of ventilating systems, combustion equipment stacks, medical-surgical vacuum systems, plumbing vent stacks, or from areas which 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.

   2. (ii) The ventilation systems shall be designed and balanced to provide the pressure relationship as shown in Table 8 of this section (below).

      TABLE 8 PRESSURE RELATIONSHIPS AND VENTILATION OF NURSING HOME FACILITIES

      Area designation	Pressure relationship adjacent areas	Minimum air changes of outdoor air per hour supplied to room	Minimum total air changes per hour supplied to room	All air exhausted directly to outdoors	Recirculated within room units
      Resident Room	E	2	2	Optional	Optional
      Resident Area Corridor	E	2	4	Optional	Optional
      Examination and Treatment Room	E	2	6	Optional	Optional
      Physical Therapy	N	2	6	Optional	Optional
      Occupational Therapy	N	2	6	Optional	Optional
      Soiled Workroom or Soiled Holding	N	2	10	Yes	No
      Clean Workroom or Clean Holding	P	2	4	Optional	Optional
      Toilet Room	N	Optional	10	Yes	No
      Bathroom	N	Optional	10	Yes	No
      Janitors' Closets	N	Optional	10	Yes	No
      Sterilizer Equipment Rooms	N	Optional	10	Yes	No
      Linen and Trash Chute Rooms	N	Optional	10	Yes	No
      Food Preparation Center	E	2	10	Yes	No
      Warewashing Room	N	Optional	10	Yes	No
      Dietary Day Storage	E	Optional	2	Yes	No
      Laundry, General	E	2	2	Yes	No
      Soiled Linen Sorting and Storage	N	Optional	10	Yes	No
      Clean Linen Storage	P	2	2	Optional	Optional
      P = Positive N = Negative E = Equal

   3. (iii) The bottoms of ventilation openings shall be not less than three inches above the floor of any room.
   4. (iv) Corridors shall not be used to supply air to or exhaust air from any room, except that air from corridors may be used to ventilate bathrooms, toilet rooms, janitors' closets, and small electrical or telephone closets opening directly on corridors.

   5. (v) All central ventilation or air conditioning systems shall be equipped with filters having efficiencies no less than those specified in Table 9 of this subdivision, below. The filter bed shall be located upstream of the air conditioning equipment, unless a prefilter is employed. In this case, the prefilter shall be upstream of the equipment and the main filter may be located further downstream.

      TABLE 9

      FILTER EFFICIENCIES FOR CENTRAL VENTILATION AND AIR CONDITIONING SYSTEMS IN NURSING HOME FACILITIES

      Area designation	Minimum number of filter beds	Filter efficiency (percent) main filter bed
      Resident Care, Treatment Diagnostic & Related Areas	1	80*
      Food Preparation Areas and Laundries	1	80
      Administrative, Bulk Storage and Soiled Holding Areas	1	25

      *

      May be reduced to 35 percent for all outdoor air systems.

   6. (vi) All filter(s) efficiencies shall be average atmospheric dust spot efficiencies tested in accordance with ANSI/ASHRAE Standard 52.2-1999, Method of Testing Air-Cleaning Devices for Removal Efficiency by Particle Size, 1999 edition. Further details concerning this referenced material are contained in section 711.2(b) of this Title. Filter frames shall be durable and carefully dimensioned and shall provide an air-tight fit with the enclosing duct work. All joints between filter segments and the enclosing duct work shall be gasketed or sealed to provide seal against air leakage. A manometer shall be installed across each filter bed serving central air systems.
   7. (vii) Exhaust hoods in food preparation centers shall have an exhaust rate of not less than 50 cubic feet per minute per square foot of face area. Face area is defined for this purpose as the open area from the exposed perimeter of the cooking surfaces. All hoods over cooking ranges shall be equipped with grease filters, fire extinguishing systems, and heat actuated fan controls. Cleanout openings shall be provided every 20 feet in horizontal exhaust duct systems serving these hoods.
   8. (viii) Boiler rooms shall be provided with sufficient outdoor air to maintain combustion rates of equipment and to limit temperature in working stations to 97°F.

(e) All plumbing systems and other piping systems shall be designed and installed in accordance with the requirements of the local or municipal building code authority having jurisdiction.

1. (1) Plumbing fixtures shall comply with the following:

   1. (i) The material used for plumbing fixtures shall be of non-absorptive acid-resistant material.
   2. (ii) The water supply spout for lavatories and sinks required in resident care areas shall be mounted so that its discharge point is a minimum distance of five inches above the rim of the fixture. All fixtures used by medical and nursing staff, and all lavatories used by residents and food handlers shall be trimmed with valves, which can be operated without the use of hands. Where blade handles are used for this purpose, they shall not exceed four and one-half inches in length, except that handles on clinical sinks shall be not less than six inches long.
   3. (iii) Clinical sinks shall have an integral trap in which the upper portion of a visible trap seal provides a water surface.
   4. (iv) Shower bases and tubs shall provide non-slip surfaces for standing residents.

2. (2) Water supply systems shall comply with the following:

   1. (i) Water in sufficient quantity shall be provided that is of a quality, which conforms to Part 5 of this Title.
   2. (ii) Systems shall be designed to supply water at sufficient pressure to operate all fixtures and equipment during maximum demand periods.
   3. (iii) 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.
   4. (iv) Backflow preventers (vacuum breakers) shall be installed on hose bibs, janitors sinks, bedpan flushing attachments, and on all other fixtures to which hoses or tubing can be attached.
   5. (v) Flush valves installed on plumbing fixtures shall be of a quiet operating type, equipped with silencers.
   6. (vi) Water distribution systems shall be narrated to provide hot water at each hot water outlet at all times. Hot water at shower, bathing and handwashing facilities shall not exceed 110°F.

3. (3) Hot water heating systems shall comply with the following:

   1. (i) The hot water heating system shall have sufficient capacity to supply water at the temperatures and amounts indicated below. Water temperatures shall be taken at hot water point of use or inlet to processing equipment.

   2. (ii) Storage tank(s) shall be fabricated of corrosion-resistant metal or lined with non-corrosive material.

      	Clinical	USE Dietary	Laundry
      Gallons (per hour per resident)	6 1/2	4	4 1/2
      Liters (per second per resident)	.007	.004	.005
      Temperature (F)	110*	180	180

      *Maximum

4. (4) Drainage systems shall comply with the following requirements:

   1. (i) Insofar as possible, drainage piping shall not be installed within the ceiling nor 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.
   2. (ii) Building sewers shall discharge into a community sewage system. Where such a system is not available, a facility providing sewage treatment must conform to applicable local and state regulations.
5. (5) If used, nonflammable medical gas systems installations shall be in accordance with the requirements of NFPA 99, Standard for Health Care Facilities, 1999 edition. Further details concerning this reference material are contained in section 711.2(a) of this Title.
6. (6) If used, clinical vacuum system installations shall be in accordance with the requirements of NFPA 99, Standard for Health Care Facilities, 1999 edition, and Compressed Gas Association Inc. (CGA) Pamphlet E-10: Maintenance of Medical Gas and Vacuum Systems in Health Care Facilities, third edition. Further details concerning these reference materials are contained in section 711.2 of this Title.