Chapter V

Long Term Care Facilities

18.8	MODIFICATIONS. If the facility was licensed as a Nursing Home prior to August 10, 1959, and was not in compliance with the 1958 Uniform Building Code requirements, the facility shall comply with standards as specified in Section 18, except as modified herein. The modifications are as follows:
18.2.1	See Part 25.
18.2.3	Exterior window, 50% openable, is required.
18.2.4	Each occupied room shall have at least one doorway opening directly to the outside or to a corridor leading directly or by a stairway or ramp to the outside or to an adjacent room not subject to locking, which has such access to the outside. Doors shall be at least 30” in width.
18.2.5	Artificial lighting shall be provided for general illumination, reading lamps, and night lights (plug-in types approved).
18.2.6	One lavatory shall be provided for each 10 residents.
18.2.7	One toilet shall be provided for each eight residents of each sex.
18.2.10	A call signal is required at each resident bed. Signals shall register at the nursing station.
If the facility was licensed as a Nursing Home or a Basic Nursing Home after August 10, 1959, and before the effective date of these Standards, the facility shall comply with Life Safety Code requirements the Standards specified in Section 18 and the 1958 Uniform Building Code requirements, except as modified herein.  The modifications are as follows:
18.2.1	Minimum room area shall be 100 sq. ft. for one-bed room and 80 sq. ft. per bed in multiple-bed rooms.
18.2.4	Door width may be 3'6”.
18.2.5	Artificial lighting shall be provided for general illumination, reading lamps, and night lights (plug-in types approved), except for egress lighting which shall conform to Life Safety Code requirements.
18.2.6	Handwashing facilities may be installed in a toilet room adjacent to the bedroom.
18.2.7	If centralized toilet facilities are provided, one toilet shall be provided for each eight residents of each sex. If toilet facilities are provided between adjacent bedrooms, the ratio shall be one facility for not more than four beds.
18.2.10	The resident call signal is not required to register at clean or soiled areas. Calling stations are not required at toilets, tubs, or showers.
. . .
19.8.3	Secure units shall meet fire safety standards of Section 12-2.11.1 through 12-2.11.4 of the N.F.P.A. Life Safety Code (1985), which is herein incorporated by reference. Adoption of these provisions of the 1985 Life Safety Code does not include later amendments or editions.
Renumber succeeding sections accordingly.
. . . 
24.4	PLUMBING. All plumbing in the facility shall be installed and maintained in accordance with the 1986 Colorado Model Plumbing Code and local plumbing codes All plumbing shall be maintained so that it is free of the possibility of backflow and backsiphonage, through the use of vacuum breakers and fixed air gaps, in accordance with state and local codes. The adoption of the Model Plumbing Code does not include later amendments or editions.
Renumber succeeding sections accordingly.
. . . 
25.2	GENERAL BUILDING AND FIRE SAFETY. The long-term care facility shall be constructed in accordance with the requirements of Group D occupancy, 1958 Uniform Building Code, Volume No. 1,Second Printing; or the standards imposed by any city, city and county, town, county or other political subdivision in which the facility is located, whichever is the highest, and all other applicable state laws, rules and regulations.
25.3	STRUCTURAL AND FIRE SAFETY REQUIREMENTS FOR EXISTING HEALTH FACILITIES. Long-term care facilities in existence as of August 10, 1959 shall conform with the requirements of the Building Exits Code, Fourteenth Edition, National Fire Protection Association 101-1957 except that in respect to space requirements for multiple sleeping rooms, the rooms shall have a minimum of 75 square feet per person for at least 60 percent of the residents housed in the facility and 65 square feet per person for the remaining 40 percent of the residents housed in the facility. For single occupant rooms the minimum area requirement shall be 75 square feet.
25.4	OCCUPANCY RESTRICTIONS. No building used as a health facility shall be occupied beyond the limits as specified herewith:
Type of Construction	Equipment Needed For Permitted Occupancy	Occupancy Restrictions	
Less than 2 hour construction	Approved Automatic Fire Detection System	No non-ambulatory person above second floor. No residents above third floor.	
2 hour construction or more, or any building equipped with an approved automatic sprinkler system.	None.	No limit.	

In resident areas an approved fire detection system shall be installed with 135 degree head with rate of rise and fixed temperature.
. . . 
28.3	The 1958 Uniform Building Code, Volume 1,2d printing, the Building Exits code, 14th edition, N.F.P.A. 101-1957, and Sections 12-2.11.1 through 12-2.11.4 of the N.F.P.A. Life Safety Code (1958) are available for inspection at the Health Facilities Division of the Colorado Department of Public Health and Environment at the address listed on page I of these regulations.
28.4	The 1986 Colorado Model Plumbing Code is available from the Examining Board of Plumbers, Department of Regulatory agencies, 1390 Logan Street, #400, Denver, Colorado 80203.
28.5	The effective date of this rule is July 1, 1988.

25.  General Building and Life Safety Code Requirements

25.1	Compliance with the Life Safety Code.  Facilities shall be compliant with the National Fire Protection Association (NFPA) 101, Life Safety Code (2000), which is hereby incorporated by reference.  Such incorporation by reference, as provided for in 6 CCR 1011-1, Chapter II, excludes later amendments to or editions of referenced material.
25.1.1	Facilities licensed on or before March 11, 2003 shall meet Chapter 19, Existing Health Care Occupancies, NFPA 101(2000).
25.1.2	Facilities licensed after March 11, 2003 or portions of facilities that undergo remodeling on or after October 1, 2003 shall meet Chapter 18, New Health Care Occupancies, NFPA 101.  In addition, if the remodel represents a modification of more than 50 percent of the smoke compartment, or more than 4,500 square feet, the entire smoke compartment shall be renovated to meet Chapter 18, New Health Care Occupancies, NFPA 101(2000).
25.1.3	Notwithstanding Life Safety Code (2000) provisions to the contrary:
(1)	when differing fire safety standards are imposed by federal, state or local jurisdictions, the most stringent standard shall apply.
(2)	any story containing an exterior door or an exterior window that opens to grade level shall be counted as a story.
(3)	licensed facilities shall be separated from unlicensed contigous occupancies by an occupancy separation with a fire resistance rating of not less than 2 hours.
25.2	Plan Review and Plan Review Fees.  “Plan review” means the review by the Department, or its designee, of new construction or remodeling to ensure compliance by the facility with the National Fire Protection Association (NFPA) Life Safety Code and with this Chapter V.  Plan review consists of the analysis of construction plans and onsite inspections, where warranted.  In reference to the National Fire Protection Association requirements, the Department is the authority having jurisdiction for state licensure.  
Plan review and plan review fees are required as listed below.  If the facility has been approved by the Department to use more than one building for the direct care of residents on its campus, each building is subject to the applicable base fee plus square footage costs.  Fees are nonrefundable and shall be submitted prior to the Department initiating a plan review for a facility.  
25.2.1	Initial licensure, Additions, Relocations 
(1)	Plan review is applicable to the following, and includes new facility construction and new occupancy of existing structures:  
(a)	applications for an initial license, when such initial license is not a change of ownership and the application is submitted on or after July 1, 2009.  
(b)	additions of previously uninspected or unlicensed square footage to an existing occupancy and the building permit for such addition is issued on or after July 1, 2009 or if no permit is required by the local jurisdiction, construction began on or after July 1, 2009. 
(c)	relocations of a currently licensed facility in whole or in part to another physical plant, where the occupancy date occurs on or after July 1, 2009.
(2)	Initial licensure, addition, and relocation plan review fees:  base fee of $2,500, plus square footage costs as shown in the table below.
Square Footage	Cost per Square Foot	Explanatory Note	
0-25,000 sq ft	$0.10	This is the cost for the first 25,000 sq ft of any plan submitted.	
25,001+ sq ft	$0.01	This cost is applicable to the additional square footage over 25,000 sq ft.	
25.2.2	Remodeling  
(1)	Plan review is applicable to remodeling for which the application for the building permit from the local authority having jurisdiction is dated on or after July 1, 2009, or if no permit is required by the local jurisdiction, construction began on or after July 1, 2009.  Remodeling includes, but is not limited to:
(a)	structural alteration of any size to the resident sleeping area(s).
(b)	Relocation, removal or installation of walls that results in alteration of 25% or more of the existing habitable square footage or 50% or more of a smoke compartment.  
(c)	Conversion of existing space not previously used for providing resident services, including storage space, to space used for the delivery of services to residents.  
(d)	Addition, alteration or relocation of any egress component including, but not limited to, corridors, stairwells, exit enclosures, or points of refuge.  
(e)	Installation of any new sprinkler systems or the addition, removal or relocation of 20 or more sprinkler heads.
(f)	Installation of any new fire alarm system, or addition, removal or relocation of 20 or more fire alarm system appliances including, but not limited to, pull stations, detectors and notification devices.
(g)	Installation, removal or renovation of any kitchen hood suppression system.
(h)	Essential electrical system:  replacement or addition of a generator or transfer switch.
(i)	Alteration of an existing area of the facility into a resident services area that restricts resident egress through the use of locking devices.  Such areas include but are not limited to secured units.  In addition to construction plans, the following information shall also be submitted:  
(i)	cut sheets and sequence operations for locking devices for egress and egress access doors.
(ii)	location of locked egress and egress access doors.
(iii)	if applicable, how the fencing or other enclosure around the secured outdoor area designed to prevent elopement will be installed such that it and protects the safety and security of the residents.
(2)	Remodeling plan review fees:  base fee of $2,000, plus square footage costs as shown in the table below.
Square Footage	Cost per Square Foot	Explanatory Note	
0-20,000 sq ft	$0.08	This is the cost for the first 20,000 sq ft of any plan submitted.	
20,001+ sq ft	$0.01	This cost is applicable to the additional square footage over 20,000 sq ft.	
25.2	The “Guidelines for Design and Construction for Health Care Facilities” (2006 Edition), American Institute of Architects, may be used by the Department in resolving health, building, and life safety issues for construction initiated or systems installed on or after July 1, 2009.

Chapter XI

Convalescent Centers
. . . 

1.6	General Building and Life Safety Code Requirements
1.6.1	Compliance with the Life Safety Code.  Facilities shall be compliant with the National Fire Protection Association (NFPA) 101, Life Safety Code (2000), which is hereby incorporated by reference.  Such incorporation by reference, as provided for in 6 CCR 1011-1, Chapter II, excludes later amendments to or editions of referenced material.
(1)	Facilities licensed before July 1, 2009 shall meet Chapter 19, Existing Health Care Occupancies, NFPA 101 (2000).  
(2)	Facilities licensed on or after July 1, 2009 or portions of facilities that undergo remodeling on or after October 1, 2003 shall meet Chapter 18, New Health Care Occupancies, NFPA 101 (2000).  In addition, if the remodel represents a modification of more than 50 percent, or more than 4,500 square feet of the smoke compartment, the entire smoke compartment shall be renovated to meet Chapter 18, NFPA 101 (2000).  
(3)	Notwithstanding NFPA 101 Life Safety Code provisions to the contrary:
(a)	when differing fire safety standards are imposed by federal, state or local jurisdictions, the most stringent standard shall apply.
(b)	any story containing an exterior door or an exterior window that opens to grade level shall be counted as a story.
(c)	licensed facilities shall be separated from unlicensed contigous occupancies by an occupancy separation with a fire resistance rating of not less than 2 hours.
1.6.2	Plan Review and Plan Review Fees.  “Plan review” means the review by the Department, or its designee, of new construction or remodeling to ensure compliance by the facility with the National Fire Protection Association (NFPA) Life Safety Code and with this Chapter XI.  Plan review consists of the analysis of construction plans and onsite inspections, where warranted.  In reference to the National Fire Protection Association requirements, the Department is the authority having jurisdiction for state licensure.  
Plan review and plan review fees are required as listed below.  If the facility has been approved by the Department to use more than one building for the direct care of patients on its campus, each building is subject to the applicable base fee plus square footage costs.  Fees are nonrefundable and shall be submitted prior to the Department initiating a plan review for a facility.  
(1)	Initial licensure, Additions, Relocations 
(a)	Plan review is applicable to the following, and includes new facility construction and new occupancy of existing structures:  
(i)	applications for an initial license, when such initial license is not a change of ownership and the application is submitted on or after July 1, 2009.  
(ii)	additions of previously uninspected or unlicensed square footage to an existing occupancy and the building permit for such addition is issued on or after July 1, 2009 or if no permit is required by the local jurisdiction, construction began on or after July 1, 2009. 
(iii)	relocations of a currently licensed facility in whole or in part to another physical plant, where the occupancy date occurs on or after July 1, 2009.
(b)	Initial licensure, addition, and relocation plan review fees:  base fee of $2,500, plus square footage costs as shown in the table below.
Square Footage	Cost per Square Foot	Explanatory Note	
0-25,000 sq ft	$0.10	This is the cost for the first 25,000 sq ft of any plan submitted.	
25,001+ sq ft	$0.01	This cost is applicable to the additional square footage over 25,000 sq ft.	
(2)	Remodeling  
(a)	Plan review is applicable to remodeling for which the application for the building permit from the local authority having jurisdiction is dated on or after July 1, 2009, or if no permit is required by the local jurisdiction, construction began on or after July 1, 2009.  Remodeling includes, but is not limited to:
(i)	structural alteration of any size to the patient sleeping area(s).
(ii)	Relocation, removal or installation of walls that results in alteration of 25% or more of the existing habitable square footage or 50% or more of a smoke compartment.  
(iii)	Conversion of existing space not previously used for providing patient services, including storage space, to space used for the delivery of services to patients.  
(iv)	Addition, alteration or relocation of any egress component including, but not limited to, corridors, stairwells, exit enclosures, or points of refuge.  
(v)	Installation of any new sprinkler systems or the addition, removal or relocation of 20 or more sprinkler heads.
(vi)	Installation of any new fire alarm system, or addition, removal or relocation of 20 or more fire alarm system appliances including, but not limited to, pull stations, detectors and notification devices.
(vii)	Installation, removal or renovation of any kitchen hood suppression system.
(viii)	Essential electrical system:  replacement or addition of a generator or transfer switch.
(b)	Remodeling plan review fees:  base fee of $2,000, plus square footage costs as shown in the table below.
Square Footage	Cost per Square Foot	Explanatory Note	
0-20,000 sq ft	$0.08	This is the cost for the first 20,000 sq ft of any plan submitted.	
20,001+ sq ft	$0.01	This cost is applicable to the additional square footage over 20,000 sq ft.	
1.6.3	The “Guidelines for Design and Construction for Health Care Facilities” (2006 Edition), American Institute of Architects, may be used by the Department in resolving health, building, and life safety issues for construction initiated or systems installed on or after July 1, 2009.

Chapter XXI

Hospice

. . . 

14.34.5  Licensed health care facilities, in which inpatient hospice services are provided, shall meet the building and life safety codes currently being required for licensure and certification.  Inpatient hospice facilities must meet the provisions of Chapter 10 requirements for Group 1 occupancies, Uniform Building Code, 1982 Edition, except delete the following sentence in Section 3305 (h) Openings 1.  Doors shall be maintained self-closing or shall be automatic closing by activation of a smoke detector in accordance with Section 4306 (b).  (Exception:  Hazardous areas) inpatient hospices shall meet all provisions of Chapter 12, New Health Care Occupancies, Life Safety Code, NFPA 101-1985.  
. . . 

14.35.1	Hospices maintained as residential facilities shall provide documentation of approval from local zoning commissions, fire departments, code enforcement and building departments.  Additional fire safety requirements are:
1)	if the residential facility houses 1-3 residents  (and no one resident is determined to have an evacuation capability more than 12 – see NFPA-101, 1985 – appendix F), the facility shall meet the requirements of Chapter 22, NFPA 101 – one and two family dwellings.
2)	if any resident is determined to have an evacuation capability of 12 or more or if the residential facility houses 4-16 residents, the facility shall meet the requirements of Chapter 21, NFPA-101, 1985 – Residential Board and Care Occupancies, Section 21-2, Small Facilities.
. . . 

17. REFERENCES
17.1	The following referenced codes in the regulations do not include later amendments to or editions of the incorporated material:
Chapter 10, Group 1 Occupancies, Uniform Building Code, 1982 Edition, International Conference of Building Officials
Chapter 12, New Health Care Occupancies, Life Safety Code, NFPA-101, 1985, National Fire Protection Association
NFPA 101-1985 Appendix F, National Fire Protection Association
Chapter 22, NFPA-101. 1985 One and Two Family Dwellings, National Fire Protection Association
Chapter 21, NFPA-101, 1985 Residential Board and Care Occupancies, Section 21-2, Small Facilities, National Fire Protection Association
Certified copies of the above codes are available for inspection during regular business hours. Copies of the materials shall be provided at cost and may be obtained at the address listed on page 255 of these regulations upon request.

17  General Building and Life Safety Code Requirements

17.1	Compliance with the Life Safety Code.  Facilities shall be compliant with the National Fire Protection Association (NFPA) 101, Life Safety Code (2000), which is hereby incorporated by reference.  Such incorporation by reference, as provided for in 6 CCR 1011-1, Chapter II, excludes later amendments to or editions of referenced material.
17.1.1	Facilities licensed on or before March 11, 2003 shall meet Chapter 19, Existing Health Care Occupancies, NFPA 101 (2000).  
17.1.2	Facilities licensed on or after March 11, 2003 or portions of facilities that undergo remodeling on or after October 1, 2003 shall meet Chapter 18, New Health Care Occupancies, NFPA 101 (2000).  In addition, if the remodel represents a modification of more than 50 percent, or more than 4,500 square feet of the smoke compartment, the entire smoke compartment shall be renovated to meet Chapter 18, NFPA 101 (2000).  
17.1.3	Notwithstanding NFPA 101 Life Safety Code provisions to the contrary:
(1)	when differing fire safety standards are imposed by federal, state or local jurisdictions, the most stringent standard shall apply.
(2)	any story containing an exterior door or an exterior window that opens to grade level shall be counted as a story.
(3)	licensed facilities shall be separated from unlicensed contigous occupancies by an occupancy separation with a fire resistance rating of not less than 2 hours.
17.2	Plan Review and Plan Review Fees.  “Plan review” means the review by the Department, or its designee, of new construction or remodeling to ensure compliance by the facility with the National Fire Protection Association (NFPA) Life Safety Code and with this Chapter XXI.  Plan review consists of the analysis of construction plans and onsite inspections, where warranted.  In reference to the National Fire Protection Association requirements, the Department is the authority having jurisdiction for state licensure.  
Plan review and plan review fees are required as listed below.  If the facility has been approved by the Department to use more than one building for the direct care of patients on its campus, each building is subject to the applicable base fee plus square footage costs.  Fees are nonrefundable and shall be submitted prior to the Department initiating a plan review for a facility.  
17.2.1	Initial licensure, Additions, Relocations 
(1)	Plan review is applicable to the following, and includes new facility construction and new occupancy of existing structures:  
(a)	applications for an initial license, when such initial license is not a change of ownership and the application is submitted on or after July 1, 2009.  
(b)	additions of previously uninspected or unlicensed square footage to an existing occupancy and the building permit for such addition is issued on or after July 1, 2009 or if no permit is required by the local jurisdiction, construction began on or after July 1, 2009. 
(c)	relocations of a currently licensed facility in whole or in part to another physical plant, where the occupancy date occurs on or after July 1, 2009.
(2)	Initial licensure, addition, and relocation plan review fees:  base fee of $2,500, plus square footage costs as shown in the table below.
Square Footage	Cost per Square Foot	Explanatory Note	
0-25,000 sq ft	$0.10	This is the cost for the first 25,000 sq ft of any plan submitted.	
25,001+ sq ft	$0.01	This cost is applicable to the additional square footage over 25,000 sq ft.	
17.2.2	Remodeling  
(1)	Plan review is applicable to remodeling for which the application for the building permit from the local authority having jurisdiction is dated on or after July 1, 2009, or if no permit is required by the local jurisdiction, construction began on or after July 1, 2009.  Remodeling includes, but is not limited to:
(a)	structural alteration of any size to the patient sleeping area(s).
(b)	Relocation, removal or installation of walls that results in alteration of 25% or more of the existing habitable square footage or 50% or more of a smoke compartment.  
(c)	Conversion of existing space not previously used for providing patient services, including storage space, to space used for the delivery of services to patients.  
(d)	Addition, alteration or relocation of any egress component including, but not limited to, corridors, stairwells, exit enclosures, or points of refuge.  
(e)	Installation of any new sprinkler systems or the addition, removal or relocation of 20 or more sprinkler heads.
(f)	Installation of any new fire alarm system, or addition, removal or relocation of 20 or more fire alarm system appliances including, but not limited to, pull stations, detectors and notification devices.
(g)	Installation, removal or renovation of any kitchen hood suppression system.
(h)	Essential electrical system:  replacement or addition of a generator or transfer switch.
(2)	Remodeling plan review fees:  base fee of $2,000, plus square footage costs as shown in the table below.

Square Footage	Cost per Square Foot	Explanatory Note	
0-20,000 sq ft	$0.08	This is the cost for the first 20,000 sq ft of any plan submitted.	
20,001+ sq ft	$0.01	This cost is applicable to the additional square footage over 20,000 sq ft.	
17.3	The “Guidelines for Design and Construction for Health Care Facilities” (2006 Edition), American Institute of Architects, may be used by the Department in resolving health, building, and life safety issues for construction initiated or systems installed on or after July 1, 2009.