13-024 Code Vt. R. 13-140-024-X - MATERNITY HOME/BIRTH CENTER

Section 100.00 General Provisions

110.00 Statement of Purpose:

The purpose of these regulations is to establish standards of operation, maintenance and care in all free standing Maternity Homes or Birth Centers located and doing business in Vermont. These regulations shall apply to all Maternity Homes or Birth Centers, as defined in 18 VSA § 2002 and these regulations.

120.00 Authority for the Agency of Human Services to promulgate and enforce these regulations is found in 18 VSA § 2014, and 3 VSA § 3003.

130.00 Exception and Severability

130.01 The Department of Health as the licensing agency (hereinafter "Department") reserves the right to modify or waive any individual requirement in these regulations in situations deemed appropriate by the Department. In no event shall the Department approve a modification or waiver if contrary to the health, safety or well-being of Birth Center users or the public.

130.02 If any of these regulations, or the application of any of these regulations, is determined to be invalid, the de-termination of invalidity shall not affect any other of these regulations or the application of any other of these regulations.

Section 200.00 Definitions

210.00 General Definitions

210.01 For the purpose of these regulations, words and phrases are given their normal meanings unless otherwise specifically defined in Section 220.00 below.

210.02 When used in these regulations, "shall" or "must" indicates a requirement.

220.00 Specific Definitions

220.01 The following words are defined to mean:

a. "Birth Center" or "Maternity Home" means a place, other than a hospital as defined by statute, which maintains and operates facilities for profit or otherwise, accommodating a woman or women unrelated to the operator who require maternity care. Excluded from this definition is the residence of the laboring woman.

b. "Birthing room" means a room used exclusively for a woman in labor, delivery or for postpartum and newborn care. A birthing room shall not be used for any other purpose, nor shall any birthing room accommodate more than one laboring or postpartum woman at any time.

c. "Center" unless otherwise specified shall mean a Maternity Home or Birth Center.

d. "Licensed capacity" is the maximum number of birthing rooms which the Maternity Home or Birth Center is li-censed to operate.

e. "Low risk" means a normal medical, surgical and obstetrical history and a normal uncomplicated prenatal course as determined by adequate prenatal care, and prospects for a normal uncomplicated birth as defined by The American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives.

f. "Maternity Care" means a high level of nursing care, prescribed by the physician, and medical care required by obstetrical patients prior to delivery, during delivery, and for such period following delivery as the physician may indicate.

g. "Midwife" means a person educated in the discipline of nursing and midwifery, certified by examination by the American College of Nurse-Midwives, and holding a current license to practice nursing in Vermont.

h. "Newborn Care" means care of the newborn in accordance with the procedures and techniques recommended in the most recent edition of "Hospital Care of Newborn Infants" published by the American Academy of Pediatrics.

i. "Person" means an individual, trust, state, partnership, committee, corporation, association, and other organizations such as joint-stock companies and insurance companies, or a political subdivision or instrumentality of a state including a municipal corporation.

j. "Physician" means a person who is licensed according to the provisions of 26 VSA § 1391.

k. "Regulated/Controlled Drugs" are those on the current Federal controlled substances inventory list and/or those designated in regulations of the Vermont Board of Health pursuant to 18 VSA § 4202.

Section 300.00 Licensure

310.00 General Requirements

310.01 No person shall establish, conduct or maintain a Center in the State of Vermont without first obtaining a license in the manner prescribed in these regulations.

310.02 No Center shall be licensed which is located more than ten (10) minutes by immediately available transportation from a transfer hospital as described in Section 470.02 of these regulations.

320.00 Pre-Licensure Requirements

320.01 Any person who seeks to establish, construct or otherwise initiate the development of a new Center or who seeks to significantly enlarge, expand or add to existing services, equipment or structures of a Center may be subject to requirements of the Certificate of Need Law, 18 VSA § 2401 et. seq. and regulations adopted to implement that law. It is the responsibility of that person to seek a determination from the Department as to whether a Certificate of Need is required.

320.02 Any person who seeks to establish, construct or operate a Center shall:

a. Submit plans and specifications for review and approval, prior to beginning construction, to the following State agencies:

1. Vermont Department of Health Division of Medical Care Regulation 60 Main Street, P.O. Box 70 Burlington, VT 05402

2. Vermont Department of Labor & Industry Division of Fire Prevention 120 State Street State Office Building Montpelier, VT 05602

b. Provide written evidence to the Department of compliance with local zoning codes, or a statement signed by an authorized representative of a city, town, or village that such a code has not been adopted in the community.

320.03 At least 90 days prior to the projected opening date, the Center shall request inspections by the agencies to which plans and specifications were submitted. Modifications shall be made as required by these agencies to comply with laws and regulations.

320.04 At least 30 days prior to the projected opening date, the Center must furnish the Department with written proof that adequate staffing and personnel are provided in accordance with these regulations. Adequacy of staffing levels shall be determined solely by the Department.

Such proof must include:

a. A written agreement with a Center Director;

b. A written agreement with a Medical Director;

c. A written agreement with a certified nurse-midwife if one is to be employed by the Center;

d. A written agreement with a board-certified obstetrician/gynecologist as described in Section 470.01(a) of these regulations;

e. A written agreement with a board-certified pediatrician as described in Section 470.01(b) of these regulations; and

f. A list of all positions required for the efficient operation of the Center in accordance with the regulations.

320.05 Upon performance of all pre-licensure requirements, the applicant shall complete a license application pro-vided by the Department, and submit it to the Department with the required fee.

330.00 License

330.01 License applications shall be forwarded to the Department for any of the following changes in status:

a. Construction of a new or replacement Center;

b. Addition to or renovation of an existing Center;

c. Increase or decrease in licensed capacity;

d. Change of ownership;

e. Change of Center name;

f. Change of address or location; and

g. Expiration of current license.

330.02 Applications shall be made on forms provided by the Department. The applicant shall provide all information and supporting documents requested by the Department. Any material misstatement on an application or on sup-porting documents shall be grounds for suspension of the Center's license.

330.03 All applications for licensure shall be received by the Department at least 30 days prior to the projected change in status for which a new license is required. A renewal application on forms provided by the Department shall be returned to the Department at least 10 days prior to the current expiration date.

330.04 Applications shall be accompanied by a fee of $ 10.00 plus $ 2.00 for each birthing room, payable to the Treasurer, State of Vermont.

330.05 Upon verification of compliance with all applicable laws and regulations, the Department shall issue the applicant a license.

330.06 If the applicant fails to comply with the applicable laws or regulations, the Department shall deny the application. Notification of such denial shall be in writing by registered/certified mail and shall set forth the grounds for denial and shall inform the applicant of the opportunity for a hearing. Hearings shall be conducted in accordance with the Administrative Procedures Act, 3 VSA § 801, et. seq.

330.07 Each license expires one year from the date of issuance, or on the date stated on the license.

330.08 In its discretion the Department may issue a temporary license for such period or periods and subject to such conditions as the Department considers appropriate. Each application for a temporary license shall be accompanied by a license fee of $ 10.00 plus $ 2.00 per birthing room.

330.09 Licenses are issued to the person and for the premises named in the application, and are not transferable or assignable. A separate license is required for Centers which are maintained on separate premises even though they are under common ownership or management.

330.10 The number of women in labor/delivery in a Center shall not exceed its licensed capacity. No Center shall have less than two birthing rooms.

330.11 Each Center shall have a policy which establishes the maximum number of people permitted to accompany each woman during labor and delivery.

330.12 Each license in the licensee's possession is the property of the State of Vermont. The licensee shall surrender the license to the Department immediately upon a change in status ad described in Section 330.01.

330.13 Licenses shall be conspicuously posted in a prominent location within the licensed premises, convenient to public view.

340.00 Inspection and Correction of Deficiencies

340.01 Any authorized representative of the Department may, at any time, without notice, enter and inspect any building or premises licensed under these regulations. Such representatives shall have complete access to all records and files, including those of women and newborns, required to be kept by law and these regulations.

340.02 All licensed Centers shall be inspected by the Department as often as the Department considers necessary, but not less than once annually.

340.03

a. The Department shall notify the Center in writing of all failures to comply with laws or these regulations discovered during inspections. The Center shall prepare a written plan of correction for all such failures and submit it to the Department for approval by the Department. Failure to submit an acceptable plan of correction within 10 working days from receipt of notice of deficiencies may result in sanctions as set forth in Section 350.00 of these Regulations.

b. In no circumstances shall the allotted time for correction of deficiencies exceed 90 days unless the deficiencies pertain to the physical plant. The Department of Labor and Industry or other appropriate governmental agency must certify to the Department that more then 90 days are required to correct such deficiencies. The Department may, in its discretion, extend the time for correction of deficiencies pertaining to physical plant for a specific time period.

c. If, at the end of the allotted time, investigation reveals that the Center has failed to correct all deficiencies, the Center may be subject to sanctions as set forth in Section 350.00 below.

340.04 Written reports on the results of each inspection shall be prepared by the Department and forwarded to the Center.

350.00 Sanctions

350.01 The Department may deny, suspend or revoke a license whenever the Center:

a. Fails to comply with any provision of these regulations;

b. Commits, aids, abets or permits the commission of any illegal act;

c. Operates in a manner inimical to the public health, welfare and safety of the people of the State of Vermont.

350.02 The Department may restrict or limit admissions to a Center for a specified period of time when the Center is, in the opinion of the Department, not in compliance with these Regulations.

Section 400.00 Organization and Management

410.00 Governing Body

410.01 Each Center shall have an organized governing body responsible for management and control of the Center and for compliance by the Center with all applicable federal, state and local laws and regulations.

410.02 The governing body shall be responsible for designating a qualified Center Director and a qualified Medical Director.

410.03 The governing body shall establish written by-laws and policies to be followed in the operation of the Center which delineate the organization of the Center, delegate authority and responsibility for daily operation, identify the types of services offered and state the goals and objectives.

420.00 Center Director

420.01 Each Center shall employ a Center Director, who shall be responsible to the governing body for the operation of the Center. The Center Director may also serve as the Medical Director, provided that the Center Director is a physician.

420.02 The Center Director may be a certified nurse-midwife.

420.03 The Center Director is responsible for the following:

a. Daily operation of the Center in full compliance with all applicable laws and regulations;

b. Initiation, implementation and updating of the Center's policies, contract and agreements;

c. Employment of properly licensed and trained personnel and appropriate delegation of duties;

d. Adoption of written policies and procedures pertaining to the health and safety of women, newborns, and personnel, and to the protection of the rights of women and newborns;

e. Maintenance of on-going liaison between the governing body and the staff;

f. Implementation of a quality assurance program;

g. The reporting of births and deaths in conformity with Vermont laws.

430.00 Medical Director

430.01 Each Center shall employ a Medical Director who is a licensed physician with admitting privileges at the receiving hospital. The Medical Director may also serve as the Center Director.

430.02 The Medical Director is responsible for the following:

a. Emergency services;

b. Formulation of the Center's policies and protocols, in consultation with the certified nurse-midwife, if applicable;

c. Contents of emergency medical kits, emergency equipment and the Center's stock medications;

d. Inservice training of direct care personnel;

e. Surveillance of employee health status;

f. A quality assurance program which shall include:

1. regular staff meetings and case presentation;

2. record audit; and

3. peer review.

440.00 Certified Nurse-Midwife

440.01 A Center may employ one or more certified nurse-midwives on a full or part-time basis.

440.02 The certified nurse-midwife is responsible for the following:

a. Supervision of all nursing personnel;

b. Formulation of the Center's policies and protocols for nursing/midwifery services;

c. Recording of all nursing/midwifery information in the woman/newborn medical records;

d. Family childbirth education and preparation for parenting; and

e. Control of the supply and supervision of the administration of medications.

450.00 Personnel

450.01 General Provisions

a. A certified nurse-midwife or physician shall personally attend each birth. In addition, a second staff member, trained in resuscitation and care of the newborn, shall also be present at each birth.

b. Qualified staff shall be on duty and awake at all times when a laboring woman or newborn is present in the Center.

c. An employee who has, or is suspected to have, a communicable disease, shall not be on duty in the Center until the disease is no longer contagious.

450.02 Training

a. An educational program shall be conducted for the orientation of new personnel and for improvement of skills of all personnel;

b. Such educational program must be offered at least annually and shall include:

1. review of the Center's policies and protocols;

2. measures for the prevention and control of infection;

3. equipment maintenance;

4. emergency plans and procedures;

5. confidentiality of medical records; and

6. laws and regulations governing the operation of Centers.

c. The program shall be conducted at regular intervals, dependent on the needs of the Center and the size of staff. Records shall be kept which indicate the content of the training and attendance.

450.03 Records

a. A personnel record shall be maintained for each employee. Records of past employees shall be kept for seven years. All personnel records are open for inspection by the Department. Such records shall include at least:

1. name, home address, birth date, social security number;

2. current and background information, including qualifications for employment;

3. record of pre-employment and annual physical examinations, including evidence of laboratory results indicating Rubella immunity or a signed physician's statement indicating the date of Rubella immunization;

4. date of employment;

5. if applicable, occupational or professional license number of each employee; and

6. references.

b. A performance evaluation of each employee shall be conducted at least annually and recorded in the employee's file.

c. A record shall be kept of all employee accidents and illnesses occurring on Center premises which require physician intervention or absence from assigned duties or work schedule.

460.00 Medical Records and Reports

460.01 General Provisions

a. The Center is responsible for proper maintenance of required records and the issuance of required reports.

b. The Center shall provide adequate and safe storage of all required records. All records must be completed prior to filing, and shall be filed in a manner which facilitates retrieval of the completed record when needed.

c. All information contained in individual records of women and newborns shall be confidential and may be disclosed only to the Department and other authorized persons. Written consent of the woman or child's guardian as applicable is required for the release of information to persons not otherwise authorized.

d. In the event of change in ownership of any licensed Center, all records shall remain in the Center. When a Center closes, records shall be stored in a safe place for seven years. The Center shall notify the Department of the place of storage and permit the Department access to those records.

e. All records shall be maintained for at least seven years from date of final discharge of the woman. Minors' re-cords shall be maintained until the minor reaches the age of majority, or seven years after final discharge, whichever is longer.

f. All reports and records shall be made available for inspection by the Department on request.

460.20 Medical Records

a. A medical record shall be established and maintained in accordance with accepted professional standards and practices for each woman admitted to a Center.

b. Entries in the medical record relating to diagnostic tests, treatments, medication and other similar services shall be made legibly, typewritten or in ink, by the responsible persons at the time of administration.

c. Each medical record shall contain sufficient information to identify the woman and to document treatment, care and results. Each record shall contain at least the following:

1. identification data;

2. medical history;

3. assessment forms and updates;

4. care plans and updates;

5. accident reports;

6. medication reports;

7. diagnostic and therapeutic orders;

8. medical consent forms;

9. physician's and/or midwife's progress notes and observations;

10. laboratory reports, x-ray reports and other clinical findings;

11. consultation and referral reports; and

12. disposition and final summary notes.

d. At the time of discharge, the discharge summary shall include a summary of the course of events during the woman's stay, and follow-up plans for the mother and baby during the postpartum period.

e. A record shall be established for every infant born at the Center. All infant records shall be cross-referenced with the mother's medical record. Each infant record shall contain:

1. identification data including mother's name;

2. time of birth;

3. APGAR score at one minute and five minutes;

4. birth weight and length;

5. head and chest circumference;

6. gestational age;

7. site, nature and amount of any drug administered to the newborn, including ophthalmia neonatorum prophylaxis and vitamin K;

8. newborn screening for inborn errors of metabolism; and

9. documentation regarding physical examination.

470.00 Other Records, Reports and Agreements

470.01 Agreements with Consultants and Outside Resources

a. The Center shall enter into a written agreement with a board-certified obstetrician/gynecologist who shall agree to:

1. consult on obstetrics and gynecology;

2. participate in a quality assurance program; and

3. review at least annually the Center's policies, procedures and educational program.

b. The Center shall enter into a written agreement with a board-certified pediatrician who shall agree to:

1. consult on pediatrics;

2. participate in a quality assurance program; and

3. review at least annually the Center's policies, procedures and educational program.

c. If the Center does not employ a qualified person to render a specific service which is necessary for the care of women or newborns, or does not have the equipment to provide a specific service, the Center shall enter into written agreements for the provision of these services so that they will be available as needed.

d. The Center shall enter into a written agreement with a licensed emergency care ambulance service. Such agreement shall provide for immediate transportation to one or more transfer hospitals upon request of a Center physician or midwife.

470.02 Transfer Agreements

a. Each Center shall have in effect a written transfer agreement with one or more hospitals to ensure the prompt, safe and orderly transfer of women and/or newborns. All transfer agreements shall be signed by the Hospital Administrator and the Center Director, and shall be kept on file in the Center.

b. No hospital may be a party to a transfer agreement if that hospital is located more than ten (10) minutes away by immediately available transportation from the Center.

c. A transfer agreement shall provide for the immediate admission of women and/or newborns upon request by the Center physician and/or midwife.

470.03 Records of Regulated/Controlled Drugs

a. Each Center shall maintain complete records of all controlled or regulated drugs received and/or distributed in the Center.

b. All controlled or regulated drug records shall be maintained in compliance with all state and federal laws and regulations.

c. Controlled or regulated drug records shall be open at all times to inspection by members of the Board of Pharmacy, their authorized agents, law enforcement authorities of the State, and the Department.

470.04 Accident Records and Reports

a. Accidents involving Center users or visitors shall be reported to the Department and to the injured person's physician by the Center Director within 24 hours of the accident. Reportable accidents are those in which the person dies, becomes non-ambulatory, requires the services of a physician in the Center, or is admitted to a hospital.

b. The Center Director shall prepare a written report of the accident, including its causes, investigation, proposed corrective measures and implementation of such measures. Accident reports shall be kept on file for inspection by the Department.

470.05 Annual Statistical Report

The Center Director shall prepare and submit to the Department an annual statistical report on a form provided for this purpose by the Department.

Section 500.00 Direct Services

510.00 Care of Women and Newborns

510.01 The Center shall not admit or retain women and/or newborns for whom adequate care cannot be provided.

510.02 The Center shall establish and adhere to specific admission criteria which meet the American College of Obstetrics and Gynecology and the American College of Nurse-Midwives definition of low-risk pregnancies, appropriate for care and delivery in a Center.

510.03 No woman shall be admitted to a Center unless she has previously signed an agreement to be transferred to the transfer hospital at any time a Center physician or midwife determines that such transfer is necessary to protect the health of the mother, fetus or newborn.

510.04 A Center shall maintain written policies and procedures covering all care of women and newborns. Such policies and procedures shall include at least the following:

a. Admission criteria;

b. Infection control;

c. Problem identification;

d. Medication, including anesthesia and analgesia;

e. Referrals and consultation;

f. Discharge/transfer protocols;

g. All services offered by the Center;

h. Orientation and education; and

i. Emergency plans and procedures.

510.05 Policies and procedures relating to the care of women/newborns shall be revised as necessary, but not less then once annually.

510.06 Prior to discharge, appointments shall be made for maternal and newborn examinations which shall be scheduled no more than 72 hours from the time of discharge.

510.07 All mothers and infants shall be discharged within 24 hours from time of birth.

510.08 In case of emergency transport, the midwife or physician shall accompany the woman and/or newborn to the hospital whenever possible. The Center shall, whenever practicable, transfer the woman's medical record and personal belongings to the hospital at time of transfer.

510.09 A Center may provide the basic laboratory services that are commonly furnished in a physician's office.

510.10 Standard emergency equipment shall include at least the following for each birthing room:

a. Infant warmer;

b. Intravenous fluids;

c. Resuscitation equipment for mother and infant;

d. Oxygen for emergency use;

e. Sphygmomanometer;

f. Auscultation equipment; and

g. Suction, including appropriate sized tubes for adults and infants.

510.11 No anesthesia except local anesthesia for episiotomy and repair shall be used in a Center. Pitocin, or any other medication shall not be used to induce or augment labor.

510.12 Surgical procedures shall be limited to those normally accompanying uncomplicated childbirth, such as episiotomy and repair. Procedures such as forceps, tubal ligation or Cesarean Sections shall not be performed in a Center. If a medical emergency necessitates use of any of these or other emergency procedures, a report shall be made to the Department by the Center within 24 hours from the occurrence.

510.13 Only ready-to-use formula shall be available at a Center. No formula preparation shall be permitted at a Center.

510.14 All drugs in the Center shall be properly labeled and safely stored.

510.15 Discontinued, outdated, recalled, adulterated or deteriorated drugs and biologicals shall not be used, and shall be destroyed. Containers with illegible, incomplete or missing labels shall be returned to the issuing pharmacist for proper disposition.

510.16 All bleaches, disinfectants, insecticides and other hazardous substances shall be plainly marked and safely stored separately from food and medications.

Section 600.00 Rights of Women and Newborns

600.01 No Center shall discriminate because of religion, race, color, national origin or marital status.

600.02 Each Center shall establish a written policy regarding the rights and responsibilities of patients.

600.03 Each woman shall be fully informed of her rights and responsibilities as evidenced by her written acknowledgement prior to or upon admission. Additionally, Center rights for women/newborns shall be given to Center users and a copy shall be posted in a conspicuous location in the Center.

a. Each woman shall be fully informed of her health and medical condition upon admission and at any time during her stay.

b. Every woman shall be afforded an opportunity to participate in the planning of her prenatal care, childbirth and care of her newborn.

c. Prior to or at the time of admission, each woman shall be informed of services available and charges for those services. Such information shall be in writing.

d. All women and newborns shall be free from mental and physical abuse.

600.04 Each woman shall be informed of the admission/discharge criteria as well as the risks that could develop during pregnancy, labor, birth and immediately after delivery both to her and to her baby.

600.05 Nothing in these Regulations shall be interpreted to prevent a mother from choosing a particular physician for the care of her newborn.

Section 700.00 Facility

710.00 Design, Construction and Safety

710.01 All Centers shall be designed, constructed, maintained, and operated to minimize the possibility of a fire or other life-threatening emergency to the staff and users. The Center shall meet all appropriate state, federal and local regulations, codes and ordinances, including the state fire prevention codes.

710.02 The Center Director shall maintain a written disaster preparedness plan, developed within the guidelines used by the Division of Civil Defense of the Vermont Department of Public Safety, the Vermont Department of Health and the Vermont Department of Labor and Industry. The plan shall include procedures for evacuation, transfer of re-cords and drugs, and notification of appropriate persons and fire containment. If the Center is located with ten (10) miles of a nuclear power facility, the plan shall include specific measures for the protection of Center users and staff in the event of a nuclear facility accident.

710.03 The Center shall be maintained to provide a safe, clean, home-like environment. However, the rooms and furnishings must be easy to clean.

710.04 Birthing rooms shall be located to provide unimpeded, rapid access to an exit of the building where emergency transportation vehicles may be accommodated. Hallways and doors providing access and entry into the Center and birthing rooms shall be demonstrated to be of adequate width and conformation to accommodate movement of ambulance stretchers and wheelchairs by a documented dry run of ingress and egress by an emergency squad. The birthing rooms shall accommodate:

a. A bed large enough for a mother and baby;

b. Work space around the bed;

c. Birth attendants and support persons;

d. Chairs;

e. Bedside/procedure tables;

f. A bassinet or cradle;

g. Space for supplies, equipment and family belongings;

h. Access to a sink with hot and cold running water with elbow-wrist controls; and

i. Unobstructed path for exit.

710.05 Toilet and Bath Facilities: Private toilet and bath/shower facilities shall be available at all times to the laboring woman. These rooms shall be equipped with doors and hardware which will permit access from the outside in an emergency. When such rooms have only one opening or are small, the doors shall be capable of opening outwards or be otherwise designed to be opened without need to push against a woman who may have collapsed within the room. Showers and bathtubs shall be equipped with grab bars and non-slip surfaces. Separate toilet facilities shall be available for family and staff use.

710.06 Family Room: The family room shall include a play area for children and a living room setting of tables, chairs and a sofa that may be converted into a bed for use by family members and/or friends.

710.07 Kitchen: The kitchen shall include a refrigerator, stove or hot plate, sink, cupboard and counter space for the convenience of the family. The stove must be vented directly to the outside. Food may be prepared by the family or, if catering is provided by the Center, Health Department Food Service Regulations shall be met. All food preparation areas and equipment shall be kept clean to prevent contamination by insects and rodents. Doors, windows and other openings to outer air shall be screened against flies and insects.

710.08 Laundry: A Center may contract for laundry services. If a washer and dryer are maintained in the Center, they should be maintained in good working order, with 160 [degrees] F temperature for laundering and the direct venting of the dryer to the outside.

710.09 Support Service Areas: Adequate space for library, record storage, staff offices and minor laboratory tests, if provided shall be identified to the Department.

710.10 Heating and Ventilation: A safe and adequate source of heat and ventilation shall be provided and maintained. Bathrooms, toilet rooms, kitchen area, laundries and utility rooms must be ventilated to the outside by window, air shaft, exhaust fan or ventilating duct of sufficient size.

710.11 Plumbing, Water Supply, Waste Disposal:

a. All plumbing shall be installed to prevent back-siphonage and cross connections between potable and non-potable water. All plumbing fixtures shall be clean and free from cracks, breakage and leaks. Each Center shall be connected to an approved public water supply. If a public water supply is not available, the water shall meet standards adopted by the Department. Samples of private water supplies shall be tested every six months at the State Health Department Laboratory.

b. Water shall be adequate in temperature, volume and pressure for all purposes, including fire fighting, plumbing and drainage for the disposal of sewage, infectious discharge, household and institutional wastes, and shall comply with all state and federal regulations.

710.12 Lighting and Power: There shall be adequate lighting in all areas throughout the Center, and provisions shall be made for emergency lighting during a power failure. An adequate number of outlets shall be provided for use of equipment.

710.13 Floors, Walls, Ceilings: All surfaces must be kept clean and be free from holes and cracks that could collect dirt or harbor insects and rodents. Ceilings and walls shall provide adequate acoustical control. Ceilings shall be of proper height for functional use of all areas and for the comfort of the occupants.

710.14 Accessibility to the Physically Handicapped: Each Center shall be accessible to and functional for physically handicapped women, staff and visitors.

710.15 When professional offices of the care provider are part of the Center, the office suite shall be separated physically and functionally from the birthing rooms. In no case shall an examining room serve as a birthing room. 3 V.S.A. § 3003; 18 V.S.A. § 2014

Notes

13-024 Code Vt. R. 13-140-024-X

EFFECTIVE DATE: August 16, 1983 (Secretary of State Rule Log # 83-36)