| (B) Interior finishes, lighting, and furnishings shall
present an atmosphere which is as noninstitutional as possible, consistent
with applicable fire safety requirements. Security and safety devices
should not be present in a manner to attract or challenge tampering
by patients.
(2) Architectural requirements. Architectural requirements
shall be in accordance with §134.122(d)(1) of this title and
this paragraph.
(A) Handicapped accessibility requirements. At least
10% of patient room suites, bathing units and toilets, and all public
and common use areas shall be designed and constructed to be handicapped
accessible. These requirements shall apply in all new construction
and when an existing nursing suite or a portion thereof is converted
from one service to another.
(B) Patient room suites. A patient room suite shall
consist of the patient room and a toilet room or bathroom. Patient
room suites shall comply with the following requirements.
(i) Maximum patient room capacity. The maximum patient
room capacity shall be two patients. In existing facilities where
renovation work is undertaken and the present capacity is more than
two patients, the maximum room capacity shall be no more than the
present capacity with a maximum of four patients.
(ii) Single-bed patient room. In a single-bed patient
room, the minimum clear floor area shall be 100 square feet. The minimum
clear floor area in an accessible private patient room shall be 120
square feet. The minimum room dimension shall be not less than 10
feet.
(iii) Multi-bed patient room. In a multi-bed patient
room, the minimum clear floor area shall be 80 square feet per bed.
Minimum clear floor space in an accessible multi-bed room shall be
110 square feet per bed. Design of multi-bed patient rooms shall not
restrict independent patient access to the corridor, lavatory, or
bathroom.
(iv) Arrangement of patient rooms. Minor encroachments
including columns and wall hung lavatories that do not interfere with
functions may be ignored when determining space requirements for patient
rooms.
(I) Required clear floor space in patient rooms shall
be exclusive of toilet rooms, closets, lockers, built-in cabinets,
wardrobes, alcoves, or vestibules.
(II) A clearance of 3 feet 8 inches shall be available
at the foot of each bed in multi-bed patient rooms to permit the passage
of equipment and beds. A minimum distance of three feet between a
wall and the side of a bed and four feet between beds shall be provided.
A minimum distance of five feet between a wall and the side of a bed
and four feet between beds shall be provided in an accessible semi-private
room or one intended for rehabilitation patients. Arrangement of beds
shall be such that sufficient space is provided for a bed and maneuvering
space for a wheelchair.
(III) Sleeping areas shall have doors for privacy.
Design for visual privacy in multi-bed rooms shall not restrict patient
access to the room, toilet, or observation by staff.
(v) Patient bathroom. Each patient shall have access
to a bathroom without having to enter the general corridor area. Each
bathroom shall contain a toilet, hand washing fixtures, and storage
shelf or cabinet and serve not more than four patient beds or two
patient rooms. Hand washing fixtures may be located in the patient
room.
(vi) Bathing rooms. One bathtub or shower shall be
provided for each four patient beds or space which is not otherwise
served by bathing rooms within patients' rooms. Each tub or shower
shall be in an individual room or enclosure which provides space for
the private use of the bathing fixture and for drying and dressing.
(vii) Patient storage. Each patient shall have a separate
wardrobe, locker, or closet that is suitable for hanging full-length
garments and for storing personal effects. A minimum of 12 lineal
inches of hanging space shall be provided per patient.
(C) Security rooms. When security rooms are provided
by the treatment program narrative, the security rooms shall be single
patient suite rooms designed to minimize potential for escape, hiding,
injury to self or others, or suicide. Access to toilets, showers,
and wardrobes shall be restricted. The patient room suite shall be
in accordance with subparagraph (B)(ii) of this paragraph. Security
rooms may be centralized on one unit or decentralized among units.
(D) Seclusion suite. There shall be a seclusion suite
in each nursing suite intended for short-term occupancy by a single
person requiring security and protection from self or others. The
seclusion suite shall consist of seclusion room(s), an anteroom or
a vestibule, a toilet, and hand washing fixtures.
(i) Each seclusion room shall be located and designed
in a manner affording direct visual supervision by nursing staff and
shall be constructed to prevent patient hiding, escape, injury, or
suicide. There shall be a minimum of one seclusion room for each 24
beds or any portion thereof.
(I) The floor area of each seclusion room shall be
not less than 60 square feet. The minimum room dimension shall be
six feet.
(II) The seclusion room shall have a minimum ceiling
height of nine feet.
(III) The door to each seclusion room shall have no
hardware on the room side and shall open out. A vision panel shall
be provided in each door to permit staff observation of the entire
room while maintaining privacy from the public and other patients.
The seclusion room door shall swing out.
(IV) Each seclusion room shall have natural light (skylight
or window) in order to maintain a therapeutic environment. Skylight
wells or windows shall be not less than 400 square inches in area.
(ii) Access to the seclusion room from any public space
such as a corridor shall be through an anteroom. When the seclusion
suite is directly accessible from the nurse station, a vestibule
may be provided in place of an anteroom. A cased opening to the vestibule
in lieu of a door may be provided as long as the arrangement assures
privacy from the public and other patients.
(I) The minimum dimension of the anteroom or vestibule
shall be eight feet.
(II) The door to the anteroom shall swing in.
(iii) There shall be at least one toilet room directly
accessible from the anteroom or vestibule.
(I) The toilet room shall be large enough to safely
manage the patient.
(II) The toilet room door shall swing out into the
anteroom or vestibule.
(III) A water closet and hand washing fixtures shall
be provided in the toilet room. An unbreakable wall hung mirror may
be provided.
(IV) Doors for the seclusion room and anteroom shall
be not less than 3 feet 8 inches in width.
(V) When the interior of the seclusion room is padded,
the padding shall be a Class "A." The flame spread rating shall be
0-25 and the smoke development rating shall be 0-450 in accordance
with NFPA 101, Chapter 8.
(E) Airborne infection isolation suites. When an isolation
suite is provided, the suite may be located within a nursing suite
or in a separate isolation unit. Each airborne infection isolation
suite shall consist of a work area, a patient room, and a patient
bathroom.
(i) The work area may be a separately enclosed anteroom
or a vestibule that is open to and is located immediately inside the
door to the patient room. It shall have amenities for hand washing,
gowning, and storage of clean and soiled materials. One enclosed anteroom
may serve multiple isolation rooms.
(ii) Each patient room shall have a clear floor area
of 120 square feet exclusive of the work area and shall contain only
one bed.
(iii) Each bathroom shall be designed for the use of
the handicapped and shall contain bathing fixtures, toilet fixtures
and hand washing fixtures. Each bathroom shall be arranged to provide
access from the patient room without entering or passing through the
work area.
(iv) At least one airborne infection isolation suite
with an enclosed anteroom shall be provided.
(v) Ventilation requirements for the isolation rooms
shall be in accordance with Table 3 of §134.131(c) of this title.
(vi) Doors to airborne infection isolation rooms shall
be provided with self-closing devices.
(F) Social spaces. A minimum of two separate social
spaces, one appropriate for noisy activities and the other for quiet
activities, shall be provided. The combined total area shall be not
less than 40 square feet per bed space with not less than 160 square
feet for each of the two spaces, whichever is greater. This space
may be shared with the dining area or room.
(G) Group therapy room. A room for group therapy shall
be included. The room shall not be less than 250 square feet. The
group therapy room may be combined with the quiet space required in
subparagraph (F) of this paragraph provided that a space of not less
than 370 square feet is available for both the quiet activity room
and group therapy activities.
Cont'd... |
