| (a) Administration and public suite. The following
rooms or areas shall be provided.
(1) Primary entrance. An entrance at grade level shall
be accessible and protected from inclement weather with a drive-under
canopy for loading and unloading passengers.
(2) Lobby. A main lobby shall be located at the primary
entrance and shall include a reception and information counter or
desk, waiting space(s), public toilet facilities, public telephones,
drinking fountain(s), and storage room or alcove for wheelchairs.
(3) Admissions area. An admissions area shall include
a waiting area, work counters or desk, private interview spaces, and
storage room or alcove for wheelchairs. The waiting area and wheelchair
storage may be shared with similar areas located in the main lobby.
(4) General or individual office(s). Office space shall
be provided for business transactions, medical and financial records,
and administrative and professional staffs.
(5) Multipurpose room(s). Room(s) shall be provided
for conferences, meetings, and health education purposes including
provisions for showing visual aids.
(6) Storage. Storage for office equipment and supplies
shall be provided. The construction protection for the storage room
or area shall be in accordance with the National Fire Protection Association
101, Code for Safety to Life from Fire in Buildings and Structures,
1997 edition (NFPA 101), §18-3.1. All documents published by
the NFPA as referenced in this section may be obtained by writing
or calling the NFPA at the following address and telephone number:
Post Office Box 9101, 1 Batterymarch Park, Quincy, Massachusetts 02269-9101,
(800) 344-3555.
(b) Cart cleaning and sanitizing unit. A cart cleaning
and sanitizing unit is optional for crisis stabilization units.
(1) Architectural requirements.
(A) Cart cleaning, sanitizing and storage shall be
provided for carts serving dietary services and linen services.
(B) Cart facilities may be provided for each service
or be centrally located.
(C) Hand washing fixtures shall be provided in cart
cleaning, sanitizing and storage areas.
(2) Details and finishes. Details and finishes shall
be in accordance with §134.122(d)(2) of this title (relating
to New Construction Requirements) and this paragraph.
(A) Flooring in the cart cleaning and sanitizing unit
shall be of the seamless type, or ceramic or quarry tile as required
by §134.122(d)(2)(B)(iii)(III) or (IV) of this title.
(B) Ceilings in the cart cleaning and sanitizing unit
shall be the monolithic type as required by §134.122(d)(2)(B)(vi)(III)
of this title.
(3) Piping systems and plumbing fixtures. Piping systems
and plumbing fixtures shall be in accordance with §134.122(d)(4)
of this title and this paragraph.
(A) Hand washing fixtures shall be provided with hot
and cold water. Hot and cold water fixtures shall be provided in cart
cleaning and sanitizing locations.
(B) Where floor drains or floor sinks are installed,
they shall be of a type that can be easily cleaned by removal of the
cover. Removable stainless steel mesh shall be provided in addition
to a grilled drain cover to prevent entry of large particles of waste
which might cause stoppages. Floor drains and floor sinks shall be
located to avoid conditions where removal of covers for cleaning is
difficult.
(c) Central sterile supply suite. A central sterile
supply suite is optional for crisis stabilization units.
(1) Architectural requirements.
(A) Supply storage. A storage room for clean and sterile
supplies shall be provided. The storage room shall have adequate areas
and counters for breakdown of prepackaged supplies.
(B) Equipment storage. An equipment storage room shall
be provided.
(2) Details and finishes. Details and finishes shall
be in accordance with §134.122(d)(2) of this title and this paragraph.
Ceilings in supply storage room shall be monolithic type in accordance
with §134.122(d)(2)(vi)(III) of this title.
(3) Mechanical Requirements. Mechanical requirements
shall be in accordance with §134.122(d)(3) of this title and
this paragraph.
(A) The sterile supply room shall include provisions
for ventilation, humidity, and temperature control.
(B) Filtration requirements for air handling units
serving the central sterile supply suite shall be equipped with filters
having efficiencies equal to, or greater than specified in Table 4
of §134.131(d) of this title (relating to Tables).
(C) Duct linings exposed to air movement shall not
be used in ducts serving the central sterile supply suite unless terminal
filters of at least 90% efficiency are installed downstream of linings.
This requirement shall not apply to mixing boxes and acoustical traps
that have special coverings over such lining.
(d) Dietary suite.
(1) Architectural requirements.
(A) General. Construction, equipment, and installation
shall comply with the standards specified in Chapter 228 of this title
(relating to Retail Food).
(B) Food service facilities. Food services shall be
provided by an on-site food preparation system or an off-site food
service system or a combination of the two. The following minimum
functional elements shall be provided on-site regardless of the type
of dietary services.
(i) Dining area. Provide dining space(s) for ambulatory
patients, staff, and visitors with a minimum floor space of 15 square
feet per person to be seated. The footage requirement does not include
serving areas. The dining area and service areas shall be separate
from the food preparation and distribution areas.
(ii) Receiving area. This receiving area shall have
direct access to the outside for incoming dietary supplies or off-site
food preparation service and shall be separate from the general receiving
area. The receiving area shall contain a control station and an area
for breakout for loading, unloading, uncrating, and weighing supplies.
The entrance area to the receiving area shall be covered from the
weather.
(iii) Storage spaces. Storage spaces shall be convenient
to receiving area and food preparation area and shall be located to
exclude traffic through the food preparation area. Regardless of the
type of food services provided, the facility shall provide storage
of food for emergency use for a minimum of four calendar days.
(I) Storage space(s). Storage space(s) shall be provided
for bulk, refrigerated, and frozen foods.
(II) Cleaning supply storage. This room or closet shall
be used to store non-food items that might contaminate edibles. This
storage area may be combined with the housekeeping room.
(iv) Food preparation area. Counter space shall be
provided for food prep work, equipment, and an area to assemble trays
for distribution for patient meals.
(v) Ice making equipment. Ice making equipment shall
be provided for both drinks and food products (self-dispensing equipment)
and for general use (storage-bin type equipment).
(vi) Hand washing. Hand washing fixtures with hands-free
operable controls shall be conveniently located at all food preparation
areas and serving areas.
(vii) Food service carts. When a cart distribution
system is provided, space shall be provided for storage, loading,
distribution, receiving, and sanitizing of the food service carts.
The cart traffic shall be designed to eliminate any danger of cross-circulation
between outgoing food carts and incoming soiled carts, and the cleaning
and sanitizing process. Cart circulation shall not be through food
processing areas.
(viii) Ware washing room. A ware washing room equipped
with commercial type dishwasher equipment shall be located separate
from the food preparation and serving areas. Space shall be provided
for receiving, scraping, sorting, and stacking soiled tableware and
for transferring clean tableware to the using areas. Hand washing
facilities with hands-free operable controls shall be located within
the soiled dish wash area. A physical separation to prevent cross
traffic between the dirty side and clean side of the dish wash areas
shall be provided.
(ix) Pot washing facilities. A three compartmented
sink of adequate size for intended use shall be provided convenient
to the food preparation area. Supplemental heat for hot water to clean
pots and pans shall be by booster heater or by steam jet.
(x) Waste storage room. A food waste storage room shall
be conveniently located to the food preparation and ware washing
areas but not within the food preparation area. It shall have direct
access to the facility's waste collection and disposal facilities.
A waste storage room is optional for CSUs.
(xi) Sanitizing facilities. Storage areas and sanitizing
facilities for garbage or refuse cans, carts, and mobile tray conveyors
shall be provided. All containers for trash storage shall have tight-fitting
lids.
(xii) Housekeeping room. A housekeeping room shall
be provided for the exclusive use of the dietary department. Where
hot water or steam is used for general cleaning, additional space
within the room shall be provided for the storage of hoses and nozzles.
(xiii) Office spaces. An office shall be provided
for the use of the food service manager or the dietary service manager.
In smaller facilities, a designated alcove may be located in an area
that is part of the food preparation area.
(xiv) Toilets and locker spaces. A toilet room(s) shall
be provided for the exclusive use of the dietary staff. Toilets shall
not open directly into the food preparation areas, but must be in
close proximity to them. For larger facilities, a locker room or space
for lockers shall be provided for staff belongings.
(C) Additional service areas, rooms and facilities.
When an on-site food preparation system is used, in addition to the
items required in subparagraph (B), the following service areas, rooms
and facilities shall be provided.
(i) Food preparation facilities. When food preparation
systems are provided, there shall be space and equipment for preparing,
cooking, and baking.
(ii) Tray assembly line. A patient tray assembly and
distribution area shall be located within close proximity to the food
preparation and distribution areas.
(iii) Food storage. The food storage room shall be
adequate in size to accommodate food for a seven calendar day menu
cycle.
(iv) Additional storage area(s). Additional area(s)
shall be provided for the storage of cooking wares, extra trays, flatware,
plastic and paper products, and portable equipment.
(v) Drying storage area. Provisions shall be made for
drying and storage of pots and pans from the pot washing room.
(D) Equipment. Equipment for use in the dietary suite
shall meet the following requirements.
(i) Mechanical devices shall be heavy duty, suitable
for the use intended, and easily cleaned. Where equipment is movable,
provide heavy duty locking casters. Equipment with fixed utility connections
shall not be equipped with casters.
(ii) Floor, wall, and top panels of walk-in coolers,
refrigerators, and freezers shall be insulated. Coolers and refrigerators
shall be capable of maintaining a temperature down to freezing. Freezers
shall be capable of maintaining a temperature of 20 degrees below
0 degrees Fahrenheit. Coolers, refrigerators, and freezers shall
be thermostatically controlled to maintain desired temperature settings
in increments of two degrees or less. Interior temperatures shall
be indicated digitally and visible from the exterior. Controls shall
include audible and visible high and low temperature alarm. The time
of alarm shall be automatically recorded.
(iii) Walk-in units may be lockable from the outside
but must have a release mechanism for exit from inside at all times.
The interior shall be lighted. All shelving shall be corrosion resistant,
easily cleaned, and constructed and anchored to support a loading
of at least 100 pounds per linear foot.
(iv) All cooking equipment shall be equipped with automatic
shut-off devices to prevent excessive heat buildup.
(E) Vending services. When vending machines are provided,
a dedicated room or an alcove shall be located so that access is available
at all times.
(2) Details and finishes. Details and finishes shall
be in accordance with §134.122(d)(2) of this title and this paragraph.
(A) Details.
(i) Food storage shelves shall not be less than six
inches above the finished floor and the space below the bottom shelf
shall be closed in and sealed tight for ease of cleaning.
(ii) Operable windows and doors not equipped with automatic
closing devices shall be equipped with insect screens.
(iii) Food processing areas in the central dietary
kitchen shall have ceiling heights not less than nine feet. Ceiling
mounted equipment shall be supported from rigid structures located
above the finished ceiling.
(iv) Mirrors shall not be installed at hand washing
fixtures in the food preparation areas.
(B) Finishes.
(i) Floors in areas used for food preparation, food
assembly, soiled and clean ware cleaning shall be water-resistant
and grease-proof. Floor surfaces, including tile joints, shall be
resistant to food acids.
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