Section 1225 — [OSHPD 2]-SKILLED NURSING AND INTERMEDIATE-CARE FACILITIES

The provisions of this section shall apply to skilled nursing and intermediate-care facilities, including distinct part skilled nursing and intermediate-care services of a general acute-care or acute psychiatric hospital license, provided either is in a separate unit or a freestanding building. Skilled nursing facilities and intermediate-care facilities shall provide all common elements and support services. The required services for skilled nursing and intermediate-care facility licensure: physician, skilled nursing, dietary, pharma- ceutical services and activity program shall be provided. At the option of the provider, the medical model or the household model may be used.

1225.1.1 Small house skilled nursing facilities. Skilled nursing facilities participating in the Small House Nursing Facilities Pilot Program established by and in conformance with Section 1323.5 of the California Health and Safety Code, shall meet all the provi- sions of Section 1225.4 Common Elements and Section 1225.5.2 Household Model applicable to small house skilled nursing facilities.

1225.1.2 Subacute care. Patient rooms providing subacute care shall comply with Section 1225.5.1.2. Equipment and components supporting subacute bed(s) shall have special seismic certification per Section 1705. Electrical requirements shall comply with Cali- fornia Electrical Code Article 517.

Note: Construction documents for OSHPD 2 buildings without subacute beds shall explicitly state that the skilled nursing facility or intermediate care facility does not admit patients needing sustained electrical life support equipment

New buildings and additions, alterations or repairs to existing buildings subject to licensure shall comply with appli- cable provisions of the California Electrical Code, California Mechanical Code, California Plumbing Code, California Fire Code (Parts 3, 4, 5 and 9 of Title 24), and this section.

Exception: See Section 1224.2.

1225.2.1 Services/systems and utilities. Services/systems and utilities shall only originate in, pass through or under structures which are under the jurisdiction of the Office of Statewide Hospital Planning and Development (OSHPD).

1225.2.2 Means of egress. Means of egress shall only pass through structures that are under the jurisdiction of the Office of State- wide Hospital Planning and Development (OSHPD).

1225.4.1 NURSING SERVICE SPACE.

1225.4.1.1 Nurse station. A nurse station in free-standing skilled nursing and intermediate-care facilities shall be provided within each nursing unit. Nurse stations shall be designed to serve no more than 60 beds.

1225.4.1.1.1 Components. Nurse stations shall be provided with a cabinet, a desk, space for records, a bulletin board, a tele- phone, a specifically designated, lockable and illuminated medicine storage compartment and a handwashing station. If a separate medicine room is provided, it shall have a lockable door and a sink. This sink cannot replace the required nurse station handwashing fixture. 1225.4.1.1.2 Size. Nurse stations serving 25 or less beds shall have a minimum floor area of 100 square feet (9.29 m [2] ). Nurse stations servicing more than 25 beds shall have a minimum floor area of 125 square feet (11.6 m [2] ). The minimum dimension of any nurse station shall not be less than 8 feet (2438 mm).

1225.4.1.1.3 Distance. In free-standing skilled nursing and intermediate-care facilities, the distance between the nurse station entrance and the center of the doorway of the most remote patient bedroom shall not exceed 150 linear feet (45,720 mm).

Exception: The 150-foot (45,720 mm) limit does not apply to distinct part skilled nursing and intermediate-care services provided as a separate unit in a general acute-care hospital or acute psychiatric hospital.

1225.4.1.2 Room identification. Each patient room shall be labeled with an identification number, letter or combination of the

two.

Exception: Small house skilled nursing facilities.

1225.4.1.3 Utility rooms. Utility rooms shall be provided in each nursing unit. Soiled and clean utility or holding rooms shall be separated and have no direct connection.

1225.4.1.3.1 Clean utility room. If the room is used for preparing patient care items, it shall contain a work counter, a hand- washing station and storage facilities for clean and sterile supplies. If the room is used only for storage and holding as part of a system for distribution of clean and sterile materials, the work counter and handwashing station may be omitted.

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1225.4.1.3.2 Soiled workroom or soiled holding room. This room shall be separate from the clean utility room. The soiled workroom/utility room shall contain a clinical sink (or equivalent flushing-rim fixture). The room shall contain a handwashing station. The above fixtures shall both have a hot and cold mixing faucet. The room shall have a work counter and space for sepa- rate covered containers for soiled linen and waste. Rooms used only for temporary holding of soiled material may omit the clinical sink and work counter. If the flushing-rim clinical sink is eliminated, facilities for cleaning bedpans shall be provided elsewhere.

station. The above fixtures shall both have a hot and cold mixing faucet. The room shall have a work counter and space for sepa- rate covered containers for soiled linen and waste. Rooms used only for temporary holding of soiled material may omit the clinical sink and work counter. If the flushing-rim clinical sink is eliminated, facilities for cleaning bedpans shall be provided elsewhere.

1225.4.1.4 Visual privacy. A method of assuring visual privacy for each patient shall be provided in patient rooms and in tub, shower and toilet rooms.

1225.4.1.5 Treatment or exam room. If provided, the treatment or exam room shall comply with all of the requirements of Section 1224.4.4.

1225.4.1.6 Toilet room and bath facilities. Separate toilet room facilities shall be provided for the use of patients, staff and the public. Fixtures serving individual patient rooms shall not be considered as meeting the required ratios for bedrooms not served by individual adjoining toilet room or bathrooms.

1225.4.1.6.1 Grab bars. Each toilet, bathtub and shower serving patients shall be provided with conveniently located grab bars.

1225.4.1.6.2 Toilet rooms. One patient toilet room shall serve no more than two patients. The toilet room shall contain a toilet, a handwashing station, a mirror and individual storage for the personal effects of each patient.

Exception. Where renovation of existing patient rooms is undertaken in facilities built under the 2013, or prior, California Building Code, each toilet room may continue to serve up to the number of beds previously served, but not more than two patient rooms or eight beds.

1225.4.1.6.3 Bathroom facilities. Bathtubs or showers shall be provided at a ratio of 1:20 patients, and for each major fraction thereof. A separate private toilet shall be provided that is directly accessible to each multi-bathing fixture central bathing area without requiring entry into the general corridor.

1225.4.1.7 Patient/nurse call system. A patient/nurse call system complying with Section 517.123, California Electrical Code, shall be provided.

1225.4.1.7.1 In small house skilled nursing facilities, visitor toilet room(s) shall be equipped with a nurse call station.

1225.4.1.8 Special-purpose rooms. Special-purpose rooms for the purpose of single-patient occupancy shall be provided at a ratio of one room for every 35 patients or fraction thereof. Airborne infection isolation rooms may be included in determining the number of special-purpose rooms required for the facilities.

Exception: The special-purpose room may be omitted if all patient rooms are single-resident rooms.

1225.4.1.9 Airborne infection isolation rooms. If provided, the airborne infection isolation room shall comply with all of the requirements of Section 1224.14.3.

1225.4.1.10 Protective environment room(s). If provided, the protective environment room shall comply with all of the require- ments of Section 1224.14.4.

1225.4.1.11 Quiet room. If a quiet room is provided, the quiet room shall comply with the following requirements.

1225.4.1.11.1 Space requirements. Refer to Section 1225.5.1.2, Nursing service space.

1225.4.1.11.2 Toilet room. Provide a patient toilet room adjacent to the quiet room. The patient toilet room shall not be shared with another patient room. If the quiet room is located in a common area, the patient toilet room may be shared with compat- ible services or activities.

1225.4.1.11.3 Noise control. The quiet room shall comply with the acoustic requirements of Section 1224.4.19, Noise control.

1225.4.2 DIETETIC SERVICE SPACE.

1225.4.2.1 General. Food service facilities and equipment shall conform with these standards, the standards of the National Sani- tation Foundation and the requirements of the local public health agency.

1225.4.2.1.1 Distribution. Provision(s) shall be made for transport of hot and cold foods as required, appropriate for the type of food service selected.

1225.4.2.1.2 Dining space. Separate dining spaces shall be provided for patients and staff. These spaces shall be separate from the food preparation and distribution areas.

Exception: Shared dining shall be provided for patients and staff in small house skilled nursing facilities.

1225.4.2.1.3 Location. The design and location of dining facilities shall encourage patient use.

1225.4.2.1.4 Food service. Facilities shall be furnished to provide nourishment and snacks between scheduled meal service.

1225.4.2.2 Functional elements. The following facilities, in the size and number appropriate for the type of food service selected, shall be provided:

1225.4.2.2.1 Location. Food-service areas shall be directly accessible to the entry for food supply deliveries and for the removal of kitchen wastes.

1225.4.2.2.2 Receiving/control stations. A control station shall be provided for the receiving and control of incoming dietary supplies.

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1225.4.2.2.3 Food preparation facilities. Food preparation facilities shall be provided to accommodate the method of food preparation required. 1. Conventional food preparation systems require space and equipment for preparing, cooking and baking. 2. Convenience food service systems using frozen prepared meals, bulk packaged entrees, individual packaged portions or those using contractual commissary services require space and equipment for thawing, portioning, cook- ing and baking.

1225.4.2.2.4 Handwashing stations. Handwashing stations shall be located in the food preparation area.

1225.4.2.2.5 Ice-making facilities. Ice-making facilities may be located in the food preparation area or in a separate room. They shall be easily cleanable and immediately accessible to the dietary function.

1225.4.2.2.6 Assembly and distribution. A patient tray assembly area shall be provided and shall be immediately accessible to the food preparation and distribution areas. 1. If food service carts are utilized, a cart distribution system shall accommodate spaces for storage, loading, distribu- tion, receiving and sanitizing of the food service carts. Cart circulation shall not be through food preparation areas.

1225.4.2.2.7 Ware-washing facilities. Ware-washing space shall be provided in a room separate from the food preparation and serving area. It shall be designed to prevent contamination of clean wares with soiled wares through cross-traffic. The clean wares shall be transferred for storage or use in the dining area without having to pass through food preparation areas. 1. Commercial-type ware-washing equipment shall be provided. 2. Space shall be provided for receiving, scraping, sorting and stacking soiled tableware and for transferring clean tableware to the using areas. 3. Handwashing stations shall be provided in the ware-washing space.

1225.4.2.2.8 Pot-washing facilities. Pot-washing facilities shall include multi-compartmented sinks.

1225.4.2.2.9 Office space. Office or other space shall be provided for the dietician or dietetic service supervisor.

1225.4.2.2.10 Storage. 1. Food storage space, including cold storage, shall be provided for a supply of food of at least a 7 day staple, 2 day frozen, 2 day perishable, and an emergency food and water supply. All food shall be stored clear of the floor. The lowest shelf shall be not less than 12 inches (305 mm) above the floor or shall be closed in and sealed tight, for ease of cleaning. As a minimum, dietary storage space shall be provided in accordance with the following schedule:

Licensed Bed Capacity Storage Space 1 to 99 beds 2 square feet (0.19 m [2] ) per bed 100 to 199 beds 200 square feet (18.58 m [2] ) plus 1 square foot 0.0929 m [2] ) per bed in excess of 100 beds 200 beds and over 300 square feet (27.99 m [2] ), plus [1] / 2 square foot (0.0465 m [2] ) per bed in excess of 200 beds Space to allow refrigeration for the storage of frozen and chilled foods shall be provided at a minimum of 2 cubic feet (0.057 m [3] ) of usable space per bed. 2. Additional storage space for dietetic service supplies, such as paper products, equipment, tray delivery carts, etc. shall be provided. 3. Storage areas and sanitizing facilities for cans, carts and mobile-tray conveyors shall be provided. 4. Waste, storage and recycling facilities (per local requirements) shall be located in a separate room easily accessible to the outside for direct pickup or disposal.

1225.4.2.2.11 Toilet rooms. Toilet rooms shall be provided for the exclusive use of the dietary staff. They shall not open directly into the food preparation areas, but shall be readily accessible.

Exception: Small house skilled nursing facilities utilizing staff trained for dietary and care-giving responsibilities may provide toilet room(s) serving both the dietary and nursing service areas.

1225.4.2.2.12 Lockers. An enclosed, separate area shall be provided for dietetic service employees’ clothing and personal belongings.

Exception: Small house skilled nursing facilities utilizing staff trained for dietary and care-giving responsibilities may provide common locker room(s) serving both the dietary and nursing service areas.

1225.4.2.2.13 Housekeeping room. A housekeeping room meeting the requirements of Section 1224.4.15 shall be located within the dietary department for the exclusive use of the dietary department.

1225.4.2.3 Outside service. On approval of the Licensing Agency, when food is provided by an outside food service, the facility shall maintain adequate space, equipment and food supplies to accommodate required functional elements listed in Section 1225.4.2.2, as required to provide patient food service in the event that the outside food service is interrupted.

SUPPORT SERVICES.

1225.4.3 ADMINISTRATION SPACE.

1225.4.3.1 Administration and public spaces. An administration area shall be provided which shall include space for business, administration, admitting, public toilet room(s), lobby and public telephone.

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1225.4.3.2 Medical record storage. Space shall be provided for the storage of medical records.

1225.4.3.3 Office. An office for the director of nurses shall be provided.

1225.4.3.4 Small house skilled nursing facilities. Small house skilled nursing facility units may provide the administration and public spaces, medical record storage and the nursing director’s office in a separate centralized support area attached to the unit(s) or detached in a separate building in close proximity to the unit(s), as a part of the small house skilled nursing facility. This building shall be under OSHPD jurisdiction.

1225.4.4 STERILE SUPPLIES.

1225.4.4.1 Storage. Each facility shall provide space for the storage of disposable sterile supplies or provide space for sterilization and disinfection equipment.

Exception: Facilities with contractual arrangements for outside autoclaving and sterilizing services.

1225.4.4.2 Central sterile supply. If provided, shall accommodate the following:

1225.4.4.2.1 Minimum requirements. A central supply and sterilizing area shall be provided. Rooms and spaces shall accom- modate the following services and equipment: 1. Soiled work area. A receiving and gross cleaning area which shall contain work space and equipment for cleaning medical and surgical equipment and for disposal of or processing of soiled material. 2. Clean work area. A clean work area which shall contain work space and equipment for sterilizing medical and surgi- cal equipment and supplies. 3. Sterilizing space. 4. Storage. Space for sterile supplies and unsterile supplies.

1225.4.4.2.2 Sterilizers. All sterilizers and autoclaves which emit steam exhaust shall be vented to the outside of the building. Such vents shall be independent from the plumbing vent system.

Exception: Small instrument sterilizers.

1225.4.5 STORAGE.

1225.4.5.1 Required areas. Facilities shall provide combined general and specialized storage in accordance with the following schedule:

Licensed Bed Capacity Storage Area 1 to 10 beds 120 square feet (11.15 m [2] ) minimum 11 to 100 beds 12 square feet (1.11 m [2] ) per bed Over 100 beds 1,200 square feet (111.48 m [2] ) plus 5 square feet (0.46 m [2] ) per bed for each bed over 100

1225.4.5.2 Specialized storage. Shall include those spaces identified in the dietetic food storage of Section 1225.4.2.2.10 and as follows:

1225.4.5.2.1 Linen. Separate and enclosed facilities for clean and soiled linen in each nursing unit. The clean linen storage space shall have a minimum area of 10 square feet (0.93 m [2] ) and may be within the clean utility room. The soiled linen collection space shall have an area of no less than 10 square feet (0.93 m [2] ), except where linen chutes are provided, and may be within the soiled utility room. 1225.4.5.2.2 Supply. One supply storage space having a minimum area of 15 square feet (1.39 m [2] ) shall be provided in each nurs- ing unit. Supply storage may be within the clean utility room used only as part of a system for distributing clean and sterile supplies.

1225.4.5.2.3 Wheelchairs. A room or space shall be provided in each nursing unit for wheelchairs and stretchers. The wheel- chair and stretcher space shall have a minimum area of 15 square feet (1.39 m [2] ).

1225.4.5.2.4 Separate supplies. Sterile and unsterile supplies shall be stored separately.

1225.4.5.2.5 Location. All storage spaces shall be readily accessible in the licensed facility.

1225.4.6 HOUSEKEEPING ROOMS. Housekeeping rooms shall be provided to serve each department and nursing unit, and may be shared by compatible departments, except when specifically required by other sections.

1225.4.7 LAUNDRY. If a laundry is to be provided, the following is required in addition to the laundry room: 1. A separate soiled linen receiving, holding and sorting room with handwashing station. 2. A separate clean linen storage, issuing and holding room. 3. Storage for laundry supplies.

1225.4.7.1 Outside service. If linen is processed off site, the following shall be provided within the facility: 1. A soiled linen holding room. 2. A separate clean linen receiving and storage room.

1225.4.8 EMPLOYEE DRESSING ROOMS AND LOCKERS. Separate dressing rooms with toilet(s), lavatories and lockers for male and female personnel shall be provided.

Exception: Small house skilled nursing facilities, with a peak shift of less than five staff, may provide a single toilet room serving both male and female personnel in compliance with the California Plumbing Code Table 4-3, footnote 7.

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The requirements of the Medical Model or the Household Model shall apply to the Nursing Unit(s) in its entirety.

1225.5.1 MEDICAL MODEL.

1225.5.1.1 General construction. Skilled nursing and intermediate-care facilities shall comply with Sections 1224.4 through 1224.13 whenever applicable.

1225.5.1.2 NURSING SERVICE SPACE.

1225.5.1.2.1 Patient bedrooms. Patients shall be accommodated only in rooms with the following minimum floor area, exclu- sive of toilet rooms, wardrobes, entrance vestibules and fixed furnishings or equipment. 1. Single-patient rooms: 110 square feet (10.21 m [2] ). 2. Multi-patient rooms: 80 square feet (7.43 m [2] ) per bed.

1225.5.1.2.2 Bed clearance. The dimensions and arrangement shall be such that there is a minimum distance of 3 feet (914 mm) between the sides and foot of the beds and any wall or any other fixed obstruction. In multiple-bed rooms, in addition to the above, a minimum clearance of 3 feet (914 mm) shall be provided between beds and a clearance of 4 feet (1219 mm) shall be available at the foot of each bed to permit the passage of equipment and beds.

1225.5.1.2.3 Patient room beds. Patient rooms shall be of such shape and dimensions to allow for the performance of routine functions, including the easy transfer of patients to and from bed to wheelchair or wheeled stretcher. Patient rooms shall provide direct access to a toilet room without entering or passing through a patient bed area. Maximum occupancy shall be two patients per patient room.

Exception: Where renovation of existing individual patient rooms is undertaken in facilities built under the 2013, or prior, California Building Code, maximum room capacity shall be no more than the present capacity, to a maximum of four patients per patient room. Placement of beds shall not be more than three deep from the exterior window. This exception is not permitted for patient rooms providing subacute care.

1225.5.1.2.4 Outside exposure. Each patient bed area shall have an outside exposure and shall not be below ground level. The window or glazed opening shall provide an unobstructed view from the head of each patient bed to the outdoors and shall be accessible to approach using a wheelchair or other patient-operated mobility device.

1225.5.1.2.5 Operation and sills. Patient room windows shall have sills not more than 36 inches (914 mm) above the floor. If operable windows are provided that require the use of tools or keys for operation, the tools or keys shall be located at the nurses’ station.

1225.5.1.2.6 Patient storage. Each patient room shall include a separate wardrobe, locker or closet spaces for storing clothing, toilet articles and other personal belongings for each patient.

Exception: Pediatric and psychiatric patient rooms.

1225.5.1.2.7 Patient toilet room. Each patient room shall have its own patient toilet room. Each patient shall have direct access to a toilet room without entering a general corridor or patient bed area in a shared patient room.

1225.5.1.3 PHARMACEUTICAL SERVICE SPACE.

1225.5.1.3.1 Drug space and storage. Adequate space shall be provided at each nursing station for the storage of drugs and preparation of medication doses.

1225.5.1.3.2 Drug access. All spaces and areas used for the storage of drugs shall be lockable and accessible to authorized personnel only.

1225.5.1.3.3 Narcotics. Specific space shall be designed for safe storage of narcotics and other dangerous drugs.

1225.5.1.3.4 Drug refrigeration. Facilities shall provide for storage of drugs requiring refrigeration.

1225.5.1.3.5 Pharmacy. The pharmacy shall not serve the general public unless a separate public entrance or a separate public serving window is utilized.

1225.5.1.4 ACTIVITY PROGRAMMING SPACE. Designated activity areas appropriate to independent and group needs of patients shall be provided as follows:

1225.5.1.4.1 Skilled nursing facilities. 1. Recreation room. Each floor of each building accommodating six or more patients shall be provided with a recreation room with a minimum of 100 square feet (9.29 m [2] ). 2. Recreation and dining. A minimum of 100 square feet (9.29 m [2] ) plus 12 square feet (1.11 m [2] ) per bed shall be provided for recreation and dining activities.

1225.5.1.4.2 Intermediate-care facilities.

1. Recreation room. Each floor of each building accommodating five or more patients shall be provided with a recre- ation room with a minimum of 150 square feet (13.94 m [2] ). 2. Recreation and dining. A minimum of 30 square feet (2.79 m [2] ) per bed for recreation and dining activities. 3. Outdoor space for activities and recreation.

1225.5.1.4.3 Equipment and supplies. Recreation and dining spaces shall be provided with space to store equipment and supplies.

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1225.5.2 HOUSEHOLD MODEL.

1225.5.2.1 General construction. Skilled nursing and intermediate-care facilities and small house skilled nursing facilities shall comply with Sections 1224.4 through 1224.13 whenever applicable, and the following sections:

1225.5.2.1.1 Door thresholds. Door thresholds, except where required at exterior doors and expansion joint covers, shall be designed to facilitate use of wheelchairs and carts and to prevent tripping, and shall provide a smooth and level transition from surface-to-surface.

1225.5.2.1.2 Seating area. A seating area(s) located out of the required egress width shall be provided along the access corridor that is used by patients.

1225.5.2.1.3 Towel bars. Towel bars shall be provided at each bathing facility.

1225.5.2.1.4 Hardware. All patient use plumbing fixtures and door operating hardware shall be equipped with lever type hardware for easy gripping and turning.

1225.5.2.1.5 Drinking fountain. A minimum of one drinking fountain shall be provided per resident floor, unless drinking water is available from the resident dietary area.

1225.5.2.2 Cluster/household unit and resident unit.

1225.5.2.2.1 Design. Each resident unit shall consist of the resident rooms, resident support areas and resident living areas. The unit shall be designed as a cluster/household resident unit or as a resident unit with double or single loaded access corridors. If the cluster/household unit design is utilized, it shall be designed around resident support and living areas with a maximum of 20 patients per cluster/household unit. If the double or single loaded corridor resident unit design is utilized, the access corridor shall be designed so that travel distance from the entrance of the resident unit to the furthest resident room door is no more than 60 feet (18.29 m) without a change of corridor direction or a node for a resident sitting area.

Exception: Small house skilled nursing facilities are limited to household units with a maximum of 12 patients per unit. Small house household units may also be developed as individual, free-standing facilities.

1225.5.2.2.2 Arrangement. Each resident unit shall be arranged to avoid unnecessary and unrelated travel through the unit.

1225.5.2.2.3 Distinct parts or neighborhoods. Both the cluster/household unit and resident unit designs may be grouped into distinct parts or neighborhoods to a maximum of 60 patients. These distinct parts or neighborhoods composed of the resident unit(s) as described in Section 1225.5.2.2.1 may share the functional requirements of the resident support areas as described in Sections 1225.5.2.4 and 1225.5.2.5 of this code.

1225.5.2.3 Resident room.

1225.5.2.3.1 Capacity. In new construction and additions, the maximum room capacity shall be two patients. Resident sleeping areas in all double resident room designs shall be visually separated from each other by a full height wall or a permanently installed sliding or folding door or partition, and shall provide each patient direct use of and direct access to an exterior window at all times. Walls, doors or partitions used to separate resident beds shall provide visual and acoustical separation. A door lead- ing to each resident bed area in addition to the corridor door is not required. Other resident room arrangements where a permanent partition or door is not used to separate the resident sleeping areas may be utilized if adequate visual separation such as a cubicle curtain(s) and an exterior window for each individual resident sleeping area is provided. In this case individual thermostats for the resident bed areas shall not be required.

e corridor door is not required. Other resident room arrangements where a_ permanent partition or door is not used to separate the resident sleeping areas may be utilized if adequate visual separation such as a cubicle curtain(s) and an exterior window for each individual resident sleeping area is provided. In this case individual thermostats for the resident bed areas shall not be required.

Exception: In small house skilled nursing facilities, resident sleeping areas in all double-resident room designs shall be visu- ally separated from each other by a full-height wall or a permanently installed sliding or folding door or partition, and shall provide each patient direct use of and direct access to an exterior window at all times. Walls, doors or partitions used to separate resident beds shall provide visual and acoustical separation.

1225.5.2.3.2 Renovation. Where renovation work is undertaken of the resident room that alters the physical configuration of the resident room and the present capacity is more than two patients, the maximum room capacity shall be no more than two patients at the conclusion of the renovation. 1225.5.2.3.3 Space requirements. Rooms shall have a minimum of 100 square feet (9.29 m [2] ) of clear floor area per bed in double resident rooms and 120 square feet (11.15 m [2] ) of clear floor area in single resident rooms, exclusive of the space consumed by toilet rooms, closets, lockers, wardrobes, lavatories, alcoves and door swings into the room or entrance vestibules, whichever is greater. For the purpose of minimum clear floor area, the entrance vestibule is defined as that floor area located between the room entrance door and the room floor area containing the resident bed(s).

1225.5.2.3.4 Arrangement. Dimensions and arrangement of resident rooms shall be designed to accommodate at least two bed positions to provide patient choice of bed placement. All such bed positions shall be designed so that the bed will not obstruct access to the supporting utilities serving the bed, such as the nurse call station, and the required electrical outlets that provide service for that bed. Only one bed position design shall be required for a bed that is equipped with a piped medical gas headwall unit, unless special requirements such as providing care for bariatric patients does permit the design of two bed posi- tions in the room.

1225.5.2.3.5 Clearance. A 3 feet (0.91 m) wide clear access to each bed shall be provided along at least 75 percent of the length of one side of the bed and shall be designed to allow access for the use of a wheelchair and other portable equipment. For beds equipped with a piped-in medical gas headwall unit, there shall be a minimum of 3 feet (0.91 m) between the sides and foot of

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the bed and any wall or any other fixed obstruction. For planning purposes, a full-size bed is assumed to be 3 feet 6 inches (1.07 m) wide by 8 feet (2.43 m) long.

1225.5.2.3.6 Renovations. For renovations that alter the physical configuration of the resident room but have existing struc- tural limitations that require two resident beds to be located in a shared resident sleeping area, there shall be a minimum of 3 feet (0.91 m) between the sides and foot of the bed and the adjacent bed. If one bed must be located to the side of the other bed, there shall be a clearance of 4 feet (1.22 m) to any fixed obstruction available at the foot of this bed to permit the passage of equipment and bed without moving the resident’s bed located nearest to the room door.

Exception: In small house skilled nursing facilities, two beds shall not be permitted in a shared resident sleeping area.

1225.5.2.3.7 Resident toilet or bath room. Each patient shall have access to a toilet room without having to enter the general corridor area or the resident bed area in a shared resident room. One toilet room shall serve no more than two patients and no more than two resident rooms. The door to the toilet room shall be side hinged and either swing out from the toilet room or be equipped with emergency release hardware. Sliding doors equipped with sliding door hardware located on the resident room side of the wall and not equipped with a bottom door track shall be permitted. If a sliding door is used in a resident toilet or bath room, a D-shaped handle at least 4 inches (10.16 cm) long shall be provided to open the door. The sliding door shall permit access, and negate the need to push against a patient who may have collapsed within the toilet room. Unless otherwise required by this code, this door shall be at least 36 inches (914.4 mm) wide. A lavatory shall be provided in each resident toilet room.

1225.5.2.3.8 Wardrobe closet. Each resident room shall be provided with a wardrobe or closet for each patient. Each wardrobe or closet shall have minimum inside dimensions of 2 feet (0.61 m) in depth by 1 foot 8 inches (0.51 m) in width. Each shall be acces- sible to the patient at all times and shall have adjustable shelf(s) and an adjustable clothes rod that is adjustable in at most 4 inches (10.16 cm) increments from 4 feet (1.22 m) to 5 feet 8 inches (1.73 m) above finished floor or higher as closet size permits. When the wardrobe or closet is designed to meet the requirements for accessibility per Chapter 11B of this code, it shall include additional accessible storage area(s) for full-length garments. The shelf may be omitted if the clothing unit provides at least two drawers. Locked storage for personal items shall be provided within the resident sleeping room or area.

1225.5.2.4 Resident support area.

1225.5.2.4.1 Features and arrangement. Size and features of each resident support area will depend upon the number and type of patients served. The resident support area may be arranged and located to serve more than one resident unit, but at least one such support area shall be provided on each resident floor. The following resident support areas shall be located in or be readily accessible to each resident unit.

rangement.**_ Size and features of each resident support area will depend upon the number and type of patients served. The resident support area may be arranged and located to serve more than one resident unit, but at least one such support area shall be provided on each resident floor. The following resident support areas shall be located in or be readily accessible to each resident unit.

1225.5.2.4.2 Staff work area. A centralized staff work area shall be provided. It shall have space for supervisory administrative work activities, charting and storage. In each resident unit, the functions of administrative work, charting and storage may be located among several separate direct care staff work areas. In this case, a centralized staff work area is not required.

1225.5.2.4.3 Clean utility. A clean utility or clean holding room for storage and distribution of clean supply materials shall be provided. If the room is used for preparing patient care items, it shall contain a work counter, a handwashing station and stor- age facilities for clean and sterile supplies. If the room is used only for storage and holding as a part of a system for distribution of clean and sterile supply materials, the work counter and handwashing station requirements may be omitted. The minimum size of the room shall be 15 square feet (1.39 m [2] ) with 1 square foot (0.092 m [2] ) of additional space provided per patient for over 15 patients and may be allocated among several clean utility or clean holding rooms or closets.

1225.5.2.4.4 Soiled utility. A soiled utility or soiled holding room(s) shall be provided. The soiled utility function shall be comprised of a flushing rim clinical service sink or other appropriate flushing fixture, with bedpan rinsing device, soiled linen receptacles, waste receptacles, handwashing station and a work counter with a usable minimum work surface area of 6 square feet (0.56 m [2] ). The total minimum size of the room shall be 20 square feet (1.86 m [2] ) with 1.5 square feet (0.140 m [2] ) of additional space provided per patient for over 15 patients and may be allocated among several soiled utility or soiled holding rooms. Rooms used only for the holding of soiled materials need contain only a handwashing station.

rface area of 6 square_ feet (0.56 m [2] ). The total minimum size of the room shall be 20 square feet (1.86 m [2] ) with 1.5 square feet (0.140 m [2] ) of additional space provided per patient for over 15 patients and may be allocated among several soiled utility or soiled holding rooms. Rooms used only for the holding of soiled materials need contain only a handwashing station.

1225.5.2.4.5 Medicine preparation. A medicine preparation room or a self-contained medicine dispensing unit shall be provided for the provision of medication distribution. The self-contained medicine dispensing unit shall be under the visual control of the staff. If a medicine preparation room is utilized, it shall be equipped with a lockable door, have a minimum area of 50 square feet (4.65 m [2] ) and shall contain a refrigerator, locked storage for controlled drugs, a handwashing station and a work counter with a minimum of 6 square feet (0.56 m [2] ) of work surface. If a self-contained medicine dispensing unit is utilized, it may be located at the nurse station, in the clean utility room, in an alcove, or in other spaces convenient for staff control provided the area occupied by the unit does not encroach upon required minimum areas. The dispensing unit may be used in a medicine preparation room as locked storage for controlled drugs within the minimum area of 50 square feet (4.65 m [2] ), however, the standard “cup sinks” provided in many self-contained units shall not be a substitute for the required handwashing station. If there is no linen storage in the clean utility room, medicine preparation may be part of the clean utility room in which case an additional 20 square feet (1.8 m [2] ) dedicated for this purpose shall be required. A refrigerator shall also be required if medicine preparation is included in this room. Non-controlled prescription drugs may be stored inside the resident’s sleeping room or toilet room if they are secured inside of an automatic closing and automatic locking dispensing unit that is secured in place.

1225.5.2.4.5.1. In small house skilled nursing facilities, if self-contained medicine dispensing units are provided, they shall be located in either a medication preparation room or a clean utility room.

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1225.5.2.4.6 Equipment storage. An equipment storage room(s) shall be provided for storage of resident unit equipment. The minimum area required shall be equal to 2 square feet (0.19 m [2] ) for each patient with no room being less than 20 square feet (1.86 m [2] ) in area.

1225.5.2.4.7 Housekeeping room. A housekeeping room(s) shall be provided for storage and use of housekeeping supplies and equipment.

1225.5.2.4.8 Clean linen room. A clean linen storage room, closet or area shall be provided. This area may be located within the clean utility or clean holding room and shall be large enough to accommodate the storage of linen carts.

1225.5.2.4.9 Nourishment room. A nourishment room or area for serving nourishments between meals shall be provided and shall contain a work counter, refrigerator, storage cabinets and sink. Ice for patients’ consumption shall be provided by an icemaker unit that may serve more than one nourishment station if the nourishment stations are in close proximity to each other. Where the icemaker unit is accessible to patients or the public, it shall be a self-dispensing type. The nourishment room shall include space for trays and dishes used for nonscheduled meal service. A handwashing station shall be in or immediately acces- sible from the nourishment room.

1225.5.2.4.9.1 In small house skilled nursing facilities, the nourishment area may be provided as part of the resident dietary area required under Section 1225.5.2.5.4.

1225.5.2.4.10 Storage alcove. A storage alcove space for a wheelchair(s) shall be provided in an area located out of the required means of exit access.

1225.5.2.4.11 Resident bathing facilities. Resident bathing facilities shall be provided with a minimum of one bathtub or one hydro tub per resident unit, or one shower for every 20 patients and for each major fraction thereof not otherwise served by bath- ing facilities in resident rooms. When centralized bathing is provided, patients shall have access to at least one bathing room per floor or unit sized to permit assisted bathing in a tub or shower in that resident unit. The bathtub in this room shall be accessible to patients in wheelchairs and the shower shall accommodate a shower chair. Other tubs or showers shall be in individual rooms or curtained enclosures with space for private use of the bathing fixture, for drying and dressing, and access to a grooming loca- tion containing a sink, mirror and counter or shelf. A separate private toilet shall be provided that is directly accessible to each multi-bathing fixture central bathing area without requiring entry into the general corridor. This toilet may also serve as a toilet training facility. This centralized bathing area shall comply with Chapter 11B of this code.

1225.5.2.4.12 Private bathing. All showers located in bathrooms connected directly to the resident room shall be designed so that a shower chair can be easily rolled over the threshold. Resident rooms and associated toilet rooms, required to be accessi- ble, shall comply with Chapter 11B of this code.

1225.5.2.5 Resident living area.

1225.5.2.5.1 Dining. Dining, lounges, and recreation and social areas for patients shall be provided in each resident unit. The total area of these spaces shall be a minimum of 35 square feet (3.25 m [2] ) per patient with a minimum total area of 225 square feet (20.90 m [2] ). At least 20 square feet (1.86 m [2] ) per patient shall be available for dining. Storage for supplies and equipment shall be provided in the recreation area.

d social areas for patients shall be provided in each resident unit. The_ total area of these spaces shall be a minimum of 35 square feet (3.25 m [2] ) per patient with a minimum total area of 225 square feet (20.90 m [2] ). At least 20 square feet (1.86 m [2] ) per patient shall be available for dining. Storage for supplies and equipment shall be provided in the recreation area.

1225.5.2.5.2 Outdoor area. Outdoor area(s) shall be provided for the use of all patients and shall include walking paths of durable materials, benches, shaded areas and visual focusing element(s) such as landscaping, sculpture(s) or fountain(s). Security fencing if used shall be of a residential design and provide some visual connection to the exterior of the secured area. If an exterior visual connection is not possible or desirable, then the interior of the outside area shall be landscaped to be visually interesting.

1225.5.2.5.3 Storage. Storage for supplies, patient needs and recreation shall be provided. The minimum required area shall be 5 square feet (0.46 m [2] ) per bed up to 600 square feet (55.74 m [2] ).

1225.5.2.5.4 Dietary area. A resident dietary area shall be provided in the resident unit for the use of staff, patients and family. The resident dietary area may include cooking equipment, countertops, kitchen sink and storage areas. This dietary area is in addition to the dietetic service space requirements in Section 1225.4.2.

1225.5.2.5.4.1 Food preparation spaces in the resident dietary area in a small house skilled nursing facility shall be designed to accommodate the method of food preparation required. The California Department of Public Health, Licensing and Certification shall review proposed food services spaces at a preliminary stage of plan review.

1225.5.2.5.4.2 The resident dietary area in a small house skilled nursing facility shall provide a handwashing station. This handwashing station shall be in addition to the kitchen sink and shall be located in or immediately accessible to the resi- dent kitchen facilities.

1225.5.2.5.4.3 When provided, the resident dietary area in a small house skilled nursing facility shall have a commercial ware-washing space meeting the requirements for the care model used. This space shall be designed to prevent cross contamination by providing area for receiving, scraping, sorting and stacking soiled tableware and for transferring clean tableware to point-of-use areas.

1225.5.2.5.4.4 The resident dietary area in a small house skilled nursing facility shall provide access to self-dispensing drinking water and self-dispensing ice. (a) Ice-making equipment shall be accessible to residents and visitors (b) Ice-making equipment shall be located, designed and installed to minimize noise. (c) Ice-making equipment shall be permitted to serve more than one food area within resident kitchen facilities.

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1225.5.2.5.5 Therapy unit. If provided, physical, speech and occupational therapy units shall comply with Sections 1225.6.2 through 1225.6.4. 1225.5.2.5.6 Barber/beauty room. If provided, the barber/beauty room shall be a minimum of 120 square feet (11.15 m [2] ) with the least dimension of 10 feet (3.05 m).

1225.5.2.5.7 Resident laundry facilities. If provided, resident laundry facilities including washing and drying equipment may be provided for staff, family or individual patient use for the laundering of patient’s personal items. If provided they shall be readily accessible from each resident unit without requiring the user to enter another resident unit or floor, and may be shared between two resident units. These resident laundry facilities may utilize residential laundry equipment. Each resident laundry area shall contain a handwashing fixture.

1225.5.2.6 STAFF SUPPORT AREA.

1225.5.2.6.1 Staff lounge. Staff lounge area(s) shall be provided. It may be shared by multiple resident units if the lounge is located so it is accessible without requiring the user to enter into or through any other resident unit.

1225.5.2.6.2 Storage. Lockable closets, drawers or compartments shall be provided on the resident unit for staff and may be located in the lounge for safekeeping of staff’s personal effects.

1225.5.2.6.3 Staff toilet rooms. Staff toilet rooms shall be readily accessible to each resident unit.

1225.5.2.6.4 Multipurpose room. At least one multipurpose room per skilled nursing facility shall be provided for confer- ences, meetings and health education purposes, and shall accommodate the use of visual aids. This room shall have a minimum area of 120 square feet (11.15 m [2] ).

1225.5.2.6.5 Conference room. Conference or consultation room for patient and family use shall be provided and may be shared by more than two resident units if it is centrally located to each.

1225.6.1 General. Waiting areas and access to optional services for outpatients shall accommodate the following:

1225.6.1.1 Outpatient waiting rooms. Waiting rooms for outpatients shall provide a seating area and space for wheelchairs, and have public corridor access to or provisions for, public toilet room(s), drinking fountain and telephone.

Note: One waiting area may serve more than one department or service.

1225.6.1.2 Circulation. If x-ray examinations are to be performed on outpatients, outpatient access to the radiological spaces shall not traverse a nursing unit.

Exception: Satellite radiology, laboratory, pharmacy, and physical and occupational therapy space serving inpatients may be located in nursing units and inpatient treatment areas.

1225.6.2 PHYSICAL THERAPY SERVICE. Refer to Section 1224.35.2.

1225.6.3 OCCUPATIONAL THERAPY SERVICE. Refer to Section 1224.35.3.

1225.6.4 SPEECH PATHOLOGY AND/OR AUDIOLOGY SERVICE. At least one space free of ambient noise shall be provided. A hand- washing station shall be provided.

1225.6.5 SOCIAL WORK SERVICE. Office space for privacy in interviewing, telephoning and conferences shall be provided.

1225.6.6 SPECIAL TREATMENT PROGRAM SERVICE. Refer to California Administrative Code (Part 1 of Title 24), Section 7-119, Func- tional Program, for requirements. Projects associated with Special Treatment Program Services in skilled nursing and intermediate- care facilities shall include a Patient Safety Risk Assessment. The skilled nursing facility shall have a minimum of 30 beds and shall meet the requirements of Chapter 3, Division 5, Title 22, California Code of Regulations.

1225.6.6.1 Location. A special treatment program service providing therapeutic services to an identified mentally disordered population group shall be located in a distinct separate unit of the facility.

1225.6.6.2 Nursing service. The nursing service space shall comply with Section 1225.4.1. 1225.6.6.3 Activity program. The activity program space shall provide a minimum of 25 square feet (2.3 m [2] ) of dining and recre- ation space per bed.

1225.6.6.4 Indoor and outdoor space. Shall be designated for the special treatment program.