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2.3 Design Elements

DRAFT 2022 FGI Guidelines for Design and Construction of Residential Health, Care, and Support Facilities 1

2.3 Design Elements

Appendix material, shown in shaded boxes at the bottom of the page, is advisory only.

2.3-1 General

2.3-1.1 Application

This chapter contains elements that are common to most types of residential health, care, and support facilities.

2.3-1.1.1 The common elements in this chapter are required only where referenced in the facility chapters in Part 3 (Residential Health Facilities), Part 4 (Residential Care and Support Facilities), and Part 5 (Non-Residential Support Facilities).

2.3-1.1.2 Additional specific requirements are located in the facility chapters in Parts 3, 4, and 5.

2.3-2 Resident, Participant, and Outpatient Areas

2.3-2.1 General

The requirements for resident care/living areas (units), community areas, and associated support areas included in this section are common to most residential health, care, and support facilities. For requirements specific to a facility type, see the facility chapters in Parts 3 through 5.

*2.3-2.2 Resident Care/Living Area (Unit)

A2.3-2.2 Resident care/living area (unit) definition. A resident care/living area (unit) is a group of resident rooms or dwelling quarters units in a residential living facility.

2.3-2.2.1 General

See facility chapters in Parts 3 and 4 for requirements for resident care/living areas (units).

2.3-2.2.2 Reserved

2.3-2.2.3 Special Care Resident Rooms

See facility chapters in Parts 3 and 4 for requirements for airborne infection isolation rooms and ventilator-dependent resident rooms, and other special care resident room types and facility chapters in Part 5 for requirements for quiet rooms in non-residential support facilities.

2.3-2.2.3.1 – 2.3-2.2.3.2 Reserved

2.3-2.2.3.3 Quiet room in a resident care/living area (unit). Where a single-resident room is provided to accommodate care requirements for residents experiencing issues such as personal conflicts, agitation, episodic mental disturbances, or similar conditions that require a quiet or low-stimulation, positive distraction room, the following requirements shall be met:

(1) Capacity. Each quiet room shall contain only one bed.

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(2) Space requirements

(a) Based on the care population, the quiet room shall be sized to accommodate the equipment, special furnishings, or positive distractions provided.

(b) The level of cognitive ability of the care population shall be identified during the functional programming process. See Section 2.2-4 (Design Criteria for Dementia, Behavioral and Mental Health, and Cognitive and Developmental Disability Facilities) for additional requirements.

(3) Toilet room. A toilet room shall be provided for each quiet room.

(a) The toilet room shall contain the following:

(i) Toilet

(ii) Hand-washing station. See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.

(iii) Mirror. See Section 2.4-2.2.8.7 (Mirror) for requirements.

(b) The toilet room shall not be shared with another resident room.

(4) Acoustic requirements. See sections 2.5-8.3 (Design Criteria for Acoustic Finishes), 2.5-8.4 (Design Criteria for Room Noise Levels), and 2.5-8.5 (Design Criteria for Performance of Interior Wall and Floor/Ceiling Constructions) for requirements.

*2.3-2.3 Resident, Participant, and Outpatient Community Areas

A2.3-2.3 Daylighting in community areas. See sections 1.2-4.5.1 (Light) and 2.5-7.2 (Daylighting Systems in Resident Living, Participant, and Outpatient Areas) for lighting and daylighting requirements and information.

*2.3-2.3.1 General

For new construction and renovation, community areas shall be designed and furnished to encourage resident, participant, and outpatient use.

A2.3-2.3.1 Nothing in the Guidelines for Design and Construction of Residential Health, Care, and Support Facilities is intended to restrict a facility from providing additional square footage per resident, participant, or outpatient beyond what is required herein for dining rooms, activity areas, and other spaces included in this section.

2.3-2.3.2 Lobby

2.3-2.3.2.1 General

(1) Shared lobbies shall be permitted in multi-occupancy buildings.

(2) See the facility chapters in Parts 3 through 5 for additional requirements.

*2.3-2.3.2.2 Vehicular drop-off and pedestrian entrance. A minimum of one marked, illuminated drop-off or entrance shall be reachable from grade level.

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A2.3-2.3.2.2 Vehicular drop-off and pedestrian entrance. Covered/canopied entrances should be provided as required to respond to the local climate and community requirements and accommodate the care population.

2.3-2.3.2.3 Storage for mobility devices. Where a central lobby is provided, storage for resident-operated mobility devices shall be provided close immediately accessible to the entry.

2.3-2.3.2.4 Mailboxes. Where a mailbox area is provided, it shall be located close readily accessible to the entry for deliveries and centralized for resident access.

2.3-2.3.2.5 Public notice area. Areas for posting required notices, documents, and other written materials shall be provided in public locations visible to and accessible to residents, staff, and visitors.

2.3-2.3.2.6 Public toilet room. A minimum of one toilet room(s) shall be located close readily accessible to the lobby.

2.3-2.3.3 Dining, Recreation, and Lounge Areas

The space needed for dining, recreation, and activities shall be determined by the following considerations:

2.3-2.3.3.1 General

(1) The extent to which users need adaptive equipment and mobility aids and assistance from support and service staff

(2) The extent to which support programs will be centralized or decentralized

(3) The number of residents or participants to be seated for dining at one time

2.3-2.3.3.2 Dining areas

(1) General

(a) The design and location of dining facilities shall encourage resident, participant, and visitor use.

(b) Planned use of dining areas for other activities shall be permitted.

*(2) Central dining facility. Where a central dining facility is provided, it shall be sized to accommodate the following:

(a) Space for dining in accordance with the needs of the care population, including residents and participants who use resident-operated mobility devices

(b) Space for residents and participants, including those using wheelchairs and resident-operated mobility devices, to access and leave their tables without disturbing others residents and participants

(c) Clear and unobstructed circulation paths for servers and food carts

(d) Space for caregivers to assist residents and participants who require assistance with eating

A2.3-2.3.3.2 (2) Space planning considerations

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a. Space planning for dining areas should incorporate additional clearances as necessary to accommodate residents and participants using wheelchairs and other mobility assistive devices.

b. The dining room should be sized at a minimum of 28 square feet (2.6 square meters) for each resident or participant at one seating. Adult day care programs may require additional participant space based on the care population being served.

(3) Decentralized dining areas. Location of separate or satellite dining areas for small groups of residents or participants shall be permitted:

(a) In or adjacent Immediately accessible to resident units

(b) As part of dayrooms for different adult day care populations

(c) Near a wellness center activity (e.g., a juice bar near a fitness center)

(d) In outdoor activity spaces. See Section 2.1-3.6.2 (Outdoor Activity Spaces).

2.3-2.3.3.3 Recreation, lounge, and activity areas. See facility chapters in Parts 3 through 5 for requirements.

2.3-2.3.3.4 Support areas for dining, recreation, lounge, and activity locations

(1) Hand-washing stations that meet the requirements in Section 2.4-2.2.8 (Hand-Washing Stations) shall be provided in, next to, or directly or immediately accessible to dining areas.

(2) Toilet facilities that accommodate residents or participants using resident-operated mobility devices shall be readily accessible to all dining, recreation, lounge, and activity locations.

2.3-2.3.4 Resident and Participant Kitchen Reserved [Relocated to 2.3-4.5.4 (Household Kitchen.]

2.3-2.3.4.1 General

(1) A “country kitchen,” a “great room,” or other activity room that supports continued resident and participant involvement in activities of daily living shall be permitted to serve as the required resident and participant kitchen facilities.

(2) Purpose. Resident and participant kitchen facilities shall be designed to support any combination of the following functions:

(a) Provision of nourishment between meals

(b) Cooking activities for residents and participants

(c) Food preparation by family members

(d) Preparation of meals by staff with or without assistance from residents or completion of meal preparation begun in a central kitchen and serving/distribution of meals

*2.3-2.3.4.2 Facility requirements. Where these kitchen facilities are provided, the following requirements shall apply:

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A2.3-2.3.4.2 Resident and participant kitchen. Also consider provision of these items:

a. Double-bowl sink with faucet and sprayer

b. Food storage

c. Resident and participant countertop. This should allow access for residents and participants using resident-operated mobility devices and facilitate staff and resident interaction.

d. Secure locked storage for sharp knives

e. Microwave

f. Coffee maker

(1) Work countertop

(2) Refrigerator

(3) Storage cabinets

(4) Sink with faucet with anti-scalding mixing valve

(5) Range, cooktop, oven, and/or any other cooking or heating device where required in the functional program. These appliances shall be equipped with secured shutoffs where residents have access to the kitchen.

*(6) Food-warming and dishwashing equipment where required in the functional program

A2.3-2.3.4.2 (6) Where dishwashing equipment is not included, consider providing a cart alcove to support carts for transferring dishware to the dishwashing equipment in the central kitchen.

(7) Access to self-dispensing drinking water and ice

(a) Ice for resident consumption shall be provided by ice-making equipment.

*(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 in resident and participant kitchen facilities.

A2.3-2.3.4.2 (7)(b) To reduce noise from ice-making equipment, consider locating the equipment in a room with a door or separating the compressor and dispenser so the compressor is not in the corridor. In some settings, use of residential ice makers, which are quieter than commercial ice makers, could be appropriate depending on the size and nature of the care population being served.

(8) A hand-washing station. This shall be located in or immediately accessible to the resident and participant kitchen facilities.

2.3-2.3.5 Personal Services (Hair Salon/Spa) Areas

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See the facility chapters in Parts 3 through 5 for requirements.

2.3-2.3.6 Family Room

Where a family room is included in a project, see facility chapters in Parts 3 through 5 for requirements.

*2.3-2.3.7 Quiet Room in a Resident or Participant Community Area

A2.3-2.3.7 Quiet room in a community area. An example of a quiet room or “time out” room that includes positive distractions is a Snoezelen room, a controlled multi-sensory environment. Time in such a room is a therapy for residents with dementia, autism, developmental disabilities, or other agitated conditions. Some facilities have also found that agitated or stressed staff have benefited from having a quiet room available.

In quiet rooms where the risk of self-injury is evident, opportunities for self-harm should be eliminated by concealing protruding elements, using surfaces to which it would be difficult to attach items, and having doors swing out so they cannot be barricaded from the inside.

2.3-2.3.7.1 Where a quiet room is provided for residents experiencing personal conflicts, agitation, episodic mental disturbances, or similar conditions that require a quiet, multi-sensory, low-stimulation, positive distraction room, the following requirements shall be met:

2.3-2.3.7.2 Space requirements

(1) Based on the care population, the quiet room shall be sized to accommodate the equipment, special furnishings, or positive distractions provided.

(2) If the care population includes residents with dementia or other cognitive issues, see Section 2.2-4 (Design Criteria for Dementia, Behavioral and Mental Health, and Cognitive and Developmental Disability Facilities) for additional information.

2.3-2.3.7.3 Toilet room

(1) A toilet room shall be adjacent to the quiet room.

(2) This toilet room shall be permitted to be shared by residents using other activity spaces.

2.3-2.3.8 Outdoor Activity Spaces

2.3-2.3.8.1 See the following Guidelines sections for requirements:

(1) Section 1.2-4.5.1 (Light)

(2) Section 1.2-4.5.2 (Views of and Access to Nature)

(3) Section 2.1-3.6.2 (Outdoor Activity Spaces)

2.3-2.3.8.2 For additional requirements for residents with dementia, behavioral and mental health issues, and cognitive and developmental disabilities, see Section 2.2-4.3.5 (Outdoor Activity Spaces).

2.3-3 Diagnostic and Treatment Areas

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2.3-3.1 General

2.3-3.1.1 Application

Where clinical and support areas described in this section are provided, the requirements in this section shall be met. See the facility chapters in Parts 3 through 5 for specific requirements.

2.3-3.1.2 Community Access

Where examination, observation, or treatment rooms in a clinical services area in a residential health, care, or support facility are used by patients from the community at-large, dedicated circulation shall be provided for outside patients.

2.3-3.2 Examination, Observation, and/or Treatment Rooms

2.3-3.2.1 General

2.3-3.2.1.1 An evaluation of specific examinations, observations, and treatments to be provided in a facility shall be completed to determine if additional space beyond that specified in Section 2.3-3.2.2 (Examination and Treatment Room Space Requirements) is required to accommodate the following:

(1) Needs of the care population

(2) Specialty equipment used

(3) Transfers or other resident movement required in the room

2.3-3.2.1.2 The type of examination table, recliner, or chair to be used shall be based on an evaluation of operational requirements and an assessment of the cognitive ability of the care population being served.

2.3-3.2.1.3 See Section 1.2-2.2.1 (Owner’s Project Requirements) and Section 2.2-4 (Design Criteria for Dementia, Behavioral and Mental Health, and Cognitive and Developmental Disability Facilities) for additional requirements and recommendations.

2.3-3.2.1.3 Where an examination or treatment room is used as an observation room, a toilet room shall be immediately accessible. [Relocated to 2.3-3.2.5 (Toilet Room).]

2.3-3.2.2 Examination and Treatment Room Space Requirements

2.3-3.2.2.1 Area

(1) Each examination or treatment room shall have a minimum clear floor area of 120 square feet (11.15 square meters).

(2) Where an examination or treatment room is used for a population that includes individuals of size, a minimum clear floor area of 210 219 square feet (19.51 20.35 square meters) shall be provided.

2.3-3.2.2.2 Clearances. Clearances shall be determined based on the type of examination table, recliner, or chair chosen for use. For further requirements based on an evaluation of patient or resident cognitive ability, see Section 2.3-3.2.1.2 (Examination, Observation, and/or Treatment Rooms—General).

(1) Room arrangement shall permit a minimum clearance of 3 feet (91.44 centimeters) at each side and at the foot of the examination table, recliner, or chair.

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*(2) Where an examination or treatment room is used for a population that includes individuals of size, clearances shall be evaluated based on the size of the equipment and furniture to be used, including (but not limited to) bariatric expanded-capacity wheelchairs, examination table or bed, and resident seating.

A2.3-3.2.2.2 (2) Examination or treatment rooms for individuals of size should have a minimum clear dimension of 17 feet (5.18 meters) and a minimum clearance of 7 feet (2.13 meters) on one side and 5 feet 6 inches (1.68 meters) on the other side and 5 feet (1.52 meters) at the foot of the treatment table or bed. Where a portable lift is used, a minimum of 35 square feet (3.25 square meters) of storage space should be provided.

*2.3-3.2.3 Resident, Participant, and Outpatient Privacy

Provision shall be made to preserve resident, participant, or outpatient privacy from observation from outside an examination or treatment room when the door is open.

A2.3-3.2.3 Resident, participant, and outpatient privacy. Visual privacy can be achieved with cubicle curtains, blinds, or other types of movable screens.

2.3-3.2.4 Hand-Washing Station

A hand-washing station shall be provided in accordance with Section 2.4-2.2.8 (Hand-Washing Stations).

2.3-3.2.5 Toilet Room

2.3-3.2.5.1 A toilet room shall be provided adjacent to or directly accessible to the examination or treatment room.

2.3-3.2.5.2 2.3-3.2.1.3 Where an examination or treatment room is used as an observation room, a toilet room shall be permitted to be immediately accessible.

2.3-3.2.5.31 Space requirements. Toilet rooms shall be sized and configured to accommodate accessibility standards that support independent resident, participant, or outpatient use.

2.3-3.2.5.42 The toilet room shall contain the following:

(1) Toilet

(2) Hand-washing station. See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.

(3) Mirror. See Section 2.4-2.2.8.7 (Mirror) for requirements.

2.3-3.2.6 Documentation Area

Accommodations for written or electronic documentation shall be provided.

2.3-3.3 Wellness Center

Where wellness facilities are part of a residential health, care, or support facility, see requirements in facility chapters in Part 3 (Residential Health Facilities) and Part 4 (Residential Care and Support Facilities) and in Chapter 5.2 (Wellness Centers).

2.3-3.4 Rehabilitation Therapy Facilities

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Where rehabilitation therapy facilities are part of a residential health, care, or support facility, see requirements in facility chapters in Part 3 (Residential Health Facilities) and Part 4 (Residential Care and Support Facilities) and in Chapter 5.3 (Outpatient Rehabilitation Therapy Facilities).

2.3-3.5 Care Consultation Area

2.3-3.5.1 General

Where care consultation is provided, the requirements in this section shall be met.

2.3-3.5.2 Space Requirements

2.3-3.5.2.1 Area. Each care consultation area shall have a minimum clear floor area of 100 square feet (9.29 square meters).

2.3-3.5.2.2 Space for care of individuals of size

(1) Where the care population includes individuals of size, the consultation area shall be sized based on equipment, furnishing, and maneuvering space requirements.

(2) Circulation from entry to exit of the facility shall be evaluated for use by and care of individuals of size.

2.3-4 Facilities for Support Services

2.3-4.1 General

2.3-4.1.1 Functional Requirements

2.3-4.1.1.1 Identifiable spaces shall be provided for each operational function, but use of a space for multiple purposes shall be permitted as long as the space complies with the requirements for each purpose served.

2.3-4.1.1.2 Except where the word “room” or “office” is used, accommodation of support functions in a multipurpose area(s) shall be permitted.

2.3-4.1.2 Size

The size of each support area shall depend on the number and types of residents served.

2.3-4.1.3 Location

2.3-4.1.3.1 Support areas for resident care shall be located in or readily accessible to each resident unit.

2.3-4.1.3.2 Arrangement and location of support areas to serve more than one resident unit shall be permitted, but at least one such support area shall be located on each resident floor.

2.3-4.2 Facilities that Support Resident, Participant, or Outpatient Care

2.3-4.2.1 Staff Work Area(s)

*2.3-4.2.1.1 Resident care/living areas (units), participant activity areas, and outpatient rehabilitation areas shall have staff work areas in centralized or decentralized direct care locations.

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A2.3-4.2.1.1 Staff work areas

a. Decentralized nursing models proximal to patient/resident rooms may improve staff efficiency, visibility, fall prevention, transfer rates, and medical errors without being disruptive to residents.

b. Whether centralized or decentralized, s Staff work areas should be designed to minimize the institutional character, command-station appearance, and noise associated with traditional nurse stations and to foster close, open relationships between residents, participants, outpatients, and staff.

c. Confidential or noisy staff conversations should be accommodated in an enclosed staff lounge and/or conference area.

d. At least part of each staff work area should be low enough and open enough to permit easy conversations between staff and seated residents using resident-operated mobility devices.

2.3-4.2.1.2 See the facility chapters in Parts 3 through 5 for additional requirements.

2.3-4.2.2 Medication Distribution and Storage Locations (Centralized and Decentralized)

*2.3-4.2.2.1 General

A2.3-4.2.2.1 <Chapter 1066>, “Physical Environments that Promote Safe Medication Use,” of the U.S. Pharmacopeia-National Formulary (USP-NF) may be used as a resource in developing the medication distribution and storage system.

(1) Provisions shall be made to support 24-hour distribution of medications.

(2) A medication room, a self-contained medication distribution unit, medication storage in resident rooms, or other approaches acceptable to the authority having jurisdiction (AHJ) shall be permitted to be used for preparing, dispensing, and administering medications.

2.3-4.2.2.2 Medication room. Where provided, a medication room shall be located on each resident care/living area (unit) for storage of emergency and contingency medications and supplies or as part of a medication distribution system.

(1) A medication room shall have a minimum area of 50 square feet (4.65 square meters) or meet the requirements in the functional program.

*(2) Each medication room shall include the following:

A2.3-4.2.2.2 (2) Medication room organization. Workspace organization elements should be described in the functional program. These include:

a. Number of staff working in the medication room

b. Key tasks to be performed in the medication room

c. Amount of space needed to support these tasks

d. Space for medication-associated equipment

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e. Space for safety technology to be used

(a) A work counter sized to accommodate functions for the facility type and care population

(b) Hand-washing station. See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.

(c) Refrigerator for storage

(d) Double-locked storage for controlled drugs

*(e) Sharps containers, where sharps are used. Where provided, these shall be placed in accordance with the OSHA Bloodborne Pathogen standard at 29 CFR 1910.1030(d)(4)(iii)(A)(2)(i).

A2.3-4.2.2.2 (2)(e) Placement of sharps containers. NIOSH provides an ergonomically ideal formula for determining the height of sharps containers by establishing the eye-level height and maximum thumb tip reach of the staff population and then including a drop angle of 15 degrees. For a standing workstation, the sharps container height should be 52 to 56 inches (1.32 to 1.42 meters) above the standing surface of the user. For a seated workstation, the sharps container height should be 38 to 42 inches (.97 to 1.07 meters) above the floor on which the chair rests. These height installation recommendations will accommodate 95 percent of all adult female staff. This information can be found in found in DHHS (NIOSH) Publication No. 97-111, “Selecting, Evaluating, and Using Sharps Disposal Containers.” NIOSH recommends locating the sharps container as close as feasible to the immediate area where sharps are used.

(f) Task-specific lighting levels as recommended in USP-NF <Chapter 1066>

*(g) Medication room sound levels that meet the requirements in the following:

A2.3-4.2.2.2 (2)(g) Distractions and interruptions interfere with staff concentration and attentiveness to medication use system activities.

(i) Table 2.5-2 (Maximum Design Criteria for Noise in Interior Spaces Caused by Building Systems)

(ii) Table 2.5-4 (Minimum Design Room Sound Absorption Coefficients)

(iii) Table 2.5-5 (Design Criteria for Minimum Sound Isolation Performance Between Enclosed Rooms)

(iv) Requirements on nurse call and paging in Section 2.5-5 (Communication Systems) the facility chapters in Parts 3 through 5.

2.3-4.2.2.3 Self-contained medication distribution units, automated medication-dispensing stations, or mobile medication-dispensing carts. Where these or other systems approved by the AHJ are used, the following shall apply:

(1) Location of such units shall be permitted at the staff work area, in the clean utility room, in an alcove, or in a resident room as approved by the AHJ.

(2) Medication units located in resident rooms shall be secured.

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(3) Areas used for medication preparation and distribution by mobile cart shall include task-specific lighting.

*2.3-4.2.2.4 Decentralized m Medication cabinets in the resident room. Where medication storage is located in the resident room, the following shall apply:

A2.3-4.2.2.4 Decentralized Where medication storage areas are provided in the resident room, should also include a writing surface or area for electronic device (laptop, tablet, etc.) should be provided for staff recording of resident data.

(1) Medication storage located in resident rooms shall be secured.

(2) Decentralized medication cabinets in resident rooms shall include task-specific lighting.

2.3-4.2.3 Central Bathing Rooms or Areas

See the facility chapters in Parts 3 through 5 for requirements.

2.3-4.2.4 Equipment and Supply Storage

*2.3-4.2.4.1 Storage for equipment and supplies for care and services. Storage space(s) for equipment and supplies used by staff for resident, participant, and outpatient care and services shall be immediately accessible to the areas when they are used.

A2.3-4.2.4.1 Equipment and supply storage

a. Equipment may include portable lifts, movable commodes, shower chairs, and carts.

b. Supplies may include linens, disposable products, slings, accessories for lifts such as battery chargers, dressings, office supplies, etc.

(1) Sufficient storage space(s) shall be provided to keep required corridor width free of equipment and supplies.

(2) Cabinets, closets, rooms, and alcoves shall be permitted to provide storage.

2.3-4.2.4.2 Storage for mobility devices and support equipment. Storage shall be provided for resident-operated mobility devices and personal support equipment that is:

(1) Sized to meet the needs of the functional program.

(2) Located out of the way of traffic and circulation.

*2.3-4.2.4.3 General storage. General storage space(s) shall be provided in the same building for furniture and equipment such as air mattresses, medical supplies, and housekeeping supplies and equipment.

A2.3-4.2.4.3 General storage. More storage space is always needed, whether for seasonal storage of lawn furniture or for holiday decorations. Tall broom closets should also be considered in residential spaces such as individual units and kitchenettes.

2.3-4.2.4.4 See the facility chapters in Parts 3 through 5 for additional requirements.

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2.3-4.2.5 Clean Utility Room

Where a clean utility room is provided, it shall meet the following requirements:

2.3-4.2.5.1 Where the clean utility room is used for preparing resident care items, it shall contain:

(1) Work counter


(3) Storage facilities for clean supplies

2.3-4.2.5.2 Where the room will be used only for storage and holding as part of a system for distribution of clean materials, omission of the work counter and hand-washing station shall be permitted.

2.3-4.2.5.3 Where the room will be used for clean linen and laundry, see Section 2.3-4.2.7 (Personal Laundry Facilities) for additional requirements.

2.3-4.2.5.4 Where the room will be also used as a medication room, see Section 2.3-4.2.2 (Medication Distribution and Storage Locations) for additional requirements.

2.3-4.2.6 Soiled Utility Room

Where a soiled utility room is provided, it shall meet the following requirements:

2.3-4.2.6.1 Combining the soiled utility room with the soiled linen and laundry and/or environmental services room shall be permitted for areas with small groups of residents.

2.3-4.2.6.2 The soiled utility room shall contain the following:

(1) Clinical sink or equivalent flushing-rim fixture with a rinsing hose or bedpan washer


(3) Space for soiled linen receptacles

(4) Space for waste receptacles

2.3-4.2.6.3 Where the room is used for soiled linen and laundry, see Section 2.3-4.2.7 (Personal Laundry Facilities) for additional requirements.

2.3-4.2.6.4 Where the room serves as an environmental services room, see facility chapters in Parts 3 through 5 for additional requirements.

2.3-4.2.7 Personal Laundry Facilities

Where decentralized personal laundry services are provided for washing and drying personal resident or participant laundry, the following requirements shall be met:

2.3-4.2.7.1 Separate laundry facilities shall be provided for small groups of residents or participants.

2.3-4.2.7.2 A work counter for sorting and folding shall be provided.

2.3-4.2.7.3 Hand-washing stations shall be provided directly or immediately accessible to the laundry room. See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.

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2.3-4.2.7.4 Shared facilities

(1) Combination of personal laundry facilities and clean utility and clean linen storage shall be permitted.

(2) Combination of personal laundry facilities and soiled utility and soiled linen holding facilities shall be permitted where the airflow is from the washing/drying area to the soiled utility/holding area.

*(3) Provision of accessible laundry equipment in a resident activity room and/or therapy room shall be permitted.

A2.3-4.2.7.4 (3) Loading, transferring, sorting, and folding laundry are familiar activities that may be therapeutic for many residents.

*2.3-4.2.8 Resident and Participant Telephone Access

Provisions shall be made in or near each resident unit to allow residents to make and receive telephone calls in private.

A2.3-4.2.8 Telephone access. Use of technology is becoming increasingly prevalent in residential care facilities. Cable television, high-speed Internet, and ready access to bedside telephones are just a few examples of the expected norm in resident rooms. Many residents will expect access to the Internet to communicate with family and friends. Provision of telephone/data connections or Wi-Fi access for each resident room should be considered.

*2.3-4.2.9 Accommodations for Telemedicine Services

Where telemedicine services are provided, provisions shall be made to support the practice of exchanging medical information between sites via electronic communications.

A2.3-4.2.9 Accommodations for telemedicine services. The following should be considered where a space is used for telemedicine services:

a. The space should be designed to accommodate the service being provided.

b. It should be possible to maintain visual and speech privacy for the duration of the visit in the room or area where services are offered.

c. The acoustic environment should facilitate communications within the room and through the telecommunication system.

d. Lighting levels should be designed to allow for video capture and help control glare from natural or artificial light sources.

e. Access to technology should be provided.

A2.3-4.2.9 Participant experience. Remote communications via electronic equipment, although not a replacement for in-person care, may be offered as a supplement where in-person care is not available or medically necessary. To assist in the adoption of telemedicine and maximize its benefits for elderly participants, those unaccustomed to electronic communication, and/or those with vision, hearing, or cognitive impairments, care should be taken to remove technological barriers and provide telemedicine endpoints that facilitate natural communication for the widest range of participants. Facilities and systems used

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for telemedicine communications should strive to maintain the level of safety, privacy, quality of care, and participant experience that would be expected of in-person communication.

*2.3-4.2.9.1 General. Where clinical telemedicine services are provided, telemedicine spaces to accommodate those services shall meet the requirements in this section.

A2.3-4.2.9.1 Telemedicine service types

a. Services may include one-on-one interactions, consultations with a participant and family members, examinations supported by a telemedicine presenter located with the participant, or specialty services such as dermatology or orthopedics. Each type of service may have specific needs for lighting and space to support the clinical function (e.g., evaluation of participant gait requires unobstructed space to walk from one end of the room to the other). Therefore, to achieve a functional design, it is important to know what services will be provided.

b. The requirements in this section are not intended to apply to virtual visits that do not require a physical examination of the participant or visits that originate from a physician’s or participant’s living unit or private room.

*2.3-4.2.9.2 Telemedicine Room

A2.3-4.2.9.2 Design considerations

a. Equipment

—Video teleconference camera placement should be set so recipients perceive the exchange as happening eye-to-eye. The discrepancy between gaze angle should be minimal.

—The video teleconference camera should have automatic gain and white point balance to maintain image quality.

—The video teleconference camera placement should avoid facing a doorway or window and directly facing light sources.

—Temperature control should be considered based on the amount of electronic equipment that may generate significant levels of heat.

—Depending on the complexity of equipment used, multiple electrical outlets may be required for equipment. Electrical outlets should be located near the unit to avoid wires/cables on the floor.

—A minimum of two Cat5e/6 data cables should be provided at each telemedicine location for network connectivity to telemedicine equipment.

—If wireless connectivity is planned, the wireless network should be evaluated to ensure video stream can be maintained per minimum vendor requirements.

—Where a cart will be used to store telemedicine equipment in a room that serves as a telemedicine room and another use, the monitor, camera, microphone, and associated telemedicine equipment should be installed on the cart.

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—Equipment is recommended to be designed for specific telemedicine needs (e.g., telestroke, general consultation e-visits).

—Where necessary, a multifunction printer should be directly accessible to the telemedicine room.

b. Architectural details

—Doors in view of the main camera should be able to be closed to assure maximum privacy during the telemedicine appointment.

—Placement of doors behind the participant should be avoided as this can make participants uncomfortable.

(1) General

(a) A room shall be provided for telemedicine services.

(b) Where participant volume does not justify provision of a dedicated telemedicine room, an office, exam room, or conference room shall be permitted to be used for this purpose.

(c) A room where clinical telemedicine services are provided shall meet the requirements of the section of the Guidelines that directly relates to the services provided and the participant population served.

*(2) Space requirements. Where used for examination purposes, the telemedicine room shall be sized to accommodate the following:

A2.3-4.2.9.2 (2) Sizing considerations

a. Where a separate camera and microphone are used rather than a computer or other electronic device, the distance between walls will determine the proximity of the camera and microphone to the participant. Use of a small room may force the camera to be located too close to the participant, limiting the view of the clinician presenting the participant for consultation. Therefore, the camera and exam table should be positioned so a presenter using and manipulating telemedicine peripherals can see both the participant and the monitor of images being transmitted to the remote clinician’s site.

b. Where the microphone is not embedded in the device being used (e.g., desktop, laptop, smartphone, or similar device), space for microphones should be placed in front of and close to the individuals speaking in the videoconference, ideally at least 4 feet (1.22 meters) from the telemedicine workstation to prevent audio feedback.

c. Stationary cameras should be placed on top of the monitor used for viewing and directed toward the participant to capture the most information possible (i.e., head plus full-body shots). This is easier with dedicated telemedicine carts than with desktop or mobile units.

d. The room should be large enough for the participant and on-site caregiver or participant presenter to move around comfortably. The participant should be able to sit in a chair as well as use the examination table. A second chair should be available for a family member.

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e. Where the examination includes gait evaluation, the room and/or adjacent corridor should provide sufficient space for this activity to be captured by the camera.

(a) An examination table situated within view of the camera

(b) Telemedicine equipment (fixed or mobile)

(c) Peripheral devices

(d) An on-site caregiver or participant presenter

(e) A hand-washing station that meets the requirements in Section 2.4-2.2.8 (Hand-Washing Stations) where hands-on participant examinations will be conducted.

(f) A documentation area

2.3-4.2.9.3 Privacy

(1) The telemedicine room shall provide speech and visual privacy with adjacent spaces based on the room’s clinical function, as indicated in Table 2.5-6 (Design Criteria for Speech Privacy for Enclosed Rooms and Open-Plan Spaces).

(2) Space shall permit arrangement of monitors, screens, or other projections of images or data so they are not visible to casual observers outside the telemedicine room.

*2.3-4.2.9.4 Acoustic considerations

A2.3-4.2.9.4 Acoustic considerations. The acoustic environment should be designed to facilitate speech intelligibility and communication. The telemedicine room should be in a quiet location that minimizes exposure to noise that can be picked up by microphones. Noise sources may include but are not limited to open office areas, busy corridors, stairwells, parking lots, waiting rooms or areas, HVAC systems, and toilet rooms. Cooling fans for equipment should be controlled and limited for telemedicine rooms.

(1) Background noise. Telemedicine rooms shall maintain background noise levels for the room’s clinical requirement in Table 2.5-2 (Maximum Design Criteria for Noise in Interior Spaces Caused by Building Systems).

(2) Speech intelligibility. Telemedicine rooms shall maintain the minimum sound absorption coefficient for the room’s clinical requirement in Table 2.5-4 (Minimum Design Room Sound Absorption Coefficients) or 0.10 (absolute), whichever is greater.

*(3) Sound isolation. Telemedicine rooms shall achieve the minimum STC rating for the room’s clinical requirement in Table 2.5-5 (Design Criteria for Minimum Sound Isolation Performance Between Enclosed Rooms).

A2.3-4.2.9.4 (3) In designing to achieve the minimum STC rating, all portions of the room’s envelope should be considered, including walls, floor/ceiling assemblies, doors, and glazing as well as field conditions that may affect the performance of those elements.

*2.3-4.2.9.5 Lighting

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A2.3-4.2.9.5 Lighting considerations

a. Direct and indirect lighting should be provided to facilitate images that have even lighting and accurately reproduced colors. For further information, see Let There Be Light: A Quick Guide to Telemedicine Lighting, published by the American Telemedicine Association.

b. Full-spectrum or warm, white light (3200–4000 K) should be provided.

c. A minimum light level of 150 foot-candles should be provided.

d. It is recommended to generally avoid colored room lighting (e.g., yellow, blue tint) where the color comes from color in the glass of the bulb (as opposed to the filament or emission in diodes) or where color is inherent in technology limitations.

e. Combined lighting arrangement (ceiling and wall) should be 60:40.

(1) The room shall provide the ability for direct frontal lighting.

*(2) Means for controlling glare from natural and artificial light sources shall be provided.

A2.3-4.2.9.5 (2) Controlling glare and shadows

a. Rooms with windows should have shades or blinds to reduce light and glare, although this may not be enough to achieve acceptable images. In rooms with windows, it should be possible for clinicians and/or participants to avoid sitting in front of a window unless the backlighting can be adequately addressed.

b. If only overhead lighting is used or if there is a light source behind the participant, a good source of diffused light is needed in front of the participant. The light source should be shining diagonally toward the participant to reduce shadows that occur on the face. Spotlights or harsh directional lighting can create unwanted shadows. Egg-crate diffusers are not recommended due to hot spots.

c. Avoid surfaces that reflect undesirably (e.g., glass).

d. Brightness should be uniform across the field of view.

e. Artificial light can compensate for time of day, weather.

f. Fill lighting can help control shadows and balance color.

2.3-4.2.9.6 Interior surfaces

*(1) Telemedicine room finishes and colors shall be selected to maintain natural rendition of color and pattern.

A2.3-4.2.9.6 (1) Interior surfaces

a. Neutral to blue hues with matte finishes, medium contrast, and soft texture are recommended for proper color rendition and to facilitate picture clarity. These shades are preferred because they offer the desired minimal light absorption and light reflectivity.

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b. Use of this color can be limited to the walls that will be the background for the camera views. This may include more than one wall depending on the configuration of the room.

c. Screens or curtains may be used to provide the appropriate background color or to hide clutter (e.g., bookshelves, framed pictures with glass).

*(2) Backdrop wall color shall have a light reflectance value of 30 to 40 percent.

A2.3-4.2.9.6 (2) Avoiding glare and contrast

a. A surface finish gloss rating level 1 or 2 (flat finish) should be used rather than gloss level 5 (semi-gloss) or gloss level 6 (gloss finish) to avoid glare and reflections. Reference the Master Painters Institute Gloss and Sheen Standards for latex versus alkyd paint gloss ratings.

b. Glare and contrast problems in the visual environment may be avoided by specifying the following light reflectance values for surfaces in the telemedicine room:

—Ceilings: 80 to 90 percent

—Furniture: 25 to 45 percent

—Flooring: 20 to 40 percent

*2.3-4.2.9.7 Site identification. Facility identification shall be provided at the site so it appears in the transmitted image unless it is embedded in the telemedicine platform.

A2.3-4.2.9.7 Site identification. Facility identification may be provided through signage, such as a sign with the name of the site in the background or site identification incorporated into the telemedicine technology platform. Identification can help keep everyone oriented and may be required for reimbursement.

*2.3-4.2.9.8 Support Areas for Telemedicine Rooms. Where portable equipment and peripheral devices are used (e.g., digital cameras and task lighting, portable EKG devices, smartphones, roaming robots), secure storage shall be provided.

A2.3-4.2.9.8 Infection prevention considerations for telemedicine spaces. Telemedicine equipment should be selected and installed to facilitate cleaning and infection prevention practices.

*2.3-4.2.9.9 Mobile Telemedicine Services. Where moving the participant to a telemedicine room is impractical or impossible (e.g., in skilled nursing or hospice facilities), a mobile cart for telemedicine equipment shall be permitted.

A2.3-4.2.9.9 It is recognized that in hospice or skilled nursing facilities, telemedicine services will likely take place in the participants’ room via a telemedicine cart and not in a dedicated telemedicine room.

*2.3-4.2.9.10 Where a cart is used for mobile telemedicine services equipment, it shall include a monitor, camera, microphone and related telemedicine equipment installed on the cart.

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A2.3-4.2.9.10 Design considerations. Depending on the complexity of equipment used, multiple electrical outlets may be required for equipment.

2.3-4.3 Support Areas for Staff

2.3-4.3.1 General

Areas that support staff breaks and respite for caregivers and administrative staff shall be provided.

*2.3-4.3.2 Staff Lounge Area

A2.3-4.3.2 Staff lounge area. Provision of the following should be considered:

a. Access to views and outdoor space from the staff lounge area. See Section 1.2-4.5.2 (Views of and Access to Nature) for more information.

b. Furniture for relaxation and respite, especially in settings where staff are commonly scheduled to work extended and double shifts

c. A notification area to facilitate communication (e.g., human resources notices, resident passing, etc.)

2.3-4.3.2.1 Staff lounge area(s) shall be permitted to be shared by more than one service resident, participant, or outpatient care area.

2.3-4.3.2.2 Staff lounge area(s) shall provide the following based on the facility needs:

(1) Refrigerator

(2) Sink

(3) Space for microwave and other appliances

*2.3-4.3.2.3 Space for vending machines shall be provided based on facility and staff needs.

A2.3-4.3.2.3 Vending machine area. Placement of vending equipment near or in staff lounge area(s) and public waiting area(s) used for outpatient therapy services should be considered.

a. Vending equipment should be coordinated with interior finish design concepts through the use of custom or false fronts or enclosures.

b. Trash collection devices should be integrated as part of any vending equipment area.

c. Environmental services facilities should be located near vending areas as they are high-use areas.

*2.3-4.3.3 Staff Toilet Room

A2.3-4.3.3 Provision of shower facilities for staff should be considered.

2.3-4.3.3.1 Toilet room(s) for staff shall contain a toilets with a hand-washing stations that meets the requirements in Section 2.4-2.2.8 (Hand-Washing Stations). and

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2.3-4.3.3.1 Staff toilet rooms shall be permitted to be unisex.

2.3-4.3.4 Staff Storage

Lockable storage shall be provided for safekeeping of staff members’ personal effects.

2.3-4.4 Support Facilities for Family and Visitors

2.3-4.4.1 General

See facility chapters in Parts 3 and 4 for requirements in addition to those in this section.

2.3-4.4.2 Overnight Guest Accommodations

See the facility chapters in Parts 3 and 4 for requirements.

2.3-4.4.3 Pet Accommodations

If pets are permitted in a facility, accommodations (e.g., sleeping areas, feeding areas, waste areas, storage for food and pet care supplies) shall be designated for them.

2.3-4.5 Food Service Facilities

2.3-4.5.1 General

Food service facilities consist of the following types:

2.3-4.5.1.1 Commercial kitchen. See Section 2.3-4.5.2 (Commercial Kitchen) for requirements.

2.3-4.5.1.2 Retail kitchen. See Section 2.3-4.5.3 (Retail Kitchen) for requirements.

2.3-4.5.1.3 Household kitchen. See Section 2.3-4.5.4 (Household Kitchen) for requirements.

2.3-4.5.1.4 Social activity kitchen. See Section 2.3-4.5.5 (Social Activity Kitchen) for requirements.

2.3-4.5.1.5 Outpatient therapy kitchen. See Section 2.3-4.5.6 (Outpatient Therapy Kitchen) for requirements.

2.3-4.5.1.6 Warming/serving kitchen. See Section 2.3-4.5.7 (Warming/Serving Kitchen) for requirements.

*2.3-4.5.2 Commercial Kitchen

Where a commercial kitchen is provided, it shall not be permitted to serve as a household, social activity, or outpatient therapy kitchen.

A2.3-4.5.2 Commercial kitchen. The purpose of a commercial kitchen is to support meal services for a home or community. Preparation and production of meals (typically in large quantities) is performed in the commercial kitchen and then transported to other kitchen or dining spaces.

2.3-4.5.2.11.1 Application. (1) Facilities and equipment shall be provided to support the food services the facility offers staff, visitors, residents, and/or participants.

2.3-4.5.2.2 Location and layout

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*(12) Food receiving, storage, and preparation areas shall be located to support staff oversight of operations.

A2.3-4.5.2.2 (1) Receiving and storage. The areas for food receiving (e.g., loading dock) and storage should be located in easy proximity to the commercial kitchen to ensure food safety.

(3) Facilities shall be furnished to support provision of nourishment and snacks between scheduled meals. See Section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements.

*(2)2.3-4.5.1.2 Layout. The equipment and design layout shall provide a workflow that minimizes potential for cross-contamination of clean food and wares with contaminated trays from residents, participants, outpatients, staff, or visitors.

A2.3-4.5.2.21.2 (2) Layout

a. Small retail options, cafes, or minimal amounts of storage may be remote from the main food service area. Circulation patterns for delivering food to satellite locations should be considered.

b. Where food service facilities are split into multiple vertical levels, a dedicated elevator and an internal service stair should connect the multi-level food service operations.

(3) The commercial kitchen shall be designed to prevent access by residents and visitors.

2.3-4.5.2.3 Regulations. Food service facilities and equipment shall comply with the requirements of:

(1) 2.3-4.5.2.1 U.S. Food and Drug Administration (FDA)

(2) 2.3-4.5.2.2 U.S. Department of Agriculture (USDA)

(3) 2.3-4.5.2.3 Underwriters Laboratories, Inc. (UL)

(4) 2.3-4.5.2.4 NSF International (NSF)

2.3-4.5.2.43 Functional Elements Support Spaces

Where food services are provided on-site, the following facilities support spaces, in the size and number appropriate for the type of food service selected, shall be provided:

(1) 2.3-4.5.3.1 Control station for managing food supplies

(2) 2.3-4.5.3.2 Hand-washing station(s) in the food preparation area. See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.

(3) 2.3-4.5.3.3 Food preparation facilities to accommodate the method of food preparation used

(a) (1) Where conventional food preparation systems are used, space and equipment shall be provided for food preparation, cooking, and baking.

(b) (2) Where convenience food service systems using frozen prepared meals, bulk packaged entrees, and individual packaged portions or systems using contracted, outsourced services are used, space and equipment shall be provided for thawing, portioning, cooking, and baking.

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(c) (3) Where “cook-chill” food preparation systems are used, space and equipment shall be provided for food preparation, cooking and baking, chilling, portioning, and reheating.

(4) 2.3-4.5.3.4 Ice-making equipment and drinking water source

(a) (1) Location of ice-making equipment in the food preparation area or in a separate room shall be permitted as long as the equipment is directly accessible to the food preparation area.

(b) (2) Ice-making equipment shall be cleanable.

(c) (3) Ice-making equipment shall be self-dispensing if it is accessible to residents, participants, and/or visitors.

(d) (4) Ice-making equipment under control of staff and not for use by residents, participants, and/or visitors shall be permitted to be bin-type or self-dispensing.

(e) (5) See Section 2.3-2.3.4.2 (7) (Access to self-dispensing drinking water and ice) for decentralized ice-making requirements.

(f) (6) A filtered self-dispensing drinking water source shall be provided.

(5) 2.3-4.5.3.5 Assembly and distribution facilities. Depending on the care model, facilities shall be provided to support assembly and distribution of resident meals. These shall be permitted to be centralized or decentralized.

(6) 2.3-4.5.3.6 Warewashing space. Commercial-type warewashing equipment shall be provided.

(a) (1) Depending on the care model, warewashing space shall be provided in a room or an alcove separate from the food preparation and serving area.

(i) (a) This shall be permitted to be centralized or decentralized.

(ii) (b) Where a cluster/neighborhood, household/small house or similar model of care is used, commercial warewashing may be decentralized and located in a resident or participant household kitchen. See Section 2.3-2.3.44.5.4 (Resident and Participant Household Kitchen) for requirements.

(b) (2) Space shall be provided for receiving, scraping, sorting, and stacking soiled tableware and for transferring clean tableware to point-of-use areas.

(c) (3) Hand-washing stations shall be provided in or directly accessible to warewashing space(s). See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.

(d) (4) Warewashing facilities shall be designed to prevent contamination of clean wares or food preparation areas with soiled wares through cross-traffic.

(7) 2.3-4.5.3.7 Pot-washing facilities. Depending on the type of food service and the care model, pot-washing facilities shall be provided. This shall be permitted to be centralized or decentralized.

(8) 2.3-4.5.3.8 Offices(s). Office(s) or desk spaces for a dietitian, dietary service manager, head chef, or other food service professional shall be provided in or adjacent immediately accessible to the kitchen.

(9) 2.3-4.5.3.9 Storage. The following shall be provided:

*(a) (1) Food storage space, including cold storage

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A2.3-4.5.2.4 (9) (a)3.9 (1) Facilities in remote geographic areas may require proportionally more food storage facilities.

(b) (2) Storage areas and sanitizing facilities for cans, carts, and mobile-tray conveyors, where used

(c) (3) Waste, storage, and recycling facilities (per that meet local health and building code requirements) located with and provide access to the outside for direct pickup or disposal

(10) 2.3-4.5.3.10 Environmental services room

(a) (1) Location(a) An environmental services room shall be located in immediately accessible to the commercial kitchen where food service is centralized.

(b) An environmental services room shall be located in or directly accessible to a resident unit where food service is decentralized.

(b) (2) See Section 2.3-4.9.3.2 (Environmental services room) for room requirements.

(11) 2.3-4.5.3.11 Cold storage equipment

(a) (1) Where provided, freezers and refrigerators, including walk-in refrigerators, coolers, where used, shall be insulated at the floor, as well as at walls, and top.

(b) (2) Coolers, refrigerators, and freezers

(i) (a) Coolers, refrigerators, and freezers shall be thermostatically controlled to maintain desired temperature settings in increments of 2 degrees or less.

(ii) (b) Coolers and refrigerators shall be capable of maintaining a temperature down to freezing of 32°F (0°C).

(iii) (c) Freezers shall be capable of maintaining a temperature of 20 degrees below 0°F (-17.78°C).

(iv) (d) Interior temperatures shall be indicated on the exterior of the equipment.

(c) (3) Walk-in refrigerators units, where used

(i) (a) All Where provided, walk-in refrigerators and low-temperature units shall have a view panel in the door and safety release mechanism for exit from the inside.

(ii) (b) Shelving shall be corrosion-resistant, cleanable, and constructed and anchored to support a load of at least 100 pounds per linear foot (148.80 45.36 kilograms/linear meter).

(iii) (c) The interior shall be lighted.

*(12) 2.3-4.5.3.12 Cart wash. Where carts are used, a designated cart wash area with a sloped floor, floor drain, and source of water and sanitizing agents shall be provided.

A2.3-4.5.2.4 (12) 3.12Cart wash

a. A high-pressure water and chemical hose/spray system should be provided to facilitate cleaning.

b. A cart drying area with floor drain should be provided where carts can air-dry.

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2.3-4.5.3 Retail Kitchen 5.2-2.3.3.2 Dining area

(1) Where a café, bistro setting, or central dining facility is provided, following requirements shall apply:

2.3-4.5.3.1 Application

(1) Where a retail kitchen is provided, it shall meet the requirements in this section.

(2) Where a retail kitchen is used as a commercial kitchen, it shall meet the requirements in Section 2.3-4.5.2 (Commercial Kitchen).

(3) The retail kitchen shall not be permitted to serve as a social activity or outpatient therapy kitchen.

(b) (4) Space shall be provided for dining in accordance with the needs of the care population, including participants who use participant-operated mobility devices.

(c) (5) Space shall allow participants to access and leave their tables without disturbing other participants.

(2) For central dining facilities, clear and unobstructed circulation paths for servers and food carts shall be provided.

(3) (6) Planned use of dining areas for other activities shall be permitted.

2.3-4.5.3.2 Location and layout

5.2-2.3.3.2 (1)(a) (1) The design and location of the retail kitchen shall encourage participant and visitor use.

(2) For facilities that also have commercial kitchens, clear and unobstructed circulation paths for servers and food carts shall be provided.

(3) Food receiving, storage, and preparation areas shall be located to support staff oversight of operations.

2.3-4.5.3.3. Regulations. Retail kitchen facilities and equipment shall comply with federal, state, and local building and health codes.

2.3-4.5.3.4 Retail kitchen requirements. Facilities and equipment shall be provided to support the food services the facility offers to staff, visitors, residents, and/or participants.

2.3-4.5.3.5 Access to the retail kitchen. Physical access to the retail kitchen shall be restricted to staff.

2.3-4.5.4 Household Kitchen 2.3-2.3.4 Resident and Participant Kitchen

*2.3-4.5.4.1 Application. Where provided, the household kitchen shall be designed to support any combination of the following functions:

2.3-2.3.4.1 (1)A2.3-4.5.4.1 General. A household kitchen, also sometimes called a “country kitchen,” a “great room,” or other activity room that supports resident and participant involvement in activities of daily living shall be permitted to serve as the required resident and participant kitchen facilities. The household kitchen has an important role in supporting a positive visual and olfactory connection for residents.

(1) Provision of nourishment between meals

2.3 Design Elements


(2) Cooking activities for residents and participants

(3) Food preparation by family members

(4) Preparation of meals by staff with or without assistance from residents, completion of meal preparation begun in a commercial kitchen, and serving/distribution of meals

*2.3-4.5.4.2 Location and layout. The household kitchen shall be located immediately accessible to the household.

A2.3-4.5.4.2 Location

a. Where the travel distance from resident rooms to the household kitchen exceeds 100 feet (30.48 meters), consider providing interim seating arrangements to allow residents to stop and rest.

b. When determining the location for the household kitchen, consideration should be given to circulation routes and proximity to the commercial kitchen. The ability to quietly and discreetly deliver food and supplies from the commercial kitchen is desirable.

2.3-4.5.4.3 Regulations. Household kitchen facilities and equipment shall comply with federal, state, and local building and health codes.

*2.3-4.5.4.42.3.4.2 Facility Household kitchen requirements. Where these kitchen facilities are a household kitchen is provided, it shall include the following: the following requirements shall apply:

A2.3-4.5.4.4 Household kitchen

a. Equipment that matches the residential character of the household and is durable enough to support extensive use by multiple individuals should be provided in the household kitchen.

b. Provision of the following should also be considered:

—Resident and participant countertop or island. This should allow access for residents and participants using resident-operated mobility devices and facilitate staff and resident interaction.

—Double-bowl sink with faucet and sprayer —Secure locked storage for sharp knives —Microwave —Coffee maker

(1) Work countertop. Prep station countertops shall be made of porcelain, stainless steel, solid-surface materials, or impervious plastic laminate assembly.

*(2) Refrigerator

A2.3-4.5.4.4 (2) The refrigerator should be located near the household kitchen entrance/exit for ease of resident accessibility.

*(3) Food storage Storage cabinets

2.3 Design Elements


A2.3-4.5.4.4 (3) Food storage (both dry and refrigerated) that allows staff to easily manage the daily needs of kitchen production should be provided. Consideration should be given to providing wire shelving in the pantry.

(4) Sink with faucet with anti-scalding mixing valve

(5) Range, cooktop, oven, and/or any other cooking or heating device where required in the functional program. These appliances shall be equipped with secured shutoffs where residents have access to the kitchen.

*(6) Food-warming and dishwashing equipment where required in the functional program

A2.3-4.5.4.4 (6) Where dishwashing equipment is not included, consider providing a cart alcove to support carts for transferring dishware to the dishwashing equipment in the commercial kitchen.

(7) Access to self-dispensing drinking water and ice

(a) Ice for resident consumption shall be provided by ice-making equipment.

*(b) Ice-making equipment shall be designed, located, and installed to minimize noise.

A2.3-4.5.4.4 (7)(b) To reduce noise from ice-making equipment, consider locating the equipment in a room with a door (e.g., a pantry) or separating the compressor and dispenser so the compressor is not in the corridor. In some settings, use of residential ice makers, which are quieter than commercial ice makers, could be appropriate depending on the size and nature of the care population being served.

(c) Ice-making equipment shall be permitted to serve more than one food area.

(8) A hand-washing station. A hand-washing station shall be located immediately accessible to the household kitchen. See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.

(9) Environmental services closet. Where food service is decentralized, an environmental services closet shall be located readily accessible to the household.

*2.3-4.5.4.5 Resident access to the household kitchen. Where physical barriers to the household kitchen are not required by the local or state jurisdiction, residents shall have access to the household kitchen.

A2.3-4.5.4.5 Where barriers are required by local or state jurisdiction, they should not be visually intrusive.

*2.3-4.5.4.6 Access to nature

A2.3-4.5.4.6 Access to views of nature should be considered to provide a positive and home-like dining experience.

*2.3-4.5.4.7 Lighting

A2.3-4.5.4.7 . Lighting that meets the requirements in ANSI/IES RP-28: Lighting and the Visual Environment for Seniors and the Low Vision Population should be considered to provide a positive dining experience. For more information on

2.3 Design Elements


daylighting and lighting levels, see Section 2.5-7 (Daylighting and Artificial Lighting Systems).

2.3-4.5.5 Social Activity Kitchen

2.3-4.5.5.1 Application. Where a social activity kitchen is provided, it shall be designed to support life enhancement activities related to food preparation that are not central to regular meal delivery.

2.3-4.5.5.2 Location and layout. The social activity kitchen shall be located immediately accessible to social activity spaces.

2.3-4.5.5.3 Reserved

2.3-4.5.5.4 Design requirements. The social activity kitchen shall meet the following requirements:

(1) Work areas, counters, and/or tables shall be suitable for resident-operated mobility device access and standard seat access.

(2) Where prep station countertops are provided, they shall be made of porcelain, stainless steel, solid-surface materials, or impervious plastic laminate assembly.

(3) The range, cooktop, and/or oven shall have secured shutoffs.

(4) Food storage shall be provided.

(5) Hand-washing station(s) in the food preparation area shall be provided. See Section 2.4-2.2.2.8 (Hand-washing station) for requirements.

*(6) An area for practicing activities of daily living shall be provided.

A2.3-4.5.5.4 (6) Areas for practicing activities of daily living could include a household or outpatient therapy kitchen, bathroom, or other area that supports daily function for a resident or client. Residents living in a facility could also practice activities of daily living in their resident rooms or in a community space used as support space for occupational therapy.

*5.3-2.3.4 2.3-4.5.6 Outpatient Therapy Kitchen


*(1) Where a functioning outpatient therapy kitchen facilities with an operating kitchen are (rather than a mock-up for therapy only) is provided, it shall meet the following requirements shall apply in this section.

A5.3-2.3.4A2.3-4.5.6.1 (1) Outpatient therapy kitchen. Examples of outpatient therapy kitchen facilities include a country household kitchen or residential social activity kitchen for continued or improved involvement in instrumental activities of daily living. Because the purpose of a therapy kitchen is to replicate a kitchen in a participant’s home, therapy kitchens generally are not subject to the same accessibility requirements as other kitchens.

5.3-2.3.4.1(2) Purpose. Design of the outpatient therapy kitchen to shall support cooking activities used for occupational and physical therapy. shall be permitted:

2.3 Design Elements


2.3-4.5.6.2 Location. The outpatient therapy kitchen shall be located immediately accessible to occupational and physical therapy services.

2.3-4.5.6.3 Reserved

5.3-2.3.4.2*2.3-4.5.6.4 Design requirements. The Where provided, outpatient therapy kitchen facilities shall include the following:

A2.3-4.5.6.4 Dishwasher. A dishwasher should be considered if the functional program or therapy plan includes unloading dishes as part of the therapy program.

(1) Work counter

(2) Refrigerator

(3) Storage cabinets

(4) Sink

(5) Range, cooktop, and/or oven with emergency shutoffs. Provision of a functional cooking appliance shall be permitted.

(6) Dishwasher Hand-washing station. A hand-washing station that meets the requirements in Section 2.4-2.2.8 (Hand-Washing Stations) shall be located immediately accessible to the therapy kitchen.

*2.3-4.5.6.5 Lighting

A2.3-4.5.6.5 Lighting should be considered that meets the requirements in ANSI/IES RP-28: Lighting and the Visual Environment for Seniors and the Low Vision Population.

3.1-4.5.3 *2.3-4.5.7 Warming/Serving Kitchen

If the facility has a service contract with an outside vendor for food service, a warming kitchen designed to meet the following requirements shall be provided.

3.1-4.5.3.1 Where an outside vendor is used to provide meals, the facility shall include dedicated space and equipment for a warming kitchen, including space for minimal equipment for preparation of breakfast, emergency, or after-hours meals.

3.1-4.5.3.2 The resident kitchen shall be permitted to serve as an alternative location to accommodate the function of a warming kitchen. See Section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements.

A2.3-4.5.7 Purpose. The purpose of a warming/serving kitchen, also known as a satellite kitchen, is to support meal services for a home or community by facilitating the final preparation, plating, and presentation of meals that have been prepared in a commercial kitchen and transported to the warming/serving kitchen prior to serving. It may also provide space for dishwashing items such as glassware, china, and silverware that will not be returned to the commercial kitchen for washing.


2.3 Design Elements


*(1) Where a warming/serving kitchen is provided, it shall meet the requirements in this section.

(2) Access. The warming/serving kitchen shall be secured to prevent unauthorized access.

*2.3-4.5.7.2 Location. The warming/serving kitchen shall be located directly accessible to the dining room, household kitchen, or similar space where meals will be served to residents or participants.

A2.3-4.5.7.2 Consideration should be given to the proximity of the warming/serving kitchen to the commercial kitchen and provision of a convenient and direct circulation route, including horizontal and vertical means of conveyance, as applicable.

*2.3-4.5.7.3 Layout. The layout of the warming/serving kitchen shall provide a workflow that minimizes potential for cross-contamination of clean and soiled wares.

A2.3-4.5.7.3 Equipment

a. Equipment in the size and number appropriate for the type of food service being accommodated could include the following:

—Food transport cabinet (hot and cold) —Worktable —Range/oven —Exhaust hood with fire suppression —Steam table or cold well(s) —Plate warmer —Cold preparation table —Beverage equipment (hot and cold) —Ice maker/dispenser —Beverage table —Refrigerator —Freezer —Microwave —Ice cream cabinet

b. If items such as glassware, china, silverware, and/or utensils are to remain in the warming/serving kitchen, the following additional equipment may also be provided:

—Dishwasher —Warewashing sink —Eyewash station —Condensate hood —Dishracks —Dish dollies

c. If bulk pots and pans are washed in the warming/serving kitchen, a three-compartment sink should also be provided.

2.3-4.5.7.4 Regulations. Warming/serving kitchen facilities and equipment shall comply with federal, state, and local building and health codes.

2.3 Design Elements


2.3-4.5.7.5. Hand-washing station. A hand-washing station shall be provided in the warming/serving kitchen. See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.

2.3-4.6 Linen and Laundry Service Facilities

See facility chapters in Parts 3 through 5 for requirements.

2.3-4.7 Materials Management Facilities

*2.3-4.7.1 General

A2.3-4.7.1 Materials management includes procurement, receipt, storage, and distribution of services or products, including delivery of goods and pickup of materials for which handling is outsourced (e.g., soiled linen).

2.3-4.7.2 Receiving Areas

Where provided, a loading dock and receiving and breakout area(s) shall be permitted to be shared with other services.

2.3-4.8 Waste Management Facilities

2.3-4.8.1 Waste Collection and Storage Facilities

2.3-4.8.1.1 Facilities shall be provided for sanitary storage of waste and recyclables per local requirements ordinances.

2.3-4.8.1.2 These facilities shall be separate from food preparation, personal hygiene, and other clean functions.

2.3-4.8.1.3 See Section 2.2-2.5.1 (Storage and Collection of Recyclables and Discarded Goods) for additional requirements.

*2.3-4.8.2 Waste Disposal Facilities

Facilities for removal of waste (e.g., trash, medical waste, etc.) and recyclables shall be provided.

A2.3-4.8.2 Waste disposal facilities. Facilities for trash and waste removal may include trash chutes, individual container storage, or a combination of both. The process to be used for trash and waste removal should be identified so that physical space square footage can be determined.

2.3-4.9 Environmental Services Rooms

2.3-4.9.1 Location

Environmental services rooms shall be located throughout the facility as required to maintain a clean and sanitary environment.

2.3-4.9.2 Number

At least one environmental services room shall be provided for each floor and specific departments or areas (e.g., rehabilitation therapy departments/areas, food service areas, loading dock receiving, pick-up areas, etc.).

2.3 Design Elements


2.3-4.9.3 Facility Requirements

2.3-4.9.3.1 The amount of space provided in environmental services rooms shall be based on the size and number of housekeeping cart(s) used by the facility.

*2.3-4.9.3.2 Each environmental services room shall contain the following:

A2.3-4.9.3.2 A hand-washing station, hand sanitation station, or other means for hand-washing should be provided in the environmental services room.

(1) Service sink or floor-mounted mop sink

(2) An area for handling chemicals

(3) Storage space for housekeeping equipment, supplies, and chemicals

2.3-4.9.3.3 A means for securing environmental services rooms shall be provided.

2.3-4.10 Facilities for Engineering and Maintenance Services

2.3-4.10.1 General

The facilities included in this section shall be provided to support operations and maintenance functions.

2.3-4.10.2 General Maintenance Area

A general maintenance area shall be provided.

2.3-4.10.3 Equipment Locations

Room(s) or separate building(s) shall be provided for boilers, mechanical equipment, and electrical equipment.

2.3-4.10.4 Operations and Maintenance Records Storage

Provisions shall be made for storage of facility drawings, maintenance records, manuals, and similar records.

2.3-4.10.5 Maintenance Equipment and Supply Storage

2.3-4.10.5.1 A storage room shall be provided for building maintenance supplies.

2.3-4.10.5.2 Storage for solvents and flammable liquids shall comply with local, state, and federal code requirements.

2.3-4.10.5.3 Where grounds are maintained by in-house staff, yard equipment and supply storage areas shall be readily accessible to the areas to be maintained.

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