65E-12.109. Minimum Construction Standards for New CSU and SRT Facilities Initially Licensed After July 14, 1993

(1) General Provisions.

(a) Construction Requirements.

1. New facility construction and additions, refurbishing, renovations and alterations to existing facilities shall comply with the following codes and standards:

a. The building codes described in Rule 9B-3.047, F.A.C.;

b. The fire codes contained in Chapter 4A-3, F.A.C., as described in the National Fire Protection Association (N.F.P.A.) 101, Chapters 12 and 13, Special Definitions, as applicable to limited health care facilities, which is included by reference in Chapter 59A-3, F.A.C.;

c. The accessibility by handicapped persons standards in Chapter 553, Part V, F.S.; and

d. The federal Americans with Disabilities Act as referenced in Chapter 59A-3, F.A.C.

2. Modernization or Renovation. Any alteration, or any installation of new equipment, shall be accomplished, as nearly as practical, in conformance with the requirements for new construction. Alterations shall not diminish the level of safety or usable client space below that which exists prior to the alteration. Life safety features which do not meet the requirements for existing buildings shall not be further diminished. Life safety features in excess of those required for new construction are not required to be maintained. In no case shall the resulting life safety be less than that required for existing buildings.

3. Sewage, including liquid wastes from cleaning operations, shall be disposed of in a public sewage system or other approved sewage system in accordance with Chapters 381, F.S., and 403, F.S.

4. All sanitary facilities shall comply with the requirements of Chapter 64E-10, F.A.C.

5. All plumbing shall comply with the requirements of Chapter 9B-51, F.A.C., Plumbing, or with the plumbing code legally applicable to the area where the facility is located.

6. The water supply must be adequate, of safe and sanitary quality and from an approved source in accordance with Chapters 381, F.S., and 64E-4, F.A.C.

7. Appropriate health and sanitation inspections and a Certificate of Occupancy shall be obtained before occupying any new facility or addition. A report of the most recent inspections must be on file and accessible to authorized individuals.

8. No unsprinkled building classification as defined in the 1985 Standard Building Code, as incorporated by reference in Chapter 59A-3, F.A.C., is allowed.

9. All facilities shall be protected throughout by an approved automatic sprinkler and smoke detection system to include a smoke detector in every bedroom. Provision must be made for automatic emergency forces notification.

10. Surge protection in compliance with the National Electric Code Article 280, as incorporated by reference in Chapter 59A-3, F.A.C., shall be installed to protect each service entrance equipment and have integral visual indication of surge protector failure. Additional surge protection shall be provided for all low voltage and power connections to all electronic equipment and conductors entering or exiting the building and other life safety systems equipment such as fire alarm, telephone, and nurse call. Protection shall be in accordance with appropriate IEEE standards for the type of equipment being protected.

(b) Overall Functional Design.

1. The CSU or SRT shall be designed to provide a locked perimeter around a living unit and fenced exercise area within which individuals can reside 24-hours-a-day in an environment designed to minimize potential for injury. The CSU or SRT structure shall be single story ground level facility. These facilities shall have separate off-unit reception and administration areas which may also be locked. Service corridors and pathways to other non-unit activities shall not be through the locked CSU or SRT unit.

2. The walls throughout all client areas of the CSU or SRT shall either be concrete block or a double layer of gypsum wallboard or three-quarter inch think plaster or metal lath to minimize maintenance of the facility. The general architecture of the unit shall provide for optimal line-of-sight observation from the nurses’ station throughout the unit, minimizing hidden spots and blind corners.

3. The CSU or SRT shall be designed to create a pleasant functional therapeutic environment throughout, by the use of sunlight, colors, designs, textures, and furnishings. The design shall achieve a secure unit which looks more residential than institutional in its construction and furnishings, while incorporating substantial safety considerations throughout.

4. The CSU or SRT shall be designed in order that the general unit be divided into a close observation area and a general observation area based upon the need for frequent physical proximity, singular observation of individuals, and lowered stimulation levels. These areas do not need physical separation; for example, they may be the left and right sides of the unit.

a. Close Observation Area. This area shall include persons brought onto the CSU or SRT needing initial observation or restraints, individualized observation, and lowered stimulation levels, all of which require the frequent physical proximity of nurses. This area shall be directly adjacent to the primary unit doorway and nurses’ station. The immediately adjacent rooms shall be used for single occupancy and restraint or seclusion. These rooms shall be remote from routine high activity areas and corridors.

b. General Observation Area. This shall include areas where persons routinely congregate or walk through such as multi-occupant bedrooms, activity rooms, smoking areas, dining room and routine traffic corridors, or pathways. The dining and activity areas shall be directly observable, or under constant staff supervision, but may be a greater distance from the nurses’ station.

5. All areas of CSUs and SRTs shall be ventilated by central, ducted supply and return forced air systems. Toilets, bathrooms and soiled function rooms shall be mechanically exhausted to the outside. Ventilation units shall distribute tempered heated or cooled air to all spaces and shall supply outside air in the quantity of either the sum of all exhausts or 20 cfm per person whichever is greater. The quality of all exhausts must match the intake volume of all outside air. Supply, exhaust, and return fans shall run continuously while the building is occupied. Areas in which smoking is permitted shall be well vented by at least 35 cfm per person to the outside in order to minimize smoke diffusion throughout the unit.

6. All doors opening directly onto the unit from non-client rooms or office areas shall be equipped with locksets which are key released to leave the client area and permit unobstructed return to the client area. Door closures are required to deny persons receiving services accidental unsupervised access to the contents of staff offices, janitorial closets, and mechanical areas.

7. Corridors shall ensure maximum clear distances by recessing water fountains and fire extinguishers, or placing them in alcoves. Corridors in client areas must be at least a six foot clear width; non-client areas must be at least 44 inches minimum clear width. Corridor ceilings shall be a minimum height of seven feet six inches.

8. Hot and cold running water under pressure shall be readily available in all washing, bathing, food preparation, and food handling areas. Hot water in client areas shall be at least 100 degrees Fahrenheit, but not exceed 120 degrees Fahrenheit.

9. The minimum size for doors shall be no less than three feet wide and six feet eight inches high. Areas accessible to persons with physical disabilities shall comply with applicable codes and standards.

10. Since glass fragments are a safety hazard throughout the unit, the use of glass shall be minimal.

11. All television sets must be securely fastened.

12. Door closures shall not be utilized in unobserved client areas.

13. All CSUs and SRTs equipped with electronic locks on internal doors or egress doors shall ensure that such locks have manual common key mechanical override that will operate in the event of a power failure or fire. Egress pathways and doors shall be locked as provided for in Life Safety Code, National Fire Protection Association (N.F.P.A.) 101, Chapter 12, as incorporated by reference in Chapter 59A-3, F.A.C.

14. CSUs and SRTs with electronic or magnetic door locks or other fundamental operational components which are electric shall have either: a battery back-up system rated for facility emergency power draw and capable of sustaining door locks and emergency operations for a minimum period of 6 hours; or an emergency generator with transfer switch with a battery pack back-up system capable of operating for 2 hours at facility emergency power draw level.

15. The use of door vision panels and windows shall minimize the opportunity for isolation of staff or persons served in unobserved areas. This does not include privacy provisions such as bathrooms and bedrooms.

(2) Uniform Specifications.

(a) Design shall ensure that each person receiving services in a CSU or SRT is provided a minimum of 175 square feet of usable client space.

(b) Tamper-resistant screws shall be used to protect electrical switches and outlets throughout the facility in all areas accessible to persons receiving services. Lighting fixtures shall be tamper-proof type throughout the facility in all areas accessible to persons receiving services.

(c) All electrical switches and outlets in wet areas shall be ground-fault protected with a remote breaker switch. Tamper-proof, safety type duplex outlets shall be used in all areas accessible to persons receiving services.

(d) Air ducts shall be covered with a perforated type metal grill, not residential louvered grills, throughout the unit in all areas accessible to persons receiving services.

(e) All hose bibs shall be equipped with a vacuum breaker device.

(f) The unit shall have a minimum of one drinking fountain.

(g) Ceiling height in bedrooms, activity areas, and bathrooms shall be at least nine feet.

(h) The operation of all perimeter locks shall ensure reasonable control over both access and egress.

(3) Administration and Public Areas.

(a) Waiting rooms shall have an adjacent rest room which is designed to accommodate persons with physical disabilities.

(b) The entrance shall be grade-level, sheltered from inclement weather and accessible to persons with physical disabilities.

(c) The lobby shall include a drinking fountain and space for clerical personnel. Private interview space for emergency screening of voluntary persons shall be adjacent to the lobby.

(4) Emergency Screening Area For CSUs.

(a) This shall be a locked area in which law enforcement admissions may be received. This area shall not be wholly isolated visually from the CSU to provide safety for emergency screening personnel who may become isolated in this area. This area shall provide for medical clearance, emergency screening, bathroom facilities, and other activities which may be necessary.

(b) A separate entrance shall be provided directly to emergency screening areas and examination rooms for law enforcement personnel. It shall have a driveway where a law enforcement vehicle can pull immediately adjacent to the building before transferring a person through the separate entrance to the emergency screening area. The law enforcement entrance shall also have a lock box where the law enforcement officer can lock his weapons during such time as he is in the facility.

(c) A separate bathroom with supervised shower area shall be located so that all persons being admitted may be showered before being admitted to the residential section of the unit.

(5) Seclusion Rooms.

(a) Each CSU shall have a minimum of two seclusion rooms that shall share a common vestibule with a bathroom off the vestibule area. Each SRT shall have at least one seclusion room. Seclusion rooms shall be free of sharp edges or corners and be strongly constructed to withstand repeated physical assaults. Walls shall be either concrete block or double layered to provide resistance and be smooth. The ceilings shall be nine feet in clear height, hard-coated, and lighting fixtures recessed and tamper-proof. Lighting fixtures shall be nonbreakable, preferably Lexan, and shall be installed with tamper-proof screws, as shall any other items in the seclusion rooms. The seclusion room door shall be heavy wood or metal at least 36 inches in width and shall open outward. The door frame shall be heavy steel and shall be thoroughly bolted into the wall and cemented in.

(b) At least one seclusion room in the CSU shall have a sturdily constructed bed, without sharp edges and bolted to the floor. A bed in the SRT seclusion room is optional; however, if present, the bed shall meet the same requirements as specified for the CSU. Its placement in the room shall provide adequate space for staff to apply restraints and not assist individuals in tampering with the lights, smoke detectors, cameras, or other items that may be in the ceiling of the room. There shall be a rheostat control mechanism outside the room to adjust the illumination of the light in the seclusion room.

(c) The floor and walls, up to a height of three feet, shall be coated with an impermeable finish to resist penetration of body fluids. One seclusion room shall have a floor drain. A hose bib shall be in a readily adjacent area such as a bathroom.

(d) There shall be a vision panel in the door of the seclusion room, no larger than eight inches by eight inches, which provides a view of the entire room. This vision panel shall be Lexan or other suitably strong material and it shall be securely mounted in the door. Provisions shall be made to ensure privacy from the public and other persons receiving services while providing easy access for staff observation.

(e) Seclusion rooms shall be a minimum of 70 square feet and a minimum room dimension of nine feet.

(f) Fire sprinkler heads shall be ceiling mounted and either recessed or flush mounted type without a looped spray dispersal head.

(g) A voice activated and switchable emergency calling system for monitoring persons receiving services shall be provided in each seclusion room.

(h) Each seclusion room shall have an electronic visual monitoring system capable of viewing the entire room and be monitored from the nurses’ station.

(6) Janitor’s Closet.

(a) A janitor’s closet shall be on the unit. It shall contain a floor receptor for mop water and provide space for mop bucket, brooms, and other minimal items. Caustic and other dangerous chemicals shall not be stored in this closet.

(b) This closet shall have an automatic door closer and have automatic relocking type lock.

(7) Bathrooms.

(a) Access to a bathroom shall not be through another person’s bedroom. Bathrooms shall provide space, in addition to bathing, for dry clothes and changing of clothes and for observation staff. The shower head shall be recessed or have a smooth curve from which items cannot be hung. There shall be no overhead rod, privacy stall supports, protrusions, or fixtures capable of carrying more than 40 pounds of weight. The ceiling shall be hard coated. Sprinkler heads shall be either recessed or a flush mounted type dispersal head. The toilet shall be a flushometer-type, not residential with water tank and cover. Toilets shall be of heavy duty construction securely fastened to the floor and have seats with locking nuts. Secure cleanout access shall be provided for the toilet to clean out plugs and pipes. Floor drains in bathroom areas shall be of sufficient size that they cannot be plugged by standing on them.

(b) Mirrors shall not be common glass. A polycarbonate mirror, fully secured, and flat-mounted to the wall is required. Polished metal mirrors shall not be permitted.

(c) Lighting fixtures shall be recessed and tamper-proof with Lexan or other strong translucent material.

(d) Bathroom fixtures, shower, lavatory, and toilet shall be readily accessible from a common area. If not accessible from a common area, they will be deemed to be available only to the occupants of directly adjoining bedroom or bedrooms.

(e) Each CSU and SRT shall have a bathroom of sufficient size for use by persons with physical disabilities. It shall include toilet, lavatory, shower, and safety grab bars for shower and toilet.

(f) The facility shall have a minimum ratio of one shower for each eight persons receiving services and one toilet and lavatory for each six persons receiving services. Individual shower stalls and dressing areas shall be provided. The use of gang showers is prohibited.

(8) Nurses’ Station.

(a) The nurses’ station shall be positioned so that the unit may be under constant direct visual surveillance. Charting and records areas shall be located in the rear of the nurses’ station, and not in a separate area, so that staff on duty can readily observe the client areas. A bathroom shall be nearby for staff use. The nurses’ station, if separated from client areas, shall utilize either Lexan or safety wire glass for enclosure to above counter top level. If not enclosed the counter top shall be at least 18 inches in width.

(b) Thirty is the maximum number of beds which may be served by a common nurses’ station in collocated units, as described in subsection 65E-12.106(23) of this Rule.

(c) The nurses’ station, which functions as the primary control center, shall have necessary electronic assistance such as camera monitors and intercoms in more remote areas where persons may become isolated. Areas warranting visual and auditory monitoring includes remote entrance or egress doors, isolated hallways, after hours law enforcement entrance, emergency screening area, and fenced recreational yard.

(9) Medication Room. The medication room shall be located near the nurses’ station. The medication room shall have a sink, refrigerator, locked storage, and facilities for dispensing medication. Security against unauthorized access must be assured. The refrigerator shall store medications and clean materials only.

(10) Examination Room. A suitable examination room shall be provided for physical examinations, nursing assessments, and other related medical activities. It shall include a sink for handwashing.

(11) Bedrooms.

(a) Ceilings shall be non-accessible to prohibit persons receiving services from entering attic spaces or having access to overhead pipes and beams. Light switches and electrical outlets shall be secured with non-tamper type screws. When feasible each bedroom shall have a window, operable by staff, with an exterior view. Window sills shall not exceed a height of 36 inches above floor level and should incorporate protective screens or Lexan type material to prevent direct access to glass surfaces. There should be no overhead protrusions available for hanging in excess of 40 pounds weight.

(b) Beds and other heavy furniture suitable for barricading the door shall be secured to the floor or walls.

(c) Multiple occupant bedrooms shall be limited to a maximum of four occupants and shall be a minimum size of 60 square feet per bed with no less than a 30 inch separation between beds. Single occupant bedrooms shall be a minimum of 80 square feet.

(d) Bedroom doors shall be a minimum of 36 inches wide.

(12) Kitchen and Nourishment Preparation Area.

(a) Preparation or food handling areas shall have water and plumbing fixtures suitable for cleaning dining utensils. The requirements for nourishment preparation areas is less than that of kitchens due to the minimal scale of operations for these areas. If these areas are accessible to persons receiving services, they should include appropriate safety considerations for sharp and other dangerous instruments and the elimination of hot surfaces. Space shall be provided for disposal of wet garbage. Refrigeration and freezer space shall be provided in these areas for the carry-over of a minimum amount of perishable food.

(b) Kitchens shall comply with Chapter 64E-11, F.A.C., Food Preparation and Sanitation Requirements, as well as the 1985 National Fire Protection Association, Section 101, Chapters 12 and 13, Fire Safety Requirements as incorporated by reference in Chapter 59A-3, F.A.C. Kitchens shall be designed with flow-through type operation where food arriving is immediately placed into dry storage or freezer units without walking through food preparation areas. The flow-through type system would provide for the preparation of food, serving and dishes returned with garbage and waste going out to an adjacent dumpster and can-wash with water collection curbing and drain. A concrete pad shall be provided for the trash dumpster and garbage truck entrance.

(c) Kitchens shall be equipped with fire-suppression hoods and through-wall grease laden air evacuation and ventilation systems. All electrical outlets shall be ground-faulted. If meals are to be served via an open area, directly from the kitchen, this area shall have a fire-rated steel retractable overhead door type mechanism to continue the firewall protection around the kitchen area. Kitchens shall have heat detectors rather than smoke sensors.

(d) External to the kitchen, and outside the waste exit door, there shall be a curbed slop sink for mops and dirty kitchen water with an immediately accessible hose bib and drain. This area shall be external to the kitchen area, but immediately adjacent to it, to provide ready disposal of waste water as well as for the removal of cleaning items from the kitchen when they are not in use.

(e) There shall be a large food storage pantry in or adjacent to the kitchen.

(f) Facilities utilizing off-site kitchens for food preparation shall have an on-site food reception, warming, and holding area of sufficient size and with sufficient equipment to warm and hold food for each meal served. Required space shall include provision for proper disposal or holding of used implements and disposal of wet garbage in accordance with Chapter 64E-11, F.A.C.

(13) Dining Area. Each CSU or SRT shall have an attractive dining area on the unit. Seating capacity shall reflect the licensed capacity of the entire CSU or SRT, although residents may eat or be served in shifts during daily operations. Individual, rather than bench seating, shall be used for easy floor cleaning.

(14) Unit Laundry Facilities.

(a) Provision shall be made for the storage of soiled laundry in an adjacent, isolated, fire-resistant area.

(b) Each CSU or SRT shall have a personal laundry room which shall incorporate a flow-through design in which dirty laundry enters, is sorted, placed in the washer, dried, folded and moved out without crossing clean laundry with dirty laundry. CSUs and SRTs shall have a small washer and dryer for immediate unit needs and to wash clothes. These washing and drying units shall be equipped to sanitize clothes as a preventive measure of infection control.

(c) The soiled laundry room shall have a locked door equipped with automatic door closer to restrict access to cleaning chemicals. The soiled laundry room air shall be exhausted outside the facility.

(15) Clean Laundry Room.

(a) A separate space shall be provided for clean laundry capable of storing an adequate supply of laundry for the size of the CSU or SRT. The laundry closet shall have a locked door to prevent access to these items by persons receiving services.

(b) Items stored on the top shelf shall provide an 18 inch clear space from sprinkler heads so as to not block dispersal of water.

(16) Fenced Recreational Area.

(a) CSUs and SRTs shall have a no less than six foot high fenced, out-of-doors area where persons receiving services may have access to fresh air and exercise. It must provide privacy for persons receiving services otherwise exposed to public view. This area shall be constructed to retain persons inside the area and minimize elopements from the area, although it is not a secure area.

(b) The fenced area shall provide some shaded area where persons receiving services may be out of doors without being in direct sunlight or may receive sunlight as they desire. The enclosing fences shall have an exit gate which is located away from the building as a secondary egress from the fenced area, for use in fire situations, or access by lawn maintenance equipment. The gate shall be provided with a lock which is readily accessible from both sides. The area of this fenced enclosure shall be at least 1,100 square feet including an activity area having dimensions of not less than 20 feet by 40 feet.

(c) Objects shall not be placed near the fence to provide a ready step ladder over the fence and, if fabric fencing is used, the horizontal bracing used for corners shall be outside the fabric to preclude its use as an escape ladder step. The fenced area shall be designed, without blind corners, to be readily visible by one staff member standing in a central location. If desired, the fence may be topped with a 45 degree inward slanting restraining type wire. The use of barbed wire and other sharp injurious materials, however, is prohibited.

(d) This area, as all other primary fire exit routes, shall have egress lighting which is connected to the power side of the facility electrical panel so that in the event of a fire and electrical panel disconnect, the exit and congregation areas would still have lighting.

(17) Multi-Purpose Room. In addition to open, on-unit floor space, each CSU and SRT shall have an accessible multipurpose room for group activities of at least 180 square feet. This area may be the dining area.

(18) Furnishings.

(a) CSU and SRT furniture shall be durably constructed for heavy wear and use. Furniture shall not be readily throwable. Furnishings shall have a flame resistant rating.

(b) Hollow-based type furniture shall not be used as they provide ready concealment of contraband items such as medications, sharps, wires, or cords.

(c) Furnishings shall have finishes which are readily cleanable.

(d) Bedroom furniture shall provide limited storage space since individuals stay a short period of time and personal supplies are limited.

(e) Within the above constraints, furniture shall contribute to the appearance of a residential rather than institutional environment.

(19) Off Unit Storage Areas.

(a) Each CSU and SRT shall have appropriate storage, in non-client areas, for operating supplies and materials.

(b) Adjacent non-client area storage for personal belongings must be a minimum of eight cubic feet for each person receiving services.

Specific Authority 394.879(1), (2) FS. Law Implemented 394.875 FS. History–New 7-14-92, Formerly 10E-12.109, Amended 9-1-98.