Health, Family Health and Preparedness, Licensing

Rule R432-8

Specialty Hospital - Chemical Dependency/Substance Abuse Construction

Notice of Proposed Rule

(Amendment)

DAR File No.: 35463
Filed: 11/18/2011 04:17:01 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

In Section R432-8-5, changes the base standard for Chemical Dependency specialty hospitals from referencing the general hospital standards to the psychiatric hospital standards. Updates a referenced standard that is out of date and out of print. Coordinates with the revised title of federal accessibility standards. In Section R432-8-6, clarifications and changes in terminology. In Section R432-8-7, coordinates with the change from general hospital standards to psychiatric hospital standards and reformatting and renumbering of a referenced standard. These changes have been vetted in two meetings with providers and interested parties and have been approved by the Health Facilities Committee.

Summary of the rule or change:

In Section R432-8-5, changes the referenced base standards for chemical dependency hospital from general (medically acute) hospital standards to psychiatric hospital standards. Updates the adopted reference from the 2001 Guidelines for Design and Construction of Hospital and HealthCare Facilities to the 2010 edition of the Guidelines for Design and Construction of Health Care Facilities. In Section R432-8-6, requires dining and day space for all patients, not just facilities with more than 100 patients. In Section R432-8-7, coordinates with the change from general hospital base standards to psychiatric standards and reformatting of the referenced standard.

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 21

This rule or change incorporates by reference the following material:

• Updates Guidelines for Design and Construction of Health Care Facilities, published by ASHE (American Society of Healthcare Engineering), 2010 edition

Anticipated cost or savings to:

the state budget:

The cost of purchasing the new referenced standard and the cost of printing and distribution of the revised rule is covered in Rule R432-4, General Construction, which is being amended concurrent with this rule. No others costs are expected. (DAR NOTE: The proposed amendment to Rule R432-4 is under DAR No. 35459 in this issue, December 15, 2011, of the Bulletin.)

local governments:

The rule change has no impact on local government because these standards are enforced at the state level.

small businesses:

There are currently no Chemical Dependency/Substance Specialty Hospitals in Utah.

persons other than small businesses, businesses, or local governmental entities:

There are currently no Chemical Dependency/Substance Specialty Hospitals in Utah.

Compliance costs for affected persons:

There are currently no Chemical Dependency/Substance Specialty Hospitals in Utah. The rule change will not increase compliance costs for prospective providers. If Chemical Dependency special hospitals are ever constructed in Utah a substantial savings is expected by building the facility to psychiatric standards rather than general hospital standards.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule has been extensively discussed with the regulated businesses and they appear to concur that updating the rule to adopt updated federal accessibility standards and the 2010 edition of the Guidelines for Design and Construction of Health Care Facilities is appropriate. Public comment received will be carefully evaluated for any unforeseen fiscal impact.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Family Health and Preparedness, Licensing
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Joel Hoffman at the above address, by phone at 801-538-6279, by FAX at 801-538-6024, or by Internet E-mail at jhoffman@utah.gov
• Andrew Baxter at the above address, by phone at 801-538-6140, by FAX at 801-538-6325, or by Internet E-mail at andrewbaxter@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

01/17/2012

This rule may become effective on:

01/24/2012

Authorized by:

David Patton, Executive Director

R432. Health, Family Health and Preparedness, Licensing.

R432-8. Specialty Hospital - Chemical Dependency/Substance Abuse Construction.

R432-8-1. Legal Authority.

This rule is adopted pursuant to Title 26, Chapter 21.

 

R432-8-2. Purpose.

This rule applies to a hospital that chooses to be licensed as a specialty hospital and which has as its major single service the treatment of patients with chemical dependency or substance abuse. The rule identifies the construction standards for a specialty hospital, if the hospital chooses to have a dual major service, e.g., chemical dependency or substance and psychiatric care, then both of the appropriate specialty hospital construction rules apply.

 

R432-8-3. General Design Requirements.

See R432-4-1 through R432-4-22.

 

R432-8-4. General Construction, Ancillary Support Facilities.

R432-4-23 applies with the following modifications:

(1) Corridors. Corridors in patient use areas shall be a minimum six feet wide.

(2) Door leaf width for patient room doors and doors to patient treatment rooms shall be a minimum three feet.

(3) Ceiling finishes. Ceiling construction in patient and seclusion rooms shall be monolithic.

(4) Bed pan flushing devices are optional.

(5) Windows, in rooms intended for 24-hour occupancy, shall be operable.

(6) Emergency Electrical Service.

(a) An on-site emergency generator shall be provided.

(b) The following services shall be connected to the emergency generator:

(i) life safety branch, as defined in section 517-32 of the National Electric Code NFPA 70;

(ii) critical branch, as defined in 517-33 of the National Electric Code NFPA 70;

(iii) equipment system, as defined in 517-34 of the National Electric Code NFPA 70;

(iv) telephone;

(v) nurse call;

(vi) heating equipment necessary to provide adequate heated space to house all patients under emergency conditions;

(vii) one duplex convenience outlet in each patient bedroom;

(viii) one duplex convenience outlet at each nurse station;

(ix) duplex convenience outlets in the emergency heated area at a ratio of one for each ten patients.

(6) Nurse Call System.

(a) A nurse call system is optional.

(b) If a nurse call system is installed, provisions shall be made for the easy removal or covering of call buttons.

 

R432-8-5. General Construction, Patient Service Facilities.

(1) The requirements of R432-4-24 and the requirements of [Chapter 7 including the Appendix]Sections 2.1 and 2.5 of the Guidelines for Design and Construction of [Hospital and] Health Care Facilities, [2001]2010 edition (Guidelines) shall be met. Where a modification is cited, the modification supersedes conflicting requirements of R432-4-24 and the Guidelines.[ Swing beds must meet Sections 7 and 8 of the Guidelines.]

(2) The environment of the nursing unit shall give a feeling of openness with emphasis on natural light and exterior views.

(a) Interior finishes, lighting, and furnishings shall suggest a residential rather than an institutional setting.

(b) Security and safety devices shall be presented in a manner which will not attract or challenge tampering by patients.

(3) Patient rooms.

(a) At least two single-bed rooms, with private toilet rooms, shall be provided for each nursing unit.

(b) Minimum patient room areas, exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules, shall be 100 square feet in single-bed rooms and 80 square feet per bed in multiple-bed rooms. The areas listed are minimum and do not prohibit larger rooms.

(c) Patient rooms shall include a wardrobe, closet, or locker, having minimum clear dimensions of 22 inches deep by 36 inches wide, suitable for hanging full-length garments. A break-away clothes rod and adjustable shelf shall be provided.

(d) Visual privacy is not required in all multiple-bed rooms, however privacy curtains shall be provided in five percent of multiple-bed rooms for use in treating detoxification patients.

(4) Laundry facilities shall be available to patients, including an automatic washer and dryer.

(5) Bathing facilities shall be provided in each nursing unit at a ratio of one bathing facility for each six beds not otherwise served by bathing facilities within individual patient rooms.

(a) Each bathtub or shower shall be in an individual room or enclosure adequately sized to allow staff assistance and designed to provide privacy during bathing, drying, and dressing.

(b) At least one shower in central bathing facilities shall be designed in accordance with [ADAAG]ADA/ABA-AG for use by a wheelchair patient.

(6) A toilet room with direct access from the bathing area shall be provided at each central bathing area.

(a) Doors to toilet rooms shall comply with [ADAAG]ADA/ABA-AG. The doors shall permit access from the outside in case of an emergency.

(b) A handwashing fixture shall be provided for each toilet in each toilet room.

(c) At least one patient toilet room in each nursing unit shall contain a shower or tub in addition to the toilet and lavatory. Fixtures shall be wheel chair accessible.

(7) There shall be at least one seclusion room for each 24 beds, or a fraction thereof, located for direct nursing staff supervision or equipped with a closed circuit television system with a monitor at the nursing station.

(a) Each seclusion room shall be designed for occupancy by one patient. The room shall have an area of at least 60 square feet and shall be constructed to prevent patient hiding, escape, injury, or suicide.

(b) If a facility has more than one nursing unit, the number of seclusion rooms shall be a function of the total number of beds in the facility.

(c) Seclusion rooms may be grouped in a common area.

(d) Special fixtures and hardware for electrical circuits shall be used to provide safety for the occupant.

(e) Doors shall be 44 inches wide and shall permit staff observation of the patient while providing patient privacy.

(f) Seclusion rooms shall be accessed through an anteroom or vestibule which also provides direct access to toilet rooms. The toilet and anteroom shall be large enough to safely manage the patient.

(g) Seclusion rooms including floor, walls, ceiling, and all openings, shall be protected with not less than one-hour-rated construction.

 

R432-8-6. Additional Specific Category Requirements.

(1) Dining, Recreation and Day Space. The facility layout shall include a minimum total inpatient space for dining, recreation, and day use computed on the basis of 30 square feet per bed[ for all beds in excess of 100].

(a) The facility shall include a minimum of 200 square feet for outpatients and visitors when dining is part of a day [care]treatment program.

(b) If dining is not part of a day [care]treatment program, the facility shall provide a minimum of 100 square feet of additional outpatient day space.

(c) Enclosed storage space for recreation equipment and supplies shall be provided in addition to the requirements of day use.

(2) Recreation and Group Therapy Space. At least two separate social areas, one designed for noisy activities and one designed for quiet activities, shall be provided as follows:

(a) At least 120 square feet shall be provided for each area.

(b) The combined area of the two areas shall be at least 40 square feet per patient.

(c) Activity areas may be utilized for dining activities and may serve more than one adult nursing unit.

(d) Activity areas shall be provided for pediatric and adolescent nursing units which are separate from adult areas.

(e) Space for group therapy shall be provided and activity spaces may be used for group therapy activities.

(3) Examination and treatment rooms shall be provided except when all patient rooms are single-bed rooms.

(a) An examination and treatment room may be shared by multiple nursing units.

(b) If provided, the room shall have a minimum floor area of 110 square feet, excluding space for vestibules, toilet, closets, and work counters, whether fixed or movable.

(c) The minimum allowable floor dimension shall be ten feet.

(d) The room shall contain a lavatory or sink equipped for handwashing, work counter, storage facilities, and a desk, counter, or shelf space for writing.

(4) A consultation room shall be provided.

(a) Rooms shall have a minimum floor space of 100 square feet, and be provided at a room-to-bed ratio of one consultation room for each 12 beds.

(b) They shall be designed for acoustical and visual privacy and constructed using wall construction assemblies with a minimum STC rating of 50.

(c) They shall provide appropriate space for evaluation of patient needs and progress, including work areas for evaluators and work space for patients.

(5) A multipurpose room for staff and patient conferences, education, demonstrations, and consultation, shall be provided.

(a) It shall be separate from required activity areas defined in R432-8-6(2).

(b) If provided in the administration area, it may be utilized for this requirement if it is conveniently accessible from a patient-use corridor.

(6) If child education is provided through facility-based programs, a room shall be provided in the adolescent unit for this purpose. The room shall contain at least 20 square feet per pediatric and adolescent bed, but not less than 250 square feet. Multiple use rooms may be used, but must be available for educational programs on a first priority basis.

(7) Pediatric and adolescent nursing units shall be physically separated from adult nursing units and examination and treatment rooms. In addition to the [service] requirements of R432-8-[7]6(1) through (5), individual rooms or a multipurpose room shall be provided for dining, education, and recreation. Insulation, isolation, and structural provisions shall minimize the transmission of impact noise through the floor, walls, or ceiling of these multipurpose rooms. Service rooms may be shared by more than one pediatric or adolescent nursing unit, but shall not be shared with adult nursing units.

(a) A patient toilet room, in addition to those serving bed areas, shall be conveniently accessible from multipurpose rooms.

(b) Storage closets or cabinets for toys, educational, and recreational equipment shall be provided.

 

R432-8-7. Exclusions From the Standard.

The following sections of the Guidelines do not apply:

[(1) Parking, Section 7.1.D, Subsection 7.2.A4, and 7.2.A.

(2) Infectious Isolation Rooms, Section 7.2.c.

(3) Protective Isolation Rooms, Section 7.2.D.

(4) Seclusion Rooms, Section 7.2.E.

(5) Critical Care Units, Section 7.3.

(6) Newborn Nurseries, Section 7.4.

(7) Pediatric and Adolescent Unit, Section 7.5.

(8) Psychiatric Nursing Unit, Section 7.6.

(9) Surgical Suite, Section 7.7.

(10) Obstetrical Suite, Section 7.8.

(11) Emergency Services, Section 7.9.

(12) Imaging Suite, Section 7.10.

(13) Nuclear Medicine, Section 7.11.

(14) Laboratory Services, Section 7.12.

(15) Renal Dialysis Unit, Section 7.14.

(16) Rehabilitation Therapy Department, Section 7.13.

(17) Respiratory Therapy Services, Section 7.15.

(18) Morgue, Section 7.16.

(19) Pharmacy, Section 7.17.

(20)](1) Linen Services, Section [7.23]2.5-5.2.

 

R432-8-8. Penalties.

The Department may assess a civil money penalty of up to $10,000 and deny approval for patient utilization of new or remodeled areas if a health care provider does not submit architectural drawings to the Bureau of Licensing. The Department may assess a civil money penalty of up to $10,000 if the licensee fails to follow approved architectural plans. The Department may assess a civil money penalty of up to $1,000 per day for each day a new or renovated area is occupied prior to licensing agency approval.

 

KEY: health care facilities

Date of Enactment or Last Substantive Amendment: [February 4, 2010]2012

Notice of Continuation: November 24, 2009

Authorizing, and Implemented or Interpreted Law: 26-21-5; 26-21-2.1; 26-21-20