// CODE SNIPPET
Section 1228 Acute Psychiatric Hospitals
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The provisions of this section shall apply to
acute psychiatric hospitals.
New buildings and additions, alterations
or repairs to existing buildings subject to licensure shall
comply with applicable provisions of the California Electrical
Code, California Mechanical Code, California Plumbing
Code, California Energy Code, California Fire Code (Parts
3, 4, 5, 6 and 9 of Title 24) and this section.
Note: Refer to the applicable exceptions under Section
1224.2.
Refer to California Administrative
Code (Part 1 of Title 24), Section 7-119, Functional
Program, for requirements. Projects associated
with acute psychiatric hospitals and with psychiatric nursing
units in general acute-care hospitals shall include a
Patient Safety Risk Assessment.
The definitions provided under Section
1224.3 apply to this section except as modified below:
ACUTE PSYCHIATRIC HOSPITAL. Acute psychiatric hospital means a hospital having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff which provides 24-hour inpatient care for mentally disordered, incompetent or other patients referred to in Division 5 (commencing with Section 5000) or Division 6 (commencing with Section 6000) of the Welfare and Institutions Code, including the following basic services: medical, nursing, rehabilitative, pharmacy and dietary services.
BASIC SERVICES. Basic services mean those essential services required by law for licensure as an acute psychiatric hospital including medical, nursing, rehabilitative, pharmaceutical, dietary and support services.
HOSPITAL. Hospital, where used in this section, means an acute psychiatric hospital.
SALLY PORT. A compartment provided with two or more doors where the intended purpose is to prevent continuous and unobstructed passage by allowing the release of only one door at a time.
ACUTE PSYCHIATRIC HOSPITAL. Acute psychiatric hospital means a hospital having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff which provides 24-hour inpatient care for mentally disordered, incompetent or other patients referred to in Division 5 (commencing with Section 5000) or Division 6 (commencing with Section 6000) of the Welfare and Institutions Code, including the following basic services: medical, nursing, rehabilitative, pharmacy and dietary services.
BASIC SERVICES. Basic services mean those essential services required by law for licensure as an acute psychiatric hospital including medical, nursing, rehabilitative, pharmaceutical, dietary and support services.
HOSPITAL. Hospital, where used in this section, means an acute psychiatric hospital.
SALLY PORT. A compartment provided with two or more doors where the intended purpose is to prevent continuous and unobstructed passage by allowing the release of only one door at a time.
Acute psychiatric
hospitals shall comply with the provisions under Section
1224.4, General Construction, where applicable, except as
supplemented, amended or modified below. Specific application
shall respond to the patient injury and suicide prevention
component of the Patient Safety Risk Assessment prepared
under California Administrative Code (Part 1 of Title 24),
Section 7-119.
Examination
rooms in acute psychiatric hospitals shall meet the
requirements of Section 1224.4.4.1.1 as amended
below:
Examination rooms
shall be permitted to serve several nursing units
and shall be permitted to be on a different floor,
unless prohibited by specific sections of this code
or by the Patient Safety Risk Assessment.
Examination
rooms shall have a minimum clear floor area of
120 square feet (11.15 m2).
Where provided,
refer to Section 1224.4.4.1.2.
Where provided, refer to Section
1224.4.4.1.3.
Refer to Section
1224.4.4.1.4.
Where provided, a quiet
room for a single patient who requires a period of
solitude but does not require a seclusion room, shall
have a minimum clear floor area of 80 square feet
(7.43 m2).
Refer to Section 1224.4.4.2.
Where provided, refer to Section 1224.4.4.3.
Refer to Section
1224.4.4.4.
Refer to Section
1224.4.4.5.
Refer to Section
1224.4.4.6.
Refer to Section
1224.4.4.7.
Where provided,
refer to Section 1224.4.5.
Refer to Section
1224.4.6 for requirements regarding station outlets, gas
and vacuum systems, hyperbaric facilities, laboratories,
and nurse call systems.
Refer to Section 1224.4.7
Refer to Section
1224.4.8 with the following modifications and amendments:
- Where indicated by the Patient Safety Risk Assessment, toilet room doors shall be equipped with keyed locks that allow staff to control access to the toilet room.
- Use of door closers is to be avoided unless required by other sections of this code.
- Door hinges shall be designed to minimize accessible anchor points (e.g., cut hinge type, piano hinge, concealed hinge, etc.).
- Except for specifically designed ligature-resistant hardware, door lever handles shall point downward when in the latched and in the unlatched position.
- All hardware shall have tamper-resistant fasteners.
- Windows located in patient care areas, or areas
used by patients, shall limit the opportunities for
patients to inflict harm to themselves or others.
- All glazing (interior and exterior) shall be fabricated
with polycarbonate or laminate on the
inside of the glazing or with any glazing that
meets or exceeds the requirements for Class 1.4
per ASTM F1233-08 (2013), Standard Test
Method for Security Glazing Material and Systems.
Exception: Use of tempered glass for interior borrowed lights shall be permitted where allowed by the Patient Safety Risk Assessment. - Where window treatments are provided, they shall be designed without accessible anchor points.
- Where operable windows are provided in patient rooms or suites, openings shall be limited to prevent the passage of a 4-inch (102 mm) sphere.
- All glazing (interior and exterior) shall be fabricated
with polycarbonate or laminate on the
inside of the glazing or with any glazing that
meets or exceeds the requirements for Class 1.4
per ASTM F1233-08 (2013), Standard Test
Method for Security Glazing Material and Systems.
- Anchorage for windows and window assemblies (including frames, hinges and locking devices) shall be designed to resist impact loads applied from the inside and shall be tested in accordance with ANSI Z97.1, Safety Glazing Materials Used in Buildings.
- A minimum net glazed area of not less than 8 percent of the floor area of each indoor activity space and dining space shall be provided.
Refer to Section 1224.4.10
unless noted otherwise.
Interior finishes shall comply
with Section 1224.4.11 as amended in this section. Special
design consideration shall be given to injury and suicide
prevention in the context of the Patient Safety Risk Assessment.
Refer to Section 1224.4.11.4 with
the following modifications and amendments:
Ceilings shall be monolithic in seclusion rooms, exam/treatment rooms, patient bedrooms, patient toilet rooms, or patient bathing facilities.
Ceilings shall be monolithic in seclusion rooms, exam/treatment rooms, patient bedrooms, patient toilet rooms, or patient bathing facilities.
Refer to Section 1224.4.12
Refer to Section 1224.4.13.
Refer
to Section 1224.4.14.
Refer to Section 1224.4.15
Refer to Section
1224.4.16.
Refer to Section 1224.4.17.
Refer to Section 1224.4.18 with the
following modifications and amendments:
Refer to Section 1224.4.19.
Built-in furnishings in
areas accessible to patients shall comply with the following
requirements:
- Built-in furnishings with doors or drawers shall not be provided.
- Open shelves shall be fixed with tamper-resistant hardware.
- When provided, clothing rods or hooks shall be ligature resistant.
- The following are not permitted:
- Towel bars.
- Shower curtain rods.
- Lever handles, except where a specifically designed ligature-resistant lever handle is used.
Lighting in areas identified in
the Patient Safety Risk Assessment as high- and
medium-risk areas shall be tamper resistant. Refer to
California Electrical Code.
When electrical receptacles
are provided in a patient bedroom, the receptacles
shall be in compliance with California Electrical
Code.
All handwashing fixtures
that are accessible to patients, including those
located in patient rooms and patient toilet rooms, shall
include ligature-resistant features that do not compromise
compliance with the hot and cold water supply controls,
laminar flow, and sink requirements of the California
Plumbing Code. Handwashing fixtures within patient
rooms and patient toilet rooms in psychiatric nursing units
are not required to be equipped with gooseneck spouts
and the discharge point may be less than 5 inches (127
mm) above the fixture rim.
Refer to Section 1224.5.
The psychiatric rehabilitation
activities service space may be centralized for common use or
may be located in each nursing unit in response to the Patient
Safety Risk Assessment. The following areas are required in
the psychiatric rehabilitation activities service space:
- At least two separate activity rooms, one appropriate for group recreation and one for quiet activities to serve as a patient lounge, shall be provided.
- Space requirements. The combined area of these rooms shall have a minimum of 25 square feet (2.32 m2) per patient bed, with at least 120 square feet (11.15 m2) of clear floor area for each of the two spaces.
An outdoor activity
area shall be provided. Outdoor areas shall meet the
following requirements:
- Fences and walls shall be designed to:
- Be installed with tamper-resistant hardware.
- Have a minimum height of 10 feet (3048 mm) above the outdoor area elevation.
- Be anchored and constructed to withstand the body force of a 350-pound (158-kg) person.
- If provided, gates or doors in the fence or wall
shall:
- Swing away from the outdoor activity area.
- Have the hinge installed on the outside of the outdoor activity area.
- Be provided with a locking mechanism that has been coordinated with egress requirements of Section 1004.5, Outdoor areas.
- Lights shall not be accessible to patients. Lighting in the outdoor activity area shall not be pole mounted.
- If provided, security cameras shall not be accessible to patients and cameras shall view the entire outdoor activity area.
- If provided, furniture shall be secured from movement. Furniture shall not be placed in locations where it can be used to climb the fence or wall.
- Space for staff conferences, patient evaluation
and progress reports.
- Where outpatients are treated, there shall be a waiting area compliant with the requirements of Section 1228.4.5.
Where provided,
the physical therapy service space shall comply
with Section 1224.35.2.
Where
provided, occupational therapy service space shall comply
with Section 1224.35.3.
Where provided, the speech pathology service
space shall comply with Section 1224.35.4.
Psychiatric nursing units shall comply with the requirements
of this section. If the nursing unit is a locked unit, the primary
access point to the unit shall be through a sally port. For
"secure treatment facilities," alternate designs for locked
unit access without individual sally ports may be approved by
the enforcement agency when it can be demonstrated that the
alternate design meets performance requirements without
compromising any health or life-safety requirement.
Each patient bedroom shall
meet the following standards:
Maximum room capacity shall
be two patients.
Exception: Where renovation of existing individual
acute psychiatric hospital patient rooms is undertaken
in facilities built under the 2013, or prior,
California Building Code, maximum room capacity
shall be no more than the present capacity, to a
maximum of eight patients per patient room. Placement
of beds shall not be more than three deep from
the exterior window.
Patient bedrooms
shall have a minimum clear floor area of 100 square
feet (9.29 m2) for single-bed rooms and 80 square feet
(7.43 m2) per bed for multiple-bed rooms.
Each patient bedroom shall
have a window in accordance with Section 1228.4.9.
Refer to Section
1224.14.1.5.
Handwashing stations
shall comply with Section 1228.4.22. Handwashing
stations are required in patient toilet rooms.
Handwashing stations are not required in patient bedrooms.
Each patient shall have in
their room a separate wardrobe, locker, or closet for
storing personal effects. Shelves for folded garments
shall be used instead of arrangements for hanging garments.
Visual privacy in multibed rooms
(e.g., cubicle curtains) is not required in psychiatric
nursing units.
Each patient room
shall be labeled with an identification number, letter or
combination of the two.
Provision for the services listed
below shall be in or immediately accessible to each psychiatric
nursing unit. The size and location of each service
area will depend upon the numbers and types of beds
served. Identifiable spaces are required for each of the indicated
functions. If a service area is specifically permitted to
serve more than one nursing unit, there shall be at least one
such service area located on each nursing unit floor.
Refer to Section 1224.4.4.2.
A separate
charting area with provisions for acoustic and
patient file privacy shall be provided.
Refer to
Section 1228.4.22 for the definition of handwashing
station. Handwashing stations in high- or mediumpatient-risk
areas shall be ligature resistant.
Office(s) for staff shall
be provided.
- Staff lounge facilities. Staff lounge facilities may be combined between units.
- Staff toilet rooms.
- Staff storage locations. Securable closets or cabinet compartments for the personal effects of nursing personnel shall be immediately accessible to the administrative center or nurse station.
Multipurpose
rooms shall be provided for staff, patients, patients'
families for patient visits, conferences, reports, education,
training sessions, and consultation. These rooms
shall be readily accessible to each nursing unit. One
such room may serve several psychiatric nursing units.
Refer
to Section 1228.4.4.1.1.
Refer to Section
1228.4.4.6
Refer to Section
1228.4.4.7.
Refer to Section
1228.4.4.4.