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1228.1 Scope
The provisions of this section shall apply to acute psychiatric hospitals.
1228.2 Application
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.
1228.2.1 Functional Program
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.
1228.3 Definitions
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.
1228.4 General Construction
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.
1228.4.1 Reserved
1228.4.2 Reserved
1228.4.3 Reserved
1228.4.4 Support Areas for Patients
1228.4.4.1 Examination and Treatment Rooms
1228.4.4.1.1 Examination Room
Examination rooms in acute psychiatric hospitals shall meet the requirements of Section 1224.4.4.1.1 as amended below:
1228.4.4.1.1.1 Location
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.
1228.4.4.1.1.2 Space Requirements
Examination rooms shall have a minimum clear floor area of 120 square feet (11.15 m2).
1228.4.4.1.2 Treatment Room
Where provided, refer to Section 1224.4.4.1.2.
1228.4.4.1.3 Airborne Infection Isolation Exam/ Treatment Room
Where provided, refer to Section 1224.4.4.1.3.
1228.4.4.1.4 Seclusion Room
Refer to Section 1224.4.4.1.4.
1228.4.4.1.5 Quiet Room
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).
1228.4.4.2 Administrative Center(s) or Nurse Station(s)
1228.4.4.3 Specimen and Blood Collection Facilities
Where provided, refer to Section 1224.4.4.3.
1228.4.4.4 Medication Station
Refer to Section 1224.4.4.4.
1228.4.4.5 Nourishment Area or Room
Refer to Section 1224.4.4.5.
1228.4.4.6 Clean Utility/Work Room
Refer to Section 1224.4.4.6.
1228.4.4.7 Soiled Utility/Work Room
Refer to Section 1224.4.4.7.
1228.4.5 Outpatient Waiting Rooms
Where provided, refer to Section 1224.4.5.
1228.4.6 Miscellaneous Requirements
Refer to Section 1224.4.6 for requirements regarding station outlets, gas and vacuum systems, hyperbaric facilities, laboratories, and nurse call systems.
1228.4.7 Corridors
1228.4.8 Doors and Door Openings
Refer to Section 1224.4.8 with the following modifications and amendments:
  1. 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.
  2. Use of door closers is to be avoided unless required by other sections of this code.
  3. Door hinges shall be designed to minimize accessible anchor points (e.g., cut hinge type, piano hinge, concealed hinge, etc.).
  4. Except for specifically designed ligature-resistant hardware, door lever handles shall point downward when in the latched and in the unlatched position.
  5. All hardware shall have tamper-resistant fasteners.
1228.4.9 Windows and Screens
  1. Windows located in patient care areas, or areas used by patients, shall limit the opportunities for patients to inflict harm to themselves or others.

    1. 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.
    2. Where window treatments are provided, they shall be designed without accessible anchor points.
    3. 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.
  2. 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.
  3. 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.
1228.4.10 Ceiling Heights
Refer to Section 1224.4.10 unless noted otherwise.
1228.4.11 Interior Finishes
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.
1228.4.11.1 Reserved
1228.4.11.2 Reserved
1228.4.11.3 Reserved
1228.4.11.4 Ceilings
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.
  1. In these rooms, the ceiling shall be secured from patient access.
  2. Mechanical, electrical, and plumbing systems, other than terminal elements serving the room (e.g., diffusers, registers, luminaires, etc.), shall be concealed above the ceiling.
1228.4.12 Courts
1228.4.13 Elevators
1228.4.14 Garbage, Solid Waste and Trash Storage
1228.4.15 Housekeeping Room
1228.4.16 Laundry and Trash Chutes
Refer to Section 1224.4.16.
1228.4.17 Telephones
1228.4.18 Grab Bars
Refer to Section 1224.4.18 with the following modifications and amendments:
  1. Grab bars, including those that are part of fixtures such as soap dishes, shall be sufficiently anchored to sustain a concentrated load of 250 pounds (113.4 kg).
  2. Grab bars shall be graspable and shall be ligature resistant.
1228.4.19 Noise Control
1228.4.20 Built-in Furnishings
Built-in furnishings in areas accessible to patients shall comply with the following requirements:
  1. Built-in furnishings with doors or drawers shall not be provided.
  2. Open shelves shall be fixed with tamper-resistant hardware.
  3. When provided, clothing rods or hooks shall be ligature resistant.
  4. The following are not permitted:

    1. Towel bars.
    2. Shower curtain rods.
    3. Lever handles, except where a specifically designed ligature-resistant lever handle is used.
1228.4.21 Building Systems
1228.4.21.1 Lighting
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.
1228.4.21.2 Receptacles
When electrical receptacles are provided in a patient bedroom, the receptacles shall be in compliance with California Electrical Code.
1228.4.22 Handwashing Stations
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.
1228.5 Communication System
Refer to Section 1224.5.
1228.6 Reserved
1228.7 Reserved
1228.8 Reserved
1228.9 Reserved
1228.10 Reserved
1228.11 Reserved
1228.12 Reserved
1228.13 Psychiatric Rehabilitation Activities Service Space
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:
1228.13.1 Patient Care Areas
1228.13.1.1 Indoor Activity Rooms
  1. 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.
  2. 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.
1228.13.1.2 Outdoor Activity Area
An outdoor activity area shall be provided. Outdoor areas shall meet the following requirements:
  1. Fences and walls shall be designed to:

    1. Be installed with tamper-resistant hardware.
    2. Have a minimum height of 10 feet (3048 mm) above the outdoor area elevation.
    3. Be anchored and constructed to withstand the body force of a 350-pound (158-kg) person.
  2. If provided, gates or doors in the fence or wall shall:

    1. Swing away from the outdoor activity area.
    2. Have the hinge installed on the outside of the outdoor activity area.
    3. Be provided with a locking mechanism that has been coordinated with egress requirements of Section 1004.5, Outdoor areas.
  3. Lights shall not be accessible to patients. Lighting in the outdoor activity area shall not be pole mounted.
  4. If provided, security cameras shall not be accessible to patients and cameras shall view the entire outdoor activity area.
  5. 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.
1228.13.1.3 General Support Areas
  1. Space for staff conferences, patient evaluation and progress reports.

    1. Staff conference room. A conference and treatment planning room shall be provided.
    2. Office space separate from the activities area.
  2. Where outpatients are treated, there shall be a waiting area compliant with the requirements of Section 1228.4.5.
1228.13.2 Physical Therapy Service Space
Where provided, the physical therapy service space shall comply with Section 1224.35.2.
1228.13.3 Occupational Therapy Service Space
Where provided, occupational therapy service space shall comply with Section 1224.35.3.
1228.13.4 Speech Pathology and/or Audiology Service Space
Where provided, the speech pathology service space shall comply with Section 1224.35.4.
1228.14 Psychiatric Nursing Service Space
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.
1228.14.1 Patient Rooms
Each patient bedroom shall meet the following standards:
1228.14.1.1 Capacity
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.
1228.14.1.2 Space Requirements
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.
1228.14.1.3 Windows
Each patient bedroom shall have a window in accordance with Section 1228.4.9.
1228.14.1.4 Reserved
1228.14.1.5 Outside Exposure
Refer to Section 1224.14.1.5.
1228.14.1.6 Handwashing Stations
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.
1228.14.1.7 Patient Toilet Room
  1. Each patient shall have access to a toilet room without having to enter a corridor.

    Exception: Corridor access to the patient toilet room shall be permitted at pediatric or adolescent patient bedrooms and in specific patient bedrooms where the use of corridor access is part of the hospital's written Patient Safety Risk Assessment and management program.
  2. One toilet room shall serve no more than two patient bedrooms and no more than four patients.
  3. The toilet room shall contain a toilet and a handwashing station.
1228.14.1.8 Patient Storage
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.
1228.14.1.9 Privacy
Visual privacy in multibed rooms (e.g., cubicle curtains) is not required in psychiatric nursing units.
1228.14.1.10 Grab Bars
Grab bars provided in accessible patient toilet rooms shall comply with Section 1228.4.18.
1228.14.1.11 Room Identification
Each patient room shall be labeled with an identification number, letter or combination of the two.
1228.14.2 Service Areas
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.
1228.14.2.1 Administrative Center(s) or Nurse Station(s)
1228.14.2.1.1 Documentation Area
A separate charting area with provisions for acoustic and patient file privacy shall be provided.
1228.14.2.1.2 Handwashing Station(s)
Refer to Section 1228.4.22 for the definition of handwashing station. Handwashing stations in high- or mediumpatient-risk areas shall be ligature resistant.
1228.14.2.2 Office(s) for Staff
Office(s) for staff shall be provided.
1228.14.2.3 Support Areas for Staff
  1. Staff lounge facilities. Staff lounge facilities may be combined between units.
  2. Staff toilet rooms.
  3. 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.
1228.14.2.4 Multipurpose Room(s)
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.
1228.14.2.5 Examination and Treatment Room
UpCodes note: The section number of this amendment on the original document was "1224.14.2.5". UpCodes has corrected this to "1228.14.2.5".
1228.14.2.6 Clean Utility/Workroom
Refer to Section 1228.4.4.6
1228.14.2.7 Soiled Utility/Workroom
Refer to Section 1228.4.4.7.
1228.14.2.8 Medication Station
Refer to Section 1228.4.4.4.
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