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// CODE SNIPPET

Section 457 Mental Health Programs

2017 FBC - Building, 6th edition > 4 Special Detailed Requirements Based on Use and Occupancy > 457 Mental Health Programs
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457.1 Public Mental Health Crisis Stabilization Units and Short-Term Residential Treatment Programs

457.1.1 Scope

Crisis stabilization units and short-term residential treatment units shall comply with the design and construction standards in this section.

Note: Other administrative and programmatic provisions may apply. See Department of Children and Family Services (DCFS) Rule 65E-12, Florida Administrative Code, and Chapter 394, Florida Statutes.

457.1.2 Definitions

CRISIS STABILIZATION UNIT (CSU). A statesupported mental health service or program and is a short-term alternative to inpatient psychiatric hospitalization and an integrated part of a designated public receiving facility under the authority of Chapter 394, Florida Statutes. A CSU provides brief intensive services for individuals who are presented as acutely mentally ill on a 24-hour-a-day, seven-day-a-week basis, under the licensing authority of the department of Children and Families and the Agency for Health Care Administration. The purpose of a CSU is emergency psychiatric reception, psychiatric examination, to stabilize and redirect people to the most appropriate and least restrictive treatment settings consistent with their needs.

SHORT-TERM RESIDENTIAL TREATMENT PROGRAM (SRT). A state-supported acute care 24-hour-a-day, seven-day-a-week residential alternative service, generally of 90 days or less, and which is an integrated part of a designated public receiving facility and receives state mental health funds under the authority of Chapter 394, Florida Statutes. The purpose of an SRT is to provide less acute intensive short-term treatment to individuals who have previously been admitted to either a hospital or CSU and have been transferred to the SRT as being temporarily in need of a 24-hour-aday structured therapeutic setting in a less restrictive, but longer-stay alternative to hospitalization.

457.1.3

Facility standards for facilities licensed prior to or on July 14, 1993.

457.1.3.1 Building Construction Requirements

457.1.3.1.1

Construction, additions, refurbishing, renovations, and alterations to existing facilities shall comply with the following codes and standards:

  1. The building codes described in the Florida Building Code;
  2. The fire codes contained in Chapter 69A-44, "Minimum Fire Safety Standards for Residential Alcohol and Drug Abuse Treatment and Prevention Programs, Mental Health Residential Treatment Facilities and Crisis Stabilization Units," Florida Administrative Code, as described in NFPA 101, Chapters 18 and 19, Special Definitions, as adopted by the Florida Fire Prevention Code, as applicable to limited health care facilities, which is included by reference in Chapter 59A-3, Florida Administrative Code.

457.1.3.2 Minimum Physical Plant Requirements

Each CSU and SRT shall conform to the requirements of Sections 457.1.3.2.1 through 457.1.3.2.12.

457.1.3.2.1

In multiple occupancy bedrooms or sleeping areas there shall be a minimum of 60 square feet (6 m2) per bed and no less than a 30-inch (762 mm) separation between beds. Bedrooms shall be limited to a maximum of four occupants.

457.1.3.2.2

The minimum size of a single occupant bedroom shall be 55 square feet (5 m2).

457.1.3.2.3

Each CSU shall have at least one seclusion room and another room which may be used as a seclusion room. Each SRT shall have a seclusion room. Seclusion rooms shall be a minimum of 55 square feet (5 m2). If a restraint bed is utilized it shall have access around it and be bolted to the floor. Seclusion rooms shall minimally include a mattress. Ceilings shall be solid, and all lighting fixtures shall be tamperproof, and power receptacles are not permitted in the room.

457.1.3.2.4

The facility shall have at least one water fountain readily accessible for the use of persons receiving services.

457.1.3.2.5

The facility shall have a minimum ratio of one shower for each eight individuals and one toilet and lavatory for each six individuals. Individual shower stalls and dressing areas shall be provided. The use of gang showers is prohibited. Access to a bathroom shall not be through another person's room.

457.1.3.2.6

The facility shall have a locked area for personal possessions being held for safekeeping. Individual shelves or other similar dividers shall be provided in the locked area for the storage of personal possessions. The facility shall have written policies and procedures to ensure reasonable access to personal possessions.

457.1.3.2.7

Each facility shall have a fenced outside recreation area with a minimum fence height of no less than 6 feet (1829 mm) suitable for impeding elopements.

457.1.3.2.8

External windows shall have security screens or equivalent protection.

457.1.3.2.9

The facility shall provide an appropriate separate nontreatment area to serve as a general reception area with accommodations for such activities as receiving visitors. This reception area shall be separated from the treatment area by a locked doorway.

457.1.3.2.10

When a CSU is collocated with another program, as provided for in Section 65E-12.106(23), Florida Administrative Code, the following minimum facility requirements shall be met.

Collocation means the operation of CSU and SRT, or CSU and substance abuse detoxification services from a common nurses' station without treatment system integration. It may result in the administration of those services by the same organization and the sharing of common services, such as housekeeping, maintenance and professional services.

  1. A CSU shall be separated and secured by locked doors, used by persons receiving services, from the SRT and detoxification units.
  2. Whenever a CSU is collocated with an SRT or substance abuse detoxification unit there shall be no compromise in CSU standards. In all instances, whenever there is a conflict between CSU rules and SRT, alcohol or drug abuse rules, the more restrictive rules shall apply.

457.1.3.2.11

All CSUs shall be locked facilities and, to the maximum extent practical, provide a locked perimeter around a living unit and fenced exercise area within which individuals can reside 24 hours-aday in an environment designed to minimize potential for injury. Where this is not possible, operational compensation shall be made as follows:

  1. Each person receiving services shall be provided a minimum of 175 square feet (16 m2) of usable client space within the CSU. Useable client space is the sum, in gross square feet, of all rooms, interior wall to interior wall, that are part of a CSU and SRT facility. Mechanical and electrical rooms, administrative and staff offices, screening areas, nurses' stations, visitor and reception areas, crawl space and attic space are excluded. Bedrooms shall be spacious and attractive, and activity rooms or space shall be provided.
  2. CSU facilities shall be locked to provide reasonable control over access to and egress from the unit, recreational area, and emergency reception areas. When individuals are moved to other areas, the pathways shall also be locked or have adequate control provisions to prevent elopement. Such controlled passageways shall include access to the emergency reception area, unit proper, off unit doorways, and recreational areas.
  3. All unit door locks shall employ a common key for rapid access in emergency situations with quick releasing or single-turn mechanisms.

457.1.3.2.12

Food preparation areas for 13 or more persons shall comply with the provisions of Chapter 64E-11, Florida Administrative Code, "Food Hygiene."

457.1.3.3 Health and Sanitation

457.1.3.3.1

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

457.1.3.3.2

Hot and cold running water under pressure shall be readily available in all washing, bathing and food preparation areas. Hot water in areas used by persons being served shall be at least 100°F (38°C) but not exceed 120°F (49°C).

457.1.3.4 Seclusion Room

Each CSU shall have at least one seclusion room located in the CSU facility. Additional space shall be available that can be used either as a seclusion room or bedroom, as need dictates. Policies and procedures shall be developed on handling emergency situations that require seclusion. Each SRT shall have a seclusion room.

457.1.4 Minimum Construction Standards for CSU and SRT Facilities Initially Licensed After July 14, 1993

457.1.4.1 Construction Requirements

457.1.4.1.1 New Facility Construction

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

  1. The building codes described in the Florida Building Code.
  2. The fire codes contained in Chapter 69A-44, "Minimum Fire Safety Standards for Residential Alcohol and Drug Abuse Treatment and Prevention Programs, Mental Health Residential Treatment Facilities and Crisis Stabilization Units," Florida Administrative Code, as described in NFPA 101, Chapters 12 and 13, "Special Definitions," as adopted by the Florida Fire Prevention Code, as applicable to limited health care facilities, which is included by reference in Chapter 59A-3, Florida Administrative Code.
  3. The accessibility requirements of the Florida Building Code, Accessibility.

457.1.4.1.2 Plumbing

All plumbing shall comply with the requirements of the Florida Building Code, Plumbing.

457.1.4.1.3 Inspections and Certificate of Occupancy

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.

457.1.4.1.4 Sprinklers

No unsprinklered building classification as defined in the Florida Building Code, Building, is allowed. All facilities shall be protected throughout by an approved automatic sprinkler and smoke detection system to include a smoke detector in every bedroom. Provision shall be made for automatic emergency forces notification.

457.1.4.1.5 Surge Protection

Surge protection in compliance with the National Electric Code, Article 280, as incorporated by reference in Chapter 27 of the Florida Building Code, Building, 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.

457.1.4.2 Overall Functional Design

457.1.4.2.1

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 a 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 nonunit activities shall not be through the locked CSU or SRT unit.

457.1.4.2.2

The walls throughout all client areas of the CSU or SRT shall either be concrete block or a double layer of gypsum wallboard or 3/4-inch (19 mm) thick plaster on 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.

457.1.4.2.3

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.

457.1.4.2.4

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.

457.1.4.2.4.1 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.

457.1.4.2.4.2 General Observation Area

This shall include areas where persons routinely congregate or walk through such as multioccupant 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.

457.1.4.2.5

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 (0.009 m3/s) 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 (0.02 m3/s) per person to the outside in order to minimize smoke diffusion throughout the unit.

457.1.4.2.6

All doors opening directly onto the unit from nonclient 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.

457.1.4.2.7

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 6 foot (1829 mm) clear width; nonclient areas must be at least 44 inches (1118 mm) minimum clear width. Corridor ceilings shall be a minimum height of 7 feet 6 inches (2284 mm).

457.1.4.2.8

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°F (38°C), but not exceed 120°F (49°C).
SEE MORE

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