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Part 1 General

Part 2 Common Elements for Residential Health, Care, and Support Facilities

Part 3 Residential Health Facilities

Part 4 Residential Care and Support Facilities

Part 5 Non-Residential Support Facilities

Heads up: There are no amended sections in this chapter.
Appendix material, shown in shaded boxes at the bottom of the page, is advisory only.
This chapter contains elements that are common to most types of residential health, care, and support facilities.
The common elements in this chapter are required only where referenced in the facility chapters in Part 3 (Residential Health Facilities), Part 4 (Residential Care and Support Facilities), and Part 5 (Non-Residential Support Facilities).
Additional specific requirements are located in the facility chapters in Parts 3, 4, and 5.
See Section 1.2-5.5 (Planning for Sustainability) for additional requirements.
The site design shall be developed to minimize negative environmental impacts associated with buildings and related site development.
A2.2-2.1.1 Sustainable design features. A minimum of 40 percent of the entire site should incorporate one or any combination of the following:
  1. Bio-retention facilities, rain gardens, filter strips, grass swales, vegetated level spreaders, constructed wetlands, planters, or open space with plantings in a growing medium at least 12 inches (300 mm) deep. Planted areas should be bio-diverse with at least 60 percent coverage in native or adapted plants.
  2. A green roof with a growing medium at least 3 inches (75 mm) deep.
  3. Permeable pavement, permeable pavers (open-grid pavers), or open graded (uniform-sized) aggregate with a minimum percolation rate of 2 gallons/minute/ft2 (100 L/minute/m2). Consideration of their effect on the care population (including cognitive and physical ability) and how exterior spaces will be used should be evaluated before selecting permeable pavement, permeable pavers, or open graded aggregate.
Site development considerations shall include the following:
Land use
Storm water management
Habitat preservation
Landscape design and irrigation systems
Shading
Natural ventilation
Renewable energy use
Mitigation of effects from heat islands
To reduce energy consumption, the site and building orientation shall be evaluated for potential solar and wind energy feasibility and subsequent installations.
The orientation of the buildings on the site shall be evaluated to maximize use of daylighting. See appendix section A1.2-2.2.2.2 (1)(a) (Building orientation) for more information about building orientation and related site issues.
The location of the building shall be evaluated according to the impact of site exterior noise, acoustics, and the care population. See Section 1.2-5.2 (Acoustic Planning) and Section 2.5-8 (Acoustic Design Systems) for additional requirements.
Landscape areas shall be evaluated for irrigation needs and estimated water consumption.
A2.2-2.1.3.4 Irrigation of landscape areas
  1. An irrigation system should supply no more than a third of the improved landscape area with potable water. All other irrigation should be provided from alternative on-site sources of water or municipally reclaimed water.
  2. Automatic irrigation systems should be hydro-zoned to water according to the needs of different plant materials, such as turf grass vs. shrubs. Landscaping sprinklers should be installed to prevent water spray either on or within 3 feet (91.44 centimeters) of a building.
  3. Irrigation systems serving the project site should be controlled by a smart controller that uses weather data to adjust irrigation schedules or an on-site rain or moisture sensor that automatically shuts the system off after a predetermined amount of rainfall or sensed moisture in the soil.
  4. A temporary irrigation system used exclusively for new landscape establishment should be used no longer than necessary for successful landscape establishment.
A2.2-2.2 Energy efficiency. Health care facilities should set energy efficiency goals and consider energy efficiency strategies while making sure to meet the light power density and functional needs of residents and staff.
  1. Sample energy efficiency goals
    • —Apply ASHRAE 90.1: Energy Standard for Buildings Except Low-Rise Residential Buildings.
    • —Apply ANSI/ASHRAE/ASHE Standard 189.3: Design, Construction, and Operation of Sustainable High-Performance Health Care Facilities.
    • —Design to earn ENERGY STAR rating.
    • —Design to meet LEED, Green Globes, or other green building rating system energy criteria.
    • —Design to meet International Green Construction Code (IgCC) requirements.
  2. Sample energy efficiency strategies
    • —Use computer modeling early in schematic design of major new projects to help develop energy efficiency strategies and opportunities.
    • —Reduce overall energy demand. Sample strategies for this purpose include using a high-efficiency building envelope; passive and low-energy sources of lighting (including daylighting); advanced lighting controls integrated with daylighting strategies; heat recovery and natural ventilation; and high-efficiency equipment, as part of building mechanical and electrical systems (e.g., chillers and air handlers) and for plug loads (e.g., ENERGY STAR copiers, computers, medical equipment, appliances).
    • —Optimize energy efficiency. Mechanical and electrical control systems should optimize consumption to the minimum actual needs for the building. Consider using multiple modular HVAC equipment units or variable-speed drives for variable loads. Consider co-generation systems for converting natural gas to heating (or cooling) and electricity. Select equipment with improved energy efficiency ratings.
    • —Reduce environmental impacts associated with combustion of fossil fuels and refrigerant selection. Consider various renewable sources of energy generation, including purchase of green power, solar and wind energy, or geothermal ground source heat pumps.
Energy efficiency goals shall be considered in all phases of facility development or renovation. Architectural elements that reduce energy consumption shall be considered as part of facility design.
The quality of the health care facility environment shall be supportive of the occupants and the function served. Therefore, design for energy efficiency shall enhance, not adversely affect, resident health, safety, and accepted personal comfort levels.
A2.2-2.2.2 For information on lighting, lighting levels, and automated lighting controls, see Section 2.5-7 (Daylighting and Artificial Lighting Systems).
Mechanical and electrical systems shall be selected and sized to meet loads, minimize space use, and take advantage of climate characteristics, daylighting opportunities, and building orientation to reduce overall energy demand and consumption.
Products shall comply with the minimum efficiencies addressed in one or more of the following:
  1. National Appliance Energy Conservation Act (NAECA)
  2. Energy Policy Act (EPAct)
  3. Energy Independence and Security Act (EISA)
A2.2-2.3.1 Potable water consumption can be reduced by using low-consumption plumbing fixtures and controls, low-consumption irrigation systems, and landscape design such as xeriscaping as well as replacing items such as water-cooled pumps and compressors that use potable water sources with non-evaporative heat rejection equipment (air-cooled or ground source) or equipment that uses non-potable water sources.
Potable water quality and conservation strategies shall be evaluated in all phases of facility development or renovation.
Design for water conservation shall not adversely affect resident health, safety, or infection control.
A2.2-2.3.2 Water measurement devices. Measurement devices with remote communication capability should be provided to collect water consumption data for the domestic water supply to the building. In addition, for individual leased, rented, or other tenant or sub-tenant space in any building totaling more than 50,000 square feet (4,645 square meters), separate sub-meters should be provided for potable and reclaimed water used in the building project. For subsystems with multiple similar units, such as multi-cell cooling towers, only one measurement device is required for the subsystem. Utility company service entrance/interval meters should be permitted for use in complying with this requirement.
Evaluate plumbing fixtures and fittings to maximize water conservation based on the care population.
Where potable water is used, evaluate once-through cooling equipment for water recovery options.
A2.2-2.3.4 Water recovery options. Where potable water is used in an open-loop (once-through) configuration as the emergency backup cooling system, it should not be used as the primary cooling system. The primary cooling system in these critical applications should be a closed-loop system requiring no potable water use except for system makeup.
A2.2-2.4 Indoor environmental quality
  1. A healthy and productive indoor environment should be accomplished through design measures such as adequate ventilation, low- or zero-VOC (volatile organic compound) finishes and furnishings, reduced moisture entrapment, daylighting, and acoustic design measures. Such measures should not conflict with health care safety and infection control codes, standards, and requirements.
  2. Carpeting, upholstery, paint, adhesives, and manufactured wood products may emit volatile organic compounds, such as formaldehyde and benzene. Use low- or zero-VOC paints, stains, adhesives, sealants, and other construction materials, where practical, for building products.
  3. Materials or construction systems that are permeable and can trap moisture may promote microbial growth. All permeable building materials should be protected from exposure to moisture prior to and during construction. If permeable materials are exposed to moisture, they should be dried within 72 hours or removed.
  4. High-volume photocopiers and aerosolized cleaners and medications have been identified as sources of indoor air pollution. Dedicated exhaust ventilation may be necessary for specialty areas where these pollutants may accumulate or be disbursed (e.g., housekeeping, maintenance, and copy rooms and hair salons).
See Section 1.2-5.4 (Indoor Air Quality Planning) for additional requirements.
A2.2-2.4.1 Indoor air quality
  1. Thermal environmental conditions for human occupancy. The building should be designed in compliance with Section 6.1 (Design) and Section 6.2 (Documentation) of ANSI/ASHRAE 55: Thermal Environmental Conditions for Human Occupancy.
    For additional information, see appendix section A1.2-4.5.4 (User control of environment), Section 2.5-3.1.2 (Ventilation and Space Conditioning), and building system sections in the facility chapters in Parts 3 through 5.
  2. Tobacco smoke-free environment
    • —Signage indicating that smoking is not allowed in buildings should be posted within 10 feet (3 meters) of each building entrance.
    • —Where designated smoking areas are provided, they should be located a minimum of 25 feet (7.6 meters) from building entrances, outdoor air intakes, and operable windows.
See appendix table A2.2-a (Maximum Concentration of Air Pollution Relevant to Indoor Air Quality) for recommended allowable concentrations.

Appendix Table A2.2-a
Maximum Concentration of Air Pollution Relevant to Indoor Air Quality
Contaminant Maximum Concentration (µg/m3 unless otherwise noted)
NON-VOLATILE ORGANIC COMPOUNDS
Carbon monoxide (CO) 9 ppm and no greater than 2 ppm above outdoor levels
Ozone 0.075 ppm (8-hour to 24-hour)
Particulates (PM2.5) 35 (24-hour)
Particulates (PM10) 150 (24-hour)
VOLATILE ORGANIC COMPOUNDS
Acetaldehyde 140
Acrylonitrile 5
Benzene 60
1,3-Butadiene 20
t-Butyl methyl ether (Methyl-t-butyl ether) 8,000
Carbon disulfide 800
Caprolactam1 100
Carbon tetrachloride 40
Chlorobenzene 1,000
Chloroform 300
1,4-Dichlorobenzene 800
Dichloromethane (Methylene chloride) 400
1,4-Dioxane 3,000
Ethylbenzene 2,000
Ethylene glycol 400
Formaldehyde 33
2-Ethylhexanoic acid1 25
n-Hexane 7,000
1-Methyl-2-pyrrolidinone1 160
Naphthalene 9
Nonanal1 13
Octanal1 7.2
Phenol 200
4-Phenylcyclohexene (4-PCH)1 2.5
2-Propanol (Isopropanol) 7,000
Styrene 900
Tetrachloroethene (Tetrachloroethylene, Perchloroethylene) 35
Toluene 300
1,1,1-Trichloroethane (Methyl chloroform) 1,000
Trichloroethene (Trichloroethylene) 600
Xylene isomers 700
Total volatile organic compounds (TVOC) _2
1This test is required only if carpets and fabrics with styrene butadiene rubber (SBR) latex backing material are installed as part of the base building systems.
2TVOC reporting should be in accordance with the California Department of Public Health Standard Method for the Testing and Evaluation of Volatile Organic Chemical Emissions from Indoor Sources Using Environmental Chambers as well as the individual VOC levels listed in this table.
A2.2-2.4.1.1 Emissions and VOCs
  1. Adhesives and sealants. Products in this category include adhesives for the following materials: carpet, resilient, and wood flooring; base cove; ceramic tile; drywall and other wall and ceiling panels; aerosol adhesives; and adhesive primers. They also include the following sealants: acoustic sealants; firestop materials; HVAC air duct sealants; and primers and caulks. All adhesives and sealants used in the interior of the building (e.g., inside the weatherproofing system and applied on-site) should comply with the following requirements:
    • —Emissions requirements. Emissions should be determined according to the limit requirements in the Standard Method for the Testing and Evaluation of Volatile Organic Chemical Emissions from Indoor Sources Using Environmental Chambers, version 1.2, published by the California Department of Public Health.
    • —VOC content requirements. VOC content should comply with and should be determined according to the following requirements:
      • • Adhesives, sealants, and sealant primers: SCAQMD Rule 1168: Adhesive and Sealant Applications. HVAC duct sealants should be classified in the "Other" category in the SCAQMD Rule 1168 sealants table.
      • • Aerosol adhesives: Green Seal Standard GS-36: Adhesives for Commercial Use.
      Exception: The following solvent welding and sealant products are not required to meet the emissions or VOC content requirements listed above.
    • —Cleaners, solvent cements, and primers used with plastic piping and conduit in plumbing, fire suppression, and electrical systems.
    • —HVAC air duct sealants when the air temperature of the space in which they are applied is less than 40° F (4.5° C).
  2. Paints and coatings. Products in this category include sealers, stains, clear wood finishes, floor sealers and coatings, waterproofing sealers, primers, flat paints and coatings, non-flat paints and coatings, and rust-preventative coatings. Paints and coatings used on the interior of the building (defined as inside the weatherproofing system and applied on-site) should comply with the following:
    • —Emissions requirements. Emissions should be determined according to the limit requirements in the California Department of Public Health Standard Method for the Testing and Evaluation of Volatile Organic Chemical Emissions from Indoor Sources Using Environmental Chambers, version 1.2.
    • —VOC content requirements. VOC content should comply with and be determined according to the following requirements:
      • • Architectural paints, coatings and primers applied to interior surfaces: Green Seal Standard GS-11: Paints, Coatings, Stains, and Sealers.
      • • Clear wood finishes, floor coatings, stains, sealers, and shellacs: SCAQMD Rule 1113.
  3. Floor covering materials. Floor covering materials installed in the building interior should comply with the following:
    • Limit requirements in California Department of Public Health Standard Method for the Testing and Evaluation of Volatile Organic Chemical Emissions from Indoor Sources Using Environmental Chambers, version 1.2
    • —Multiple-attribute standards with third-party certification, inclusive of indoor air quality:
      • • ANSI A138.1: Green Squared Specifications for Sustainable Ceramic Tiles, Glass Tiles, and Tile Installation Materials
      • • NSC 373: Sustainability Assessment for Natural Dimension Stone
      • • NSF/ANSI 140: Sustainability Assessment for Carpet
      • • NSF/ANSI 332: Sustainability Assessment for Resilient Floor Coverings
  4. Composite wood, wood structural panel, and agrifiber products. Composite wood, wood structural panel, and agrifiber products used on the interior of the building (defined as inside the weatherproofing system) should contain no added urea-formaldehyde resins.
    • —Laminating adhesives used to fabricate on-site and shop-applied composite wood and agrifiber assemblies should contain no added urea-formaldehyde resins.
    • —Composite wood and agrifiber products are defined as particleboard, medium-density fiberboard (MDF), wheatboard, straw-board, panel substrates, and door cores.
    • —Emissions for products covered by this section should be determined according to and should comply with one of the following:
      • • Third-party certification indicating compliance with Title VI—Formaldehyde Standards for Composite Wood Products of the federal Toxic Substance Control Act
      • • Limit requirements in California Department of Public Health Standard Method for the Testing and Evaluation of Volatile Organic Chemical Emissions from Indoor Sources Using Environmental Chambers, version 1.2
      Exception: Structural panel components such as plywood, particle board, wafer board, and oriented strand board identified as EXPOSURE 1, EXTERIOR, or HUD-APPROVED are considered acceptable for interior use.
  5. Ceiling and wall systems. These systems include ceiling and wall insulation, acoustic ceiling panels, tackable wall panels, gypsum wall board and panels, and wall-coverings.
    • —Emissions for these products should be determined according to limit requirements in California Department of Public HeaIth Standard Method for the Testing and Evaluation of Volatile Organic Chemical Emissions from Indoor Sources Using Environmental Chambers, version 1.2.
    • —Multiple-attribute standards with third-party certification, inclusive of indoor air quality:
      • • ANSI A138.1: Green Squared Specifications for Sustainable Ceramic Tiles, Glass Tiles, and Tile Installation Materials
      • • GS-11: Paints, Coatings, Stains, and Sealers
      • • GS-36: Adhesives for Commercial Use
      • • NSF/ANSI 342: Sustainability Assessment for Wallcoverings
      • • UL 100: Standard for Sustainability for Gypsum Boards and Panels
      • • UL 102: Standard for Sustainability for Door Leafs
  6. Furniture
    • —Emissions for these products should be determined according to limit requirements in California Department of Public Health Standard Method for the Testing and Evaluation of Volatile Organic Chemical Emissions from Indoor Sources Using Environmental Chambers, version 1.2.
    • —Office furniture installed prior to occupancy should be tested according to ANSI/BIFMA M7.1: Standard Test Method for Determining VOC Emissions from Office Furniture Systems, Components, and Seating and should not exceed the limit requirements in Section 7.6 of ANSI/BIFMA e3: Furniture Sustainability Standard.
    • Resident room furniture and seating installed prior to occupancy should be tested according to ANSI/BFMA M7.1.
  1. For minimum ventilation requirements, see Section 2.5-3 (Heating, Ventilation, and Air-Conditioning Systems) and facility chapters in Parts 3 through 5.
  2. For filtration and air cleaner requirements, see Section 2.5-3 (Heating, Ventilation, and Air-Conditioning Systems) and facility chapters in Parts 3 through 5.
Building entrances, except entrances to individual dwelling units and service areas, shall employ an entry mat or entry mat system to reduce particulate in the indoor environment.
(1)  Omission of mats shall be permitted at secondary entrances or entrances with minimal pedestrian traffic.
(2)  No surface shall be used that impedes resident ambulation or contributes to fall risks.
*(3)  Mat size. Each surface shall have a minimum width equivalent to the width of the entry opening.
A2.2-2.4.1.3 (3) Building entry mat length
  1. The minimum length should be measured in the primary direction of travel.
  2. Length of entry mat surfaces should be permitted to be reduced due to the presence of a barrier (e.g., a counter, partition, wall) or local regulations prohibiting the use of scraper surfaces outside the entry. In this case, entry mat surfaces shall have a minimum length of 3 feet (1 meter) of indoor surface, with a minimum combined length of 6 feet (2 meters).
See Section 1.2-5.2 (Acoustic Planning) and Section 2.5-8 (Acoustic Design Systems) for requirements.
This section includes requirements for the selection and management of materials and resources, including construction waste management and for storage and collection of recyclables. It also includes recommendations for the use of reduced impact materials in construction projects in appendix section A2.2-2.5. See Section 2.4-2 (Architectural Details, Surfaces, and Furnishings) for requirements in addition to those in this section.
A2.2-2.5 Use of reduced-impact materials. Described are some ways to increase the use of reduced-impact materials for building assemblies and interior fit-outs.
  1. Consider the whole building life cycle. A minimum of two different building designs should be evaluated using ASTM E2921: Standard Practice for Minimum Criteria for Comparing Whole Building Life Cycle Assessments for Use with Building Codes and Rating Systems and the following criteria:
    • —Global warming potential
    • —Acidification potential
    • —Eutrophication potential
    • —Ozone depletion potential
    • —Smog potential
    The goal is to select a proposed final building design with lower anticipated environmental impact. Assemblies and the building envelope should be part of the project design.
    Life cycle assessment tools such as the following can be used to evaluate comparable building designs during the conceptual design phase:
    • —Athena Impact Estimator for Buildings (calculatelca.com/software/impact-estimator/)
    • —GaBi Software Building LCA (www.gabi-software.com/america/solutions/building-lca/)
    • —SimaPro Sustainability Life Cycle Assessment Carbon Footprinting (www.simapro.co.uk)
    • —Tally (choosetally.com/)
  2. Reuse portions of an existing building, if possible and applicable.
  3. Incorporate reused, refurbished, and/or off-site salvaged materials or furnishings into a project in place of new materials.
  4. Evaluate the material content of products used in a building based on performance criteria and building service life.
    • —Use a multiple-attribute approach by basing product selection on standards and certifications such as those listed here:
      • • ANSI A138.1: Green Squared - American National Standard Specifications for Sustainable Ceramic Tiles, Glass Tiles, and Tile Installation Materials
      • • ANSI/BIFMA e3: Furniture Sustainability Standard
      • • BIFMA LEVEL, the sustainability certification program for furniture
      • • NSC 373: Sustainable Production of Natural Dimension Stone
      • • NSF 140: Sustainability Assessment for Carpet
      • • NSF 332: Sustainability Assessment for Resilient Floor Coverings
      • • NSF 336: Sustainability Assessment for Commercial Furnishings Fabric
      • • NSF 342: Sustainability Assessment for Wallcovering Products
      • • NSF 347: Sustainability Assessment for Single Ply Roofing Membranes
      • • UL 100: Standard for Sustainability for Gypsum Boards and Panels
      • • UL 102: Standard for Sustainability for Swinging Door Leafs
    • —Use third-party certification such as sustainable forestry certification systems:
      • • American Tree Farm System, ATFS Standards for Sustainability for Forest Certification
      • • CAN/CSA-Z809: Sustainable Forest Management: Requirements and Guidance
      • • Forest Stewardship Council Standard FSC-STD-01-001 (V4-0): FSC Principles and Criteria for Forest Stewardship
      • • Programme for the Endorsement of Forest Certification national standards
      • Sustainable Forestry Initiative 2010-2014 Standard
    • —Select products with an environmental product declaration (EPD) or product life cycle assessment (LCA):
      • • Third-party verified Type III Environmental Product Declaration (EPD) according to ISO 21930: Sustainability in buildings and civil engineering works, which includes, at minimum, a cradle-to-gate scope
      • • Third-party verified product life cycle assessment based on ISO Standards 14040: Environmental management—Life cycle assessment—Principles and framework and 14044: Environmental management—Life cycle assessment—Requirements and guidelines
A2.2-2.5.1 Storage and collection of recyclables and discarded goods
  1. Building service life plan. A building service life plan should be created that estimates the service life of the building's structural system, building systems, building envelope, interior fit-out, and hardscape materials. See appendix section A2.2-2.5 (Use of reduced-impact materials) for additional information.
  2. Construction waste management plan. During the project planning phase, a waste management plan should be established before demolition or construction begins. At completion of construction, a final waste management report should be completed that identifies all waste and recycling/reuse materials.
For new building projects, there shall be areas serving the entire building that are dedicated to the collection and storage of non-hazardous materials for recycling, including paper, corrugated cardboard, glass, plastics, and metals.
A2.2-2.5.1.1 Recyclables
  1. For renovation projects, space should be evaluated for inclusion of designated recycling areas, both for the area being renovated and for overall collection points.
  2. For both renovation and new construction projects, space should be provided for recycling containers at point of use (e.g., offices, copy areas, food service areas, etc.).
  3. The size and functionality of recycling areas should be coordinated with anticipated collection services to maximize the effectiveness of the dedicated areas.
Fluorescent and high-intensity discharge (HID) lamps and ballasts.
  1. An area shall be provided for the collection and storage of fluorescent and HID lamps and ballasts.
  2. Accessibility of the area shall facilitate proper disposal and recycling according to state and local hazardous waste requirements.
This section gives requirements and recommendations for emissions, effluents, and pollution control, including refrigerants, boilers, emergency backup generators, effluent flows, and waste streams.
A2.2-2.6 See ANSI/ASHRAE/ASHE Standard 189.3: Design, Construction, and Operation of Sustainable High-Performance Health Care Facilities, Section 11, "The Building's Impact on Emissions, Effluent, and Pollution Control," for more information.
  1. Use of CFC-based refrigerants shall not be permitted in HVAC&R systems except in small HVAC units (defined as containing less than 0.5 lb [0.23 kg] of refrigerant).
  2. Uses of CFC-based refrigerants shall be permitted in equipment such as standard refrigerators, small water coolers, and other cooling equipment that contains less than 0.5 lb (0.23 kg) of refrigerant.
Strategies to reduce the effects of climate change through reduction of greenhouse gas emissions (primarily carbon dioxide) shall be considered in building design and selection of mechanical equipment.
A2.2-2.6.1.2 Reduction of greenhouse gas. New and renovated facilities should be designed to comply with the carbon reduction goals outlined in the Architecture 2030 Challenge (www.architecture2030.org). Strategies that reduced energy demand also contribute to the reduction of greenhouse gas emissions. The use of renewable energy sources and the purchase of green energy reduce carbon dioxide emissions as well.
Hazardous materials management plan
A2.2-2.6.2.1 Hazardous materials management plan
  1. Polychlorinated biphenyl (PCB) removal
    • —In all building renovations and new construction, a plan should be developed for the discovery, testing, and mitigation of PCBs to assure proper removal and appropriate disposal of PCBs.
    • —The plan should comply with all applicable regulatory requirements for identification and proper disposal of PCBs.
  2. Asbestos-containing materials (ACM) management
    • —In all building renovations and new construction, processes should be established and followed that fulfill the facility's policy for the discovery, testing, and mitigation of ACMs to ensure proper removal and appropriate disposal of ACMs.
    • —The plan should comply with all applicable regulatory requirements for identification and proper disposal of ACMs.
Moisture control
A2.2-2.6.2.2 Moisture control. The following actions should be taken during construction to control moisture that may damage materials or contribute to potentially harmful biological growth:
  1. Absorptive materials stored or installed on-site should be protected from moisture damage.
  2. Air-handling components, including ductwork and air handlers, should be protected from moisture and wiped down prior to installation.
  3. Building construction materials that show visual evidence of biological growth due to the presence of moisture should not be installed.
See Chapter 1.4-5 (Commissioning) for requirements.
Where it has been determined that a facility will need to accommodate residents who are persons of size, areas of the facility designated to accommodate these residents and the associated path of egress to arrive at these areas shall be designed to address weight support and clearances identified during the planning phase.
A2.2-3 Design considerations for accommodations for care of persons of size
  1. Accommodations for persons of size and the equipment needed to care for them require more operational space and more storage than a traditional resident health, care, or support environment. Therefore, additional square footage may be required to accommodate these needs.
    Size increases will be determined by the space needs of expanded-capacity portable equipment (e.g., beds, wheelchairs, lifts) and fixed equipment (e.g., exam tables) designed for persons of size. Equipment used for persons of size is considerably larger than standard equipment. For example, a bed with a 1,000-pound capacity is 44 inches (101.6 centimeters) to 57 inches (144.78 centimeters) wide by 96 inches (243.84 centimeters) to 102 inches (259.08 centimeters) long.
    See Section 2.3-3.2.2 (Examination and Treatment Room Space Requirements) and Section 3.1-2.2.3.2 (Resident Room for Persons of Size: Space requirements) for space requirements for resident rooms and exam rooms for persons of size. 
    Toilet fixtures should be floor-mounted and designed to sustain a minimum concentrated load of 800 pounds (362.88 kilograms)—or as indicated for the care population being served—and mounted a minimum of 24 inches (60.96 centimeters) on center from the finished wall. A clear floor space of 5 feet (1.52 meters) should be provided on one side of the toilet for access and assistance. Sinks also need to be floor-mounted, as people may lean on a sink and its surrounds while using the bathroom. A clear floor area of 5 feet (1.52 meters) should be provided on either side of the sink and toilet to accommodate a caregiver who is assisting the resident. It is also good practice to provide a handrail designed to sustain a minimum concentrated load of 800 pounds (362.88 kilograms), or as indicated for the care population being served, adjacent to the sink to give the resident a means of support other than the sink and its surrounds.
    If a resident is able to walk, he or she will likely need to use a handrail for support or balance. Such handrails should be designed to support and sustain a minimum concentrated load of 800 pounds (362.88 kilograms).
  2. Other design issues to consider for accommodating persons of size include ingress/egress to primary treatment and service areas. The rooms and/or destinations at the ends of these traverses also need special consideration to accommodate persons of size, whether resident, participant, or outpatient:
    • —Exam rooms. Exam rooms should be programmed and sized to accommodate the user and the associated care team.
    • —Waiting rooms. Furnishings with capacity adequate for persons of size should be interspersed with more traditional furnishings to avoid confining persons of size to specific areas of the waiting environment.
    • —Community spaces. Living rooms, dining rooms, activity rooms, and similar interior spaces as well as exterior gardens and similar outdoor spaces should be sized to accommodate the number of persons of size—residents or participants—expected as identified during the planning phase.
    • —Additional staff/resident or participant interaction areas. These areas include resident assessment spaces, food service, physical rehabilitation areas, and family interaction areas.
A2.2-4 Residential mental health facilities.
Residential mental health facilities exist in a number of manifestations under a variety of names. All offer care to residents who do not require the level of care of a psychiatric hospital. Generally, these facilities are more residential in character and have programs for a specified period of time and diagnosis, such as for alcohol and drug abuse treatment. Residents can enter such a facility either voluntarily or involuntarily. Accreditation programs include the Joint Commission and the Commission on Accreditation of Rehabilitation Facilities. This appendix section provides general information and guidance for this type of facility. State and local licensing authorities should be contacted for more specific requirements.
  1. Residential mental health facilities may include specific site features, clinical supports, and residential, common, and administrative areas that are similar to those provided at psychiatric hospitals. These services may be shared or provided by contract, depending on program requirements.
  2. Where a facility serves any combination of pediatric, adolescent, or adult care populations, there should be a separation between the areas that serve them.
  3. An indoor activity area should be provided, and provision of an outdoor activity and exercise area is highly recommended.
  4. Spaces to accommodate educational therapy/services are recommended for all residents and typically required by individual states.
  5. All building systems accessible to residents should meet the requirements of the resident safety risk assessment; see Section 1.2-3 (Resident Safety Risk Assessment).
  1. These facilities are designed for the particular needs and behaviors of residents with dementia, mental health diagnoses, and cognitive and developmental disabilities. They are secured where required to be so in the functional program.
  2. Design recommendations for these facilities include the following:
    • —A key architectural objective should be to minimize the institutional aspects of care and create a living environment for residents with furniture, furnishings, and fixtures that are appropriate from a safety standpoint and are residential in appearance.
    • —Proper planning and design should elevate the spirit and sensibilities of both residents and care providers.
    • —A sense of community with a respect for privacy should be encouraged.
    • —Facilities should provide a healing environment that stimulates mind and body for people with dementia, mental health diagnoses, and cognitive and developmental disabilities.
    • —Features that are included to provide resident safety and security should be unobtrusive and integrated in a manner that supports this concept.
  3. Resources regarding design for this population include the following:
    • —Dementia Design Info database (School of Architecture & Urban Planning, University of Wisconsin-Milwaukee in partnership with I.D.E.A.S., Inc., and Polisher Research Institute). This resource provides information on space design, user needs, and levels of scale for site, building, room/space, details, finishes, FF&E, and experiential ambience, décor, and aesthetics.
    • —Behavioral Health Design Guide (Facility Guidelines Institute)
    • —Mental Health Facilities Design Guide (Department of Veterans Affairs, Office of Construction & Facilities Management)
    • —Patient Safety Standards, Materials and Systems Guidelines (New York State Office of Mental Health)
    • —VHA Handbook 1330.01: Health Care Services for Women Veterans (Department of Veterans Affairs, Veterans Health Administration)
The facility shall be designed to facilitate the highest level of functioning for all residents.
The resident living environment shall be equipped with special features (e.g., personalized resident bedrooms, features that support resident orientation to the surroundings, secured storage, safe outdoor areas, and security considerations) to support individuals with varying levels of cognitive impairment.
Consistent with an individual facility's functional program, the design concepts and architectural details described in this section, which are intended to address safety risks to residents and staff in care settings for residents with dementia, mental health diagnoses, and cognitive and developmental disabilities, shall be integrated into the project to reduce those risks.
Resident security shall be provided through systems that secure the resident unit and comply with life safety codes.
A2.2-4.2.1 Elopement prevention. Where elopement is a concern, the following should be considered:
  1. The number of entrances and exits from residential areas should be kept to a minimum.
  2. Secure therapeutic outdoor areas, using security measures that are as non-institutional as possible, should be provided.
  3. Electronic door controls, including delayed egress, should be used for emergency egress where allowed by code.
  4. Circulation patterns should be simple and without blind spots.
  5. Means of casual observation of resident living areas should be provided from staff offices and work areas.
  6. Locks on wardrobes, closets, or cupboards should be inconspicuous.
  7. A secure vestibule with a pair of locked doors should be provided at the entrance as needed to minimize resident elopement.
  8. Protective film should be added to the interior face of laminated glazing panels to inhibit access to glass shards if the glass is damaged.
  9. Entry, exit, or service doors may be disguised, provided all of the following are met:
    • • Staff can readily unlock the door at all times.
    • • The door-releasing hardware, where provided, is readily accessible for staff use.
    • • Where door leaves, windows, and door hardware, other than door-releasing hardware, are covered by a mural, the mural does not impair the operation of the door.
    • • The location and operation of a door disguised with a mural is identified in the fire safety plan and included in staff training.
  10. Locating exit doors outside of direct resident line of sight may also be effective.
The resident care model shall be the basis for the type of security system used, whether it is operationally and/or physically based.

If the functional program requires limiting the movements of any resident(s) for their safety, all door locking arrangements shall be in full compliance with applicable requirements of NFPA 101: Life Safety Code.
Areas to be secured shall be based on the needs of the care population and shall be permitted to include, bathing, soiled utility, service areas, storage and staff work areas.
In facilities serving residents with various care needs (e.g., dementia, mental health diagnoses, cognitive and developmental disabilities, and other care populations), common areas shall be permitted to be shared provided the needs of all residents sharing the areas are met.
For units housing residents with a primary psychiatric diagnosis, fail-secure locking shall be provided in compliance with NFPA 101 and the International Building Code as indicated in the resident safety risk assessment.
Provision of operable windows shall be permitted.
  1. Operable windows shall be designed to address elopement and accidental falls.
  2. Operable windows shall comply with the requirements in Section 2.4-2.2.6 (Windows).
  3. Where indicated by the resident safety risk assessment, security glazing shall be used for mental health units.
Physical environment features shall be considered to reduce harm and address potential risks to the care population.
A2.2-4.2.2 Physical environment features and harm reduction
  1. Provision of the following physical environment features can reduce opportunities for residents to harm themselves, other residents, and staff:
    • —An open layout that gives staff the ability to observe resident living areas
    • —Architectural elements that cannot be used as weapons for self-harm or to harm others
    • —Abuse-resistant architectural details and materials in areas where residents are sometimes left alone
    • —Technology to allow observation of areas not readily visible to staff
    • —Sufficient locked storage for equipment, carts, and supplies. Corridor alcoves should not be used for storing or parking equipment, carts, and assistive devices.
  2. Elevated platforms, balconies, or low openings or sills, from which residents could jump, should be avoided.
  3. The use of lifts, whether ceiling-mounted or portable, is a special issue for which potentially conflicting safety considerations should be evaluated.
Provision of relaxation spaces for agitated residents shall be considered to reduce stress for residents.
A2.2-4.2.3 Relaxation spaces for agitated residents. Care settings and information systems should be designed to optimize the functioning of, prevent secondary disabilities for, manage potentially aggressive behavior of, and reduce social stigma for individuals with serious mental illness. Resident stressors can be reduced by providing single-occupancy bedrooms, appropriate levels of daylight, and reduction of noise. Resident areas that allow for relaxation and control of the social environment, such as quiet rooms and secure outdoor space, should be provided to reduce stress. Positive distraction(s) for residents are often supplied by creating designated spaces for residents who are agitated, irritated, or need time to regroup. Sensory-stimulating and sensory-calming environmental design, used to create what are referred to as multi-sensory environments, rely on a variety of features and equipment to stimulate the senses supporting activity-based interventions that meet functional performance and therapeutic needs.
One example is a Snoezelen room, which provides different types of calming and relaxing features such as artwork (fixed and moving), lighting, sound, and comfortable seating for an individual in a hyperagitated state for short periods of time. Another example is a comfort room, which is typically used as a low-stimulus environment for stress reduction in the care of residents.
Resident stress is identified as a concern in the following appendix sections in Chapter 1.2 (Planning/Predesign Process): A1.2-1.3.1 (How environment of care...), A1.2-3.1.5.2 (Evaluation of risks), A1.2-4.5.3.1 (Organized approach to clarity of access), and A1.2-4.5.4 (User control of environment).
For further requirements, see the resident safety risk assessment component described in Section 1.2-3.5 (Resident Dementia and Mental Health Risks) and the facility chapters in Parts 3 through 5.
A2.2-4.3.2 Support areas for the resident unit
  1. Support areas for staff. Due to the level of staff stress in caring for residents with cognitive impairment and in working with family caregivers, places of respite and staff break areas that include access to views, secured storage for personal items, and food preparation areas should be provided.
  2. Support areas for residents. Due to the need for private time with a spouse or other family member, resident area(s) that includes privacy with a loved one should be provided.
Special design elements for dementia residents shall be considered in addition to those in Section 2.2-4.2 (Physical Environment Elements for Risk Reduction).
A2.2-4.3.2.2 Special design elements for dementia resident rooms
  1. Private rooms are recommended. Research indicates psychosocial and physical/clinical benefits from single-resident rooms, such as improved sleep patterns, reduced irritability, and reduced conflict between residents.
  2. The toilet should be placed in direct line of sight from the resident toilet room doorway and should be directly visible from the sleeping area.
  3. Closets should be designed to provide the resident with limited daily clothing choices.
  4. Simple, single-mixer control devices should be provided on faucets.
  5. Designs that could promote unintended behavior (e.g., location of trash can by toilet, high-contrast grilles on packaged terminal air conditioner (PTAC) units, etc.) should be avoided.
  6. To increase usability of architectural features (e.g., toilets, handrails, doors, manual light controls), a value contrast should be provided between the features and adjacent surfaces (e.g., walls, door frames). See Table 4D-2 (Performance Criteria for Surfaces and Materials) in the National Institute of Building Sciences' Design Guidelines for the Visual Environment.
  7. Use visual cueing elements to assist resident's wayfinding. Backlighting visual cues can help individuals with aging eyes and low vision notice cues.
  8. Night-lights with warm correlated color temperature sources (amber or red) at a very low light level should be used for the path between the sleeping area and the bathroom. Based on resident's needs and preferences, controlling night-lights with motion sensors should be considered.
A2.2-4.3.3 Family area. A private room for residents and families should be provided.
A2.2-4.3.3.2 Dining areas
  1. For those residents requiring extra assistance or time for eating meals, space shall be provided to allow staff and/or residents to complete their meals with dignity.
  2. Smaller-scale dining areas are recommended for those with dementia and mental illness to simplify relationships and avoid overstimulation and distraction.
  3. Use of square tables is encouraged for residents with dementia because seating spaces are defined and recognizable.
See Section 2.1-3.6.2 (Outdoor Activity Spaces) for additional requirements and information.
Secure outdoor gardens and lounge areas shall be available for residents living in an Alzheimer's/dementia and/or mental or cognitive health facility or setting.
A2.2-4.3.5.1 Access to nature. Easy, unrestricted, and frequent access to a walking garden designed for barrier-free recreation with destinations offers residents these benefits:
  1. Reduction in cortisol levels
  2. Improved physical activity levels
  3. Reduced stress and agitation
  4. Improved cognition and sleep
  5. Reduced use of antipsychotics
  6. Reduced falls and reduction in fall-related morbidity for individuals with impaired cognition such as dementia
Plant materials used in outdoor activity spaces shall be nontoxic and not poisonous to humans.
A2.2-4.4 Blind corners should be avoided.
See appendix section A2.4-2.2.12.3-1 (Wayfinding to serve residents with dementia) for recommendations.
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