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.
The requirements for resident care/living areas (units), community areas, and associated support areas included in this section are common to most residential health, care, and support facilities. For requirements specific to a facility type, see the facility chapters in Parts 3 through 5.
A2.3-2.2 Resident care/living area (unit) definition. A resident care/living area (unit) is a group of resident rooms or dwelling quarters in a residential living facility.
See facility chapters in Parts 3 and 4 for requirements for resident care/living areas (units).
See facility chapters in Parts 3 and 4 for requirements for airborne infection isolation rooms and ventilator-dependent resident rooms, and other special care resident room types and facility chapters in Part 5 for requirements for quiet rooms in non-residential support facilities.
Where a single resident room is provided to accommodate care requirements for residents experiencing issues such as personal conflicts, agitation, episodic mental disturbances, or similar conditions that require a quiet or low-stimulation, positive distraction room, the following requirements shall be met:
  1. Capacity. Each quiet room shall contain only one bed.
  2. Space requirements
    1. Based on the care population, the quiet room shall be sized to accommodate the equipment, special furnishings, or positive distractions provided.
    2. The level of cognitive ability of the care population shall be identified during the functional programming process. See Section 2.2-4 (Design Criteria for Dementia, Mental Health, and Cognitive and Developmental Disability Facilities) for additional requirements.
  3. Toilet room. A toilet room shall be provided for each quiet room.
    1. The toilet room shall contain the following:
      1. Toilet
      2. Hand-washing station
      3. Mirror. For requirements, see Section 2.4-2.2.8.7 (Mirror).
    2. The toilet room shall not be shared with another resident room.
  4. Acoustic requirements. See Section 2.5-8.3 (Design Criteria for Acoustic Finishes), Section 2.5-8.4 (Design Criteria for Room Noise Levels), and Section 2.5-8.5 (Design Criteria for Performance of Interior Wall and Floor/Ceiling Constructions) for requirements.
A2.3-2.3 Daylighting in community areas. See Section 1.2-4.5.1 (Light) and Section 2.5-7.2 (Daylighting Systems in Resident Living, Participant, and Outpatient Areas) for requirements and information.
For new construction and renovation, community areas shall be designed and furnished to encourage resident, participant, and outpatient use.
A2.3-2.3.1 Nothing in the Guidelines for Design and Construction of Residential Health, Care, and Support Facilities is intended to restrict a facility from providing additional square footage per resident, participant, or outpatient beyond what is required herein for dining rooms, activity areas, and other spaces included in this section.
  1. See the facility chapters in Parts 3 through 5 for additional requirements.
  2. Shared lobbies shall be permitted in multi-occupancy buildings.
A minimum of one marked, illuminated drop-off or entrance shall be reachable from grade level.
A2.3-2.3.2.2 Vehicular drop-off and pedestrian entrance. Covered/canopied entrances should be provided as required to accommodate the care population and respond to the local climate and community requirements.
Where a central lobby is provided, storage for resident-operated mobility devices shall be provided close to the entry.
Where a mailbox area is provided, it shall be located close to the entry for deliveries and centralized for resident access.
Areas for posting required notices, documents, and other written materials shall be provided in public locations visible to and accessible to residents, staff, and visitors.
A toilet room(s) shall be located close to the lobby.
The space needed for dining, recreation, and activities shall be determined by the following considerations:
  1. The extent to which users need adaptive equipment and mobility aids and assistance from support and service staff
  2. The extent to which support programs will be centralized or decentralized
  3. The number of residents or participants to be seated for dining at one time
(1)  General
(a)  The design and location of dining facilities shall encourage resident, participant, and visitor use.
(b)  Planned use of dining areas for other activities shall be permitted.
*(2)  Central dining facility. Where a central dining facility is provided, it shall be sized to accommodate the following:
(a)  Space for dining in accordance with the needs of the care population, including residents and participants who use resident-operated mobility devices
(b)  Space for residents and participants, including those using wheelchairs and resident-operated mobility devices, to access and leave their tables without disturbing other residents and participants
(c)  Clear and unobstructed circulation paths for servers and food carts
(d)  Space for caregivers to assist residents and participants who require assistance with eating
(3)  Decentralized dining areas. Location of separate or satellite dining areas for small groups of residents or participants shall be permitted:
(a)  In or adjacent to resident units
(b)  As part of dayrooms for different adult day care populations
(c)  Near a wellness center activity (e.g., a juice bar near a fitness center)
(d)  In outdoor activity spaces. See Section 2.1-3.6.2 (Outdoor Activity Spaces).
A2.3-2.3.3.2 (2) The dining room should be sized at a minimum of 28 square feet (2.60 square meters) for each resident or participant at one seating. Adult day care programs may require additional participant space based on the care population being served.
See facility chapters in Parts 3 through 5 for requirements.
  1. Hand-washing stations shall be provided in, next to, or directly accessible to dining areas.
  2. Toilet facilities that accommodate residents or participants using resident-operated mobility devices shall be readily accessible to all dining, recreation, lounge, and activity locations.
  1. A "country kitchen," a "great room," or other activity room that supports continued resident and participant involvement in activities of daily living shall be permitted to serve as the required resident and participant kitchen facilities.
  2. Purpose. Resident and participant kitchen facilities shall be designed to support any combination of the following functions:
    1. Provision of nourishment between meals
    2. Cooking activities for residents and participants
    3. Food preparation by family members
    4. Preparation of meals by staff with or without assistance from residents or completion of meal preparation begun in a central kitchen and serving/distribution of meals
Where these kitchen facilities are provided, the following requirements shall apply:
(1)  Work countertop
(2)  Refrigerator
(3)  Storage cabinets
(4)  Sink with faucet with anti-scalding mixing valve
(5)  Range, cooktop, oven, and/or any other cooking or heating device where required in the functional program. These appliances shall be equipped with secured shutoffs where residents have access to the kitchen.
*(6)  Food-warming and dishwashing equipment where required in the functional program
(7)  Access to self-dispensing drinking water and ice
(a)  Ice for resident consumption shall be provided by ice-making equipment.
*(b)  Ice-making equipment shall be located, designed, and installed to minimize noise.
(c)  Ice-making equipment shall be permitted to serve more than one food area in resident and participant kitchen facilities.
(8)  A hand-washing station. This shall be located in or immediately accessible to the resident and participant kitchen facilities.
A2.3-2.3.4.2 Resident and participant kitchen. Also consider provision of these items:
  1. Double-bowl sink with faucet and sprayer
  2. Food storage
  3. Resident and participant countertop. This should allow access for residents and participants using resident-operated mobility devices and facilitate staff and resident interaction.
  4. Secure locked storage for sharp knives
  5. Microwave
  6. Coffee-maker
A2.3-2.3.4.2 (6) Where dishwashing equipment is not included, consider providing a cart alcove to support carts for transferring dishware to the dishwashing equipment in the central kitchen.
A2.3-2.3.4.2 (7)(b) To reduce noise from ice-making equipment, consider locating the equipment in a room with a door or separating the compressor and dispenser so the compressor is not in the corridor. In some settings, use of residential ice makers, which are quieter than commercial ice makers, could be appropriate depending on the size and nature of the care population being served.
See the facility chapters in Parts 3 through 5 for requirements.
Where a family room is included in a project, see facility chapters in Parts 3 through 5 for requirements.
A2.3-2.3.7 Quiet room in a community area. An example of a quiet room or "time out" room that includes positive distractions is a Snoezelen room, a controlled multi-sensory environment. Time in such a room is a therapy for residents with dementia, autism, developmental disabilities, or other agitated conditions. Some facilities have also found that agitated or stressed staff have benefited from having a quiet room available.
In quiet rooms where the risk of self-injury is evident, opportunities for self-harm should be eliminated by concealing protruding elements, using surfaces to which it would be difficult to attach items, and having doors swing out so they cannot be barricaded from the inside.
Where a quiet room is provided for residents experiencing personal conflicts, agitation, episodic mental disturbances, or similar conditions that require a quiet, multi-sensory, low-stimulation, positive distraction room, the following requirements shall be met:
  1. Based on the care population, the quiet room shall be sized to accommodate the equipment, special furnishings, or positive distractions provided.
  2. If the care population includes residents with dementia or other cognitive issues, see Section 2.2-4 (Design Criteria for Dementia, Mental Health, and Cognitive and Developmental Disability Facilities) for additional information.
  1. A toilet room shall be adjacent to the quiet room.
  2. This toilet room shall be permitted to be shared by residents using other activity spaces.
See the following Guidelines sections for requirements:
  1. Section 1.2-4.5.1 (Light)
  2. Section 1.2-4.5.2 (Views of and Access to Nature)
  3. Section 2.1-3.6.2 (Outdoor Activity Spaces)
For additional requirements for residents with dementia, mental health issues, and cognitive and developmental disabilities, see Section 2.2-4.3.5 (Outdoor Activity Spaces).
Where clinical and support areas described in this section are provided, the requirements in this section shall be met. See the facility chapters in Parts 3 through 5 for specific requirements.
Where examination, observation, or treatment rooms in a clinical services area in a residential health, care, or support facility are used by patients from the community at-large, dedicated circulation shall be provided for outside patients.
An evaluation of specific examinations, observations, and treatments to be provided in a facility shall be completed to determine if additional space beyond that specified in Section 2.3-3.2.2 (Examination and Treatment Room Space Requirements) is required to accommodate the following:
  1. Needs of the care population
  2. Specialty equipment used
  3. Transfers or other resident movement required in the room
The type of examination table, recliner, or chair to be used shall be based on an evaluation of operational requirements and an assessment of the cognitive ability of the care population being served. See Section 1.2-2.2.1 (Owner's Project Requirements) and Section 2.2-4 (Design Criteria for Dementia, Mental Health, and Cognitive and Developmental Disability Facilities) for requirements and recommendations.
Where an examination or treatment room is used as an observation room, a toilet room shall be immediately accessible.
  1. Each examination or treatment room shall have a minimum clear floor area of 120 square feet (11.15 square meters).
  2. Where an examination or treatment room is used for a population that includes persons of size, a minimum clear floor area of 219 square feet (20.35 square meters) shall be provided.
Clearances shall be determined based on the type of examination table, recliner, or chair chosen for use. For further requirements based on an evaluation of patient or resident cognitive ability, see Section 2.3-3.2.1.2 (Examination, Observation, and/or Treatment Rooms—General).
  1. Room arrangement shall permit a minimum clearance of 3 feet (91.44 centimeters) at each side and at the foot of the examination table, recliner, or chair.
  2. Where an examination or treatment room is used for a population that includes persons of size, clearances shall be evaluated based on the size of the equipment and furniture to be used, including (but not limited to) bariatric wheelchairs, examination table or bed, and resident seating.
A2.3-3.2.2.2 (2) Examination or treatment rooms for persons of size should have a minimum clear dimension of 17 feet (5.18 meters) and a minimum clearance of 7 feet (2.13 meters) on one side and 5 feet 6 inches (1.68 meters) on the other side and 5 feet (1.52 meters) at the foot of the treatment table or bed. Where a portable lift is used, a minimum of 35 square feet (3.25 square meters) of storage space should be provided.
Provision shall be made to preserve resident, participant, or outpatient privacy from observation from outside an examination or treatment room when the door is open.
A2.3-3.2.3 Resident, participant, and outpatient privacy. Visual privacy can be achieved with cubicle curtains, blinds, or other types of movable screens.
A hand-washing station shall be provided in accordance with Section 2.4-2.2.8 (Hand-Washing Stations).
A toilet room shall be provided adjacent to or directly accessible from the examination or treatment room.
Toilet rooms shall be sized and configured to accommodate accessibility standards that support independent resident, participant, or outpatient use.
The toilet room shall contain the following:
  1. Toilet
  2. Hand-washing station
  3. Mirror. For requirements, see Section 2.4-2.2.8.7 (Mirror).
Accommodations for written or electronic documentation shall be provided.
Where wellness facilities are part of a residential health, care, or support facility, see requirements in facility chapters in Part 3 (Residential Health Facilities) and Part 4 (Residential Care and Support Facilities) and in Chapter 5.2 (Wellness Centers).
Where rehabilitation therapy facilities are part of a residential health, care, or support facility, see requirements in facility chapters in Part 3 (Residential Health Facilities) and Part 4 (Residential Care and Support Facilities) and in Chapter 5.3 (Outpatient Rehabilitation Therapy Facilities).
Where care consultation is provided, the requirements in this section shall be met.
Each care consultation area shall have a minimum clear floor area of 100 square feet (9.29 square meters).
  1. Where the care population includes persons of size, the consultation area shall be sized based on equipment, furnishing, and maneuvering space requirements.
  2. Circulation from entry to exit of the facility shall be evaluated for use by and care of persons of size.
Identifiable spaces shall be provided for each operational function, but use of a space for multiple purposes shall be permitted as long as the space complies with the requirements for each purpose served.
Except where the word "room" or "office" is used, accommodation of support functions in a multipurpose area(s) shall be permitted.
The size of each support area shall depend on the number and types of residents served.
Support areas for resident care shall be located in or readily accessible to each resident unit.
Arrangement and location of support areas to serve more than one resident unit shall be permitted, but at least one such support area shall be located on each resident floor.
Resident care/living areas (units), participant activity areas, and outpatient rehabilitation areas shall have staff work areas in centralized or decentralized direct care locations.
A2.3-4.2.1.1 Staff work areas
  1. Decentralized nursing models proximal to patient/resident rooms may improve staff efficiency, visibility, fall prevention, transfer rates, and medical errors without being disruptive to residents.
  2. Whether centralized or decentralized, staff work areas should be designed to minimize the institutional character, command-station appearance, and noise associated with traditional nurse stations and to foster close, open relationships between residents, participants, outpatients, and staff.
  3. Confidential or noisy staff conversations should be accommodated in an enclosed staff lounge and/or conference area.
  4. At least part of each staff work area should be low enough and open enough to permit easy conversations between staff and residents seated utilizing resident-operated mobility devices.
See the facility chapters in Parts 3 through 5 for additional requirements.
  1. Provisions shall be made to support 24-hour distribution of medications.
  2. A medication room, a self-contained medication distribution unit, medication storage in resident rooms, or other approaches acceptable to the authority having jurisdiction (AHJ) shall be permitted to be used for preparing, dispensing, and administering medications.
A2.3-4.2.2.1 <Chapter 1066>, "Physical Environments that Promote Safe Medication Use," of the U.S. Pharmacopeia-National Formulary (USP-NF) may be used as a resource in developing the medication distribution and storage system.
Where provided, a medication room shall be located on each resident care/living area (unit) for storage of emergency and contingency medications and supplies or as part of a medication distribution system.
(1)  A medication room shall have a minimum area of 50 square feet (4.65 square meters) or meet the requirements in the functional program.
*(2)  Each medication room shall include the following:
(a)  A work counter sized to accommodate functions for the facility type and care population
(b)  Hand-washing station. See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.
(c)  Refrigerator for storage
(d)  Double-locked storage for controlled drugs
*(e)  Sharps containers, where sharps are used. Where provided, these shall be placed in accordance with the OSHA Bloodborne Pathogen standard at 29 CFR 1910.1030(d) (4)(iii)(A)(2)(i).
(f)  Task-specific lighting levels as recommended in USP-NF <Chapter 1066>
*(g)  Medication room sound levels
(i)  See Table 2.5-4 (Minimum Design Room Sound Absorption Coefficients), Table 2.5-2 (Maximum Design Criteria for Noise in Interior Spaces Caused by Building Systems), and Table 2.5-5 (Design Criteria for Minimum Sound Isolation Performance Between Enclosed Rooms) for acoustic requirements.
(ii)  See Section 2.5-5 (Communication Systems) for additional requirements on nurse call and paging.
A2.3-4.2.2.2 (2) Medication room organization.
Work space organization elements should be described in the functional program. These include:
  1. Number of staff working in the medication room
  2. Key tasks to be performed in the medication room
  3. Amount of space needed to support these tasks
  4. Space for medication-associated equipment
  5. Space for safety technology to be used
A2.3-4.2.2.2 (2)(e) Placement of sharps containers. NIOSH provides an ergonomically ideal formula for determining the height of sharps containers by establishing the eye-level height and maximum thumb tip reach of the staff population and then including a drop angle of 15 degrees. For a standing work station, the sharps container height should be 52 to 56 inches above the standing surface of the user. For a seated work station, the sharps container height should be 38 to 42 inches above the floor on which the chair rests. These height installation recommendations will accommodate 95 percent of all adult female staff. This information can be found in found in DHHS (NIOSH) Publication No. 97-111, "Selecting, Evaluating, and Using Sharps Disposal Containers." NIOSH recommends locating the sharps container as close as feasible to the immediate area where sharps are used.
A2.3-4.2.2.2 (2)(g) Distractions and interruptions interfere with staff concentration and attentiveness to medication use system activities.
Where these or other systems approved by the AHJ are used, the following shall apply:
  1. Location of such units shall be permitted at the staff work area, in the clean utility room, in an alcove, or in a resident room as approved by the AHJ.
  2. Medication units located in resident rooms shall be secured.
  3. Areas used for medication preparation and distribution by mobile cart shall include task-specific lighting.
Where medication storage is located in the resident room, the following shall apply:
  1. Medication storage located in resident rooms shall be secured.
  2. Decentralized medication cabinets in resident rooms shall include task-specific lighting.
A2.3-4.2.2.4 Decentralized medication storage areas should also include a writing surface or area for electronic device (laptop, tablet, etc.) for staff recording of resident data.
See the facility chapters in Parts 3 through 5 for requirements.
Storage space(s) for equipment and supplies used by staff for resident, participant, and outpatient care and services shall be immediately accessible to the areas where they are used.
  1. Sufficient storage space(s) shall be provided to keep required corridor width free of equipment and supplies.
  2. Cabinets, closets, rooms, and alcoves shall be permitted to provide storage.
A2.3-4.2.4.1 Equipment and supply storage
  1. Equipment may include portable lifts, movable commodes, shower chairs, and carts.
  2. Supplies may include linens, disposable products, slings, accessories for lifts such as battery chargers, dressings, office supplies, etc.
Storage shall be provided for resident-operated mobility devices and personal support equipment that is:
  1. Sized to meet the needs of the functional program.
  2. Located out of the way of traffic and circulation.
General storage space(s) shall be provided in the same building for furniture and equipment such as air mattresses, medical supplies, and housekeeping supplies and equipment.
A2.3-4.2.4.3 General storage. More storage space is always needed, whether for seasonal storage of lawn furniture or for holiday decorations. Tall broom closets should also be considered in residential spaces such as individual units and kitchenettes.
See the facility chapters in Parts 3 through 5 for additional requirements.
Where a clean utility room is provided, it shall meet the following requirements:
Where the clean utility room is used for preparing resident care items, it shall contain:
  1. Work counter
  2. Hand-washing station
  3. Storage facilities for clean supplies
Where the room is used only for storage and holding as part of a system for distribution of clean materials, omission of the work counter and hand-washing station shall be permitted.
Where the room is used for clean linen and laundry, see Section 2.3-4.2.7 (Personal Laundry Facilities) for additional requirements.
Where the room is also used as a medication room, see Section 2.3-4.2.2 (Medication Distribution and Storage Locations) for additional requirements.
Where a soiled utility room is provided, it shall meet the following requirements:
Combining the soiled utility room with the soiled linen and laundry and/or environmental services room shall be permitted for areas with small groups of residents.
The soiled utility room shall contain the following:
  1. Clinical sink or equivalent flushing-rim fixture with a rinsing hose or bedpan washer
  2. Hand-washing station
  3. Space for soiled linen receptacles
  4. Space for waste receptacles
Where the room is used for soiled linen and laundry, see Section 2.3-4.2.7 (Personal Laundry Facilities) for additional requirements.
Where the room serves as an environmental services room, see facility chapters in Parts 3 through 5 for additional requirements.
Where decentralized personal laundry services are provided for washing and drying personal resident or participant laundry, the following requirements shall be met:
Separate laundry facilities shall be provided for small groups of residents or participants.
A work counter for sorting and folding shall be provided.
Hand-washing stations shall be provided in, adjacent to, or directly accessible from the laundry room.
(1)  Combination of personal laundry facilities and soiled utility and soiled linen holding facilities shall be permitted where the airflow is from the washing/drying area to the soiled utility/holding area.
(2)  Combination of personal laundry facilities and clean utility and clean linen storage shall be permitted.
*(3)  Provision of accessible laundry equipment in a resident activity room and/or therapy room shall be permitted.
A2.3-4.2.7.4 (3) Loading, transferring, sorting, and folding laundry are familiar activities that may be therapeutic for many residents.
Provisions shall be made in or near each resident unit to allow residents to make and receive telephone calls in private.
A2.3-4.2.8 Telephone access. Use of technology is becoming increasingly prevalent in residential care facilities. Cable television, high-speed Internet, and ready access to bedside telephones are just a few examples of the expected norm in resident rooms. Many residents will expect access to the Internet to communicate with family and friends. Provision of telephone/data connections or wi-fi access for each resident room should be considered.
Where telemedicine services are provided, provisions shall be made to support the practice of exchanging medical information between sites via electronic communications.
A2.3-4.2.9 Accommodations for telemedicine services. The following should be considered where a space is used for telemedicine services:
  1. The space should be designed to accommodate the service being provided.
  2. It should be possible to maintain visual and speech privacy for the duration of the visit in the room or area where services are offered.
  3. The acoustic environment should facilitate communications within the room and through the telecommunication system.
  4. Lighting levels should be designed to allow for video capture and help control glare from natural or artificial light sources.
  5. Access to technology should be provided.
Areas that support staff breaks and respite for caregivers and administrative staff shall be provided.
A2.3-4.3.2 Staff lounge area. Provision of the following should be considered:
  1. Access to views and outdoor space from the staff lounge area. See Section 1.2-4.5.2 (Views of and Access to Nature) for more information.
  2. Furniture for relaxation and respite, especially in settings where staff are commonly scheduled to work extended and double shifts
  3. A notification area to facilitate communication (e.g., human resources notices, resident passing, etc.)
Staff lounge area(s) shall be permitted to be shared by more than one service.
Staff lounge area(s) shall provide the following based on the facility needs:
  1. Refrigerator
  2. Sink
  3. Space for microwave and other appliances
Space for vending machines shall be provided based on facility and staff needs.
A2.3-4.3.2.3 Vending machine area. Placement of vending equipment near or in staff lounge area(s) and public waiting area(s) used for outpatient therapy services should be considered.
  1. Vending equipment should be coordinated with interior finish design concepts through the use of custom or false fronts or enclosures.
  2. Trash collection devices should be integrated as part of any vending equipment area.
  3. Environmental services facilities should be located near vending areas as they are high-use areas.
Toilet room(s) shall contain toilets with hand-washing stations for staff and shall be permitted to be unisex.
A2.3-4.3.3 Provision of shower facilities for staff should be considered.
Lockable storage shall be provided for safekeeping of staff members' personal effects.
See facility chapters in Parts 3 and 4 for requirements in addition to those in this section.
See the facility chapters in Parts 3 and 4 for requirements.
If pets are permitted in a facility, accommodations (e.g., sleeping areas, feeding areas, waste areas, storage for food and pet care supplies) shall be designated for them.
  1. Facilities and equipment shall be provided to support the food services the facility offers staff, visitors, residents, and/or participants.
  2. Food receiving, storage, and preparation areas shall be located to support staff oversight of operations.
  3. Facilities shall be furnished to support provision of nourishment and snacks between scheduled meals. See Section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements.
The equipment and design layout shall provide a workflow that minimizes potential for cross-contamination of clean food and wares with contaminated trays from residents, participants, outpatients, staff, or visitors.
A2.3-4.5.1.2 Layout
  1. Small retail options, cafes, or minimal amounts of storage may be remote from the main food service area.
  2. Where food service facilities are split into multiple vertical levels, a dedicated elevator and an internal service stair should connect the multi-level food service operations.
Food service facilities and equipment shall comply with the requirements of:
U.S. Food and Drug Administration (FDA)
U.S. Department of Agriculture (USDA)
Underwriters Laboratories, Inc. (UL)
NSF International (NSF)
Where food services are provided on-site, the following facilities, in the size and number appropriate for the type of food service selected, shall be provided:
for managing food supplies
in the food preparation area. See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements.
to accommodate the method of food preparation used
  1. Where conventional food preparation systems are used, space and equipment shall be provided for food preparation, cooking, and baking.
  2. Where convenience food service systems using frozen prepared meals, bulk packaged entrees, and individual packaged portions or systems using contracted, outsourced services are used, space and equipment shall be provided for thawing, portioning, cooking, and baking.
  3. Where "cook-chill" food preparation systems are used, space and equipment shall be provided for food preparation, cooking and baking, chilling, portioning, and reheating.
  1. Location of ice-making equipment in the food preparation area or in a separate room shall be permitted as long as the equipment is directly accessible to the food preparation area.
  2. Ice-making equipment shall be cleanable.
  3. Ice-making equipment shall be self-dispensing if it is accessible to residents, participants, and/or visitors.
  4. Ice-making equipment under control of staff and not for use by residents, participants, and/or visitors shall be permitted to be bin-type or self-dispensing.
  5. See Section 2.3-2.3.4.2 (7) (Access to self-dispensing drinking water and ice) for decentralized ice-making requirements.
  6. A filtered self-dispensing drinking water source shall be provided.
Depending on the care model, facilities shall be provided to support assembly and distribution of resident meals. These shall be permitted to be centralized or decentralized.
Commercial-type warewashing equipment shall be provided.
  1. Depending on the care model, warewashing space shall be provided in a room or an alcove separate from the food preparation and serving area.
    1. This shall be permitted to be centralized or decentralized.
    2. Where a cluster/neighborhood, household/small house or similar model of care is used, commercial warewashing may be decentralized and located in a resident or participant kitchen. See Section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements.
  2. Space shall be provided for receiving, scraping, sorting, and stacking soiled tableware and for transferring clean tableware to point-of-use areas.
  3. Hand-washing stations shall be provided in or directly accessible to warewashing space(s).
  4. Warewashing facilities shall be designed to prevent contamination of clean wares or food preparation areas with soiled wares through cross-traffic.
Depending on the type of food service and the care model, pot-washing facilities shall be provided. This shall be permitted to be centralized or decentralized.
Office(s) or desk spaces for dietitian(s), a dietary service manager, head chef, or other food service professional shall be provided in or adjacent to the kitchen.
The following shall be provided:
*(1)  Food storage space, including cold storage
(2)  Storage areas and sanitizing facilities for cans, carts, and mobile-tray conveyors (where used)
(3)  Waste, storage, and recycling facilities (per local requirements) located with access to the outside for direct pickup or disposal
A2.3-4.5.3.9 (1) Facilities in remote geographic areas may require proportionally more food storage facilities.
  1. Location
    1. An environmental services room shall be located in the commercial kitchen where food service is centralized.
    2. An environmental services room shall be located in or directly accessible to a resident unit where food service is decentralized.
  2. See Section 2.3-4.9.3.2 (Environmental services room) for room requirements.
  1. Walk-in coolers, refrigerators, and freezers, where used, shall be insulated at the floor as well as at walls and top.
  2. Coolers, refrigerators, and freezers
    1. Coolers, refrigerators, and freezers shall be thermostatically controlled to maintain desired temperature settings in increments of 2 degrees or less.
    2. Coolers and refrigerators shall be capable of maintaining a temperature down to freezing.
    3. Freezers shall be capable of maintaining a temperature of 20 degrees below 0°F (-117.78°C).
    4. Interior temperatures shall be indicated on the exterior of the equipment.
  3. Walk-in units, where used
    1. All walk-in refrigerator and low-temperature units shall have a view panel in the door and safety release mechanism for exit from the inside.
    2. Shelving shall be corrosion-resistant, cleanable, and constructed and anchored to support a load of at least 100 lbs. per linear foot (148.80 kg/linear meter).
    3. The interior shall be lighted.
Where carts are used, a designated area with a sloped floor with floor drain and a source of water and sanitizing agents shall be provided.
A2.3-4.5.3.12 Cart wash
  1. A high-pressure water and chemical hose/spray system should be provided to facilitate cleaning.
  2. A cart drying area with floor drain should be provided where carts can air-dry.
See facility chapters in Parts 3 through 5 for requirements.
A2.3-4.7.1 Materials management includes procurement, receipt, storage, and distribution of services or products, including both delivery of goods and pickup of materials for which handling is outsourced (e.g., soiled linen).
Where provided, a loading dock and receiving and breakout area(s) shall be permitted to be shared with other services.
Facilities shall be provided for sanitary storage of waste and recyclables per local requirements that are separate from food preparation, personal hygiene, and other clean functions. See Section 2.2-2.5.1 (Storage and Collection of Recyclables and Discarded Goods) for additional requirements.
Facilities for removal of waste (e.g., trash, medical waste, etc.) and recyclables shall be provided.
A2.3-4.8.2 Waste disposal facilities. Facilities for trash and waste removal may include trash chutes, individual container storage, or a combination of both. The process to be used for trash and waste removal should be identified so that physical space square footage can be determined.
Environmental services rooms shall be located throughout the facility as required to maintain a clean and sanitary environment.
At least one environmental services room shall be provided for each floor and specific departments or areas (e.g., rehabilitation therapy departments/areas, food service areas, loading dock receiving, pick-up areas, etc.).
The amount of space provided in environmental services rooms shall be based on the size and number of housekeeping cart(s) used by the facility.
Each environmental services room shall contain the following:
  1. Service sink or floor-mounted mop sink
  2. An area for handling chemicals
  3. Storage space for housekeeping equipment, supplies, and chemicals
A2.3-4.9.3.2 A hand-washing station, hand sanitation station, or other means for hand-washing should be provided in the environmental services room.
A means for securing environmental services rooms shall be provided.
The facilities included in this section shall be provided to support operations and maintenance functions.
A general maintenance area shall be provided.
Room(s) or separate building(s) shall be provided for boilers, mechanical equipment, and electrical equipment.
Provisions shall be made for storage of facility drawings, maintenance records, manuals, and similar records.
A storage room shall be provided for building maintenance supplies.
Storage for solvents and flammable liquids shall comply with local, state, and federal code requirements.
Where grounds are maintained by in-house staff, yard equipment and supply storage areas shall be readily accessible to the areas to be maintained.
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