Title: Section 404.10 - Environment

Effective Date

01/01/2015

404.10 Environment

(a)
The minimum physical plant requirements necessary for certification for existing facilities to provide integrated care services are described herein. Providers licensed or certified by a state licensing agency after the effective date of this Part that wish to provide integrated care services or anticipate new construction or significant renovations shall comply with the requirements under Part 710 (Approval of Medical Facility Construction), Part 711 (General Standards of Construction) and Part 715 (Standards of Construction for Freestanding Ambulatory Care Facilities) of Title 10 of New York Codes, Rules and Regulations.

(b)
Outpatient clinic sites proposing to integrate services pursuant to these standards must currently be in compliance with the applicable state licensing agency’s environmental standards currently governing the site.

(c) Standards for Integrated Care Services Clinics.
In addition to being in compliance with the applicable state licensing agency’s environmental standards currently governing the site as required under subdivision (b) of this section, integrated services providers shall meet the following requirements:

(1)
General Facility Requirements

(i)
A current and accurate floor plan, specifying room locations, dimensions and functions will be provided to each applicable state licensing agency. Program space, exceptmedical examination and treatment rooms, may be shared between certified outpatient services pursuant to an approved schedule. Individual and group rooms shall not be utilized for multiple services simultaneously.

(ii) An adequately furnished waiting area shall be available to those waiting for services and shall be supervised to control access to the facility. There shall be sufficient separation and supervision of various treatment groups (e.g. children) to ensure safety.

(iii) Accessibility for person with disabilities, including availability of accessible bathroom facilities.

(iv) Sufficient space for individual and group sessions consistent with the number of people served and the service offered shall be available. Space shall afford visual and acoustical privacy for both individuals served and staff.

(v) Sufficient and appropriate furnishings and program related equipment and materials for the population served.

(vi) Areas for the prop
er storage, preparation and use or dispensing of medications and medical supplies and equipment shall be made available. Sharps containers shall be provided and secured, syringes and other supplies should be securely stored, and provisions for holding medical waste are required.

(vii) C
ontrolled access to and maintenance of records and confidentiality of all patient information.

(viii)
Annual inspection and testing of the existing fire alarm system, including battery operated smoke detectors, fire extinguishers, emergency lighting systems, illuminated exit signs and environmental controls and heating/cooling systems shall be conducted.

(ix) Facilities shall be maintained
in a clean and responsible manner which protects the health and safety of all occupants.

(2)
Specific Facility Requirements for Integrating Primary Care Services

(i) Notwithstanding
Part 710 (Approval of Medical Facility Construction), Part 711 (General Standards of Construction) and Part 715 (Standards of Construction for Freestanding Ambulatory Care Facilities) of Title 10 NYCRR,physical plant standards under this sub-clause apply to a behavioral health clinic provider authorized to integrate primary care services with no more than 3 proposed examination rooms for physical health services.

(a) Clean Storage
. A separate room or closet for storing clean and

sterile supplies shall be provided. This storage shall be in addition to that of cabinets and shelves within the examination rooms or patient treatment areas.

(b) An integrated services provider shall dispose of soiled linens and trash appropriately, either through specially-designated receptacles or separate holding room depending upon the volume of soiled materials generated.

(c) If utilizing a receptacle for soiled linens and trash, such receptacle shall not exceed 32 gallons in capacity, except as set forth in clause (d), and shall meet the following:

(1) The average density of the container capacity in a room or space shall not exceed 0.5 gal/ft sq.

(2) A receptacle with a capacity of 32 gallon shall not exceed any 64 ft sq. area.

(3) Mobile soiled linen or trash collection receptacles greater than 32 gallons shall be located in a room protected as a hazardous area when not attended.

(d) If utilizing a receptacle for soiled linens and trash exceeding 32 gallons in capacity at any given time, the integrated services provider shall maintain a soiled holding room.

(1) Soiled holding is for separate collection, storage, and disposal of soiled materials.

(2) A soiled holding room shall be provided, if a dedicated space cannot be provided in the storage area.

(3) All contaminated materials shall be located and placed in a secured and sealed container and disposed of properly in accordance with all applicable laws and regulations. This shall be in the dedicated storage space that is secured and
access is only by the integrated care services clinic staff.

(4) The containers used solely for recycling clean waste or for patient records awaiting destruction outside a hazardous storage area shall be a maximum capacity of 96 gallons. Containers used solely for recycling clean waste or for patient records awaiting destruction outside of a hazardous storage area may exceed 96 gallons, but only if the provider/supplier is in compliance with National Fire Protection Association (NFPA) 101 Life Safety Code, 2012 edition, sections 18/19.7.5.7.2.

(e)Toilet Rooms

(1) A toilet room containing a hand-washing station shall be accessible from all examination and treat­ment rooms.

(2) Public Toilet. Toilet(s) for public use shall be immediately accessible to the waiting area. In smaller units (less than four employees), the toilet may be unisex.

(3) Where a facility contains no more than three exam­ination and/or treatment rooms, the patient toilet shall be permitted to serve waiting areas.

(4) Staff toilet and lounge shall be provided in addition to and separate from public and patient facilities.

(5) Centralized staff facilities are not required in small centers. In small centers, staff may utilize shared toilet facilities. Small centers less than four employees.

(6) Floors shall have a smooth, hard, non-absorbent surface that extends upward onto the walls at least 6 inches (152 mm). Vinyl composition tile (VCT) shall not be used in toilet rooms.

(f) Examination and Treatment Rooms

(1) No more than 3 examination rooms shall be provided.

(2) At least one examination room shall be available for each provider who may be on duty at any one time.

(3) Provision shall be made to preserve patient privacy from observation from outside an examina­tion/treatment room through an open door.

(4) A counter or shelf space for completing documentation shall be provided.

(g) Space Requirements

(1) Each examination/observation room shall have a minimum clear floor area of 80 square feet.

(2) The examination room can be a minimum of 72 square feet in size. If other examination rooms meet the Americans with Disabilities Act (ADA) standards for accessible design set forth in Parts 35 and 36 of Title 28 of the Code of Federal Regulations (ADA accessibility standards), assistance can be provided by an individual accompanying the patient or a staff member who escorts the patient in and out of the examination room.

(3) If three examination rooms are provided, two shall meet the ADA accessibility standards.

(4) Room arrangement shall permit a min­imum clear dimension of 2 feet 8 inches (81.28 centimeters) at each side and at the foot of the examination table, recliner, or chair.

(5) Each room shall be designed so that the dimensions of the room are proportional to the square footage to avoid configurations that might hinder the functionality of the program space.

(h) Hand-Washing Stations

(1) A hand-washing station shall be provided in each room where hands-on patient care is provided.

(2) Hand sanitation dispensers shall be provided in addition to hand-washing stations.

(3) Hand-washing basins/countertops shall be made of porcelain, stainless steel, or solid sur­face materials. Basins shall be permitted to be set into plastic laminate countertops if, at a minimum, the substrate is marine-grade ply­wood (or equivalent) with an impervious seal.

(4) Sinks shall have well-fitted and sealed basins to prevent water leaks onto or into cabinetry and wall spaces.

(5) The water pressure at the fixture shall be regulated.

(6) Design of sinks shall not permit storage beneath the sink basin, and should accommodate ADA accessibility standards for clearance under the sink basin.

(i) Waiting Area

(1) The waiting area for patients and any individuals that accompanies patients shall be under staff control.

(2) The seating shall contain no fewer than two spaces for each consultation room and no fewer than 1.5 spaces for the combined projected capacity at one time of the group rooms.

(3) Where the psychiatric outpatient unit has a formal pediatrics service, a separate, controlled area for pediatric patients shall be provided.

(4) The waiting area shall accommodate wheelchairs.

(5) Provisions for drinking water shall be available for waiting patients. In shared facilities, provisions for drinking water may be outside the outpatient area if convenient for use.

(j) Corridor Allowed to be Used as a Waiting Area

(1) Fixed furniture in egress corridor. The furniture must be securely attached to the floor or wall and can be on only one side of the corridor. Each grouping of furniture cannot exceed 50 square feet and must be at least 10 feet from other groupings.

(2) Furniture shall be located so as to not obstruct access to building service and fire protection equipment, such as fire extinguishers, manual fire alarm boxes, shutoff valves, and similar equipment

(3) Corridors throughout the smoke compartment shall be protected by an electrically supervised automatic smoke detection system, or the fixed furniture spaces shall be arranged and located to allow direct supervision by the facility staff from a nurses’ station or similar space

(4) The smoke compartment shall be protected throughout by an approved, supervised automatic sprinkler system.

(k) Combustible Decorations in Egress Corridors and Rooms

(1) Combustible decorations shall be flame-retardant or are treated with approved fire-retardant coating that is listed and labeled for application to the material to which it is applied
.

(2) The decorations shall meet the requirements of NFPA 701, Standard Methods of Fire Tests for Flame Propagation of Textiles and Films
.

(3) The decorations exhibit a heat release rate not exceeding 100 KW when tested in accordance with NFPA 289, Standard Method of Fire Test for Individual Fuel Packages, using the 20 KW ignition source
.

(4) The decorations, such as photographs, paintings, and other art, are attached directly to walls, ceiling, and non-fire rated doors in accordance with the following:

i. Decorations on non-fire rated doors shall not interfere with the operation or any required latching of the door.

ii. Decorations shall not exceed 20 percent of the wall, ceiling, or door areas inside any room or space of a smoke compartment that is not protected throughout by an approved automatic sprinkler system.

iii. Decorations shall not exceed 30 percent of the wall, ceiling, and door areas inside any room or space of a smoke compartment that is protected throughout by an approved supervised automatic sprinkler system.

(l) Existing openings in exit enclosures to mechanical equipment spaces that are protected by fire-rated door assemblies. These mechanical equipment spaces must be used only for non-fuel-fired mechanical equipment, must contain no storage of combustible materials, and must be located in sprinklered buildings. This waiver allowance will be permitted only if the provider/supplier is in compliance with all other applicable NFPA 101 Life Safety Code, 2000 edition, exit provisions, as well as with section 7.1.3.2.1(9)(c) of the NFPA 101 Life Safety Code, 2012 edition.

(ii)
Behavioral health clinic providers authorized to integrate physical health services with more than 3 proposed examination rooms shall comply with the requirements under Part 710 (Approval of Medical Facility Construction), Part 711 (General Standards of Construction) and Part 715 (Standards of Construction for Freestanding Ambulatory Care Facilities) of Title 10 NYCRR.

(d)
Building Code Requirements

(1)
All services and facilities are required to adhere to applicable building codes as well as all local occupancy, use, building and zoning laws.

(2)
A valid Certificate of Occupancy is required.

(3)
NFPA 101 Life Safety Code, 2000 edition, for Chapter 20 New Ambulatory Health Care, Chapter 21 Existing Ambulatory Health Care, Chapter 38 New Business, and Chapter 39 Existing Business occupancies.

(4)
New York State Sanitary Code.

(5)
All occupied areas shall be ventilated by natural and/or mechanical means.

(6)
Air-handling duct systems shall meet the requirements of NFPA 90A.

Volume

VOLUME C (Title 10)

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