(a)

1. (1) When part of a general hospital, these units shall be designed for the care of inpatients.
2. (2) Nonambulatory inpatients may be treated in a medical unit until their medical condition allows for transfer to the psychiatric nursing unit.
3. (3) Provisions shall be made in the design for adapting the area for various types of psychiatric therapies.

(b)

1. (1) The environment of the unit should be characterized by a feeling of openness with emphasis on natural light and exterior views.
2. (2) Various functions should be accessible from common areas while not compromising desirable levels of patient privacy.

3. (3)

   1. (A) Interior finishes, lighting, and furnishings should suggest a residential rather than an institutional setting.
   2. (B) These should, however, conform with applicable fire safety codes.
4. (4) Security and safety devices should not be presented in a manner to attract or challenge tampering by patients.

(e) Each nursing unit shall provide the following:

1. (1)

   1. (A) Patient rooms.
   2. (B) The patient room requirements noted in 20 CAR § 41-147, physical facilities — patient accommodations — adult medical, surgical — communicable or pulmonary disease, shall be applied to patient rooms in psychiatric nursing units except as follows:

(b) (b) Covering call button outlets;

1. (ii) Bedpan flushing devices shall be omitted from patient room toilets;

   1. (iii) Handwashing stations are not required in patient rooms;

      1. (iv) Visual privacy in multibed rooms (e.g., cubicle curtains) is not required;
      2. (v) The ceiling and the air distribution devices, lighting fixtures, sprinkler heads, and other appurtenances shall be of a tamper-resistant type;
      3. (vi) Each patient room shall be provided with a private toilet that meets the following requirements:

(b) (b) The door shall be capable of swinging outward; and

1. (c) (c) The ceiling shall be of tamper-resistant construction and the air distribution devices, lighting fixtures, sprinkler heads, and other appurtenances shall be of the tamper-resistant type; and

   1. (vii)

(a) (a) Patient rooms, exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules, shall be at least:

1. (1) (1) One hundred square feet (100 sq. ft.) for single-bed rooms; and
2. (2) (2) Eighty square feet (80 sq. ft.) per bed for multiple-bed rooms.

(b) (b) The dimensions and room arrangement criteria of 20 CAR § 41-147 does not apply;

1. (2) Service areas. The standards noted in 20 CAR § 41-147, physical facilities — patient accommodations — adult medical, surgical — communicable or pulmonary disease, shall apply to service areas for psychiatric nursing units with the following modifications:

   1. (A)

      1. (i) A secured storage area shall be provided for patients’ belongings that are determined to be potentially harmful (e.g., razors, nail files, cigarette lighters).
      2. (ii) This area shall be controlled by staff;
   2. (B) Medication station shall include provisions for security against unauthorized access;

   3. (C) Food service within the unit may be one (1) or a combination of the following:

      1. (i) A nourishment station;
      2. (ii) A kitchenette designed for patient use with staff control of heating and cooking devices; and
      3. (iii) A kitchen service within the unit including:

(b) (b) Storage space;

1. (c) (c) Refrigerator; and

   1. (d) (d) Facilities for meal preparation;
   2. (D) Storage space for stretchers and wheelchairs may be outside the psychiatric unit, provided that provisions are made for convenient access as needed for disabled patients;

   3. (E)

      1. (i) In psychiatric nursing units, a bathtub or shower shall be provided for every six (6) beds not otherwise served by bathing facilities within the patient rooms.
      2. (ii) Bathing facilities shall be designed and located for patient convenience and privacy;

   4. (F)

      1. (i) A separate charting area shall be provided with provisions for acoustical privacy.
      2. (ii) A viewing window to permit observation of patient areas by the charting nurse or physician may be used if the arrangement is such that patient files cannot be read from outside the charting space;

   5. (G)

      1. (i) At least two (2) separate social spaces, one (1) appropriate for noisy activities and one (1) for quiet activities, shall be provided.
      2. (ii) The combined area shall be a minimum of forty square feet (40 sq. ft.) per patient with a minimum of one hundred twenty square feet (120 sq. ft.) for each of the two (2) spaces.
      3. (iii) This space may be shared by dining activities;

   6. (H)

      1. (i) Space for group therapy shall be provided.
      2. (ii) This may be combined with the quiet space noted above in subdivision (e)(2)(G) of this section when the unit accommodates not more than twelve (12) patients and when at least two hundred twenty-five square feet (225 sq. ft.) of enclosed private space is available for group therapy activities;

   7. (I)

      1. (i) Patient laundry facilities with an automatic washer and dryer shall be provided.
      2. (ii) The following elements shall also be provided, but may be either within the psychiatric unit or immediately accessible to it unless otherwise dictated by the functional program;

   8. (J)

      1. (i) A room or rooms for examination and treatment with a minimum floor area of one hundred twenty square feet (120 sq. ft.).
      2. (ii) Examination and treatment room or rooms for medical-surgical patients may be shared by the psychiatric unit patients.
      3. (iii) These may be on a different floor if conveniently accessible;

   9. (K)

      1. (i) Separate consultation room or rooms with minimum floor space of one hundred square feet (100 sq. ft.) each, provided at a room-to-bed ratio of one (1) consultation room for every twelve (12) psychiatric beds.
      2. (ii) The room or rooms shall be:

(b) (b) Constructed to achieve a noise reduction of at least forty-five (45) decibels.

1. (iii) This room is not required if all rooms are private;

   1. (L)

      1. (i) Psychiatric units each containing fifteen square feet (15 sq. ft.) of separate space per patient for patient therapy/multipurpose use, with a minimum total area of at least two hundred square feet (200 sq. ft.), whichever is greater.
      2. (ii) Space shall include provision for:

(b) (b) Work counter or counters;

1. (c) (c) Storage; and

   1. (d) (d) Displays.

      1. (iii) This space may serve more than one (1) nursing unit.
      2. (iv) When psychiatric nursing unit or units contain less than twelve (12) beds, the therapy and other functions may be performed within the noisy activities area if at least an additional ten square feet (10 sq. ft.) per patient served is included; and
   2. (M) A conference and treatment planning room for use by the psychiatric unit; and

2. (3) Seclusion treatment room.

   1. (A) There shall be at least one (1) seclusion room for:

      1. (i) Up to twenty-four (24) beds; or
      2. (ii) A major fraction thereof.
   2. (B) If a facility has more than one (1) psychiatric nursing unit, the number of seclusion rooms shall be a function of the total number of psychiatric beds in the facility; and

   3. (C)

      1. (i) Seclusion rooms may be grouped together.
      2. (ii)

(b) (b) The room or rooms shall be located for direct nursing staff supervision.

1. (c) (c) Each room shall be for only one (1) patient.

   1. (d) (d) It shall:
2. (1) (1) Have an area of at least sixty square feet (60 sq. ft.); and

3. (2) (2) Be constructed to prevent patient:

   1. (A) (A) Hiding;
   2. (B) (B) Escape;
   3. (C) (C) Injury; or
   4. (D) (D) Suicide.

(e) (e) Where restraint beds are required by the functional program, eighty square feet (80 sq. ft.) shall be required.

1. (iii)

(b) (b) Outside corners shall be omitted where possible.

1. (c) (c) The ceiling shall be of tamper-resistant construction and the air distribution devices, lighting fixtures, sprinkler heads, and other appurtenances shall be of the tamper-resistant type.

   1. (d) (d) The walls shall be completely free of objects.

(g) (g) Doors shall:

1. (1) (1) Be three feet eight inches (3’ 8”) wide; and
2. (2) (2) Permit staff observation of the patient while also maintaining provisions for patient privacy.

(h) (h) Seclusion treatment rooms shall be accessed by an anteroom or vestibule that also provides direct access to a toilet room.

1. (i) (i) The toilet room and anteroom shall provide for safe management of the patient.

   1. (iv)