1. (a) General requirements.

   1. (1)

      1. (A) It is the intent of this subpart that ASCUs shall be designed to accommodate the complex and varied needs of residents with dementia.
      2. (B) The physical environment does not exist in isolation, but interacts with the:

2. (i) Activity program;

   1. (ii) Level of resident capability;

      1. (iii) Staffing; and

         1. (iv) Social milieu of the unit.

   2. (2) The environment shall be designed and developed to meet the following objectives:

      1. (A) Maximize awareness and orientation;
      2. (B) Ensure safety and security;
      3. (C) Provide privacy and a sense of control;
      4. (D) Support functional abilities; and
      5. (E) Develop environmental stimulation and challenge within a positive social milieu.

3. (b) Physical design. In addition to the physical design standards required for the facility’s license, an ASCU shall include the following:

   1. (1) A floor plan design that does not require visitors or staff to pass through the ASCU to reach other areas of the facility;
   2. (2) A multipurpose room or rooms for dining, group and individual activities, and family visits, which complies with the long-term care licensure requirements for common space;

   3. (3)

      1. (A) Secured outdoor space and walkways that allow residents to ambulate, with or without assistive devices such as wheelchairs or walkers, but prevents undetected egress.
      2. (B) Such walkways shall meet the accessibility requirements of the most current long-term care and Americans with Disabilities Act structural building codes or regulations.
      3. (C) Unrestricted access to secured outdoor space and walkways shall be provided, and such areas shall have fencing or barriers that prevent injury and elopement.
      4. (D) Fencing shall be no less than seventy-two inches (72”) high;
   4. (4) Prohibition of the use of plants that are poisonous or toxic for human contact or consumption;

   5. (5)

      1. (A) Visual contrast between floors and walls, and doorways and walls, in resident use areas.
      2. (B) Except for fire exits, exit doors and access ways shall be designed to minimize contrast and to obscure or conceal areas the residents should not enter;
   6. (6) Nonreflective floors, walls, and ceilings to minimize glare;
   7. (7) Evenly distributed lighting to minimize glare and shadows; and

   8. (8) A monitoring or nurses’ station with:

      1. (A) A call system to alert staff to any emergency needs of the residents; and

      2. (B) A space for charting and for storage of residents' records.

         1. (c) Physical environment and safety. The ASCU shall:

   9. (1)

      1. (A) Provide freedom of movement for the residents to common areas and to their personal spaces.
      2. (B) The facility shall not lock residents out of, or inside, their rooms;
   10. (2) Provide plates and eating utensils which provide visual contrast between the utensils and the table and that maximizes the independence of the residents;

   11. (3)

       1. (A) In common areas, provide comfortable seating sufficient to seat all residents at the same time.
       2. (B) The seating shall consist of a ratio of one (1) gliding or rocking chair for every five (5) residents;
   12. (4) Encourage and assist residents to decorate and furnish their rooms with personal items and furnishings based on the resident’s needs and preferences as documented by the ASCU in the social history;
   13. (5) Individually identify each resident's room based on the resident’s cognitive level to assist residents in locating their rooms and to permit them to differentiate their room from the rooms of other residents;
   14. (6) Keep corridors and passageways through common use areas free of objects which may cause falls, or which may obstruct passage by physically impaired individuals; and
   15. (7) Only use public address systems in the unit for emergencies.

Codification Notes: The Americans with Disabilities Act is codified generally at 42 U.S.C. § 12101 et seq.