902 KAR 20:330

902 KAR 20:330. Psychiatric residential treatment facilities.

RELATES TO: KRS 216B.010-216B.130, 216B.450-216B.459, 216B.990

STATUTORY AUTHORITY: KRS 216B.042, 216B.105, EO 2004-726

NECESSITY, FUNCTION, AND CONFORMITY: KRS 216B.042 and 216B.105 mandate that the Kentucky Cabinet for Health and Family Services regulate health facilities and services. This administrative regulation establishes physical plant requirements for psychiatric residential treatment facilities. This administrative regulation allows existing facilities or residential occupancies, with modifications, to be licensed in this category of health care.

Section 1. Definitions.

(1) "Certificate of need" is defined in KRS 216B.015(8).

(2) "Licensure agency" means the Cabinet for Health and Family Services, Office of the Inspector General.

(3) "Living unit" means the area within a single building that is supplied by the facility for daily living and therapeutic interaction of no more than nine (9) residents.

(4) "Psychiatric residential treatment facility" or "PRTF" is defined in KRS 216B.450(5).

Section 2. Preparation and Approval of Plans and Specifications.

After receiving a certificate of need the following procedures shall be followed:

(1) Before construction shall begin for the erection of new buildings or alterations to existing buildings or any changes in facilities, the licensee or applicant shall submit plans in the detail specified in Section 3 of this administrative regulation to the licensure agency for approval.

(2) All architectural, mechanical and electrical drawings shall bear either the seal of a professional engineer registered in the Commonwealth of Kentucky or an architect registered in the Commonwealth of Kentucky.

(3) Drawings shall not exceed thirty-six (36) inches by forty-six (46) inches when trimmed.

(4) All plans and specifications shall be approved by the licensure agency prior to commencement of construction of new buildings or alterations of existing buildings.

(5) Plans and specifications in specific detail as required by the Kentucky Building Code, 815 KAR 7:120, shall be submitted together with architectural or engineering stamps as required by KRS Chapters 322 and 323, to the Office of Housing, Buildings and Construction for determining compliance with the Kentucky Building Code. Plans and specifications shall be approved by the Office of Housing, Buildings and Construction and appropriate local building permits shall be obtained prior to commencement of construction.

(6) Access to the work. Representatives of the appropriate state agencies shall have access at all reasonable times to the work wherever it is in preparation or progress, and the contractor shall provide proper facilities for that access and inspection.

Section 3. Compliance with Building Codes, Ordinances and Administrative Regulations.

(1) General. A PRTF shall be in compliance with building codes, ordinances, and administrative regulations which are enforced by city, county, or state jurisdictions.

(2) The following requirements shall apply if applicable and as adopted by the respective agency authority:

(a) Requirements for fire safety pursuant to 815 KAR 10:060.

(b) Requirements for plumbing pursuant to 815 KAR 20:010 through 20:195.

(d) Requirements for making buildings and facilities accessible to and usable by persons with disabilities pursuant to 28 C.F.R. Part 36.

(3) Prior to occupancy, a facility shall have final approval from appropriate agencies.

(4) All facilities shall be currently approved by the Office of Housing, Buildings and Construction before licensure and relicensure is granted by the licensure agency.

Section 4. Facility Requirements and Special Conditions.

(1) Facilities shall be accessible to and usable by persons with disabilities in compliance with the provisions of the Americans With Disabilities Act, 42 U.S.C. 12101 et seq.

(2) Access to a facility shall be by means of a paved or gravel roadway which shall be available for use by traffic prior to a license being issued to a facility for occupancy.

(3) A copy of the narrative program for each project shall be provided to the licensure agency by the sponsor which describes the functional space requirements, staffing patterns, departmental relationships, and other basic information relating to the fulfillment of the objectives of the facility.

(4) The number and types of rooms of the diagnostic, clinical, and administrative facilities to be provided shall be determined by the services to be provided and the estimated patient load as described in the narrative program.

Section 5. Living Unit.

A living unit shall be located within a single building and shall include:

(1) Bedrooms.

(a) Bedrooms shall not be used to sleep more than two (2) children and shall have clearances of at least three (3) feet between each bed, and four (4) feet from the foot of the beds.

(b) Bedrooms shall be equipped with a bed for each resident. Beds shall be not less than thirty-six (36) inches wide nor less than five (5) feet in length and shall be long and wide enough to accommodate the resident's size. A mattress cover, two (2) sheets, a pillow, bed covering as is required to keep the resident comfortable shall be provided for each bed. Rubber or impervious sheets shall be placed over the mattress cover if appropriate. Each bed shall be equipped with a support mechanism and a clean mattress.

(c) Beds occupied by residents shall be placed so that no child will experience discomfort because of proximity to radiators, heat outlets, or exposure to drafts.

(d) There shall be separate sleeping quarters for males and females.

(e) Residents shall not be housed in rooms, detached buildings, or other enclosures which have not been previously inspected and approved for residential use by the licensure agency and the Office of Housing, Buildings and Construction.

(f) Bedrooms shall not be located more than sixty (60) feet from the duty stations, and the doors shall be within visual contact with the duty station.

(g) A room shall not be used as a resident bedroom if the access is through another resident's bedroom.

(2) Bathrooms.

(a) Each living unit shall have a minimum of one (1) wash basin with hot and cold water, one (1) flush toilet, and one (1) bath or shower with hot and cold water for every five (5) residents, or fraction thereof, residing within the living unit. (Separate toilet and bath/shower facilities shall be provided for each sex.)

(b) Each bathroom shall be supplied with toilet paper, towels, soap, and wastebaskets.

(c) If more than one (1) toilet is provided in the same room, each toilet shall be partitioned and include a door capable of remaining closed which affords full visual privacy.

(d) Bathtubs and showers shall have enclosures or screens for individual privacy. Shower heads shall be of institutional safety type.

(e) At least one (1) bathing facility shall have space for a wheelchair resident with an assisting attendant. It may serve both sexes.

(f) Each bathroom shall contain at least one (1) nondistorting mirror secured to the wall at a convenient height for both individuals with disabilities and other residents.

(g) The bathrooms shall not be constructed to create a thoroughfare bathroom to bedrooms. The bathroom shall only have one (1) door.

(3) Wardrobe or closet for each resident. Minimum clear dimensions: one (1) foot and ten (10) inches deep by one (1) foot and eight (8) inches wide with full length hanging space; provide clothes rod and shelf. Additional areas shall be provided for storage of resident's winter coats, raincoats and other bulky articles of clothing, etc. Those areas shall be key-locked and under staff control.

(4) Desk and chair for each resident. Minimum clear dimensions for the desk: one (1) foot and six (6) inches deep by three (3) feet wide by two (2) feet high.

(5) Window. Degree of security required shall be as determined by the program. Where glass fragments could create a hazard, safety glazing or other appropriate security features shall be incorporated.

(6) If a staff call system is included, provisions shall be made to permit removal of call buttons or use of blank plates as appropriate.

(7) Resident's living, dining, and recreation area:

(a) The total area provided for living and recreation shall be not less than forty (40) square feet per resident;

(b) The total area provided for dining shall not be less than fifteen (15) square feet per resident.

(d) Indoor recreation equipment in good condition and appropriate for the ages of residents on the living unit shall be provided and maintained.

(e) Storage shall be provided for recreational equipment and supplies. (Such as wall cabinets or closets.)

(f) The facility shall provide space for outdoor recreation activities for residents. The outdoor area shall be free from litter, glass and other objects which pose undue safety hazards to residents.

(g) Outdoor recreation equipment in good condition and appropriate for the age of the residents shall be provided and maintained.

(8) Service areas for each living unit. The size and location of each area shall depend on the number of residents served and shall include:

(a) A duty station. Adequate space for charting and other required administrative functions shall be provided.

(b) A medicine area.

1. Provision shall be made for twenty-four (24) hour distribution of medicine to residents and this may be from a medicine preparation room or unit, a self-contained medicine dispensing unit, or by another approved system.

2. If a medicine preparation room or unit is used, it shall be under the treatment staff's visual control and contain a work counter, refrigerator, sink and locked storage for biologicals and drugs.

3. If a medicine dispensing unit is used, it may be located at the duty station, in a clean workroom, or in an alcove under direct control of the treatment or pharmacy staff.

4. Controlled substances shall be kept under double lock.

(9) A working sink, stove and refrigerator, unless a kitchen is directly available within the same building as the living unit.

Section 6. Kitchen Area.

If a commercial service is used or meals are provided by an adjacent facility, dietary areas and equipment shall be designed to accommodate the requirements for sanitary, efficient and safe storage, processing, and handling; otherwise the following shall be provided:

(1) Food serving facilities to accommodate residents and staff.

(2) Refrigerated storage to accommodate a three (3) day supply minimum.

(3) Dry storage to accommodate a three (3) day supply minimum.

(4) Janitor's closet. Storage for housekeeping supplies and equipment. A locked area shall be provided for hazardous materials.

Section 7. Administration Area.

Sufficient space shall be allotted for administrative operations.

Section 8. Consultation and Visitation Rooms.

Professional consultation rooms shall be provided which provide for the privacy and dignity of the patient during interview, examination, treatment, and visitation.

Section 9. Pharmacy or Drug Area.

There shall be adequate facilities for the safe storage and handling of pharmaceuticals including double locking of controlled substances and refrigeration for biologicals and drugs which require refrigeration.

Section 10. Seclusion Room.

(1) A seclusion room may be provided.

2. A seclusion room:

(a) Shall be completely padded and be constructed to minimize the resident's hiding, escape, injury or suicide; and

(b) Shall be used only for short-term occupancies by residents who may have become violent or suicidal.

(3) Special fixtures, hardware, furniture or other items which might potentially endanger the safety of the secluded resident shall not be placed in a seclusion room.

(4) Electrical switches, receptacles, etc. shall not be provided in a seclusion room.

(5) A seclusion room door shall swing outward and have provisions for staff observation while maintaining privacy from the public and other patients.

(6) A seclusion room shall be designed to allow for constant visual inspection of the entire room.

Section 11. Storage and Service Areas. The following shall be included:

(1) Sufficient storage space shall be provided.

(2) Engineering service and equipment areas. The following shall be provided if applicable:

(a) Storage room for housekeeping equipment. Not required if space is available in janitor's closets or elsewhere.

(b) Refuse area, for holding trash prior to disposal, shall be located convenient to service entrance.

Section 12. Details and Finishes.

A high degree of safety for the occupants in minimizing the incidence of accidents shall be provided. Hazards such as sharp corners shall be avoided. All details and finishes shall meet the following requirements:

(1) Details.

(a) All doors opening onto corridors shall be swing-type except elevator doors. Alcoves and similar spaces which generally do not require doors shall be excluded from this requirement.

(b) All doors to resident room toilet rooms shall swing outward or shall be equipped with hardware which will permit access in any emergency.

(d) Towel rack or dispensers shall be provided at all lavatories and sinks used for handwashing.

(e) Ceiling heights shall not be less than seven (7) feet and six (6) inches.

(2) Finishes.

(a) Floors shall be easily cleanable and shall have the wear resistance appropriate for the location involved. Floors in kitchen and related spaces shall be waterproof and grease-proof. In all areas where floors are subject to wetting, they shall have a nonslip finish.

(b) Adjacent dissimilar floor materials shall be flush with each other to provide an unbroken surface.

(c) Walls shall be washable and, in the immediate area of plumbing fixtures, the finish shall be moisture-proof. Wall bases in dietary areas shall be free of spaces that can harbor insects.

(d) Ceilings shall be maintained for cleanliness.

(e) Rooms containing heat-producing equipment such as laundries and food preparation areas shall be insulated and ventilated to prevent any floor surface from exceeding a temperature of ten (10) degrees Fahrenheit above the ambient room temperature.

Section 13. Construction.

(1) Foundations shall rest on natural solid ground if a satisfactory soil is available at reasonable depths.

(2) Proper soil bearing values shall be established in accordance with recognized standards.

(3) If solid ground is not encountered at practical depths, the structure shall be supported on driven piles or drilled piers designed to support the intended load without detrimental settlement.

Section 14. Mechanical Requirements.

(1) Steam and hot water systems. If boilers are provided in residential treatment facilities the design and installation shall comply with 815 KAR 20:010 through 20:195.

(2) Temperature.

(a) A minimum temperature of sixty-eight (68) degrees Fahrenheit shall be provided for in occupied areas in winter conditions.

(b) A maximum temperature of eighty-five (85) degrees Fahrenheit shall be provided for in occupied areas in summer conditions.

(3) Plumbing and other piping systems.

(a) All showers and bathtubs shall be equipped with a temperature control device which controls hot water at a maximum temperature of 110 degrees Fahrenheit.

(b) Fixtures used in the dietary area, the clean work room and medi/prep area shall be trimmed with valves which can be operated without the use of hands.

(d) Fixtures shall be installed to provide adequate side clearances for proper use of the blade handles.

(4) Water supply systems.

(a) A water supply system shall be designed to supply water to the fixtures and equipment on the upper floors at a minimum pressure of fifteen (15) pounds per square inch during maximum demand periods.

(b) Each water service main, branch main, riser and branch to a group of fixtures shall be valved. Stop valves shall be provided at each fixture.

(c) Hot, cold and chilled water piping and waste piping on which condensation may occur shall be insulated. Insulation of cold and chilled water lines shall include an exterior barrier.

(d) Backflow preventers (vacuum breakers) shall be installed on hose bibs and on all fixtures to which hoses or tubing can be attached such as janitor's sinks and bedpan flushing attachments.

(e) Hot water distribution systems shall be arranged to provide hot water at each fixture at all times.

(f) Piping over food preparation centers, food serving facilities, food storage areas, and other critical areas shall be kept to a minimum and shall not be exposed. Special precautions shall be taken to protect these areas from possible leakage of, or condensation from necessary overhead piping systems.

(5) Hot water heaters and tanks.

(a) The hot water heating equipment shall have sufficient capacity to supply the water at the temperature and amounts indicated below:

Gal/hr/bed	6 1/2
Temperature (Degrees Fahrenheit)	100-120

(b) A storage tank, or tanks if necessary, shall be provided and shall be fabricated of corrosion-resistant metal, or have noncorrosive lining.

(6) Plumbing approval. Prior to licensure and relicensure, all specifications shall be approved by the Kentucky Division of Plumbing, Office of Housing, Buildings and Construction.

Section 15. Electrical Requirements.

(1) General. Electrical requirements of the Kentucky Building Code shall apply if applicable.

(2) The wiring in each home shall be inspected by a certified electrical inspector and a certificate of approval shall be issued to the facility prior to occupancy; except, the wiring in existing buildings shall be approved by a certified electrical inspector only if the building has not been previously so approved for health care occupancy or if the State Fire Marshal finds that a hazardous condition exists.

(3) Switchboard and power panel. All breakers and switches shall be indexed.

(4) Lighting.

(a) All spaces occupied by people, machinery, and equipment within buildings, and the corresponding approaches, and parking lots shall have electric lighting.

(b) Residents' bedrooms shall have general lighting.

1. A reading light shall be provided for each resident if appropriate.

2. Residents' reading lights and other fixed lights not switched at the door shall have switch controls convenient for use at the luminary.

3. Night lights shall be provided in each resident's room.

(5) Receptacles (convenience outlets).

(a) Bedroom. Each resident bedroom shall have duplex receptacles as follows:

1. One (1) side of the head of each bed; receptacles for luminaries, television and motorized beds, if used, and one (1) receptacle on another wall.

2. Receptacles shall be of a safety type or protected with five (5) milliampere ground fault interrupters.

(b) Corridors. Duplex receptacles for general use shall be installed approximately fifty (50) feet apart in all corridors and within twenty-five (25) feet of ends of corridors. Receptacles shall be of a safety type or protected with five (5) milliampere ground fault interrupters.

(17 Ky.R. 2123; eff. 3-12-91; Am. 19 Ky.R. 1214; 1624; eff. 2-17-93; 24 Ky.R. 1978; eff. 5-18-98; 32 Ky.R. 678; eff. 10-19-05.)