Code of Massachusetts Regulations
105 CMR - DEPARTMENT OF PUBLIC HEALTH
Title 105 CMR 158.000 - Licensure of Adult Day Health Programs
Section 158.045 - Physical Plant Requirements

Universal Citation: 105 MA Code of Regs 105.158

Current through Register 1531, September 27, 2024

(A) General Requirements.

(1) The Program site shall be designed with adequate space for the provision of all Services.

(2) When located in a facility housing other services, the Program shall operate solely within the Program's licensed space.

(3) A Program shall be located in a site that complies with the Americans with Disability Act (ADA) and ADA Standards for Accessible Design, including, but not limited to, the following features:
(a) On ground level with at least two means of egress;

(b) Free of architectural barriers;

(c) Designed to meet the needs of disabled persons; and

(d) In compliance with local health, fire, and safety codes.

(4) Each site shall include adequate outdoor space for participants to safely arrive at and depart from the Program site.

(5) Each site shall provide a protected and secure environment for participants, including participants who wander or require increased supervision and security.

(6) The Program shall provide sufficient parking capacity to satisfy the needs of participants, personnel, and the public.

(7) Separate and additional space shall be provided for service delivery vehicles and vehicles used for participants' transfer.

(8) Each site shall include a clean and sanitary food preparation area equipped with a refrigerator, a sink, adequate counter space, and adequate storage space.

(9) If meals are cooked on-site, a Program shall have a full kitchen approved by the local Board of Health.

(10) Adequate artificial lighting shall be available in all rooms, stairways, hallways, corridors, toilet rooms, and offices.

(11) A Program with five or more unrelated participants shall comply with the Massachusetts State Building Code, 780 CMR 3.00: Use and Occupancy Classification.

(B) Participant Area.

(1) The Participant Area shall contain at least 50 square feet per participant.

(2) When a kitchen is used for activities other than meal preparation, 50% of the kitchen floor area shall be counted as Participant Area.

(3) All Participant Areas shall have hand sanitizer dispensers and access to at least one handwashing station. Hand sanitizer dispensers and handwashing stations shall be conveniently placed and accessible to staff. Hand sanitizer dispensers and handwashing stations shall be placed with consideration for participant safety.

(4) An ADH Program shall provide participant areas with access to natural light and outside views.

(5) Participant Areas shall have adequate lighting, heating, and ventilation so that participants are comfortable in all seasons of the year.

(C) Rest or Private Area. A Program shall provide a private, quiet rest area for participants who require rest or become ill. This area shall be considered part of the Participant Area. This area shall be located in a place that can be clearly monitored and that is near a toilet room.

(D) Outdoor Area.

(1) When space for outdoor activities is available, it shall be safe, accessible to the Program from indoors, and accessible to individuals with disabilities.

(2) Outdoor areas shall have a fence or landscaping to create a boundary that prevents participant elopement.

(E) Meeting Area. A Program shall provide a space for participants, family, and caregivers to have private meetings with staff. An administrative office may be used as a meeting area.

(F) Equipment and Supply Storage.

(1) Storage space shall be available for Program and operating supplies.

(2) Each site shall include a locked storage area not accessible to participants for the storage of toxic substances.

(G) Participant Toilet Rooms.

(1) A Program shall provide at least two toilet rooms, one of which is handicapped accessible. Each toilet room shall be equipped with at least one toilet and one lavatory.

(2) A Program with a licensed program capacity of 24 or more participants shall provide at least one toilet per 12 participants.

(3) At least 50% of the toilets shall be designed or adapted to provide access and maneuverability for individuals with disabilities or individuals in wheelchairs.

(4) Participant toilet rooms shall be located no more than 40 feet away from the Participant Area.

(5) Emergency call stations shall be provided in each toilet stall used by participants.

(H) Bathing Facilities.

(1) A Program shall provide at least one shower. Shower floors shall be flush and without curbs. The floor shall be sloped to the center of the shower stall. Mixing valves and controls shall be mounted outside the shower stall. Shower enclosure may not be less than 30 inches by 60 inches.

(2) Emergency call stations shall be provided in bathing facilities used by participants.

(I) Areas for Staff.

(1) A Program shall provide at least one dedicated staff toilet.

(2) A staff break area shall be provided.

(J) Nursing Office.

(1) The Program shall have a nursing office.

(2) A Program shall provide a nursing office with a minimum clear floor area of 80 square feet.

(3) The nursing office shall be equipped to accommodate nursing functions, which may include charting or providing counseling to participants, families, or caregivers.

(4) If the nursing office is used for providing treatments, a handwashing station shall be provided in the office.

(K) Medical Equipment Storage. A Program shall provide for the secure storage of medical equipment and supplies.

(L) Janitor's Closet. A janitor's closet that contains a service sink shall be provided to store and secure housekeeping items.

(M) Telephone. A telephone shall be available for participants in an area that affords privacy during use.

(N) Architectural Details.

(1) Any corridor used by participants shall have a minimum width of five feet. Staff-only corridors shall be at least three feet eight inches wide.

(2) The minimum ceiling height shall be eight feet zero inches, with the following exceptions:
(a) Ceilings in storage rooms may not be less than seven feet eight inches;

(b) Ceilings in normally unoccupied spaces may not be less than seven feet;

(c) Architecturally framed and trimmed openings in corridors, doorways, and other openings may not be less than seven feet in height.

(3) Doors and Door Hardware.
(a) Lever hardware shall be used on all doors for ease of use by participants with mobility limitations. Toilet doors used by participants shall be equipped with hardware that allows staff to manually unlock doors for emergency access.

(b) Exterior doors that may be left open shall have insect screens.

(c) All interior doors used by participants shall open with ease and little resistance.

(d) Operable windows or vents that open from the inside shall be restricted to inhibit participant elopement or suicide.

(e) Operable windows that may be left open shall have insect screens.

(O) Handwashing Stations.

(1) Fittings.
(a) General handwashing stations used by staff and participants shall be trimmed with valves that can be operated without hands.

(b) If single-lever or wrist blade devices are used, blade handles shall be at least four inches in length. Care shall be taken in location and arrangement of fittings to provide the clearance required for operation of blade-type handles.

(2) Handwashing stations shall include a hand-drying device that does not require hands to contact the dispenser.

(3) Handwashing stations shall include liquid or foam soap dispensers.

(4) Each participant handwashing station shall have a mirror. Mirror placement shall allow for convenient use by both wheelchair occupants and ambulatory persons.

(P) Grab Bars.

(1) Grab bars shall be installed in all resident toilets and bathing areas.

(2) For wall-mounted grab bars, a minimum clearance of 11/2 inches from walls shall be provided.

(3) Grab bars, including those which are part of fixtures such as soap dishes and toilet paper holders, shall have the strength to sustain a concentrated load of 250 pounds.

(Q) Handrails. Handrails shall comply with the Americans with Disabilities Act (ADA) Standards for Accessible Design, and, with respect to corridors, shall comply with the Facilities Guidelines Institute guidelines for adult day health care facilities.

(R) Flooring.

(1) Flooring surfaces shall be easily maintainable, readily cleanable, and appropriate for the location.

(2) Flooring surfaces shall allow for ease of ambulation and self-propulsion.

(3) Flooring surfaces shall provide smooth transitions between differing flooring materials.

(4) Slip-resistant flooring products shall be used for flooring surfaces in wet areas, including the kitchen, shower(s), toilet rooms, ramps, and entries from exterior to interior space.

(S) Building Systems.

(1) Heating, Ventilation, and Air-conditioning Systems.
(a) Ventilation by mechanical means shall be provided. Air conditioning and heating equipment shall be adequate and capable of maintaining the temperature in the participant area between 72°F and 78°F.

(b) Continuous exhaust ventilation to outdoors shall be provided in toilet rooms, bathing rooms, kitchen, and janitor's closet.

(2) Plumbing Systems. Hot and cold running water shall be available. Hot water at shower, bathing, and handwashing facilities shall not exceed 110°F.

(T) Fire Protection and Safety.

(1) A Program shall have:
(a) Current local board of health certificate(s), as applicable;

(b) Current occupancy permit; and

(c) Current local fire inspection certificate.

(2) All exits shall be clearly identified by exit signs, adequately lighted, and free from obstruction.

(3) Clothes dryers shall have the lint filter cleaned after each use.

(4) A Program shall have easily accessible fire extinguishers that are maintained in accordance with local fire department requirements.

(U) Storage and Use of Oxygen.

(1) Administration.
(a) A Program shall have policies and procedures in place for the safe use and storage of oxygen.

(b) Personnel responsible for the use and transport of equipment shall be trained in proper handling of cylinders, containers, hand trucks, supports, and valve protection caps.

(c) Carts and hand trucks for cylinders and containers shall be constructed for the intended purpose and shall be provided with appropriate means to retain cylinders or containers in place.

(2) Storage of 3000 Cubic Feet of Oxygen or More.
(a) Closets or rooms shall be provided for cylinder storage. Such closets or rooms shall be constructed of an assembly of building materials with a fire-resistive rating of at least one hour. Such enclosures shall serve no other purpose.

(b) Closets or rooms for oxygen storage shall be vented to the outside by a dedicated mechanical ventilation system or by natural venting. If natural venting is used, the vent opening or openings shall be at least 72 square inches total free area.

(c) Storage locations for oxygen shall be kept free of flammable materials. Flammable gases shall not be stored with oxidizing agents.

(d) Combustible materials, such as paper, cardboard, plastics, and fabrics, shall not be stored or kept near supply system cylinders or manifolds containing oxygen. Racks for cylinder storage shall be permitted to be of wooden construction.

(e) Storage of full or empty cylinders is permitted.

(f) Provisions shall be made for racks or fastenings (properly chained or supported in a proper cylinder stand or cart) to protect cylinders from accidental damage or dislocation. Oxygen cylinders shall be protected from abnormal mechanical shock, which is liable to damage the cylinder, valve, or safety device.

(g) Ordinary electric wall fixtures, switches, and receptacles shall be installed in fixed locations not less than five feet above the floor as a precaution against their physical damage.

(h) Sources of heat in storage locations shall be protected or located so that cylinders shall not be heated to the activation point of integral safety devices. Cylinders shall be kept away from radiators, steam piping, and like sources of heat. In no case shall the temperature of the cylinders exceed 130°F.

(i) Containers shall not be stored in a tightly closed space such as a closet.

(j) The door to the storage location shall be provided with a precautionary sign, readable from a distance of five feet, indicating "No Smoking, Oxygen Storage Area".

(3) Storage for Less Than 3000 Cubic Feet of Oxygen.
(a) Storage locations shall be in an enclosure or within an enclosed interior space of noncombustible or limited-combustible construction, with doors or outdoors.

(b) Oxygen shall not be stored with any flammable gas, liquid, or vapor.

(c) Oxygen shall be separated from combustibles or incompatible materials by either:
1. A minimum distance of 20 feet;

2. A minimum distance of five feet if the entire storage location is protected by an automatic sprinkler system; or

3. An enclosed cabinet of noncombustible construction having a minimum fire protection rating of 1/2 hour for cylinder storage. An approved flammable liquid storage cabinet shall be permitted to be used for cylinder storage.

(d) Storage of full or empty cylinders is permitted.

(e) Provisions shall be made for racks or fastenings (properly chained or supported in a proper cylinder stand or cart) to protect cylinders from accidental damage or dislocation. Oxygen cylinders shall be protected from abnormal mechanical shock, which is liable to damage the cylinder, valve, or safety device.

(f) Ordinary electric wall fixtures, switches, and receptacles shall be installed in fixed locations not less than five feet above the floor as a precaution against their physical damage.

(g) Sources of heat in storage locations shall be protected or located so that cylinders shall not be heated to the activation point of integral safety devices. Cylinders shall be kept away from radiators, steam piping, and like sources of heat. In no case shall the temperature of the cylinders exceed 130°F.

(h) The door to the storage location shall be provided with a precautionary sign, readable from a distance of five feet, indicating "No Smoking, Oxygen Storage Area".

(4) Storage for Less Than 300 Cubic Feet of Oxygen. Up to 300 cubic feet (12 "E" cylinders) of oxygen in cylinders may be accessible as operational supply located outside of a storage enclosure. Provisions shall be made for racks or fastenings (properly chained or supported in a proper cylinder stand or cart) to protect cylinders from accidental damage or dislocation. Oxygen cylinders shall be protected from abnormal mechanical shock, which is liable to damage the cylinder, valve, or safety device.

(5) Liquefied Gas Container Storage. Containers of liquefied oxygen shall be stored in accordance with the storage requirements for the storage of more than 3000 cubic feet of oxygen.

(6) Transferring of liquid oxygen from one container to another shall be done outside of the building or at a location specifically designated for the transferring that meets the following:
(a) Separated from any portion of a facility wherein participants are housed, examined, or treated by a separation of a fire barrier of one-hour fire-resistive construction;

(b) The area is mechanically ventilated, has sprinklers, and has ceramic or concrete flooring; and

(c) The area is posted with signs indicating that transferring is occurring, and that smoking in the immediate area is not permitted.

(7) Smoking shall be prohibited where flammable liquids, combustible gases, or where supplemental oxygen is used or stored. Such areas shall be posted with signs that read NO SMOKING or shall be posted with the international symbol for no smoking. Exception: In health care occupancies where smoking is prohibited and signs are prominently placed at all major entrances, secondary signs with language that prohibits smoking shall not be required.

(8) The use of any type of oxygen dispensing system not outlined in 105 CMR 158.000 must be approved by the Department.

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