Sec. 10.21.02.10. Physical Plant

A. Location. The premises on which a psychiatric day treatment center is to be located shall be served by a good road. Accessible public transportation is desirable.

B. Communication. There shall be at least one telephone readily available - not a pay station or locked telephone - in the building and additional telephones or extensions as may be required to summon help promptly in case of fire or other emergencies.

C. Buildings.

(1) Any building used for a psychiatric day treatment center shall be kept in good repair, neat, clean, attractive, and safe. Housekeeping shall meet the highest possible standards of hygiene and cleanliness. All floors, walls, ceilings, windows, and fixtures shall be kept clean. Interior walls and floors shall be of a character to permit frequent and easy cleaning. The building shall be accessible to the handicapped. The facility shall be kept free of unnecessary accumulations of unused furniture, equipment, linen, clothing, and similar items. All paint shall be free from lead.

(2) The director shall provide for the safety and protection of all occupants and assure the elimination of all hazards. Adequate provision and training shall be made for fire-control equipment, fire escapes, and evacuation of persons in case of fire or other emergency. Fire drills shall be held on a regular basis.

(3) Any proposed alterations, additions, or changes shall be submitted to the health authority so that they may be approved or disapproved with such recommendations as deemed necessary.

D. Sanitation.

(1) Sewage Disposal. The method of sewage disposal shall conform to COMAR 10.17.03 and be approved by the health authority.

(2) Water Supply. A safe drinking-water supply, as determined by COMAR 10.17.02 and approved by the health authority, shall be provided.

(3) Plumbing. All plumbing and plumbing fixtures shall be so constructed, installed, and maintained as to prevent cross-connections or other sanitation hazards, as required by the applicable State and local plumbing codes.

(4) Garbage and Refuse Disposal. Garbage and refuse shall be kept in watertight metal containers with tight-fitting covers and shall be removed from the premises at frequent intervals.

E. Heating.

(1) The building, whenever possible, shall be equipped with a heating plant with design capability of maintaining a temperature of 75°F in mean winter temperatures in patient areas.

(2) Space heaters and portable heaters are prohibited.

(3) Chimney, flues, and pipes connected with the heating facility shall be checked and cleaned annually.

(4) The fuel supply shall be handled according to the regulations of the State Fire Prevention Commission. If coal is used, ashes may not be stored in flammable containers pending disposal.

F. Insects and Rodents. The premises shall be maintained free of insects and rodents through an active pest-control program and elimination of garbage.

G. Gas and Electric Appliances. All gas appliances shall be installed and used in accordance with the applicable codes.

H. Screens.

(1) All outside doors, windows, and other outside openings shall be screened with wire screen or its equal with not less than 16 meshes per linear inch.

(2) All screen doors shall be equipped with self-closing devices and, when closed, fit tightly enough to prevent entrance of flies, mosquitoes, other insects, and rodents.

(3) Window screens shall fit closely enough to keep out insects and be easily removed.

I. Lighting. Each area used for therapy purposes shall be provided with sufficient artificial lighting so that the combined natural and artificial lighting shall be capable of providing a minimum illumination of 100-foot candles at work surfaces at all times when the psychiatric day treatment center. is in operation and at least 20-foot candles on all stairways and corridors. Glare shall be kept at a minimum by:

(1) Providing shades or curtains at all windows exposed to direct sunlight unless seating is arranged so that no person while at work will be required to face a glaring surface;

(2) Using lighting fixtures designed so that bare lamps or tubes are shielded at normal viewing angles;

(3) Using light-colored flat paint or other light finishes on ceilings and upper side walls (semi-gloss finishes may be used on lower side walls and other wood trim where frequent cleaning is necessary);

(4) Employing non-glossy, light-colored finishes on work tables to minimize glare by reflection.

J. Space and Ventilation Requirements.

(1) Adequate space to meet the requirements of program activities shall be available. Space for individual and group therapy, for occupational and activities therapy, and a kitchen area for patient use in acquiring and practicing activities of daily living shall be available.

(2) Rooms with a total window area of less than 10 percent and an openable window area of less than 5 percent of the floor area may be used only if there is provision for air exchange and ventilation according to the standards of the ASHRAE Code.

(3) Healthful humidity and comfortable temperatures shall be maintained in patient areas during the summer months.

K. Sanitary Facilities.

(1) The drinking-water supply may not be located in the bathroom. One drinking-water facility shall be available for every 4o persons or fewer on each floor.

(2) There shall be one toilet and one lavatory provided for every 10 persons of the same sex or fewer. The lavatory shall be in close proximity to each toilet. The floor in each toilet room shall have a waterproof, non-absorbent finish, and the walls shall be smoothly finished with a hard surface. Grab bars shall be provided in toilets and bathing areas.

(3) Towels shall be of the single-service type and shall be provided on single-service towel dispensers in all toilet rooms. Mechanical hand-drying devices may be used instead of towel dispensers.

(4) There shall be hot and cold running water, soap, and toilet paper provided in the toilet rooms at all times. The temperatures of the hot water may not exceed 125°F in patient areas.

L. Food Facilities. If food is prepared on the premises, the applicable sections of COMAR 10.15.03 relating to approved source of food, food temperatures and storage, storage of dangerous chemicals, handwashing, and dishwashing (sanitizing) shall serve as the standards.

M. Safety.

(1) Stairways shall be kept free of obstructions. Fire-exit doors shall be maintained in working order. The facility shall be free of mechanical and electrical hazards. Non-slip surfaces and coverings shall be provided in risk areas, such as tubs, showers, and stairways.

(2) Poisonous and flammable products are prohibited unless stored in accordance with State Fire Prevention code requirements.

N. Provisions for Handicapped. Provisions for the handicapped shall be made according to the American National Standards Institute (ANSI) A 117.1 to meet the anticipated needs of the population served.

O. Janitors' Closets and Slop Sinks.

(1) The facility shall provide janitors' closets with slop sinks as follows:

(a) At least one per building shall be provided in non-hospital-based programs;

(b) At least one for every 100 persons, one per resident building, or one per resident floor, whichever is most stringent, shall be provided in hospital-based programs.

(2) Mops and supplies may not be stored on the floor in the closet.

(3) The closet shall be vented to the outside.

P. Storage. Storage areas shall be provided and located according to efficiency of scheduling, operation, and patient needs.

Q. Minimal Equipment. Minimal equipment for a psychiatric day treatment center shall be adequate to meet the demands of the program according to the number of clients in attendance.