OAR 333-071-0580: Physical Environment Requirements

(1) Any person proposing to construct a new special inpatient care facility (SICF) or proposing to make certain alterations or additions to an existing SICF, must, before commencing new construction, alterations, or additions, comply with OAR chapter 333, division 675 and these rules. (2) Only the portion of an existing SICF that is being altered or renovated and any impacted ancillary areas required to ensure full functionality of the SICF must meet the requirements in sections (4) through (7) of this rule. (3) The following guidelines are adopted by reference as specified in sections (4) through (6) of this rule. Each SICF must also meet the requirements of state building and specialty codes in affect at the time of initial licensure. (a) 2018, Facility Guidelines Institute (FGI), Guidelines for the Design and Construction of Hospitals; and (b) 2018, FGI, Guidelines for the Design and Construction of Residential Health, Care and Support Facilities. (4)(a) An applicant or a licensed SICF classified as a freestanding hospice facility shall comply with the following chapters of the 2018, FGI, Guidelines for the Design and Construction of Residential Health, Care and Support Facilities, adopted by reference including all references to part, subpart, sections, subsections, paragraphs, subparagraphs and appendices except as specified in subsections (4)(b) and (c) of this rule. References in FGI to "and/or" mean "or". (A) 1.1 – Introduction; (B) 1.2 – Planning/Predesign Process; (C) 1.3 – Site Selection; (D) 1.4 – Design, Construction, and Commissioning Considerations and Requirements; (E) 1.5 – Equipment; (F) 2.1 – Site Elements; (G) 2.2 – Design Criteria; (H) 2.3 – Design Elements; (I) 2.4 – Design and Construction Requirements; (J) 2.5 – Building Systems; and (K) 3.2 – Specific Requirements for Hospice Facilities. (b) Section 2.3-4.2.2.4 of the 2018, FGI, Design and Construction of Residential Health, Care and Support Facilities, is not adopted by reference and does not apply under subsection (4)(a) of this rule. (c) The following amendments or additions are made to the 2018, FGI, Guidelines for Design and Construction of Residential Health, Care and Support Facilities, as adopted and incorporated by reference under subsection (4)(a) of this rule. All references to part, subpart, sections, paragraphs, subparagraphs and appendices relate to the 2018, FGI, Guidelines for Design and Construction of Residential Health, Care and Support Facilities. (A) Amend subsection 1.1-2.2.2 to read: "Standards set forth in the Guidelines for Design and Construction of Residential Health, Care, and Support Facilities shall be considered minimum and do not prohibit designing facilities and systems that exceed these requirements where desired by the governing body of the health, care, or support facility. Project submittal criteria shall comply with OAR chapter 333, division 675." (B) Amend subsection 1.1-3.1.2.1 to read: "Where major structural elements make total compliance impractical or impossible, exceptions shall be considered in accordance with OAR 333-071-0260." (C) Delete paragraphs (3) through (7) and amend subsection 1.1-3.1.2.2 to read: "The following exceptions to the requirements in Section 1.1-3.1.1 (Compliance Requirements) shall be permitted provided they meet the criteria specified in OAR chapter 333, division 675 and do not reduce the level of health and safety in an existing facility. (1) Routine repairs and maintenance to buildings, systems, or equipment shall not require improvements to building features or systems. (2) Replacement of building furnishings and movable or fixed equipment shall only require improvements to building systems that serve that equipment and only to the extent necessary to provide sufficient capacity for the replacement." (D) Amend subsection 1.1-3.1.4 to read: "Temporary Waivers. When parts of an existing facility essential to continued overall facility operation cannot comply with particular standards during a renovation project, a temporary waiver of those standards shall be permitted as determined by the authority having jurisdiction if resident, participant, or outpatient health and safety will not be jeopardized as a result. Reference OAR 333-071-0260 for requirements." (E) Amend subsection 1.1-5.2.1 to read: "In the absence of state or local requirements, the project shall comply with approved nationally recognized building codes except as modified in the latest CMS adopted edition of NFPA 101: Life Safety Code and/or herein." (F) Amend subsection 1.2-2.1.2.1 to read: "The care provider shall be responsible for providing a functional program for each facility project to the project architect/engineer and the authority having jurisdiction (AHJ). (1) Findings and recommendations from the resident safety risk assessment (see Section 1.2-3) shall be addressed in the functional program." (G) Amend subsection 1.2-2.1.2.2 to read: "The functional program shall include an executive summary as well as detailed information about each operation conducted in the facility that will affect the physical setting design. Refer to OAR chapter 333, division 675 for additional requirements to be included in the functional program." (H) Amend subsection 1.2-3.1.1.2 to read: "To support this goal, a resident safety risk assessment (RSRA) shall be developed and completed by an interdisciplinary team. A copy of the RSRA shall accompany construction documents submitted to the Oregon Health Authority, Facility Planning and Safety Program." (I) Delete subparagraph (e) in subsection A1.2-3.5.3.4(3). (J) Amend subparagraph (b) in subsection A1.2-4.5.1 to read: "b. Window sill height should not exceed 3 feet (.91 meter) above the floor and should be above grade. Operable windows shall be designed to prevent accidental falls when sill heights are lower than 36 inches and above the first floor." (K) Amend subparagraph (i) in subsection A1.2-4.5.2.2 to read: "i. Water features. Where provided and where allowed per the RSRA, open water features should be equipped to safely manage water quality to protect occupants from infectious or irritating aerosols. See Section 2.1-3.6.3 (Outdoor Water Features) and appendix section A2.4-2.2.13 (Decorative water features) for additional information and requirements." (L) Amend subsection 2.1-3.6.3.2 to read: "Where provided and allowed by the resident safety risk assessment (RSRA) for facilities that serve special care populations, outdoor water features shall be designed with the care population in mind to provide safe and accessible environments." (M) Delete subparagraph (i) in subsection A2.2-4.2.1. (N) Amend subparagraph (2)(a) in subsection 2.3-2.3.3.2 to read: "(a) Space for dining in accordance with the needs of the care population, including residents and participants who use resident-operated mobility devices. Provide a minimum of 28 square feet (2.60 square meters) for each resident or participant at one seating." (O) Amend subsection A2.3-2.3.3.2(2) to read: "Adult day care programs may require additional participant space based on the care population being served." (P) Amend paragraph (2) in subsection 2.3-4.2.2.1 to read: "(2) A medication room, a self-contained medication distribution unit, or other approaches acceptable to the authority having jurisdiction (AHJ) shall be permitted to be used for preparing, dispensing, and administering medications." (Q) Amend subsection 2.3-4.2.2.3 to read: "Self-contained medication distribution units, automated medication-dispensing stations, or mobile medication-dispensing carts. Where these or other systems approved by the AHJ are used, the following shall apply: (1) Location of such units shall be permitted at the staff work area, in the clean utility room, in an alcove. (2) Areas used for medication preparation and distribution by mobile cart shall include task-specific lighting." (R) Delete paragraphs (4) and (5) and amend subsection 2.3-4.5.3.4 to read: "Ice-making equipment and drinking water source. (1) Location of ice-making equipment in the food preparation area or in a separate room shall be permitted as long as the equipment is directly accessible to the food preparation area. (2) Ice-making equipment shall be cleanable. (3) Ice-making equipment shall be self-dispensing. (4) A filtered self-dispensing drinking water source shall be provided." (S) Amend subsection 2.4-2.2.4 to read: "Doors and Door Hardware. See the facility chapters in Parts 3 through 5 for requirements in addition to those in this section. Door type for residing patient bathing/toilet facilities and other single-user toilets subject to patient use. Rooms that contain bathtubs, sitz baths, showers, or toilets for patient use shall have one of the following: (1) Two separate doors (2) A door that swings outward (3) A door equipped with emergency rescue hardware (4) A sliding door". (T) Amend subsection 2.4-2.2.6.2 to read: "Sill height. Windows in resident rooms, suites, and dwelling units shall have sills located no higher than 36 inches (91.44 centimeters) above the finished floor. Operable windows shall be designed to prevent accidental falls when sill heights are lower than 36 inches and above the first floor." (U) Amend paragraphs (1) and (2) in subsection 2.4-2.2.8.1 to read: "(1) The number and placement of hand-washing stations shall be determined as indicated in other sections and by the infection control risk assessment (ICRA). (2) If not required by other sections, hand sanitation dispensers shall be permitted to be used in lieu of hand-washing stations as determined by the ICRA." (V) Amend subsection 2.4-2.2.13 to read: "Decorative Water Features Provision of decorative water features shall be permitted in residential health, care, and support facilities where allowed by the RSRA." (W) In subsection A3.2-2.2.1.2(2): (i) Amend subparagraph (b) to read: "b. Home-based hospice services. This hospice care model is ineligible for review within these guidelines as the hospice care either takes place in individual homes or in facilities under the regulation of State of Oregon, Department of Human Services (DHS). This model includes services that are brought to a resident living in an assisted living facility or independent living setting. Home-based hospice services are provided for residents who live in an independent or assisted living setting. Hospice services to be provided by a care and support facility, if any, should be identified during the functional programming process." (ii) Amend subparagraph (g) to read: "g. Nursing home-based hospice facilities. This hospice care model is ineligible for review within these guidelines as these facilities are regulated by the State of Oregon, Department of Human Services (DHS). This model follows hospice regulations and includes any number of beds housed in a nursing home setting. Nursing home-based hospice facilities provide end-of-life services and should be provided in a private room that includes adequate family space. Nursing homes should provide hospice services and related accommodations for residents and family." (X) Amend paragraph (3) in subsection 3.2-2.2.2.2 to read: "(3) Room size shall be 80 square feet for each residing patient in a double room and at least 100 square feet for each patient residing in a single room. Room size shall also be based on the care model and in-room furniture and clothing storage requirements." (Y) Amend subsection 3.2-2.3.3.3 to read: "Recreation, lounge, and activity areas. Lounge areas shall be provided for resident and visitor use at a minimum of 15 square feet per resident being served." (Z) Amend subsection 3.2-2.3.6.2 to read: "Inclusion of a gas fireplace or other comparable heating elements shall be permitted in a family room where non-operable glass doors are used. These heating element surfaces may not exceed 120 degrees Fahrenheit when they are installed in locations that are subject to incidental contact by people or with combustible material." (AA) Amend subsection 3.2-4.5.3.1 to read: "Where an outside vendor is used to provide meals for a facility of 16 or more beds, the facility shall include dedicated space and equipment for a warming kitchen, including space for minimal equipment for preparation of breakfast, emergency, or after-hours meals. These facilities serving 16 or more beds shall comply with OAR 333-150-0000 (Food Sanitation Rules) including the provisions for commercial-grade equipment, space, and policies." (BB) Amend subsection 3.2-4.5.4 to read: "Decentralized Kitchen Where food preparation is conducted on-site for 16 or more beds, the facility shall have dedicated non-public staff space and equipment for preparation of meals. See Section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements. These facilities serving 16 or more beds shall comply with OAR 333-150-0000 (Food Sanitation Rules) including the provisions for commercial-grade equipment, space, and policies." (CC) Amend paragraph (2) in subsection 3.2-4.6.2.2 to read: "(2) Washers/extractors. Washers/extractors shall be located between the soiled linen receiving and clean processing areas. Washers/Extractors shall provide a temperature of at least 160 degrees Fahrenheit for a minimum of 25 minutes or include use of a chemical disinfectant." (DD) Amend paragraph (3) in subsection 3.2-4.6.3.2 to read: "(3) Room(s) used for processing shall have a flushing-rim sink and a handwash sink." (5)(a) An applicant or a licensed SICF classified as a rehabilitation hospital shall comply with the following chapters of the 2018, FGI, Guidelines for the Design and Construction of Hospitals, adopted by reference including all references to part, subpart, sections, subsections, paragraphs, subparagraphs and appendices except as specified in subsections (5)(b) and (c) of this rule. To the extent that other FGI chapters are referenced in these chapters, a facility must also comply with the referenced chapters. References in FGI to "and/or" mean "or". (A) 1.1 – Introduction; (B) 1.2 – Planning, Design, Construction, and Commissioning; (C) 1.3 – Site; (D) 1.4 – Equipment; (E) 2.1 – Common Elements for Hospitals; (F) 2.2 – Specific Requirements for General Hospitals; (G) 2.6 – Specific Requirements for Rehabilitation Hospitals; and (H) Part 3 – Ventilation of Hospitals. (b) The chapters, sections, subsections, paragraphs, subparagraphs or appendices of the 2018, FGI, Guidelines for Design and Construction of Hospitals specified in OAR 333-535-0015(4) are not adopted by reference and do not apply under subsection (5)(a) of this rule. (c) The amendments made to the 2018, FGI, Guidelines for Design and Construction of Hospitals, as adopted and incorporated by reference, specified in OAR 333-535-0015(5) shall apply under this rule. All references to part, subpart, sections, paragraphs, subparagraphs and appendices relate to the 2018, FGI, Guidelines for Design and Construction of Hospitals. (6)(a) An applicant or a licensed SICF classified as a substance use disorder treatment facility shall comply with the following chapters of the 2018, FGI, Guidelines for the Design and Construction of Residential Health, Care and Support Facilities, adopted by reference including all references to part, subpart, sections, subsections, paragraphs, subparagraphs and appendices except as specified in subsections (6)(b) and (d) of this rule. References in FGI to "and/or" mean "or". (A) 1.1 – Introduction; (B) 1.2 – Planning/Predesign Process; (C) 1.3 – Site Selection; (D) 1.4 – Design, Construction, and Commissioning Considerations and Requirements; (E) 1.5 – Equipment; (F) 2.1 – Site Elements; (G) 2.2 – Design Criteria; (H) 2.3 – Design Elements; (I) 2.4 – Design and Construction Requirements; (J) 2.5 – Building Systems; and (K) 4.3 – Specific Requirements for Long-Term Residential Substance Abuse Treatment Facilities. (b) The amendments specified in paragraphs (4)(c)(A) through (V) of this rule shall also apply to an SICF classified as a substance use disorder treatment facility. (c) Section 2.3-4.2.2.4 of the 2018, FGI, Design and Construction of Residential Health, Care and Support Facilities, is not adopted by reference and does not apply under subsection (6)(a) of this rule. (d) The following amendments or additions are made to the 2018, FGI, Guidelines for Design and Construction of Residential Health, Care and Support Facilities, as adopted and incorporated by reference under subsection (6)(a) of this rule. All references to part, subpart, sections, paragraphs, subparagraphs and appendices relate to the 2018, FGI, Guidelines for Design and Construction of Residential Health, Care and Support Facilities. (A) Amend subsection A4.3-1.1.1.1 to read: "Long-term residential substance abuse treatment facility typology. Long-term residential treatment facilities may be located in a wide variety of settings including, but not limited to, a large suburban house, larger freestanding residential setting, or part of a nursing home, assisted living facility, homeless shelter, or facility in a prison. Only a large suburban house or larger freestanding residential setting shall be eligible for review within these guidelines for Special Inpatient Care Facility. The Oregon Health Authority (Authority) does not have jurisdiction over other settings specified. Care is provided 24 hours a day, generally in non-clinical/acute care settings. This therapeutic community (TC) is a common type of long-term residential treatment setting for substance use disorders, which typically require 18 to 24 months of treatment, although funding and insurance limitations may reduce an individual’s stay to three, six, or 12 months. The focus of a TC is resocialization of an individual using the program’s entire community as active components of treatment. Addiction is viewed in the context of an individual’s social and psychological deficits, and treatment focuses on developing personal accountability and responsibility as well as socially productive lives. Treatment is typically highly structured and can be modified for specific care populations (e.g., adolescents, homeless residents, individuals from the criminal justice system, those with mental/behavioral issues). In addition to long-term residential treatment, a therapeutic community may offer shorter-term residential or outpatient treatment. A TC acquires a medical partner has an opportunity to become a federally qualified health center or a patient-centered medical home. A specialized type of treatment setting called a 'modified therapeutic community' incorporates features of traditional therapeutic communities with a special focus on addressing co-occurring mental health conditions. Correctional institutions may incorporate in-prison TCs, and TCs are also available for people reentering society after being released from prison with the goal of reducing drug use and recidivism." (B) Amend paragraph (2) in subsection 4.3-2.2.2.2 to read: "A minimum of 70 square feet of floor space per bed is required in semi-private rooms and wards. A minimum of 100 square feet of floor space shall be provided in private rooms." (C) Amend subsection 4.3-2.2.2.7 to read: "Resident bathroom. Each resident shall have access to a bathroom. Bathroom doors shall comply with 2.4-2.2.4. (1) The bathroom shall contain the following: (a) Toilet (b) Hand-washing station. See Section 2.4-2.2.8 (Hand-Washing Stations) for requirements. (c) Mirror. See Section 2.4-2.2.8.7 (Mirror) for requirements. (d) Private individual storage for the personal effects of each resident. See Section 2.4-2.4.2 (Casework, Millwork, and Built-Ins) for requirements. (e) Shower. See Section 2.5-2.3.3.2 (Accessible showers) for requirements. (2) Where the bathroom is shared, privacy locks shall be permitted with provisions for emergency access." (D) Add subsection 4.3-2.2.3.4 to read: "Detoxification Room. The design and need for a detoxification room shall be described in the Resident Safety Risk Assessment and functional program. Where provided, a minimum of one residing patient room for detoxification, located to allow direct observation by nursing staff, shall be provided. Windows in detoxification rooms shall be of a security type that can only be opened by keys or tools that are under the control of the staff. An adjoining or closely available toilet and hand washing lavatory is also required serving detoxification residing patients only. This room shall be designed with special consideration that residing patient is incapable of self-preservation in an emergency." (E) Amend subsection 4.3-2.3.8.1 to read: "Outdoor spaces shall be provided for residents, visitors, and staff. The design and use of outdoor activity spaces shall be described in the Resident Safety Risk Assessment." (F) Amend subsection 4.3-4.5.3.1 to read: "Where an outside vendor is used to provide meals for a setting of 16 or more beds, dedicated space and equipment shall be provided for a warming kitchen, including space for minimal equipment for preparation of breakfast, emergency, or after-hours meals. These facilities serving 16 or more beds shall comply with OAR 333-150-0000 (Food Sanitation Rules) including the provisions for commercial-grade equipment, space, and policies." (G) Amend subsection 4.3-4.5.4 to read: "Decentralized Kitchen Where food preparation is conducted on-site for 16 or more beds, the facility shall have dedicated non-public staff space and equipment for preparation of meals. See section 2.3-2.3.4 (Resident and Participant Kitchen) for requirements. These facilities serving 16 or more beds shall comply with OAR 333-150-0000 (Food Sanitation Rules) including the provisions for commercial-grade equipment, space, and policies." (H) In subsection 4.3-4.6.3.2: (i) Amend subparagraph (2)(c) to read: "(c) Rooms used for processing shall have a flushing-rim sink and a handwash sink." (ii) Add paragraph (6) to read: "(6) Washers/extractors. Washers/extractors shall be located between the soiled linen receiving and clean processing areas. Washers/Extractors shall provide a temperature of at least 160 degrees Fahrenheit for a minimum of 25 minutes or include use of a chemical disinfectant." (I) Amend subsection 4.3-5.2.2.4 to read: "Doors and door hardware See Section 2.4-2.2.4 (Doors and Door Hardware) for requirements in addition to those in this section." (7) An SICF classified as a religious institution must be designed, constructed, and maintained to ensure the safety of the patients, staff, and the public and shall comply with the following: (a) General Building. The overall environment must be maintained in a manner that ensures the safety and well-being of the patients. The institution must have the following: (A) Procedures for the proper storage and disposal of trash; (B) Proper ventilation and temperature control and appropriate lighting levels to ensure a safe and secure environment; (C) An effective pest control program including that: (i) Wall openings for pipes, ducts, and conduits as well as joints at structural elements shall be sealed; and (ii) In dietary and food storage areas, wall construction, finish, and trim, including joints between walls and floors, shall be free of insect- and rodent-harboring spaces; (D) A preventive maintenance program to maintain essential mechanical, electrical, and fire protection equipment operating in an efficient and safe manner; and (E) A working call system for patients to summon aid or assistance. (b) Patient rooms. Patient rooms must be designed and equipped for adequate care, comfort, and privacy of the patient and shall meet the following conditions: (A) Accommodate no more than four patients; (B) Measure at least 80 square feet per patient in multiple patient rooms and at least 100 square feet in single patient rooms; (C) Have direct access to an exit corridor; (D) Be designed or equipped to assure full visual privacy for each patient. Design for privacy shall not restrict patient access to the toilet, room entrance, window, or other shared common areas in the patient room; (E) Have at least one operable window to the outside, provided with window coverings; (F) Have a floor at or above grade level; and (G) Be furnished with the following: (i) A separate bed of proper size and height for the convenience of the patient; (ii) A clean, comfortable mattress and pillow with protective coverings; (iii) Bedding appropriate to the weather and climate; and (iv) Functional furniture appropriate to the patient's needs and individual closet space with clothes racks and shelves accessible to the patient. (c) Plumbing and Sanitary Environment. (A) Each patient shall have access to a toilet room without entering the general corridor area. One toilet room shall serve no more than four beds and no more than two patient rooms. (i) The toilet room shall contain a toilet and a handwash station. (ii) Doors to all rooms containing bathtubs, showers, and toilets for patient use shall be hinged, sliding, or folding with door hardware that allows staff access. Where swinging doors are provided, the door shall swing outward or be provided with emergency rescue (dual-swing) hardware. (B) Adequate handwashing stations shall be provided for the total facility population and include lavatories with hot and cold running water, soap, and single use sanitary towels. (i) A hand-washing station shall be provided both in the patient room and the toilet room. This hand-washing station shall be located at or adjacent to the entrance to the patient room with unobstructed access for use by health care personnel and others entering and leaving the room. When multi-patient rooms are permitted, this station shall be located outside the patients' cubicle curtains. (ii) At least one hand-washing station shall be provided for the administrative center or nurses’ station that is within 20 feet and not through a door. (C) Bathing facilities for patients shall be provided to include at least one shower or tub for each eight beds, serving patient rooms not containing bathing facilities directly adjoining the room. Bathing facilities shall include space for drying, dressing, grooming, and a surface to temporarily place toiletries. (D) An institution licensed for more than 16 patients must provide at least one separate toilet and hand wash lavatory for staff and visitor use. The staff and visitor toilet shall not be located where it would require a visitor to travel through any intervening staff support areas. (E) There shall be an environmental services room with floor or service sink and space for temporary storage of refuse. An institution licensed for 16 or fewer patients may combine this room with other soiled rooms. (F) Cart sanitizing facilities and cart storage area for both dietary and linen services shall be available. (G) Areas subject to frequent wet cleaning methods or high amounts of moisture, including but not limited to, kitchens, soiled workrooms, soiled and clean utility rooms, environmental services rooms and toilet rooms, shall meet the following requirements: (i) The floors and wall bases shall be constructed of slip-resistant materials that are not physically affected by germicidal or other types of cleaning solutions. (ii) Floors shall be homogeneous and have sealed joints. (iii) Wall bases shall be continuous, integral or sealed to the floor and the wall, and constructed without voids. (iv) Wall surfaces in areas routinely subjected to wet spray or splatter (for example, kitchens, soiled linen processing, environmental services room) shall be smooth, scrubbable, and water-resistant. (v) Ceiling surfaces in dietary and laundry areas, bathrooms, central bathing rooms or areas with showers, soiled utility rooms, and environmental services rooms shall be impervious and moisture-resistant. (d) There shall be a clean storage room or enclosed cabinet spaces for supplies and equipment. (e) Space for patient dining at a minimum of 28 square feet per patient shall be provided. (f) A room or space for social activities which may include group therapy or other gatherings at a minimum of 15 square feet per patient shall be provided. This space may be omitted if the institution is licensed for a capacity of 16 or fewer and social space is accommodated within the shared patient dining. (g) There shall be an administrative center or nurse station. This space shall include provisions for storage of administrative supplies, a worksurface with equipment for documentation, and secure storage of staff personal belongings. (h) Patients shall have access to a telephone and accommodations shall be made to allow private conversations. (i) Food and nutrition services. The facility may provide onsite or third party contracted dietary services. All offered dietary services shall comply with Oregon Health Authority, Food Sanitation Rules, chapter 333, division 150 and other authorities having jurisdiction. (A) Onsite dietary service in an institution licensed for a capacity of 16 or fewer may be of residential type except as required by the building codes. Kitchen facilities and equipment in an institution licensed for a capacity of more than 16 must be commercial type equipment. The following must be provided: (i) A dishwasher; (ii) A pot wash sink (unless all pots are sanitized in the dishwasher); (iii) A food prep sink; (iv) A separate hand wash lavatory; (v) Stove and oven equipment for cooking and baking needs; (vi) Self-dispensing ice-making equipment; (vii) Refrigerator(s) and freezer(s); (viii) Storage for a mop and other cleaning tools and supplies used for dietary areas must be separate from those used in toilet rooms, patient rooms, and other support areas. In an institution with a capacity of more than 16, a separate janitor closet or alcove must be provided with a floor or service sink and storage for cleaning tools and supplies; and (B) Third-party contracted dietary services: (i) Provisions shall be made to prevent contamination, keep hot and cold foods at required temperature ranges in transit and on site prior to consumption. (ii) If ware washing is provided on site, either a three-compartment sink or dishwasher (commercial grade if the institution is licensed for a capacity of more than 16) shall be provided. (iii) Nourishment area: There shall be a handwash station, food prep sink (if required by the functional program), work counter, refrigerator, storage cabinets, and equipment for serving nourishment as required by the functional program. (j) Linen services: (A) On-Site Processing. If linen is to be processed on the site, the following shall be provided: (i) Soiled linen utility room with adequate space for receiving and sorting. Room(s) shall have ventilation and exhaust, a clinical sink or equivalent flushing-rim fixture with a rinsing hose or bedpan washer, handwash station, and space for linen and containers; (ii) Laundry processing room with commercial-type washing and drying equipment. Washers/extractors shall be located between the soiled linen receiving and clean processing areas. Washers/extractors shall provide a temperature of at least 160 degrees Fahrenheit for a minimum of 25 minutes or include use of a chemical disinfectant; (iii) Secure storage for laundry supplies; (iv) Clean linen inspection and mending room or area; and (v) Clean linen storage, issuing, and holding room or area. (B) If linen is processed off-site, the following shall be provided: (i) Soiled linen holding room with ventilation and exhaust; and (ii) Clean linen receiving, holding, inspection, and storage room(s). (8) The Authority may, upon written request, allow variations from these requirements (other than fire and life safety requirements) when conditions make certain changes to an SICF impractical to accomplish, as long as the intent of the requirement is met, and the care and safety of patients will not be jeopardized. An applicant or SICF must obtain written approval from the Authority in accordance with OAR 333-071-0260, for any minor variation. (9) An SICF shall conform to the editions of the Oregon State Building Code, as defined in ORS 455.010(8), under which they were constructed. SICFs to be certified for Medicare reimbursement shall meet standards of the 2012, National Fire Protection Association (NFPA) #101 and #99 Codes.