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Space Planning Guide for

Community Health Care


Facilities
DECEMBER 2014

Ministry of Health and Long-Term Care


Copies of this report can be obtained from
Health Capital Investment Branch
Email: HealthCapitalInvestmentBranch@ontario.ca
INFOline: 1-866-532-3161
TTY 1-800-387-5559

Note
The Ministry of Health and Long-Term Care (MOHLTC, the ministry) develops and issues
technical and policy documents to provide information, advice and guidance to Health Service
Providers (HSP) and those who plan, design and construct healthcare facilities.
This planning document has been developed as a tool to provide information on the space
planning and design of community-based healthcare facilities that aligns with and supports the
ministrys capital planning review and approval process. This document is not intended to cover
entire technical submission requirements for any particular stage in the ministrys capital
planning review and approval process; users are cautioned not to use it as a stand-alone
document.

Contributors
This document was developed with input from the Association of Ontario Health Centres, York
University Faculty of Health, Ministry of Health and Long-Term Care Health Promotion
Division, Local Health Integration Network Liaison Branch and Primary Health Care Branch and
Public Health Ontario.

Table of Contents
1.0

Introduction ........................................................................................................... 1

2.0

About the Guide .................................................................................................... 2

2.1
2.2
2.3
2.4
2.5

Purpose..............................................................................................................................2
Intended Users ..................................................................................................................2
Development of the Guide ................................................................................................3
Related Documents ...........................................................................................................3
How to Use the Guide .......................................................................................................4

3.0

The Ministrys Planning and Design Objectives: OASIS ............................... 5

4.0

The Guide .............................................................................................................. 6

Part A: The Facility's Role and Size .................................................................................. 6


A.1
A.2
A.3
A.4

Program and Service Definition........................................................................................6


Types of Programs and Services and Space .....................................................................6
Programs and Services and Capital Funding Eligibility ...................................................7
Space Needs and Developing a Master Plan.....................................................................7

Part B: Client Activity and Space Needs ........................................................................... 8


B.1
B.2
B.3
B.4
B.5

Types of Spaces ................................................................................................................8


Workload and Effective Room Utilization .......................................................................8
Workload Data Table Appendix A ................................................................................9
Staffing and Space Needs .................................................................................................9
Determining a List of Rooms ..........................................................................................10

Part C: Determining Total Space Needs......................................................................... 12


C.1
C.2
C.2.1
C.2.2

Room Sizes and Functional Room Requirements Net Square Feet (NSF) ..................12
Additional Design Factors to Reach the Total Area .......................................................12
Future Growth and Flexibility ........................................................................................13
Grossing Factors: Component Gross Square Footage (CGSF) and Building Gross
Square Footage (BGSF) ..................................................................................................14

C.2.3

Applying the Grossing Factors .........................................................................................15

Part D: Design Considerations ........................................................................................ 16


D.1
D.2
D.3
D.4

CSA-Z8000-11 Canadian Health Care Facilities ............................................................16


Infection Prevention and Control (IPAC) .......................................................................16
Building Systems for Community-based Healthcare Facilities Class C ..................16
Building Legislation, Codes and Standards ....................................................................17

5.0 Conclusion .................................................................................................................. 17


6.0 Implementation ........................................................................................................... 17
7.0 Bibliography ................................................................................................................ 18
Appendix A Workload Data Table................................................................................. 19
Appendix B - Room Sizes and Requirements (Space Tables) ...................................... 20

Space Planning Guide for


Community Health Care
Facilities

1.0 Introduction
Community health care facilities deliver a range of primary health care services. These are
services that the public can access close to home in non-hospital facilities. These services
include: health assessment, diagnosis and treatment services, counselling and therapy services,
education and support, as well as services to provide linkages to other on-site and outreach
programs. These are services that do not need to be administered in a hospital.
The ministry provides oversight for the planning and design for the following types of
community-based health care facilities:

Community Health Centres (CHC)


Aboriginal Health Access Centres (AHAC)
Community-Based Mental Health Programs
Community-Based Substance Abuse (Addictions) Programs
Long-term Care Supportive Housing (typically supporting programs for the frail elderly,
acquired brain injury, physically disabled and HIV/AIDS)

This Space Planning Guide (Guide) is a planning tool designed to assist community Health
Service Providers (HSP) to develop a proposed capital project for submission to the ministry for
approval. The Guide supports current government priorities and recognizes fiscal challenges by
assisting HSPs with the effective use of limited capital resources to plan high quality health care
environments. The planning principles in this Guide promote right-sizing a facility to support
efficient delivery of the HSPs services and to limit excessive operating costs over the facilitys
lifetime.
The Guide will not replace the detailed work of the HSP and its planning and design consultant
team to develop a facility; but it provides essential information that reflects the ministrys capital
funding structure and outlines the ministrys facility planning expectations for a community
health care setting.
For Supportive Housing facilities, information in this Guide may be of assistance for clinical
interview or counselling rooms, multi-purpose space, administrative spaces and general building
support rooms. The Guide does not address resident sleeping rooms, residential and related
spaces.

2.0 About the Guide


2.1 Purpose
The purpose of the Guide is to:

Establish a basic set of space-related parameters that meet the ministrys planning and
design objectives for the operational efficiency, accessibility, safety, security and
infection control measures appropriate to the community health care setting;

Identify the maximum amount of space that the ministry will provide funding for in an
approved community capital project; and,

Outline the basic steps to develop the space needs of a community health care facility.

The Guide was developed in conjunction with the ministrys Community Health Service
Provider Cost Share Guide and it is intended that these two documents are used in tandem
when planning proposed community capital projects. These two resources provide the
information necessary for HSPs to understand the types and amount of space the ministry will
cost share1 for approved community capital projects to meet program and service delivery needs.
The Guides focus is to provide guidance in defining space allocation and, in doing so, does
make reference to some technical building considerations necessary to health care facilities.
However, the purpose of the Guide is not to provide complete technical facility design guidance.
For technical building requirements such as building codes, electrical /emergency power,
heating, ventilation and air conditioning, infection control, sterilization procedures and
construction-related issues, the HSP and its design team must refer to the applicable legislation,
codes, standards and other best practice industry sources.

2.2 Intended Users


The Guide is intended for the following individuals and groups:
Administrators to develop an estimate of their facilitys space needs;
Functional programmers, architects and engineers to ensure that planned space meets best
practice design and ministry planning, design and funding requirements;
Other technical and health care professionals such as infection control and occupational
health and safety personnel; and,
Ministry staff to confirm compliance with space and functional requirements that meet
the ministrys planning and design objectives (OASIS see Section 3.0).

Cost Share otherwise known as shareable costs (def): The amount of a total project cost that the
ministry can provide capital funding for under ministry cost share guidelines (i.e. not all costs in a capital
project can be funded by the ministry. The non-shareable costs are the responsibility of the HSP).

The Guide is written to provide generic information so that both the principles and specifics can
be applied consistently to a variety of community health care facility types. It is the role of the
HSP to determine which components of the Guide are most applicable to its programs and
services.

2.3 Development of the Guide


The Guide incorporates consultation with community health care facility stakeholders; input
from various levels of Health Capital Investment Branch; and, input from other Ontario
government programs such as Local Health Integration Network (LHIN) Liaison Branch,
Primary Health Care Branch, Health Promotion and Public Health.
It also consolidates elements of Canadian health care facility standards and other health care
planning guidelines to present a comprehensive set of recommendations for the communitybased, primary health care setting.

2.4 Related Documents


Capital Planning and Approvals Process Documents
The ministrys capital planning review and approvals process consists of various stages. Each
stage builds on the information and level of detail of the previous stage. This Guide should be
used in conjunction with the following ministry documents:

The MOHLTC-LHIN Joint Review Framework for Early Capital Planning Stages
Toolkit, November 9, 2010 (MOHLTC-LHIN Toolkit)

Community Health Service Provider Cost Share Guide

Capital Planning Manual (1996)

Legislation and Regulations


For all capital projects, it is the responsibility of the HSP to ensure that project submissions are
compliant with all legislation, codes and standards, such as, but not limited to the most current
versions of the Ontario Building Code; the Ontario Fire Code; the Electrical Safety Act, other
CSA standards for health care facilities, the Accessibility for Ontarians with Disabilities Act; the
Occupational Health and Safety Act and future issues of these regulations.
CSA Z8000-11 Canadian Health Care Facilities (CSA Z8000)
Appendix B of the Guide incorporates and adapts the applicable components of CSA Z8000 for
primary and community health care facilities. Released in November of 2011, CSA Z8000 sets
new national standards for the planning and design of a wide range of health care facilities,
including acute care, but extending to primary care and ambulatory settings. CSA Z8000 is not
legislated; however, it is accepted by the ministry as the best practice standard for Ontario health
care facility design. In the absence of another Canadian standard for community health care
facilities, this ministry Guide is based on the CSA Z8000 and future issues of it.

The ministry strongly recommends all HSPs purchase of copy of CSA Z8000 and become
familiar with its overarching principles and specific recommendations, as applicable to the
HSPs programs and services.
http://shop.csa.ca/en/canada/landing-pages/z8000-canadian-health-carefacilities/page/z8000?source=Topsellers_Bestsellers

2.5 How to Use the Guide


The Guide is organized in four parts:
Part A: The Facility's Role and Size
Part B: Client Activity and Space Needs
Part C: Determining Total Space Needs and Appendix B (Space Tables)
Part D: Design Considerations Reference to CSA-Z8000
The sequence of Parts A through D reflects the basic steps of space planning which can be
described as:
Establishing the program parameters;
Developing fundamental spatial relationships to support functional programming;
Arriving at a total facility area estimate; and,
Refining the space needs to support building systems and meet detailed room functions.
The Guide should be able to assist administrators and their consultants to arrive at an initial total
space budget/estimate of floor area needed to meet the facilitys operational objectives and safely
and effectively deliver programs and services.
This initial space budget will not replace a detailed functional and operational program and
facility design, but it will provide the initial assumptions that reflect the ministrys capital
funding policy. Once a space budget is defined, it can be verified through more detailed
planning and design with the input of the HSP and its planning and design team including
functional programmers, architects, engineers and an infection control professional (ICP).
As the design progresses, the planning and design team should refer back to the details of
Appendix B: Room Sizes and Requirements to ensure that the final room designs address the
necessary technical requirements. These technical requirements incorporate CSA Z8000 and
other CSA standards and therefore, reflect current, recognized best practice in Canada.
At any time, please contact the ministry for assistance on use and application of the Guide.

3.0 The Ministrys Planning and


Design Objectives: OASIS
A fundamental goal in the planning and design of capital health care projects is to create an
environment that enables health services to be delivered in a most effective and efficient,
accessible and safe manner while respecting the needs of patients or clients, and staff. Capital
resources should be used effectively so that all capital projects are built as a long-term
investment for the community they serve.
The ministrys planning and design goals and objectives are captured under the ministrys
OASIS principles. These principles also form the fundamental principles of CSA Z8000.
Operational Efficiency; Accessibility, Safety and Security, Infection Prevention and Control;
and, Sustainability
When undertaking a capital project, the ministry expects that these objectives will be met.
Please contact the ministry for more information on the OASIS objectives

4.0 The Guide


Part A: The Facility's Role and Size
A.1 Program and Service Definition
Creating a list of rooms is the end-product of the early planning phases of a facility. Before
beginning to identify individual rooms or the physical layout of the facility, the program/service
needs should be developed. The HSP should determine the needs of its client population
regarding: the client population; programs and services; a vision of how staff can most
effectively deliver the needed programs and services; and, the required staff complement. These
parameters are outlined in more detail in the MOHLTC-LHIN Toolkit for the Pre-Capital,
Proposal and Functional Program submissions. For more information on defining service
delivery, please contact the LHIN.

A.2 Types of Programs and Services and


Space
Definition of the programs and services that will be delivered from the facility is an important
step to understanding the general space needs of the facility.
The following program and service categories are typically found in community health care
facilities:

Core Program health care services: These services include: health assessments;
diagnosis and treatment; counselling; primary mental health care; chronic disease
management; health promotion; family planning; coordination with outreach community
care providers, and others. These programs are typically defined through the programs
and service agreements that the HSP has with its operating funding agency (LHIN).

Allied Health services: These services include a range of clinical support services that
complement the clinical care team and contribute to the clients health and well-being as
part of an integrated care approach. Services may include: physiotherapy; occupational
therapy; speech therapy; social work; chiropody; and, spiritual care.2 These programs
may or may not be defined in the organizations service agreements.

Other programs: These programs are commonly referred to as community partners and
may include outreach workers from other organizations; community food programs;

CSA Z8000-11, Canadian Health Care Facilities; November, 2011; CSA; p. 244.

youth programs; and, many others. In some cases, these programs are not LHIN funded
programs (e.g. may receive municipal funding or funded through a charitable foundation
or program).

A.3 Programs and Services and Capital


Funding Eligibility
To define early planning space estimates and for budget planning purposes, the HSP should be
familiar with which programs receive operational funding from the LHIN and those partner
programs that are funded through other sources such as a municipal funding program, charitable
foundation, outreach hospital program, another ministry, or other non-ministry, government
agency.
The capital costs for the construction of space for partner programs that do not receive
operational funding from the LHIN are not eligible for ministry funding under the ministrys
funding allocation for community projects. In such a case, other sources of funding will need to
be secured to build the partner space. Please refer to the Community Health Service Provider
Cost Share Guide and consult with the ministry to identify and confirm funding eligibility for
partner organizations.
It is important for the HSP to understand which programs can receive capital funding from the
ministry and which cannot. The total availability of capital funding from all sources will impact
the affordability of how much space can be constructed.

A.4 Space Needs and Developing a Master


Plan
A master plan explores the potential for developing a specific site for the facility. When a
facility is planning to occupy a site over a period of time, the master plan helps to identify
immediate and future needs. Multi-service, large hospitals require a master plan that envisions
how the facility will expand and replace itself over a 30 - 50+ year timeframe, usually on a large
campus or across multiple sites. Smaller community health care facilities typically have a 15 20 year planning term and are often located in leased space within commercial buildings or in
single buildings with infrastructure similar to a medical office building.
Depending on the size and scale of the community HSP, the master plan may be a plan of a
property and a proposed new building; a plan of an existing single building to be renovated; or, a
floor layout within a multi-tenant building. The project may be new/purpose built or a tenant
leasehold improvement project. If the HSP envisions staged or phased growth over time, the
ministry requires a master plan that illustrates the expected growth phases.
In either case -- new build or leasehold -- prior to selecting a location, building or space, it is
necessary to define the overall amount of space needed to meet the immediate programs/service
needs and account for some future growth or flexibility. The next step will describe how to
identify the initial space needs to inform the master plan.
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Part B: Client Activity and Space


Needs
Space needs are typically identified through the creation of a Functional Program, which
includes detailed information to describe the programs, workload and staffing and spatial
requirements and layout (or block diagrams). For more information on the Functional
Program, please refer to the MOHLTC-LHIN Toolkit.

B.1 Types of Spaces


This Guide categorizes spaces into two types of activities:
1) Clinical Space*: rooms required for primary health care staff to perform their core
functions and clinical support rooms (e.g. general waiting areas, exam rooms, counselling
rooms, specialized care rooms, labs, medical staff offices, and medical/clinical utility
support rooms).
*The term clinical space is not intended for counselling space for interviewing clients
and/or families for non-physically based condition treatment or education.
2) Facility Support Space: non-clinical rooms and areas for administration and community
activities and functional rooms. These are grouped as follows:

Administrative Support Spaces required to support the delivery of primary and


allied health care staff (e.g. reception, general waiting areas, work areas, staff facilities)

Shared Spaces shared by both core program and allied health staff to deliver
programs (e.g. interview, counselling and meeting rooms, kitchens)

Cultural Spaces special rooms required for the delivery of core health care programs
that are directly related to the culture of a specific patient/client group (e.g. traditional
healing, meditative or ceremonial spaces)

Building Facility Support Spaces rooms required for the facility to be functional
(e.g. garbage, storage, mechanical and electrical)

B.2 Workload and Effective Room


Utilization
The relationship between operations and space should result in most effective usage or rightsizing of physical space; that is, all rooms are used with the least amount of time vacant or
down time, while allowing for some flexibility for unexpected or informal use.
The ministry does not support assumptions that individual, dedicated rooms are required for
single functions or one-time events unless there is clinical or program evidence.
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Opportunities should be identified where staff and group activities can share space based on
effective scheduling. The number of common areas should be carefully planned to eliminate
down time and facilitate sharing across programs.
The following are a few examples of preferred relationship between operations and space:

Exam Rooms and Waiting Room Size: Standard exam rooms should be planned to be
flexible for different uses and occupied 80% of the time. Using data such as annual
visits, appointments or encounters; clinic hours; and, how long patients stay in a room
will guide the optimum number of rooms and numbers of people in a waiting room.

Clinical Office Space: Collaborative team space with workstations in a shared space with
access to a swing or spare office for privacy should be planned as opposed to dedicated,
private offices.

Meeting Rooms: Effective scheduling of the programs should facilitate sharing of rooms
across multiple program groups, or rooms subdivided for flexibility. If the facilitys full
programming is met and there is still scheduling time available, the space may be
considered for use for other community partners. Using data such as number of group
types, frequency and length of group sessions and a draft schedule will help determine
the optimum number of rooms.

Administrative Offices: Number of staff; function (full-time/part-time); hours of


use/frequency; and, privacy needs should be used to determine whether private offices,
workstations or shared offices are appropriate.

B.3 Workload Data Table Appendix A


To determine the activity of the facility and effective room utilization, the organization should
have information on how many patients it services, the range of services being provided and how
patients are being treated, such as on-site or face-to-face visits with health service providers
and telephone consultations. The number and types of visits is information needed to determine
the type and amount of physical space needed to deliver those services. The Workload Data
table in Appendix A is a tool to provide an overview of this information.
The ministry will request this table to be completed and submitted as part of the project early
planning development process. The ministry will review the table to assist the organization in
determining the optimum number of rooms for the appropriate functions. For assistance on
completing this table, please contact the ministry.

B.4 Staffing and Space Needs


Staffing is also an important factor in determining space needs. The ministry is only able to
commit capital funding for space that has operational funding committed to it. Typically,
community HSP operational staffing budgets are determined by the LHIN. An HSP may
find that the LHIN has a fixed operational budget for the staff, despite a projected increase in
client volumes. In such as case, where the HSP may be planning for more space to support
increased volumes, the ministry recommends that the HSP work with its LHIN to review the
relationship of staff to volumes to ensure that the number of funded staff can reasonably
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manage the anticipated volumes. Please refer to the MOHLTC-LHIN Toolkit for the LHINs
process for review, alignment and endorsement of the program and services, which includes
service delivery capacity.
If the LHINs review and endorsement confirms an increase to the operational budget for
additional staff to meet projected increased volumes, then the ministry is able to support
space to accommodate more space to meet those volumes (with the assurance that increased
budgets and recruitment will be achieved).
If the LHIN cannot endorse operational budget increases for additional staff, the ministry
recommends that the organization develop alternative solutions to address demand. For
example, increased hours could be considered, or an area for future expansion or future offsite facilities could be envisioned as part of a master plan (should future additional staff
funding be approved).

B.5 Determining a List of Rooms


Once the programs and services, staffing and workload have been assessed and their impact on
space determined, a list of rooms can be determined:

Clinical and group rooms through analysis of activity, workload and utilization;

Efficient administration space determined through evaluation of staff needs;

Remaining rooms required for the facility to fully function. See Table B1.

The following table is a sample list of rooms that could be found in a community health centre.
Each facility will have its own complement of rooms based on specific programs and functions.
Table B1. Example of a Room List for a Community Health Centre
Reception Area

Shared Meeting/Multipurpose Spaces

Reception Desk with Intake Interview Area

Meeting Room(s) (# and size based on activity)

Waiting Room (incl. Child area)

Storage for meeting room supplies/furniture

Scooter/Stroller Parking

Refreshment Station (optional)

Public Washrooms (access to)

Demonstration Kitchen (Diabetes Programming)

Medical Records Room

Cultural Spaces (specific to functional program)

Clinical Area

Administration Spaces

Examination Rooms

Administration Offices and workstations/shared areas

Interview/Counselling Room(s)

Building Support Rooms

Medication Area (room, or cupboard)

IT Server / Telephone Room(s)

Clean Utility Room

Housekeeping Room

Soiled Utility Room

Electrical and Mechanical Rooms

Patient Washroom(s) (single, barrier-free)

Mechanical Room

Practitioner Work Spaces

Garbage / Waste Holding Room

Swing Office (with Team model)

Storage

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Table B2. Space Needs Table


After all rooms and spaces have been identified, a Total Space Needs Table can be created.
Please contact the ministry for a sample Space Needs template table.
The table should be organized using the format shown below:
Program

FTE
(related to
Program

Staff (#)

Room
Type/
Function

Area per
Room (SF)

Number of
Rooms

Total Area
of Rooms

Variance from
original planned
Area (%) *

Room
Requirements

*add column after initial submission for comparison between planning stages
Area per Room - Room Size
Appendix B of this Guide presents sizes of each room type that is eligible for capital funding by
the ministry. These room sizes reflect the recommended areas as per CSA Z8000 and the limits
of ministry funding capacity. The HSP should use the Community Health Service Provider Cost
Share Guide as a companion document when developing the space needs table. Please refer to
Part C of this Guide for description of Appendix B.
The total area of these room sizes will result in the net area of the facility, excluding space
needed for circulation. The subsequent development of the net room areas into the total building
area of the facility (sometimes referred to as the gross-up) is described in Part C of the
document.
A space needs table that identifies the rooms, net areas and eventual total building area is
sufficient for the Pre-Capital or Proposal stage as outlined in the MOHLTC-LHIN Toolkit. At the
Functional Program stage, the additional sections of the table are to be completed.
Space Variance
As planning progresses, changes to room size and/or requirements are likely to occur. The
planning team must note the difference and provide an explanation in the Variance column. For
room size, the variance should be described in both square feet difference and as a percentage
from the original Area of Room.
This version of the Space Needs table, which tracks the variances should be completed and
submitted with each capital stage submission.
Please contact the ministry for a sample Space Comparison template table.
Room Requirements
Each room should have a defined function or range of functions based on the program or services
being delivered or performed. In addition to program-specific functional needs, the
Requirements and Recommendations in the Appendix B Tables must be included. These
Room Requirements can be documented in the Space Needs table or separately.
The organization should include an Infection Control Professional (ICP) as part of its planning
team. The ICP should be involved at this early stage to ensure infection control measures are
accounted for in the early planning decisions and subsequently incorporated in room
requirements. The ministry will use Appendix B to review the planning submissions and will
request clarification or revision where there are discrepancies.
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Part C: Determining Total Space


Needs
C.1 Room Sizes and Functional Room
Requirements Net Square Feet (NSF)
The Room Sizes and Functional Room Requirements Tables (Space Tables) in Appendix B are
defined in two major categories:

Clinical Support Spaces

Facility Support Spaces

The Space Tables provide a complement of rooms that may occur in a community health care
facility. Each room has an assigned Net Square Foot area (NSF) and a list of Room
Requirements and Recommendations.
The NSF defines the net amount of space for each room type, not including space for circulation
or building structure and thickness of walls (building structure and exterior wall thickness is only
required to be calculated in new-build projects).
The Room Requirements and Recommendations column define the mandatory and advisory.
The advisory items are recommended if they are appropriate to the program needs. It is the
responsibility of the HSP and its consultants to ensure that the mandatory requirements and
appropriate advisory elements are incorporated in the early planning space estimates and at
subsequent detailed design.
A total Net Square Foot (total NSF) area is the result of adding the total room net areas.
The NSF for each room is a guide, representing recommended sizes based on CSA standards for
functionality and infection, prevention and control and the ministrys funding limits.
If rooms are sized larger than in the space tables in Appendix B, the ministry will require LHINendorsed clinical or program evidence demonstrating the need for the increase and LHIN support
for the operating cost impact. Please refer to the Community Health Service Provider Cost Share
Guide.

C.2 Additional Design Factors to Reach


the Total Area
Planning factors must be applied to the total NSF to achieve a Total Building Gross Square
Footage (BGSF). These include:

Future Growth and Flexibility


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Component Grossing Factor

Building Grossing Factor

C.2.1 Future Growth and Flexibility


To accommodate minor changes and/or growth in core programs, the ministry may support up to
5% of the total net area to be added to the total NSF. For Community Health Centres, this space
is intended to support growth and flexibility for the primary care or clinical program (as opposed
to group space or administrative space). For other community HSPs, it is intended for general
program-related areas. The ministry will review a variety of factors in its consideration of the
space (e.g. effective utilization of the planned spaces, lease terms, location etc.).
Any projected growth above 5% must be submitted to the ministry for review. The HSP should
work with the LHIN, using client profile projections and any data that the facility has tracked
and can demonstrate as evidence for growth.
Soft Space Planning
Future growth/flexibility space can be accommodated adjacent to the clinical zone or core
program area by using spaces that can be converted with minimal capital investment. For
example, storage, office space or interview rooms that can be easily relocated could be planned
adjacent to the clinical zone. If the soft space is intended for future clinical functions, the
mechanical ventilation of this space should be designed with the potential to provide enhanced
ventilation requirements with minimal alteration.
Future Growth and Flexibility

Up to 5% of the total NSF or an actual area.

This number becomes the new total NSF.

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C.2.2 Grossing Factors: Component


Gross Square Footage (CGSF) and
Building Gross Square Footage (BGSF)
The following factors are recommended to be used at early planning stages to estimate overall
space budgets. Variables such as existing space configuration, structure or special program
needs may change the actual area represented by these factors. As planning progresses into
detailed design, the actual areas should be measured and compared against these factors.
i)

Component Gross Square Footage (CGSF)


To account for the space required for circulation between rooms and zones, at early planning
stages, a planning factor is applied. This factor results in the Component Gross Square
Footage or CGSF. At later design stages, this area can be calculated on the drawings by
the design team and compared against the assumed CGSF planning factor.
The ministry expects planning to be efficient and balanced to minimize circulation space, yet
ensure safety and quality to achieve good patient flow, workflow and staff movement and
support accessibility.

ii)

Building Gross Square Footage (BGSF)


To account for the thickness of exterior walls, minor vertical engineering spaces (plumbing,
ventilation and electrical) and any vertical spaces such as stairways and elevators, an
additional factor is applied to the CGSF. This factor results in the Building Gross Square
Footage or BGSF.
For new-build projects, the BGSF factor must be applied to ensure that cost estimates
account for construction materials and building configuration.
For leasehold projects, there is no vertical space or exterior wall thickness to calculate. The
extent of the space is the rentable boundary. Therefore, the CGSF = BGSF.
Common Space: For leasehold projects, the facility will share some spaces with other
tenants (e.g. common lobby / main entrance areas, service rooms, vestibules, stairways and
elevators). The lease must clearly define these spaces with an associated area and lease rate.
The HSP will be responsible to pay for the use of that space within the agreed-upon rent from
its operational budget. Common space is not added to the total area and is not included in the
capital funding used to construct the space.
The Landlord is responsible for all basic upgrades to those areas, and therefore, any upgrade
work should not be included in the capital costs. However, if the facility requires specialized
improvements, it should consult with the ministry to determine if the capital improvements to
those spaces would be eligible for ministry funding support.

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C.2.3 Applying the Grossing Factors


i)

CSGF: For leasehold and new-build projects:

Component Grossing Factor

Apply a factor of 1.35 (+35 %*) to the total NSF to arrive at the total area of the
facility (within exterior walls).

35% should accommodate the circulation space necessary to link together the net
spaces and area occupied by internal walls. Projects may experience a lower factor
once the building design is refined.

For leasehold projects: the CGSF is the total gross floor area for the capital project.

*35% represents a blend of areas within the facility. Once floor plans have been developed,
the actual circulation area should be measured and documented.

ii)

BGSF: New-build projects

For new build projects, an additional grossing factor beyond the 35% factor is required to
account for the thickness of exterior walls, minor vertical engineering spaces (plumbing,
ventilation and electrical) and any vertical spaces such as stairways and elevators (if more
than 2-storeys).

Building Grossing Factor

Apply a factor of 1.15 (+15 %*) to the CGSF to arrive at the BGSF.

The BGSF is now the total building area of the capital project.

Projects may experience a lower factor once the building design is refined.

*15% represents an approximate building gross up for recent new build projects. Once floor
plans have been developed, the actual building gross up area should be measured and
documented.

15

Part D: Design Considerations


D.1 CSA-Z8000-11 Canadian Health Care
Facilities
The ministry strongly encourages each HSP and its planning and design team to obtain a copy
and be familiar with the standard and future updates. See Section 2.4 of this Guide.

D.2 Infection Prevention and Control


(IPAC)
Understanding the gamut of IPAC planning, from the early identification of the client risk profile
with the preparation of an Infection Control Risk Assessment (ICRA), to location of hand
hygiene sinks and alcohol-based hand rub stations, is critical to planning a facility. Section 4.5
of CSA Z8000 provides an excellent overview of the principles and issues to be considered. The
ministry requires that the IPAC measures of CSA Z8000 are incorporated into community health
care facilities and requires the HSP to retain an independent, accredited infection control
professional (ICP) as part of the facility planning and design team to lead the implementation of
the standards and best practice.

D.3 Building Systems for Communitybased Healthcare Facilities Class C


Health care facilities require a higher level of building services, such as ventilation, electrical and
plumbing services than a commercial building or use. It is the responsibility of the HSP and its
consultants to ensure that the facility design meets required health and life safety regulations, and
is designed to standards that create the appropriate physical environment for the type of health
care that is being provided.
As many community health care facilities are located in leased premises, selection of a suitable
location and lease terms may be impacted by the feasibility of the existing building system to
meet health care facility requirements.
Class C Health Care Facilities: Heating, Ventilation, and Air-Conditioning (HVAC)
Standards
Community health care facilities are classified as Class C facilities, as defined in CAN/CSA
Z317.2 Special Requirements for Heating, Ventilation, and Air-Conditioning (HVAC) Systems in
Healthcare Facilities (CSA Z317). Class C facilities are described by CSA as ambulatory
facilities including outpatient clinics and doctors clinics. The standard requires enhanced
ventilation and filtration systems.
This standard is embedded in the Ontario Building Code legislation; however, it is often
overlooked in early planning of smaller health care facilities, such as community health centres.
16

If the ventilation requirements are not addressed in early planning, designing to these standards
late in project planning or retrofitting results in unnecessary cost increases and delays. The
ministry expects that facilities will be designed to meet the CSA standards and these systems
accounted for in early capital cost budgets and more detailed cost estimates.

D.4 Building Legislation, Codes and


Standards
All facilities must be designed to meet applicable legislation, codes and standards. The ministry
expects that all facilities will be in compliance with the Ontario Building Code.
The Ontario Building Code references many standards as good engineering practice. These
include the Fire Code, the Electrical Safety Act and relevant CSA standards for health care
facilities. Establishing criteria for items such fire and life safety for building occupants, cabling
requirements, emergency power needs and plumbing requirements will impact budget planning
and possibly, site selection. Incorporation of the impacts of these requirements should be
addressed as early as possible in the planning process.

5.0 Conclusion
Through the use of this Guide, health care facility administrators and planners should be able to
arrive at a total space requirement for the capital project by applying the progressive steps of
program definition, effective room utilization and staffing needs, matched with the careful
assignment of rooms to support functions.
The ministry encourages that at all capital planning stages, the HSP and its design team strive for
the effective use of space to create a safe and quality environment for the delivery of health care.
Please contact the ministry with any questions or for assistance in the application of this Guide.

6.0 Implementation
This Guide will be distributed by the ministry to community health care sector stakeholders as an
approved guidance document for the planning and review of community capital proposals.
Comments and/or questions are welcomed and can be directed to the information at the front of
the Guide. Feedback will be collected by the ministry for consideration for future revisions.

17

7.0 Bibliography
CHIR (Canadian Institutes of Health Research); http://www.cihr-irsc.gc.ca/e/44079.html
Canadian Standards Association CSAZ317.1-09 - Special Requirements for Plumbing
Installations in Healthcare Facilities
Canadian Standards Association CAN/CSA-Z317.2-10 - Special Requirements for Heating,
Ventilation, and Air-Conditioning (HVAC) Systems in Healthcare Facilities
Canadian Standards Association CSA Z317.13-07 - Infection Control during Construction or
Renovation of Healthcare Facilities
Canadian Standards Association CSA Z8000-11 - Canadian Healthcare Facilities
Capital Planning Manual (1996), Ministry of Health and Long-Term Care, 1996
COMMUNITY HEALTH CENTRES TAKE BIG STEP FORWARD Community Health
Centres Will Increase Access to Primary Care, Strengthen Communities; News Release
Communiqu; Ministry of Health and Long-Term Care/ Ministre de la Sant et des Soins de
longue dure, July 17, 2006, 2006/nr-082
Declaration of Alma-Ata, International Conference on Primary Healthcare, Alma-Ata, USSR, 612 September 1978; http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf
Facility Guidelines Institute (FGI) 2010 Guidelines for Healthcare Construction, Facility
Guidelines Institute, Washington D.C.
Generic Output Specifications - Beta GOS (2008). Ministry of Health and Long-Term Care.
Health, Not Healthcare Changing the Conversation. 2010 Annual Report of the Chief
Medical Officer of Health of Ontario to the Legislative Assembly of Ontario, December 1, 2011
Looking Back, Looking Forward - The Ontario Health Services Restructuring Commission
(1996-2000) A Legacy Report , The Ontario Health Services Restructuring Commission
(HSRC), March 2000
MOHLTC LHIN Joint Review Framework for Early Capital Planning Stages Toolkit,
November 9, 2010
Ontarios Action Plan for Healthcare: Better patient care through better value from our
healthcare dollars, February 2012, Ministry of Health and Long-Term Care
Ottawa Charter for Health Promotion First International Conference on Health Promotion
Ottawa, 21 November 1986 WHO/HPR/HEP/95.1;
http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf

18

Appendix A Workload Data Table


Please contact the ministry for a copy of this form and any questions regarding the form.
Workload Data for Community Health Service Providers
HSP to complete all cells highlighted in yellow

Facility Name:

Funding Status
(use drop down options)
Stage of Project:
(usedrop down options)

Date submitted:

Project Name and HCIS #:

Completed by:
Historic

Current

Current year
previous full
(adjust for full
year visit history
year)

Operations Overview Information

Select
Select

Projected

Variance

Variance

Opening year

Opening Year
minus Current
Year

Explanation (short reason for variance)

Total number of patients with one or more site visits in year


Total number of phone encounters with patients in year
Operating days per year
Hours of operation per day
NOTE: Site visit information (one patient may
access one or many services). Populate only
services provided.
Add or delete categories as required.

Number of Private Site Visits


(per calendar year - Jan1 to Dec 31)
Average visit time
in minutes
(excluding
waiting)

Private Visits

Historic

Current

Projected

Current year
previous full
(adjust for full
year visit history
year)

Opening Year
minus Current
Year

Opening year

Primary Care
MD Primary Care
Mental Health/Psychiatric Services
NP Primary Care
Counselling, education and treatment programs (private)
Rehabilitation
Health Promotion
Illness prevention/Education
Diabetes Education
Maternal/Child
Social Work
Traditional Care (e.g. Aboriginal Healer)
Counselling
Geriatrics
Allied Health
Physiotherapy
Occupational Therapy
Speech Therapy
Audiology
Dietician
Podiatry/Chiropody
Other
Diagnostics (blood work, ECG, etc.)
Total number of site visits

*Variance Factors (volumes)

Variance
Confirmed
funding for
incremental
FTEs

Adding FTEs
within existing
budget

Program
Transfer

Total Varience Factors (must


equal Variance)

0
0
0

0
0
0
0

0
0
0
0
0
0

0
0
0
0
0
0

0
0

0
0
0

0
0
0
0
0
0
0

0
0
0
0
0
0
0

0
0

Group Programs

Average program time in minutes


Historic

Group/collaborative programs
Small Group (5-10 participants)
Medium Group (10-30 participants)
Large Group (30-100 participants)

Current

Current year
previous full
(adjust for full
year visit history
year)

Projected

*Variance Factors (volumes)

Variance
Variance

Increased
Funding for
more FTE

Opening year

Program
Transfer

Adding FTEs
within existing
budget

Total Varience Factors (must


equal Variance)

0
0
0

0
0
0

0
0

0
0

Food-related programs
Small Group (up to 10 participants)
Large Group (up to 30 participants)

*Variance Factors- Explanation: If any variance categories have been selected, provide explanation to support projected increased volumes

Draft - June 19, 2014

19

Appendix B - Room Sizes and


Requirements (Space Tables)
Appendix B1 - CLINICAL SPACES
Room Name/Item

Examination Room Standard

Net
Area
(SF)

120

Requirements and Recommendations


CSA Z8000 requires all items as "requirements" or "Mandatory", unless stated under the "Advisory"
heading. Those under "Advisory" are recommendations. The ministry supports the "Mandatory"
items as planning and design requirements. If a HCF (Health Care Facility) cannot provide the
space or amenities required, the Functional Program must provide a description why the requirement
cannot be met and the alternative measures to achieve the room function and requirements.
(a) Each examination/treatment room shall have a minimum clear floor area according to
the space requirements , exclusive of fixed casework.
(b) A wall mounted hand hygiene sink shall be located adjacent to the door along with a
hand hygiene station at the exterior of the door on the hallway side.
Note: this sink shall be used for washing of hands only and shall not be used for the
disposal of waste or any other substance. See Hand Hygiene Sink requirements.
(c) Privacy curtain shall be located adjacent to the door but away from door swing; another
curtain dividing space around exam table may be considered.
(d) Exam table shall be required to suit the function of the room.
(e) Blood pressure cuff, paper towel dispenser, sharps container and hand hygiene station
shall be mounted next to the exam table.
(f) Soiled linen hamper and soiled garbage container shall be provided.
(g) The minimum door width shall meet the requirements of the Ontario Building Code
(approximately 900mm or 36") but must be wide enough to support the accessibility
needs of the client profile. **see Advisory comments.
(h) A minimum 1500 [5'-0"] turning circle shall be provided for standard wheelchair
accessibility on one side of the exam room.
(i) A minimum 1500 [5'-0"] turning circle shall be provided for standard wheelchair
accessibility on one side of the exam room.
(j) Sharps disposal shall be provided in a safe location and near the point of use, in
accordance with Occupational Health and Safety legislation.
(k) If in accordance with the HCF's record management and operational budgets, provision
shall be made within the room for electronic charting and access to health records.
(l) The room arrangement shall provide for access and clearance (800 mm) [2'-6"] on one
side and at the foot of an adult patient as accommodated on an extended examination
table.
(m) If the HCF has been approved for Ontario Telehealth Network (OTN) access, provision
should be made for Telehealth through room colour, lighting, acoustics, the selection
and placement of furniture, and adequate space for Telehealth equipment.
(n) An exam light shall be provided over the therapy area.
(o) Rooms used for pelvic exams shall allow for the foot of the examination table to face
away from the door.
(p) Where renovation work is undertaken, every effort shall be made to meet these
minimum standards. In such cases, each room shall have a minimum clear area of
9.0 sq.m. (100 SF), exclusive of fixed or wall-mounted cabinets and built-in shelves.
Advisory:
(a) Rooms should be laid out in similar configuration.
(b) Each room should contain a work counter that can accommodate writing; staffaccessible supply storage facilities; an examination light.
(c) A vision panel adjacent to or in the door may be considered.
(d) The door width for examination rooms should be considered to support the HCF's
accessibility plan and client profile: for example, for access to examination rooms by
wheelchairs, other mobility devices, bariatric patients, and those that require other
mobility support, a door width of 1050mm (41") may be considered.

20

Appendix B1 - CLINICAL SPACES


Room Name/Item
Examination Room
Large

Net
Area
(SF)
140

(scooter access and/or


family accommodation)

Hand Hygiene Sink


(HHS)
Interview Room /
Counselling

10
120

Examination Isolation
Room (Airborne
Precaution Room or
"APR")

examination room
ante room
prep alcove

120
55
22

Requirements and Recommendations

as per requirements for Standard Examination Room but larger for family or for
scooter/mobility device access.

The ministry supports one Large Exam Room per facility. For facilities providing
services to populations with specific cultural needs, where the patient is regularly
accompanied by several people (translator, multiple family members), or, the patient
population includes a large proportion of scooter users, more than one Large
Examination Room may be required. This need must be clearly demonstrated by the
Functional Program, with exam room utilization calculations and patient flow
descriptions to illustrate that all rooms are occupied effectively. The LHIN and ministry
must both provide written agreement that the need directly supports the provision of
Primary Health Care services for the facility's population. If a HCF identifies the need
for a larger room for more complex procedures than can be accommodated in a
standard exam room, consider an additional Large Exam Room, as supported by the
room utilization model.
(a) Clearance shall be provided for a scooter turning circle of 1800mm [6'-0"].
(b) Depending on the clinic model and space availability, consideration should be given to
two points of entry: from a patient corridor/waiting zone and from a staff/clinical work
zone.
See "Hand Hygiene Requirements" for full requirements for the HHS and waterless hand hygiene
stations as required by CSA (see Appendix B4).

Counselling rooms can be sized as interview rooms (2-4 people). The room should be
furnished to meet the needs of the patient type. The required furnishings and
arrangements to support the patient care needs and ensure staff safety should be
determined by the Functional Program.

Please refer to Facility Support Spaces for requirements for Interview/Counselling


Rooms.

In general, community health care facilities should not require the inclusion of an APR.
Patients with respiratory infections can be managed through prescribed Infection
Control Management procedures such as separated waiting areas, masking and
gowning, and protection of health care workers through correct use of Personal
Protective Equipment (PPE). Refer to Public Health Ontario for recommended
procedures.
The need for an APR must be demonstrated by the Infection Control Risk Assessment
(ICRA) and presented in the Functional Program with a business case/rationale that
demonstrates need for isolation and enhanced negative pressure air handling system,
based on patient population risk and access, or lack of access to other health care
services for transportation and holding of an infectious patient. Inclusion of an APR
must be coordinated with the Emergency Management Ontario (EMO) and the LHIN, for
example, if the HCF is a designated influenza assessment clinic. Written confirmation
from EMO and the LHIN that a HCF warrants an APR must be provided to the ministry.

The following requirements apply in addition to Examination Room-Standard.


(a) Ventilation must meet CSA Z317.2 for Heating, Ventilation and Air Conditioning (HVAC)
requirements (in addition to enhanced ventilation for the clinical area).
(b) Prep Alcove: A clean area for staff to put on PPE before entering the room shall be
provided.
(c) A contained soiled area shall be provided outside the procedure room for staff to
remove PPE and clean hands prior to entering a public corridor.
(d) Layout and service requirements shall conform to current infection prevention and
control guidelines (refer to CSA Z8000-11 and Public Health Ontario resources).
(e) Depending on the Functional Program, a two-piece barrier-free washroom, directly
accessible from within the examination room and for the exclusive use of the Isolation
Room and its patient, may be considered.

21

Appendix B1 - CLINICAL SPACES


Room Name/Item

Net
Area
(SF)

Requirements and Recommendations


Specialized Rooms

The ministry supports the use of generic, standardized rooms for treatment. The need for treatment rooms with specialized requirements must
be demonstrated in the Functional Program through patient profile data, volumes and room utilization. The following is provided for
guidance, should a standard or larger examination room be demonstrated that it is clinically and/or functionally unsuitable for specific
treatments.
Chiropody Assessment /
Therapy /
Treatment Room

180

Physiotherapy /
Recreational /
Occupational Therapy
Office with combined
Treatment Area
Physiotherapy /
Occupational / Therapy
Activity Room
if no administrative

170

space provided, one


workstation for therapist
administrative functions
may be required.

Diagnostics Area
(such as bloodwork, EKG,
specimen collection)

space per chair for


blood taking

250

Combined assessment, examination and procedure room for foot care, usually
associated with a diabetes program. The Functional Program should describe the
extent of foot care procedures of the program.
(a) Room to comply with common requirements and recommendations for an
examination/procedure/treatment room.
(b) Space within the room shall be adequate to permit the treatment chair to be reclined.
(c) Room shall be located close to clean and soiled utility rooms.
(d) Room shall meet required ventilation and Infection, Prevention and Control
requirements of the College of Chiropodists of Ontario.
http://www.cocoo.on.ca/inffection-control.html
Advisory:
(a) Room should be located near other diabetes program-related rooms.
(b) Room should be located with convenient access to the reception/waiting area, staff
workstations, photocopy room.

Office is intended for examinations/assessments with sufficient storage for


demonstration equipment and educational material.

If practitioners are partial FTEs, the office should be designed to be shared, to


maximize utilization.
(a) Office shall include a hand hygiene sink (see Appendix B4)

The ministry supports shared use of one Physiotherapy / Occupational Room to serve
both programs.
(a) Room shall include a hand hygiene sink.
(b) Room shall be located close to clean and soiled utility rooms.

50
120

80

Size to be determined by Functional Program and shall meet infection prevention and
control requirements. Need for a dedicated diagnostic area must be demonstrated in
the Functional Program that other diagnostic services cannot be met by other services
within the immediate area (such as a hospital or testing labs).

The ministry supports patient-centered care practices that bring services to the patient.
Diagnostics should be accommodated within the client visit in the examination room.
For a dedicated Diagnostics area, the Functional Program must demonstrate why
diagnostic services cannot be provided in the examination room.
(a) Space shall include hand hygiene sink (if multiple stations, not less than one sink for
every four places).
(b) A separate clinical technique sink shall be provided.
(c) Space shall be provided for storage of phlebotomy supply carts and for preparation of
biopsy procedure trays (as applicable to services provided/performed).
Dental Examination/Operating Suits

Dental
Practitioner's
Office
type 1: one desk, no
meeting space
type 2: one desk,
2 visitor chairs

100

Dental Records Area

100

Clinical dental programs within a community HCF typically receive operational funding
from municipal or regional public health unit or other ministry-funded programs. The
HSP must provide written confirmation of ongoing funding commitment from the
organization and demonstrate volumes and room utilization to the ministry.
Sizes of rooms and functional requirements vary across practitioners and should be
developed in collaboration with the user group. The space allocations presented here
are for early planning assumptions only and must be reviewed and modified as
necessary by the user group.

Planners and designers must comply with all guidelines and regulations as available

110

22

Appendix B1 - CLINICAL SPACES


Room Name/Item

Net
Area
(SF)

/ Storage

Dental Exam
Room/Operatory
Dental Dark Room (if
required)
Dental Laboratory /
"Clean" area
Dental Sterilization /
"Dirty" area
Dental
Mechanical/"Pump"

100
80
120
120
50

Requirements and Recommendations


from The Royal College of Dental Surgeons of Ontario (RCDSO), as the regulatory
body for dentistry practice in Ontario, as well as any other requirements by the agency
providing operational funding.

Compliance with all technical requirements relating to (but not limited to) such as
ventilation, lead lining / protection, water temperature and instruments is required. It is
the responsibility of the planners and designers to ensure that all regulations and
requirements are satisfied.
(a) The rooms must be organized as a suite of rooms, adjacent to each other for good
patient wayfinding and workflow. Final room sizes to be determined based on technical
requirements. Size is proposed for early planning purposes.
(b) Operatory rooms should have access to daylight if possible. Support rooms that do not
require daylight should be strategically organized to maximize access to daylight for
client areas.
(c) The Dental Mechanical area may require an electrical panel dedicated to the Dental
Suite. Room to be sized according to technical requirements. Size is proposed for early
planning purposes.

Clinical Area Administration Spaces


Charting Alcove

20

Health Practitioner
Workstation (open)

65

Post-Secondary Student /
Learner Workstation
(open)

65

Clinical Administrative
Spaces

workstation
combined Office /
Exam Room
combined > see (e)
for other office sizes,
please refer to
Appendix B2, Facility
Support Spaces

65
160

65
Hotelling Workstation Visiting Specialists or
Volunteers
Medical Library (for staff) 0

A dedicated area for intermittent charting/administration may be required for larger


clinics, as demonstrated by the Functional Program.

Assign one workstation to each part-time practitioner/staff member for administrative


functions. Counselling or care-related functions shall be assigned space to suit the
function (i.e. A part-time counsellor may require access to an enclosed
interview/counselling room).

If the area is designed as a collaborative, "open workstation" model, access to a "swing


office" can be included for privacy/small meetings.
(a) Adequate space and lockable storage is required for each user.
(b) If the space is a collaborative area, acoustic privacy shall be considered.

The need for an additional administrative work area to be used by clinical Learners or
volunteer staff must be demonstrated by the Functional Program and linked to the direct
delivery of an ongoing post-secondary primary health care related program.

For Learners, the facility must demonstrate a formal relationship with a post-secondary
institution and provide a Clinical Teaching Plan to identify link to the primary care
program, Learner activities, frequency and administrative space needs. Dedicated
clinical and/or examination rooms for Learners, is not supported.

Private office space is supported only for health care practitioners who do not have
access to an examination room (such as Allied Health Workers), or require an enclosed
office to conduct combined administration and examination/counselling functions. For
administrative clinical work, a collaborative team/hub model in a workstation zone or
room is supported. The Functional Program must demonstrate need and utilization of
private offices.

If a private office is used for treatment, or giving of injection (such as insulin), a Hand
Hygiene Sink is required.

Offices not used for treatment are recommended to be located adjacent to and within
the "Class C HCF" ventilation zone of the clinical area to support future flexibility.
Advisory:
(a) Patient care areas should have priority for exterior views and access to daylight.
However, if possible, staff offices should have an exterior view.
(b) All offices should be acoustically insulated for confidentiality.
(c) The entry door should have a vision panel with blinds.
(d) Office users should have a sightline to the door when seated at their workstations.
(e) For a combined Office/Exam room, the treatment area is designed as per requirements
for Standard Examination Room but with additional space for a workstation of 50SF
(circulation included within the 120 SF of the Exam space).

One generic workstation as a flexible work area for occasional administrative tasks for
visiting specialists and/or volunteers.

Shelving for storage of medical books/volumes is to be included in workstation

23

Appendix B1 - CLINICAL SPACES


Room Name/Item

Net
Area
(SF)

Requirements and Recommendations


areas/offices/meeting rooms that are conveniently accessible to users, as determined
through the design process. Dedicated space is not supported.

Clinical Area Support Spaces


Client/Patient Washroom
(single, two-piece,
barrier-free)

50

(a)
(b)
(c)
(d)
(e)

Refer to Ontario Building


Code for barrier free standards
and requirements

(f)
(g)
(h)
(i)
(j)

Client/Patient Washroom
with Shower
(single, three-piece,
barrier-free)

75

(a)
(b)
(c)
(d)
(e)
(f)
(g)

Medication / Medical
Storage
Depending on the
amount of medication
held/administered in the
HCF, a locked cupboard
may be sufficient, as
determined by the
Functional Program.

100

(a)

(b)
(c)

(d)
(e)

Each clinical area or zone shall have one patient-dedicated washroom. A second
washroom may be considered as determined by the Functional Program and number of
examination rooms.
The toilet and sink shall be hands free operation.
Dispensers for paper towels shall be hands free (i.e., the hands only touch the towel).
A mirror and coat hooks shall be provided.
Toilets with tanks shall not be used, due to the risk of condensation.
If urine specimens are being provided in the HCF, procedures for pick-up/transport shall
ensure that no cross contamination occurs into the general clinic area.
The door shall be easily accessible by staff, while allowing privacy.
There shall be sufficient space for a 1500 mm [5'-0"] wheelchair turning radius.
The washroom shall be barrier-free and meet all building code requirements for
accessibility.
The toilet, sink and grab bars shall be capable of supporting 250kg [500 lb].
If bariatric clients are included in the demographic and space needs demonstrated in
the Functional Program, washroom fixtures and related physical design must be
adequately specified.
One client/patient washroom can contain a shower, if required for infection, prevention
and control purposes to allow staff to safely examine the client/patient. The need must
be demonstrated by the Functional Program that it serves the HCF's target population
and that operational measures (e.g. staffing, utilities and maintenance) are in place.
Written LHIN endorsement for provision of a client/shower is required with the
Functional Program.
As integrated with a two-piece washroom, the shower area shall be open to the toilet
area and a minimum dimension of 1200x1500mm [4'-0" x 5'-0"].
Showers shall have no floor lip, but the entire room shall be sloped to a drain; the floor
shall have a non-slip finish with an integral cove base.
The shower shall have grab bars and a fold-down seat.
A readily accessible emergency call device shall be provided, with shut-off only at
source.
The washroom shall be barrier-free and meet all building code requirements for
accessibility.
The washroom shall accommodate storage for soiled clothes, clean linens, and
shelving.
If bariatric clients are included in the demographic and space needs demonstrated in
the Functional Program, washroom fixtures and related physical design must be
adequately specified.
A scientific refrigerator/freezer shall be provided, as determined by the Functional
Program. Alarms and emergency power needs for refrigeration shall also be
determined by the Functional Program. Built-in battery backup systems are preferred.
The room/area shall be secure with access restricted to clinical staff.
A hand-hygiene sink shall be mounted on the wall adjacent to the door.
If medication is being prepared, the sink shall be mounted away from the medication
area due to risk of splashing and aerosolization.
Ease of access and observation of the area should be considered.
Ensure necessary area and clearances for access to refrigerators.

24

Appendix B1 - CLINICAL SPACES


Room Name/Item
Clean Storage/Supplies

Net
Area
(SF)
120min
(if
room)

can be an enclosed
room or alcove with
double doors

Soiled Utility / Holding


small (minimum)

130

medium

150

Requirements and Recommendations


(a) An enclosed room shall not be less than 120 SF. An alcove with double doors may be
sufficient, as determined by the Functional Program.
(b) Clean and soiled utility rooms shall be separated spaces.
(c) Decontamination of or cleaning up supplies shall not be permitted in the clean utility
room.
(d) Areas for storage of clean and sterile supplies shall conform to CSA Z314.15.
(e) Clean utility rooms shall not include a hand hygiene sink in the room. There shall be a
hand hygiene station located outside the room.
(f) The room or area shall be secure with access limited to clinical and support staff.
(g) If reprocessing of medical equipment is performed, the space shall meet the
requirements of CSA Z314.8, CSA Z314.2 and CSA Z314.3 as applicable.
(h) The room shall have designated locations for the types of items being stored e.g. (i)
clean and sterile supplies (ii) clean linen (iii) crash carts*, as determined by the
Functional Program. *Crash carts are not usually required in for primary care, as the
facility does not provide emergency or acute services for patients. Need for use,
maintenance and storage of a crash cart(s) should be determined through the
Functional Program, with a description of why crash carts are required for that facility.
(i) The room should be located close to the centre of the care area.
(j) Shelving units or cart surfaces shall have cleanable, smooth and non-porous surfaces
tolerant of hospital-grade disinfectants.
(k) Storage of equipment and supplies shall not be exposed to direct airflow from the HVAC
system in accordance with CSA Z314.15 and CSA Z314.3. Storage should be away
from the window, due to the risk of condensation.
(l) Flooring shall be of seamless impermeable, non-slip material. Wall base and floor
edges should be an integral cove base, tightly sealed against the wall and constructed
without any gaps.
(m) The principles of ergonomics shall be addressed when designing the storage space and
locations of supplies.
(n) Shelving for clean and sterile supplies shall be at least:
(i) 230 mm off the floor;
(ii) 450 mm from the ceiling; and
(iii) 50 mm from outside walls.
(a) Clean and soiled utility rooms shall be separated spaces.
(b) Soiled utility rooms shall only be used for temporary storage or supplies and equipment
that will be removed for cleaning, reprocessing or destruction.
(c) The room shall be located and arranged to provide easy access for staff to deposit
soiled supplies.
(d) Soiled utility rooms shall be designed and equipped to minimize/contain the
aerosolization of waste.
(e) A hand hygiene sink shall be provided. Note: This sink shall be separate from the
utility/cleaning sink.
(f) Space shall be provided at the point of use for rinsing of gross soil or debris from
reusable devices.
(g) Easy access shall be provided for closed human waste container, cleaning devices or
disposable human waste container devices.
(h) Flooring shall be of seamless impermeable, non-slip material.
(i) Splash protection shall be provided on walls near water supply, sinks or human waste
management systems.
(j) Counter tops shall be of non-porous material, free from seams and tolerant of routine
daily cleaning with hospital grade disinfectants.
(k) The room shall be secure with access restricted to clinical and support staff.
(l) Doors shall be kept closed and not propped open.
(m) The room shall be designed to minimize exposure of patients, staff, and visitors to
odour, noise and the visual impact of medical waste operations.

25

Appendix B1 - CLINICAL SPACES


Room Name/Item
Soiled Utility / Holding
(cont'd)

Housekeeping /
Janitorial Closet or
Room

Net
Area
(SF)

Requirements and Recommendations


(n) The room shall have the capacity to:
(i) segregate wastes into HCF approved containers;
(ii) hold soiled linen and items for return to outsource service;
(iii) contain a human waste management system - if required/detailed by need in
Functional Program;
(iv) contain supplies associated with waste management systems; and,
(v) provide for cleaning soiled patient equipment that is not returned to outsourcing for
sterilization.
(o) Spray wands shall not be used for rinsing of items. Equipment used for removal of
gross soiling shall minimize aerosolization of particulates.
(p) Space shall be provided for separate mobile containers for soiled linen, general waste,
medical/hazardous waste, confidential waste, and recycling, etc.
(q) The room shall provide storage for carts that will be used to move the soiled material
from the room.
(r) Hoppers should not be required in a primary care setting. Need must be demonstrated
through the Functional Program. If they are used, they shall be designed to contain any
splash and the controls shall be located so as not to expose staff to contaminants.
(s) A washer / disinfector shall be provided in accordance with the Functional Program.
Refer to Appendix B2-Facility Support Spaces

26

Appendix B2 - FACILITY SUPPORT SPACES


Room Name/Item

Net
Area
(SF)

Requirements and Recommendations

CSA Z8000 requires all items as "requirements" or "Mandatory", unless stated under the "Advisory" heading. Those under "Advisory" are
recommendations. The ministry supports the "Mandatory" items as planning and design requirements. If a HCF (Health Care Facility) cannot
provide the space or amenities required, the Functional Program must provide a description why the requirement cannot be met and the
alternative measures to achieve the room function and requirements.
Administrative Support Spaces for the Clinical Zone/Area
Reception / Control Desk

provide an additional
30% of total FTE area
for storage
provide an additional
50SF for a small
triage/interview area
for confidentiality that
provides accessibility

65
per FTE

Workstation space to be calculated using FTEs as opposed to occupants, as multiple


receptionists may share workstation(s) depending on scheduling/ work planning.
Functional Program to demonstrate utilization of workstations and FTE / Staff
assignments. Additional work space may be considered for peak-time staff if
demonstrated in the Functional Program.
(a) The reception/control desk shall be positioned so that there is security control and staff
can easily provide and receive information.
(b) The area shall be designed according to accessibility, ergonomic and occupational
health and safety principles. Refer to Accessibility Directorate of Ontario for staff and
visitor accessibility requirements.
(c) The station shall be designed to ensure personal security for staff. Security can be
achieved through engineering controls such as:
(a) desk height;
(b) transparent screen:
(i) A screen shall be erected at the reception desk to provide protection for staff
during the triage function from patients who may be or are infectious. The screen
also provides separation of contact with surface materials (i.e. shared pens, other
materials). Provision of a screen is a key component of the ICRA and must be
reviewed with the HCF, ICP and architect during the design phase. The screen
can be made of a transparent material that can sustain regular cleaning with
cleaners and disinfectants. The patient intake process and planning of the desk
and screen area shall consider confidentiality and privacy needs.
(ii) If a screen is not provided, the ICP must provide to the ministry an explanation of
the reason why it is not deemed required and what alternative screening measures
will be implemented. The ministry reserves the right to require installation of a
screen.
Note: a screen may not be appropriate for community-based mental health
programs that are based on a model of integration; however, the HCF must
provide written confirmation of alternative infection control and staff safety/security
measures.
(d) All entry points to the clinical area beyond the Reception Desk shall be secure and
require controlled access. Consider operations so that staff do not need to leave the
area to escort patients (such as intercom, "runners", volunteers).
(e) Plan the Reception Area to accommodate a patient screening process that enables
staff to determine if patients are infectious and require to be seated in the separated
area of the Waiting Area.
Advisory:
(a) Depending on workflow model, consideration should be given to create a secondary,
designated area (workstation) for re-booking appointments to ease congestion /
crowding at the intake area.
(b) A counter should be provided at the back of the workstation for storage of paper and
other procedural material. This material should not be laying on the front counter that is
approached by patients.
(c) Consideration should be given to create a secondary entry for the movement of
supplies and garbage.
(d) The placement of the computer should be convenient to allow for easy input, but not to
obstruct visual connection between staff and patient, nor to be visible by the patient.
(e) Staff shall have easy access to a hand-hygiene station. This can be a wall-hung sink in
the area or an alcohol-based sanitizer.
(f) An alcohol-based sanitizer shall be easily accessible to patients at the counter.
(g) Planning of the desk and shall address confidentiality and privacy.
(h) Consider space for charting, as determined by the workflow model.

27

Appendix B2 - FACILITY SUPPORT SPACES


Room Name/Item

Net
Area
(SF)

Requirements and Recommendations

Waiting Area

general seating

15
per seat

wheelchair/scooter/ba
riatric

30
per chair

separated area for


infectious
patients(once
screened and
masked)

20per
seat

(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)

Children's Waiting Zone


(open to Waiting Area)
up to 45

15
per child

(a)
(b)
(c)

Visitors' Coat Area

1 lineal foot for 2


coats

up to 20

Medical Records / File


Room

up to 150

If within Medical
Records/ File Room:
space is additional to
filing area; should
accommodate 1
photocopy machine
with worktable

50

If enclosed room,
separate from File
Room area

120

Assume an open coat hook area to contain 20 coats; space is in addition to Waiting
Area seat calculations.
Design coat area to keep the Waiting Area free from clutter and congestion.

(a) For protection of patient records and privacy, the area shall be secure and accessible
only to staff and other designated personnel, as determined by the Functional Program.
(b) The principles of ergonomics shall be addressed when designing the storage and filing
spaces and equipment selection.

Photocopy / Workroom

For early planning purposes, allocate two seats per treatment space (exam room
and/or counselling)
For early planning purposes, of the total number of seats, include 10% for
wheelchair/scooter/bariatric places. If more than 10% is required, provide explanation
in Functional Program as related to patient population profile.
For early planning purposes, of the total number of seats, include 20% for
separated/infectious patients (once screened and masked). Determine the anticipated
number of spaces based on Infection Control Risk Assessment (ICRA).
If the HCF includes a dental program, consider seating based on clinic scheduling and
workflow.
Waiting rooms for patients and accompanying persons shall be located close to the
entrance.
Waiting rooms should be located such that they can be observed by the reception /
appropriate staff at all times.
Zones shall be created so more infectious persons can be directed to a separate area.
Note: Zones can be established through seating, air flow, colors, walls, etc.
Public washrooms shall be provided in close proximity.
Waiting areas shall be sized to accommodate wheelchairs, scooters, and/or strollers.
Different seating types that include chairs with arms, armless chairs, and bariatric
seating shall be provided as appropriate to the expected patient population.
Seating should be able to be cleared readily except where client demographic/program
requires non-movable furniture.
A telephone should be provided with local calling access and accessibility functions.
Consider a charging station for scooters if not accommodated elsewhere.
For early planning purposes, assume space for three children.
Area is in addition to Waiting Area calculations. Inclusion of a child waiting zone is
conditional on supervision of children in this area being the responsibility of adult client
caregiver(s) and not HCF staff.
The area should be located adjacent to and open to the general Waiting Room / Area.
The walls shall be of impact-resistant materials.
The floor shall be of resilient, water-resistant material; area should be able to be
cleared readily.
Parents are encouraged to bring their own books/toys for the short waiting period. The
HCF is recommended not to provide toys or play equipment. Please refer to CHICACANADA PRACTICE RECOMMENDATIONS-Toys, October 2011.

Can be a separate room or integrated with file room.

(a) If integrated with the Medical Records/File Room, access to the Photocopy area shall
prevent unauthorized access to the Medical Records/File Room.

(b) For protection of patient records and privacy, the area shall be secure and accessible
only to staff and other designated personnel, as determined through the Functional
Program.
(c) The principles of ergonomics shall be addressed when planning the work area.
(d) Ensure adequate ventilation for office machines.

28

Appendix B2 - FACILITY SUPPORT SPACES


Room Name/Item

Net
Area
(SF)

Requirements and Recommendations

Staff Support Spaces

Administrative Offices

type 0: workstation
(administrative
assistants)

type 1: one desk, no


meeting space

type 2: one desk, 2


visitor chairs

type 3: one desk,


small meeting area

type 4: one desk,


meeting area/4 chair

type 5: Shared Office


(2 FTEs)
Staff Lunchroom / Lounge

15 SF / person +
50SF for kitchenette
space

200 assumes 10 staff


(50% occupancy of
approx. 20 FTEs)

storage/locker area
for staff in addition to
Lounge area (see
below)

65

100

Advisory:
(a) Patient care areas should have priority for exterior views and access to daylight.
However, if possible, staff offices should have an exterior view.
(b) All offices should be acoustically insulated for confidentiality.

110
120

(c) The entry door should have a vision panel with blinds.
150
(d) Office users should have a sightline to the door when seated at their workstations
160
up to 200

(a)
(b)
(c)
(d)
(e)
(f)
(g)

Staff includes Primary and Allied Care program staff and students. Note: volunteers
may or may not have access to the staff lounge, as defined per user group.
A kitchenette shall be provided.
A hand-hygiene sink shall be provided, in addition to kitchenette in-counter sink.
Natural light should be considered.
Room should accommodate hanging coats and boot storage.
Room shall have controlled access by staff and authorized persons only.
Room shall accommodate lockers for staff if required (see below).
Room shall accommodate storage area for students on placement and volunteers, if
those persons are related to direct delivery of a program/service.

Locker Area within Staff


Lunchroom/Lounge
purse locker

1.5 ea

half locker

4.5 ea

Staff Washroom - twopiece barrier-free

Private office space for HCF Administrators or Allied Health staff who require an
enclosed office for privacy functions are supported.
Administrative Assistants should be assigned 1 workstation; a rationale for an enclosed
office will be required with the Functional Program.

50

Lockers are intended for staff who do not have access to a dedicated workstation or
enclosed office space to store personal belongings.
(a) Size of locker to be determined by use as demonstrated by Functional Program (if only
for storing personal valuables, purse-size locker; if staff are changing, then half-size
locker is appropriate.)
(b) Lockers should be assigned to a single individual.
(c) For students on placement and/or volunteers, an additional storage/locker area of up to
10% of the Staff Lounge Space is supported, demonstrated by the number of
students/volunteers in the facility at any one time.

Up to two staff washrooms shall be provided within or convenient to the clinical care
area, based on numbers of FTE as demonstrated in the Functional Program.

If only one staff washroom is provided, it may include a shower (see below); if two
washrooms are provided, one shall be two-piece with wheelchair turning radius and the
other can include a shower (see below).
(a) All washrooms shall be accessible as per the Ontario Building Code accessibility
requirements.
(b) At least one staff washroom shall accommodate a 1500 mm [5'-0"] wheelchair turning
radius.

29

Appendix B2 - FACILITY SUPPORT SPACES


Room Name/Item
Staff Washroom with
Shower (single, three-piece,
barrier-free)

Net
Area
(SF)
75

Requirements and Recommendations

One Staff shower may be included to address infection, prevention and control issues,
to allow staff to shower if they become soiled during an examination/treatment. The
Functional Program should describe the need for a Staff Shower based on the HCF's
client population.
Shower should be strategically located between the clinical area and Staff
Lounge/Lockers.
Please refer to requirements for Client/Patient Shower.

Shared Spaces

Meeting Rooms

For conference-style seating, assume one meeting table and non-fixed chairs. Allocate
25 SF per occupant with minimum room size of 120 SF.

Interview / Counselling
Room** (2 - 4 people)

120

(a) Space includes table, seating, circulation and cupboard storage.

Small Meeting Room


(up to 6 people)

150

(b) Include a minimum 1500mm (5'-0") linear cabinet along one wall for equipment and
material storage and display.

Medium Meeting Room


(up to 15 people)

375

(c) Include 1 - 2 whiteboards.


(d) Include voice and data and cabling.
(e) Include for Ontario Telenetworking (OTN) infrastructure, if the HCF is approved for
OTN services.
(f) Doors shall have a glazed insert.
(g) Interview Room for counselling purposes:
(i)
may be furnished with more comfortable, lounge furniture.
(ii)
furniture shall be arranged so that the Practitioner has direct access to the door
for safety.
(iii) consider a low-mounted mirror to be used by the client / patient in a sitting
position.
(iv)
include hand hygiene station, in accordance with Public Health Ontario
guidelines.
(v)
include dimmable lighting controls.
(h) Consider shelving for communal reference material.
(i) Rooms shall be design for acoustic privacy.

25

(a) Locate in an accessible area for all users and for after-hour access.
(b) Consider location in proximity to group program areas / rooms.
(c) Ensure that procedures are in place for maintaining cleanliness of area (in-counter cup
sink).
(d) Design station to accommodate bar fridge if refrigeration is necessary. Note: the
ministry does not provide capital support for appliances such as kettles, coffee makers,
bar fridges.

** if a Quiet Room is
required, designate one
Interview Room for
flexibility

Refreshment Station

Multipurpose Rooms
Group Room
(up to 30 people)

up to 360

Multi-purpose rooms are typically used for educational sessions/presentations/group


activities. Multi-purpose rooms are intended for the internal use of the HCF for the
direct delivery of its programs and services.
For flexible room / furniture configurations, assume non-fixed seating and movable
tables. Allocate 10 SF per person.

30

Appendix B2 - FACILITY SUPPORT SPACES


Room Name/Item

Net
Area
(SF)

Multi-Purpose Room (31 100 people)

up to
1,000

Storage - Multipurpose
Rooms
Visitors' Coat Area
1 lineal foot for 2 coats

up to 100
20

(a) Tables and chairs that provide maximum flexibility should be provided.
(b) Include a minimum 5'-0" linear cabinet along one wall for equipment and material
storage and display.
(c) Storage for materials and equipment should be considered. Consider which items can
be stored in general storage and which require convenient storage in or close to room.
(d) Include voice and data and cabling.
(e) Include for OTN infrastructure, if the HCF is approved for OTN services.
(f) Consider movable partition/divider for larger rooms to improve flexibility and utilization.
(g) Include provisions for audio-visual equipment. Note: please refer to Community Health
Service Provider Cost Share Guide for retractable screens and built-in projectors.
(h) Include dimmable lighting controls.
(i) Include hand hygiene station, in accordance with Public Health Ontario guidelines.

Storage for additional foldable chairs and tables, convenient to all multi-purpose
rooms.

Assume an open coat hook area to contain 20 coats.


(a) Coat area should be visible from reception area or related to group rooms (inside
rooms for users, or in area that is easily supervised).
For early planning purposes, allocate 250 SF for groups of 8-10 demonstrations (typical
for Diabetes Education programs); allocate 400 SF for groups of 11-20. Sizes to be
determined at Functional Program. Kitchens greater than 400 SF must be justified
through a description of ministry-funded, LHIN supported programs that require such
access. Volumes, activities and frequency and sharing of use must be clearly
documented with written confirmation from the contributing programs outlining the space
needs to deliver the program. LHIN review and written endorsement will be required.

Demonstration Kitchen

Single Group
Demonstration (8 - 10
people)

up to 250

Multi-Group / Larger
Demonstration (11 20 people)

up to 400

Child Care Room or Area

Requirements and Recommendations

15 per
child

120 min
room
size

For Community Mental Health and Addiction facilities or programs (CMHAs), that are
providing meals as demonstrated in the Functional Program and project scope, a
commercial kitchen will be required in accordance with applicable codes and regulations
.
Compliance with the requirements (including grade/specifications of appliances) of the
Health Protection and Promotion Act Food Premises Regulation, including initiating and
obtaining any approvals required by a Public Health Inspector is the responsibility of the
HCF.
Kitchen design and infrastructure must comply with applicable codes and regulations.
(a) Locate with convenient or direct adjacency to meeting room or multi-purpose room
where group programs have food related programs.
(b) Consider one or two barrier-free accessible workspaces; integrate for maximum
flexibility. Note: the ministry does not provide capital support for motorized adjustable
countertops.

Dedicated space for childcare for clients/patients with small children who need
supervision while the parent is at a healthcare appointment or meeting; or, if HCF has a
direct program/service, such as Early Years, as supported by the Functional Program.

It is the HCF's responsibility to determine the legal requirements to provide dedicate


child care and determine the facility planning requirements to meet applicable
legislation and regulations.

Written LHIN endorsement for the provision of child care space and operational funding
for child care staffing must be provided.

Note: Please refer to the Community Health Service Provider Cost Share Guide for
capital funding policies for child care spaces.

The following areas for early planning purposes; exact sizing of space to be determined
through the Functional Program based on size of facility and operations.

All technical building / facility support spaces shall have secured / controlled access.

Building Support Spaces

31

Appendix B2 - FACILITY SUPPORT SPACES


Room Name/Item

Net
Area
(SF)

Requirements and Recommendations

Housekeeping / Janitorial
Room

75

(a) A housekeeping closet shall be provided in the clinical area; minimum of one closet per
7,000 SF.
(b) Every housekeeping room shall have a floor-based 600 mm 600 mm sink. This sink
shall be protected by an easily cleanable wall surface up to 1200 [3'-11"] mm from the
finished floor.
(c) The housekeeping room shall be large enough to store at least one housekeeping cart
- as determined by the Functional Program.
(d) Wall protection shall be provided to prevent damage by the carts to a height of 1200
mm [3'-11"].
(e) Room shall include:
(i)
floor sink for dumping of dirty water from pails, etc.;
(ii) fresh water source (hot and cold) for filling pails, etc.;
(iii) hand hygiene sink with paper towel dispenser and waste container;
(iv)
non-fixed shelving unit for storage of supplies (i.e., paper towels, toilet paper)
(v)
fixed shelving for storage of small quantities of cleaning products.
(f) The room shall be secure with access restricted to clinical and support staff.

Waste Holding / Garbage


Room

Regular Garbage,
Biological Waste,
Recycling, Shredding

120

(a) Garbage room must be located close to the facility's service entrance. Transport of
waste shall not occur through clinical program areas.

Assume 120 SF for


early planning; larger
space may be
required based on
Functional Program
Mechanical / Electrical
Room
Voice and Data Server
Room
Elevator Machine Room
General Storage

Laundry

In a leasehold facility, garbage rooms are the responsibility of the Landlord as part of
the tenant common space. Ensure that terms for access and maintenance are included
in the lease.

(b) Ensure secure and controlled access.


(c) Ensure ample space to permit required separation and storage of waste.
(d) Provide ventilation as required by applicable codes and regulations.
50

up to 120

50

(As required) Ensure adequate ventilation / cooling and acoustic control to adjacent
rooms.

up to
15 SF
per FTE

General storage can be distributed throughout facility as determined through Functional


Program. Does not include medical supply storage or storage associated with the
multi-purpose room(s).

50

For early planning purposes, allocate 50 SF. Final size must be determined through
engineering design to meet function and applicable codes and regulations.
Ensure adequate ventilation / cooling.

Laundry should be a stackable washer/dryer with minimal shelving in the kitchen to


launder kitchen linens only. The use of cloth gowns for staff and patients should be
reviewed as part of the ICRA; consideration should be given to disposal paper gowns.
Other laundry purposes must be demonstrated in the Functional Program.
(a) Laundry facilities should not be used for laundering patient clothing.
(b) Appliances should be residential grade for kitchen linens.

32

Appendix B2 - FACILITY SUPPORT SPACES


Room Name/Item
Scooter Parking/Storage

assume space for 3


scooters

Net
Area
(SF)
150

15
per
vehicle

Baby Carriage/Stroller
Storage

assume space for 5


strollers

25

Requirements and Recommendations

The use of mobility aids (scooters) is increasing and the size of scooters is increasing.
Planning should address the need for scooter storage/parking based on the patient
demographic.

For early planning, allocate 150 SF. Space should be provided for the parking and/or
storage of mobility aids in locations where parking/ storage will be needed. Such
locations include but are not limited to entrances, waiting rooms, clinical areas, and
meeting spaces. Space to be refined in Functional Program based on client profile.

The HCF should establish with the clinical planning team and the ICP, whether
scooters should be driven into the clinical area, or if there is a transfer point. At such a
transfer point, space for scooter and wheelchair storage must be accommodated.

Charging stations shall be provided. If recharging of multiple scooters will take place in
a designated area, the area shall meet the applicable requirements for electrical safety
and ventilation.
(a) In areas of scooter traffic, ensure that floor and wall materials and finishes are highly
durable to withstand impact.

5
per
stroller

Planning should incorporate storage areas for strollers to prevent obstruction of


corridors and other circulation/waiting areas. The HCF should determine an average
number of strollers that would require parking/storage. The location must be in
accordance with fire safety planning and maintaining clear exit pathways.
Space above 25 SF must be demonstrated through the Functional Program to illustrate
that the space required is directly related to the patient population and programs
offered that result in a higher proportion of parents and small children (i.e. Early Years,
Youth Parenting programs).

33

Appendix B3 - CULTURAL SPACES


Room Name/Item

Net
Area
(SF)

Requirements and Recommendations


This Appendix addresses cultural spaces related to the delivery of programs and services of
the community HCF. The Functional Program shall demonstrate how the inclusion of cultural
spaces is integral to the delivery of community healthcare to the target population. Evidencebased references are recommended as opposed to anecdotal descriptions. The inclusion of
such spaces will require review and approval by the ministry.
The sizes and space allocations are presented for guidance only, for information at the early
planning stages. Actual sizes shall be demonstrated by the Functional Program through
detailed description of the ceremony, space features and anticipated number and
characteristics of the users.

Aboriginal Spaces
Sweetgrass Ceremonies
general seating

15

30

wheelchair

Sweat Lodge
8 ft diameter circle to seat
8 - 12 people

approx.
225

approx.
320

10 ft diameter circle to
seat 15 - 16 people

Medicine Wheel

Traditional Healing
Medication / Herb Room /
Space

150

Functional Program to provide description of function, room requirements, establish space


based on number of persons in the room / space.
(a) Must conform to applicable codes, and regulations. Note specific municipal
regulations/requirements.
(b) If seating is provided, it should contain comfortable furniture and diverse seating
sizes and arrangements.

For early planning purposes, allocate 20 SF per person.

Functional Program to provide description of function, room requirements;


establish space based on number of persons in the room / space.
(a) The Lodge must conform with applicable codes and regulations similar to those
required for saunas.
(b) The Lodge Room should have a central fire pit. Must conform to applicable
codes, and regulations. Note specific municipal regulations/requirements.
(c) Acoustical treatment should be provided to ensure a silent environment.
(d) Doorways need to be of sufficient width to allow for access/transport of hot
materials.
(e) The Lodge Room must have the capability to be completely darkened.
(f) The location of the Sweat Lodge should ensure privacy and be away from other
buildings.
(g) Planning should consider process of changing, storing of personal articles and
movement (once changed) to Sweat Lodge.
(h) Inclusion of shower facilities is not required but may be considered with rationale
in the Functional Program.

Functional Program to provide description of function, room requirements,


establish space based on number of persons in the room / space.
(a) The Medicine Wheel is an ancient Aboriginal symbol represented as a circle
bisected by two perpendicular lines that cross at the centre point and
terminate at the outer edge. These lines yield four spokes at right angles to
each other that demarcate four quadrants within the circle. It is not
anticipated that incorporating the Medicine Wheel symbolism in the project
will have dedicated room or space requirements, although the symbol may
inform the concept of the facility.

Functional Program to provide description of function, room requirements. Room


or space is typically separate from the Medication Room for Western medicine.
Variety of shelving types required for various container formats including storage
of bags and sacks on floor.
Workstation / table with good lighting for preparation and packaging.
Refrigeration is required; emergency power for refrigeration to be considered.
Finely calibrated / accurate humidity and temperature controls required.
Secure access required.
A work sink may be required.
A hand hygiene sink should be considered either in the room or outside of the
room.

(a)
(b)
(c)
(d)
(e)
(f)
(g)

34

Appendix B3 - CULTURAL SPACES


Room Name/Item

Net
Area
(SF)

Requirements and Recommendations


Other Spaces

Meditative Space

(a)
Therapeutic Garden

(a)
(b)
(c)
(d)

Functional Program to provide description of function, room requirements, and


establish space based on number of persons and characteristics/needs in the
space.
Space may be required for multi-purpose functions such as a calming/stabilizing
room for mental health or distressed clients/patients/visitors; a quiet room for
chronic pain management/yoga, stretching.
Ensure room contains building controls for flexibility: dimmable lighting;
temperature control; ventilation.
Functional Program to provide description of function and requirements that
demonstrates need for garden activities to directly support a primary health care
program.
Functional Program to explore possible community partnerships for either access
to off-site gardens, or funding of garden as part of the HCF.
Aboriginal-related facilities may incorporate a garden for growing of traditional
healing plants and herbs as demonstrated in the Functional Program.
Storage and cleaning to be provided for garden tools and materials. A handwash sink must be provided for cleaning of soiled hands.
Exterior landscaping area and any exterior or 'accessory' building must meet
zoning requirements.
Security provisions for site access must be in place as part of the construction
and operational costs.
Site lighting for security must be incorporated.

Advisory:
(a) Consider indoor growing opportunities (i.e. herb gardens) that can be
incorporated into shared spaces (i.e. kitchen, meeting room).

35

Appendix B4 - HAND HYGIENE REQUIREMENTS


Room Name/Item
Hand Hygiene Sink

Net
Area
(SF)
10

Requirements and Recommendations

Hand hygiene sinks shall be constructed and installed as follows:


(a) Materials:
(i) Materials shall be non-porous, e.g., porcelain, enamel, vitreous china, or 18
gauge (or thicker) stainless steel.
(ii) Granite or marble shall not be used.
(b) Size:
(i) Hand hygiene sink size shall be sufficient to prevent recontamination (from
splashing) during use. Minimum inside dimension should be 350 250 mm and a
minimum depth of 225 mm.
(ii) Cup or bar sinks shall not be used for hand hygiene.
Note: Common requirements for the minimum depth of hand hygiene sinks range
from 190 to 225 mm. The current recommendation is based on the CHICACanada Healthcare Facility Design Position Statement.
(c) Construction:
(i) Hand hygiene sinks shall be shaped to prevent splashing and with a collar
directing runoff into the sink basin.
(ii) Sink shall not be capable of taking a sink plug.
(iii) Sink and spout shall be designed such that splashing and aerosolization is
minimized. The spout shall not direct water directly into drain but should hit the
basin surface in front of the drain.
(iv) Spouts shall be free of aerators\modulators\rose sprays and shall not swivel.
(v)
Strainers and anti-splash fittings at outlets shall not be used. Note: These can
easily become contaminated with bacteria.
(vi) The outside rim shall be of minimal width and have the surface angled down
towards the inside to prevent pooling of water and placement of objects on the
rim.
(vii) Traps shall be metal. Gaskets at the skin/drain connection shall be plastic or
neoprene. Rubber gaskets shall not be used.
(viii) Trap size shall be 40 mm diameter. Note: Trap size relates to drainage time and
water flow time.
(ix)
Overflows shall not be used. Note: Overflows are difficult to clean and become
contaminated very quickly, serving as reservoirs of bacteria.
(x)
Adequate flow rate shall be provided to ensure the removal of soap residue. Note:
The effectiveness of rinsing is a function of the flow rate, the pressure, and time.
(d) Location:
(i) Sinks shall be wall-mounted and at least 1 m away from any fixed work surface or
separated by a splash barrier. Sinks shall not be inserted into or immediately
adjacent to a counter.
(ii) Hand hygiene sinks shall be installed at least 865 mm above the floor and shall
not have storage underneath (due to proximity to sanitary sewer connections and
risk of leaks or water damage).
(e) Controls:
(i) Taps and controllers shall be hands free. Electric eye, foot pedal, or faucet blade
controls may be used. Electric eye operation shall be
triggered by hand, not body, placement. A means shall be provided to control the
temperature.
(ii) Automatic temperature control shall not be used.
(iii) Electric eye technology shall have a backup that allows for operation during power
interruptions and shall have a means for users to adjust water temperature
adjacent to the sink.
(f) Backsplash:
(i)
Adjacent wall surfaces shall be protected from splashes with impermeable
back/side splashes. Backsplashes shall be seam free. All
edges shall be sealed with a waterproof barrier. Backsplashes shall include the
area under the paper towel dispenser and soap dispenser.
(ii)
Backsplashes shall extend a minimum 600 mm above sink level and a minimum
of 250 mm below sink level.
(g) Soap and lotion dispensers:(i) Liquid soap and lotion dispensers shall have hands free
operation and mounted to permit unobstructed access and minimize splashing

36

Appendix B4 - HAND HYGIENE REQUIREMENTS


Room Name/Item

Net
Area
(SF)

Requirements and Recommendations


ordripping onto adjacent wall and floor surfaces.(ii) Liquid dispensers (soap or lotion)
shall use non-refillable bottles and shall be placed to prevent splash-up contamination.

Hand Drying

Accessible Sinks

Waterless hand hygiene


station
(alcohol based or other
waterless hand hygiene
dispenser)

N/A

(a) Single-use paper towels shall be provided. Cloth drying towels shall not be used. Note:
Paper hand-towels dry hands rapidly and dispensers can be used by several people at
once. They are considered to be the lowest risk of cross-infection and are the preferred
option in clinical practice areas. The World Health Organization recommends drying
hands with single-use paper towels and does not recommend electric air dryers due to
length of time to dry and risk of aerosolization.
(b) Towel dispensers shall be mounted to permit unobstructed access and minimize
splashing or dripping onto adjacent wall and floor surfaces.
(c) Towel dispenser design shall be such that towels are dispensed singly. They shall either
be hands-free or designed so that only the towel is touched during removal of towel for
use.
(d) Hot-air dryers shall not be used for hand hygiene sinks.
(e) Paper waste receptacles shall be a corrosion free material and wide mouth design.
(f) Space shall be allowed for the placement of waste bins in close proximity to the hand
hygiene sink.
(g) To avoid recontamination of the hands, paper towels should be available to use on the
exit door hardware and a trash container for used towels should be located near the exit
door.
(h) Bins, with a waste bag, shall be provided in close proximity to each hand hygiene sink. If
bins are lidded the bin shall be foot-pedal operated.
(a) Hand hygiene sinks shall be located at a level where they can be used by people in
wheelchairs and shall be available as per HCF requirements and as per the Ontario
Building Code. These are in addition to hand hygiene sinks used by staff.
(b) Hand hygiene sinks should be in accordance with ASME A112.19.2/CSA B45.1.
Wheelchair accessible sinks should be wall mounted, made of vitreous china, 510 mm
long by 685 mm wide, slab type provided with combination centre set faucets,
gooseneck spout, open drain with perforated strainer, and 32 mm cast brass adjustable
P-trap with tailpiece.
Hand hygiene stations shall be installed at the point of care to improve adherence to
infection prevention and control principles.
Advisory:
(a) Stations should be installed outside treatment rooms at the entrance.
(b) Numbers of stations should be reviewed with the local Fire Department official and/or
Chief Building Inspector.

Definitions
FTE
ICP
ICRA
IPAC
OTN
PPE
HHS
HWS

Full Time Equivalent


Infection Control Professional
Infection Control Risk Assessment
Infection Prevention and Control
Ontario Telemedicine Network
Personal Protective Equipment
Hand Hygiene Sink
Hand Wash Sink

37

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Catalogue # CIB-XXXXXXX Month/Year Queens Printer for Ontario