Académique Documents
Professionnel Documents
Culture Documents
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
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
4.0
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
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:
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.
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.
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.
The MOHLTC-LHIN Joint Review Framework for Early Capital Planning Stages
Toolkit, November 9, 2010 (MOHLTC-LHIN Toolkit)
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
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).
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)
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.
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).
Clinical and group rooms through analysis of activity, workload and utilization;
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
Scooter/Stroller Parking
Clinical Area
Administration Spaces
Examination Rooms
Interview/Counselling Room(s)
Housekeeping Room
Mechanical Room
Storage
10
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.
11
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.
13
ii)
14
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)
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).
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
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.
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
Facility Name:
Funding Status
(use drop down options)
Stage of Project:
(usedrop down options)
Date submitted:
Completed by:
Historic
Current
Current year
previous full
(adjust for full
year visit history
year)
Select
Select
Projected
Variance
Variance
Opening year
Opening Year
minus Current
Year
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
Confirmed
funding for
incremental
FTEs
Adding FTEs
within existing
budget
Program
Transfer
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
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
Variance
Increased
Funding for
more FTE
Opening year
Program
Transfer
Adding FTEs
within existing
budget
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
19
Net
Area
(SF)
120
20
Net
Area
(SF)
140
10
120
Examination Isolation
Room (Airborne
Precaution Room or
"APR")
examination room
ante room
prep alcove
120
55
22
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.
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.
21
Net
Area
(SF)
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
Diagnostics Area
(such as bloodwork, EKG,
specimen collection)
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.
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
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
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
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.
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
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.
23
Net
Area
(SF)
50
(a)
(b)
(c)
(d)
(e)
(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
Net
Area
(SF)
120min
(if
room)
can be an enclosed
room or alcove with
double doors
130
medium
150
25
Housekeeping /
Janitorial Closet or
Room
Net
Area
(SF)
26
Net
Area
(SF)
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
27
Net
Area
(SF)
Waiting Area
general seating
15
per seat
wheelchair/scooter/ba
riatric
30
per chair
20per
seat
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
15
per child
(a)
(b)
(c)
up to 20
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.
(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
Net
Area
(SF)
Administrative Offices
type 0: workstation
(administrative
assistants)
15 SF / person +
50SF for kitchenette
space
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.
1.5 ea
half locker
4.5 ea
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
Net
Area
(SF)
75
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
150
(b) Include a minimum 1500mm (5'-0") linear cabinet along one wall for equipment and
material storage and display.
375
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
30
Net
Area
(SF)
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.
Demonstration Kitchen
Single Group
Demonstration (8 - 10
people)
up to 250
Multi-Group / Larger
Demonstration (11 20 people)
up to 400
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.
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.
31
Net
Area
(SF)
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.
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.
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.
up to 120
50
(As required) Ensure adequate ventilation / cooling and acoustic control to adjacent
rooms.
up to
15 SF
per FTE
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.
32
Net
Area
(SF)
150
15
per
vehicle
Baby Carriage/Stroller
Storage
25
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
33
Net
Area
(SF)
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
(a)
(b)
(c)
(d)
(e)
(f)
(g)
34
Net
Area
(SF)
Meditative Space
(a)
Therapeutic Garden
(a)
(b)
(c)
(d)
Advisory:
(a) Consider indoor growing opportunities (i.e. herb gardens) that can be
incorporated into shared spaces (i.e. kitchen, meeting room).
35
Net
Area
(SF)
10
36
Net
Area
(SF)
Hand Drying
Accessible Sinks
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
37