Section 150.029 - Physical Environment for Dementia Special Care Units(A)General Requirements.(1) A home-like environment is encouraged for design of DSCU. The design and environment of a unit shall assist residents in their activities of daily living, enhance their quality of life, reduce tension, agitation and problem behaviors, and promote their safety.(2) The DSCU must encompass the entirety of a nursing care unit, as defined by 105 CMR 150.020: Skilled Nursing Care Facility (Level II) and Supportive Nursing Care Facility (Level III) and 150.310: Required Supporting Elements - Nursing Care Units.(3) A DSCU shall meet the requirements listed in 105 CMR 150.029(B) through (K) in addition to the requirements set forth in 105 CMR 150.017.(B)Access. The design of the DSCU shall not require visitors or staff to pass through the unit to reach other areas of the facility.(C)Outdoor Recreation Space.(1) A DSCU shall have secured outdoor space and walkways allowing residents to ambulate, with or without assistive devices such as wheelchairs or walkers, but that prevent undetected egress.(2) Such outdoor space and walkways shall be wheelchair accessible.(3) Residents shall have access to the secured outdoor space and walkways during reasonable times with supervision appropriate to each resident.(4) Outdoor recreation space shall have fencing or barriers that prevent injury and elopement.(D)Lighting.(1) The DSCU shall provide adequate and evenly distributed lighting that minimizes glare and shadows and is designed to meet the specific needs of the residents.(2) Artificial lighting shall meet the lighting requirements of the Guidelines for Design and Construction of Residential Health, Care and Support Facilities from the Facility Guidelines Institute.(E)Finishes. (1) Finishes shall include high visual contrasts between floors and walls and between doorways and walls in resident use areas. Except for fire exits, door and access ways not in resident use areas may be designed to minimize contrast to obscure or conceal areas the residents should not enter.(2) Floors, walls and ceilings shall be non-reflective to minimize glare.(3) Flooring shall not include contrasted visual patterns.(F)Resident Centered Environment. The DSCU shall promote a resident centered environment that includes the following: (1) Freedom of movement within the DSCU for the residents including to common areas and to their personal spaces, including bedrooms, at all times;(2) Assistive equipment that maximizes the independence of individual residents;(3) Comfortable seating in the common use areas;(4) Bedroom decoration and furnishings that include residents' personal items based on the resident's needs, preferences and appropriateness;(5) In addition to the requirement of 105 CMR 150.015(F)(3), individual identification of each resident's bedroom based on the resident's cognitive level to assist residents in locating their bedrooms, and to permit them to differentiate their bedroom from the bedrooms of other residents; and(6) Corridors and passageways through common-use areas kept free of objects that may cause falls, or obstruct passage by physically impaired individuals.(G)Noise Control. (1) The DSCU shall have acoustical ceilings in corridors, dining areas and activity areas to reduce noise levels.(2) No overhead paging system shall be used in the DSCU except in the case of an emergency.(3) The sound signal for the nurses call system shall be adjustable so as to minimize disruption of residents and resident activities.(H)Egress Control.(1) The facility shall develop policies and procedures to ensure the safety of residents who may wander. The procedures shall include actions to be taken to prevent elopement and actions in case a resident elopes.(2) Locking devices shall be used on exit doors, as approved by the local building inspector and fire department having jurisdiction over the facility. The locking devices shall be electronic and release when the following occurs:(a) activation of the fire alarm or sprinkler system;(b) loss of electrical power; or(c) use of a keypad located at each locked door for routine staff access. The electronic locking devices shall be connected to the emergency power circuits.(3) If the DSCU uses keypads to lock and unlock exits, then directions for their operation shall be posted on the outside of the door to allow individuals access to the unit. However, if the DSCU is the entire nursing home, then directions for the operation of the locks need not be posted on the outside of the door. The DSCUs shall not have entrance and exit doors that are closed with non-electronic keyed locks, nor shall a door with a keyed lock be placed between a resident and the exit.(I)Safety.(1) Windows shall be operable and equipped with secure locks under the control of the DSCU staff.(2) In conjunction with locked windows, the DSCU shall be equipped with a cooling system capable of maintaining a maximum temperature of 75°F throughout resident areas at all times at summer design temperatures. Temperatures must be maintained at a level that ensures the comfort and health of residents.(J)Common Space. A multipurpose room or rooms for dining, group and individual activities, and family visits comply with the following licensure requirements for common space shall be included in the DSCU. The floor areas of this multipurpose room or rooms shall accommodate the licensure requirements of at least ten square feet per bed for dining per 105 CMR 150.570: Central Dining, at least eight square feet per bed for group activities per 105 CMR 150.510: General and Special Activity Areas and at least nine square feet per bed for day room per 105 CMR 150.360: Activity Area - Nursing Care Units, for a total of at least 27-square feet per bed.(K)Implementation. A facility may request additional time to implement physical plant modifications necessary to meet the requirements of 105 CMR 150.029 pursuant to Department guidelines.Amended by Mass Register Issue 1276, eff. 12/19/2014.Amended by Mass Register Issue 1361, eff. 3/23/2018.