Judy P. Rosenstreich, Senior Policy Advisor

September 7, 2012 Department of Mental Health Redstone 26 Terrace Street Montpelier, VT 05609-1101 Attention: Judy P. Rosenstreich, Senior Policy Advisor Regarding: Guidelines Conformance Assessment Final Report September 2012 Morrisville Interim Behavioral Hospital Dear Ms. Rosenstreich, GMI is pleased to provide our professional services to review the proposed renovation plans for the facility noted above for compliance with regulatory requirements and suggestions for behavioral designs. Accessibility Guidelines for Buildings and Facilities (ADAAG) FGI Guidelines for Design and Construction of Health Care Facilities 2010 NFPA 101, Life Safety Code, 2000 edition NFPA 80, Fire Doors and Fire Windows, 1999 edition International Building Code 2006 (IBC) The preliminary evaluation is based on receipt of a Schematic Plan of the First Floor North West Wings at the Morrisville Interim Hospital (MIH) located in Morrisville, Vermont designed by the Architects of Record, Lavallee/Brensinger Architects (LBA) along with the Department of Buildings and General Services. A site visit was held on Thursday, July 26 th with yourself, staff of the Departments of Mental Health and Buildings and General Services for confirmation of existing conditions. The extent of the physical observations for the production of this report has been limited by contract to a walk-around visual inspection of the property. A secondary phase of review has been performed upon receipt of the 95% Construction Document Plan and is duly noted below regarding revisions. Information has been noted preliminary review = (PR) and secondary review = (SR) to further clarify the sequence of information for this Final Report. NFPA 101 Guidelines: Use Group I2 Institutional Type of Construction V(111) equal to International Building Code (IBC) VA Fire Resistance Ratings - Interior Bearing Walls/supporting roof only 1 hour Based on discussions with the General Contractor on the project, the roof loads are bearing on the interior walls between the rooms and corridor walls; therefore these interior walls require a 1 hour rating. NFPA 5000: 7.2.7.2.3 The rating is required for Structural elements (girders, beams, trusses, and spandrels that have direct connections to columns carrying gravity loads, and that are essential to the

stability of the building as a whole, shall have a fire resistance rating no less than that of the columns to which they are connected. Actual doors within the interior bearing walls do not have to carry the 1 hour rating. Frames within the walls would need to carry the 1 hour rating to protect the jambs/headers within the bearing walls. FGI Guidelines: The proposed renovation to the existing facility to temporarily locate an eight (8) bed InPatient Psychaitric unit provides ample square footage for the required program space. Please see GMI recommendations noted below for further review and consideration: 2.5-1.5.2.2 Perimeter Security addresses elopement prevention, prevention of contraband smuggling, visitor access control, and exit process and procedures The proposed design clearly defines the support spaces and patient program areas with the proper levels of security for adherence to the regulation noted above. See GMI recommendation below: 1) Main Entry and support programs are clearly separated from InPatient unit with a Sallyport. 2) Exam Room, Visitor/Consult are located directly off the Sallyport 3) Egress from the exterior secured courtyard has provided proper secured egress gates within the enclosure a) Walkway against building will have a roof enclosure to prevent elopement b) Design to encapsulate wood roof frame within the existing exterior pavilion will limit the potential for elopement c) GMI recommendation: regarding the exterior courtyard enclosure: Existing tree to be located outside the perimeter of the exterior courtyard Existing tree limbs to be trimmed to avoid hanging over the fence PR = Roof enclosure to extend from existing pavilion room to the exterior courtyard fence along length where the existing tree is located to prevent elopement SR = Upon further review of conditions and in discussion with the design/construction team, it has been determined if a patient could gain access to climb upon the pavilion roof, this extended roof enclosure could provide a bridge across the opening; therefore, GMI has revised our recommendation to be the following: Typical security fence to be 12 high with a 2 overhang. 2 overhang to be extended vertically along fencing that is adjacent to the existing pavilion and the existing tree effectively increasing the fence to be overall height of 14. GMI notes, FGI regulations #A2.5-2.2.3 Outdoor areas are not required; however, if patient care programs require them to be provided, they should be arranged to prevent confused residents

from wandering outside of designated resident areas. The additional work to enclose and secure the exterior courtyard for patient access is an added benefit for the program and will enhance the environment for the patients. 2.5-2.2.2 Patient Room The existing facility will maintain the locations of the existing walls which accommodates the program spaces for a Patient Bedroom with ample square footages. 1) Single Patient BR =100 sq.ft. / Double Patient BR = 160 sq.ft. Actual Patient BR within the Morrisville unit will range from 228 to 264 sq.ft. 2) Diagram location of beds to be rotated 90 degree to avoid barricading within the rooms by patients if beds are to be secured to the floors. 3) Diagram location for the patient wardrobe units show doors. PR = Confirm there will be no doors on the wardrobes within the patient bedrooms SR = Design to have no doors on Patient wardrobe units with sloped tops 2.5-2.2.4.3 Seclusion treatment room 2.1-2.4.3.4 Layout Seclusion treatment rooms shall be accessed by an anteroom that also provides access to a toilet room. The door openings to the anteroom and the toilet room shall have a minimum clear width of 3-8 1) Design currently does not provide for a door for the Seclusion Room Toilet 2) GMI recommends: a) PR the 3-8 door along the corridor into the Anteroom can swing into the anteroom removing the alcove within the corridor SR Upon further review with design/construction team, GMI agrees the alcove is directly visible from the Nurse Station & can be maintained. Anteroom door shall swing out for staff control and reduce potential problem for a staff to be pushed against the door by a patient within the Ante Room. b) PR the Seclusion Toilet Room shall have a 3-8 door swinging out into the anteroom area SR A 3-8 door has been added to the Seclusion Toilet swinging out SR Furthermore, the Seclusion Room minimum square footage shall be 80 sq.ft. for rooms which use a restraint bed 60 sq.ft. minimum for no restraint bed. Current approved plan is 83 sq.ft. A ¼ Round Ceiling Safety Mirror will be mounted in the ceiling of the room to provide full visibility to the interior of the Seclusion Room by staff from the Ante Room. 2.5-2.2.6.2 Documentation area A separate chart area with provisions for acoustical and patient file privacy shall be provided 1) Please see 2.5.2.2.7.2 GMI recommendations for this program space 2.5-2.2.6.13 Consultation room (1) One for each 12 psychiatric beds (2) The Visitor Room may serve as a consultation room 1) PR GMI recommends: adding the title Consult to this room to comply with the required program space SR The Visitor Room will be titled Visitor/Consult Room

2) Current design also notes Consult Room in front of the Medical Director which can be used for the Medical Director as their designated Consult Room; however, would not comply with the psych units Consult Room 2.5-2.2.7.2 Staff toilet room The proposed design provides for two (2) Staff Toilets behind the Nurse Station. 1) GMI recommends providing one (1) UniSex Toilet for staff 2) PR = The area behind the Nurse Station should be re-evaluated for the design with the removal of the one (1) Staff Toilet as there is a need to establish a Documentation area noted above. SR = GMI has submitted a revised layout for the Nurse Station core area. The following revisions to the layout have been incorporated into the plan: A) PR A separate and enclosed Chart/Documentation GMI Preliminary Review area has been created with direct visibility down the patient circulation SR In working with the User Group and design team, the preference is to have two (2) staff at the Nurse Station and two (2) staff in the Chart/Documentation area. GMI s Preliminary Review plan does not reflect this layout as noted in SR above. Final design to incorporate layout as noted. B) PR Unit Entry door has been located within the enclosed Chart/Documentation Room for added security to this entry door SR Unit Entry door swing will be revised to swing out of the Chart/Documentation Room C) Nurse Station has been stepped out into the corridor with the 6-0 required clearance maintained to the adjacent corner for increased visibility D) PR Two work counters could be located within the open Nurse Station if additional documentation areas are required E) PR Storage has been relocated to be directly accessible from the Med Room SR Storage is not required for Med Room. Area included within the Work Area F) PR A separate enclosed Work Area has been created for staff near the Staff Toilet SR With the relocation of the Med Room entry door, the Work Area can have either a work countertop or open shelves G) PR Door to Laundry Room has been relocated to the adjacent wall with an out-swing. A new vision panel is proposed for the wall facing the Nurse Station for monitoring of the space

SR Door could be maintained across from Nurse Station if it has a half safety glass vision panel. Wall cannot be angled as shown on sketch due to structural requirements within the building. 2.5-2.2.8.3 Patient laundry facilities Regulations require an area for patient laundry with an automatic washer and dryer be provided. 1) Location of the patient laundry room should provide visibility and control by staff to use the equipment. 2) Design currently has the patient laundry behind a Soiled Holding Room. 3) PR GMI recommends mirroring these two rooms with the laundry room and adding a vision panel into the laundry room for visibility from the Nurse Station SR The patient laundry room has now been relocated to have direct visibility for staff into the space. See proposed layout under 2.5-2.2.7.2 2.5-7.2.23(1.a) Windows All glazing (both interior and exterior), borrowed lights, and glass mirrors shall be fabricated with laminated safety glass or protected by polycarbonate, laminate, or safety screens. 1) Proposed renovations are for a temporary location. Current design is for steel security screens to be installed at windows within Patient use areas. a) PR GMI recommendation: installing laminated safety glass or 3/8 tempered glass provides clear visibility to the exterior for patients assisting in creating a more nurturing environment within the units. Due to the temporary nature of the renovations, lexan can be installed versus the steel security screens. SR The interior storm windows shall be constructed with a 3/8 polycarbonate safety glass b) PR Design of the interior storm windows with lexan should provide a horizontal and vertical intermediate mullion for added strength to the lexan material. SR Interior storm window design to be constructed providing sufficient impact strength per the selection and thickness of the glazing material used (lexan versus polycarbonate). True vertical and horizontal mullions, if required by manufacturer s calculations, shall be used. c) PR Frame for the interior window can be mounted to the face of the existing window and on top of the existing sill with eased edges to avoid any sharp corners. Tops of frame should be sloped if applied off the wall. SR Interior windows will be reviewed to be applied on the inside of the existing window frames thereby reducing the need for the sloped top. Contractor to confirm the existing conditions and depth available. If any portion of the aluminum gauge frame is not flush to the adjacent wall, all corners and edges of the aluminum frame will be eased edges to reduce the exposed corners and sharpness of the aluminum. 2) Window treatment cannot be installed behind the interior storm windows if they are fixed units; therefore, GMI recommends

a) PR GMI recommendations: applying a frosted film on the inside face of the lexan would provide a privacy for patients and still allow view to the exterior in the upper portion of window. SR frosted film will be applied to the inside face of the interior windows b) Rooms to have the interior storms are within all Patient use areas: o Patient Bedrooms o Living Room & Social Spaces o Quiet / Sensory Room o Dining Room o Group / Activity Room o Visitor & Consult Rooms Potential Facility Enhancements: Patient Bedroom Doors: Existing patient bedroom doors are 42 within in knock-down hollow metal frames. GMI recommends the following for this condition: 1) Size of door provides a potential danger for staff/patients in leverage of slamming/closing firmly a) Maintain existing frame and add an interior hollow metal frame to reduce the overall width down to a 36 door opening. The side light can be infilled with different materials (ie: laminated panel or dbl layered hi-impact panels 2) PR If the entire hollow metal door frame is decided to be removed, GMI recommends welded frames for a 36 door SR the project will incorporate removal of the existing patient bedroom doors and replacement with a 36 door within a welded hollow metal frame. Patient Use Door Hardware: Existing door latch and hinges are being replaced as part of the proposed renovation. 1) Please see the attached data sheet on a Behavioral Health door hardware for your consideration providing the most up to date protection for anti-ligature and safety. Behavioral Health Carpet Options: Recognizing the importance of providing aesthetically pleasing and acoustical properties within psychiatric In-Patient Units, carpeting has been used within some patient areas; however, maintenance is often a problem. GMI recommends a product which we have used within facilities which provides excellent sound attenuation qualities of carpet yet performs like a vinyl floor with a highly effective microbial treatment protection. Please see the attached spec data sheet for information

on the product, Flowtex. Hard samples are being sent to Michael Kuhn s attention for consideration within your facilities. Medicine Prep Room: Due to the nature of controlled and secured environments for disbursement of medications, the Med Room has been designed to have a corridor disbursement window. As additional security for the staff, this disbursement window has been designed with the following features: 1) PR An 8 deep counter 42 above finish floor (aff) is at the corridor for patients SR Upon further review with User Group, the depth of the counter along the corridor for patients will be set at 20 to restrict the reach of the patients into the Med Room through the window. 2) PR A 17 deep counter 36 aff is located within the Med Room for staff SR Further coordination with the comment noted above in 1), the depth of the countertop located within the Med Room for the staff will be set at 6-8 and per the manufacturer s requirements for the sliding glass window unit hardware. 3) PR The solid core half door swings to 90 degree against the adjacent wall and is required to be smoke tight 4) PR An additional secured piece of lexan with a pass thru for disbursement will be installed on the outer face of the hollow metal frame and secured a) this is for added protection of the staff within the Med Room from the potential of patient abuse

SR Per recommendations from the Architect of Record, Lavallee/Brensinger, and review of product literature regarding an Automatic Closing Single Sliding Window, GMI agrees this option will provide better communication between staff and patient while providing security options for closure when needed. The sliding window unit will have safety glazing similar to clear tempered glazing or polycarbonate. The sliding window will also comply with the smoke tight requirements to maintain the smoke partition along the corridor wall. The Architect of Record will confirm the following: 1) Review the proper amount of force for the automatic closure to be confirmed by Architect of Record 2) Options for sizes of openings to be reviewed with the staff of the Department of Mental Health along with the Department of Buildings and General Services GMI recommendation: provide blocking above sliding window for interior window blinds for privacy when the Med Room is not in use. InPatient Reading Light Option: Attached please find a Spec Data Sheet regarding an option for a reading light within the Patient Bedroom. This fixture could be installed above the desks and controlled by the patients. As there is an additional layer of Hi-Impact gypsum board being applied to the existing walls, this will allow the installer the opportunity to recess the light base to ensure there is no potential for any ligature. If this fixture is not recessed into the gypsum board, there is a small area between the light and base which could be a potential ligature issue; therefore, GMI always recommends recessing the fixture base within the walls. This report has focused on areas of the proposed design at the Morrisville Interim Psychiatric Hospital with regards to regulatory requirements (noted in bold) and Potential Facility Enhancements to help assure the unit maintains a safe and therapeutic environment for the program.

It has been a pleasure working with the staff of the Department of Mental Health as well as the Department of Buildings and General Services and the design/construction team. I have been pleased with the cooperative and collaborative process to review and finalize the design for the Morrisville Interim Behavioral Hospital. If you should have any further questions, please do not hesitate to contact me at any time. Sincerely, Linda Tetreault, Senior Project Manager GMI Architects Cc: Patrick Flood, Commissioner Mary Moulton, Deputy Commissioner Frank Reed, Director of Mental Health Services Michael Kuhn, Dept of Buildings & General Services