Pediatric Primary Care Specifications
To identify the physical office space requirements necessary to open a pediatric primary care clinic in California, specifically in the Oakland, San Francisco, San Mateo, and Berkeley areas for purposes of planning to open a pediatric primary care clinic in these cities.
Preliminary research shows that the state of California governs the architectural, plumbing, and mechanical specifications for primary care clinics, with no special requirements for Oakland, San Francisco, San Mateo, or Berkeley. In addition, there do not appear to be any special requirements for pediatric primary care facilities, but only for pediatric community hospitals. It is possible that the recent conversation that brought up these concerns was referring to the requirements for pediatric community hospitals and not primary care clinics.
PRIMARY CARE CLINICS
- The Health Facility Checklist Section 1226.6 covers the requirements of primary care clinics in California.
- Primary care clinics in California are defined as health facilities that are licensed under Section 1200 of the California Health & Safety code.
- Section 1200 of the California Health & Safety code states that a clinic is "an organized outpatient health facility that provides direct medical, surgical, dental, optometric, or podiatric advice, services, or treatment to patients who remain less than 24 hours, and that may also provide diagnostic or therapeutic services to patients in the home as an incident to care provided at the clinic facility."
- There is nothing in the California Health & Safety code that refers specifically to pediatric clinics of any kind.
- In the Health Facility Checklist Section 1226.6, there is only one reference that applies specifically to pediatric facilities, which is section 118.104.22.168.2 that states for architectural requirements, "At least one private consultation/treatment room shall be provided when pediatric patients are treated," but this is only for dental clinics or clinics that offer dental services.
- The remaining architectural, plumbing, and mechanical requirements for primary care clinics in California include:
- A minimum of 80 square feet of "clear floor area exclusive of fixed or wall-mounted cabinets, built-in shelves; Alcoves with a dimension of less than 8’, anterooms or vestibules."
- A "handwashing fixture located in the exam room [that is] convenient for use by staff entering and leaving the room."
- "Patient toilet rooms Shall be provided separate from public use and be located for access from patient care areas without passing through public accessible areas, or may serve outpatient waiting rooms in clinics with a maximum of three exam &/or treatment rooms."
- "Each toilet room shall include a fully accessible water closet, a fully accessible lavatory, 7-foot minimum height ceiling, and 5-inch minimum coved base for resilient floors."
- There are many other requirements as well that cover:
PEDIATRIC COMMUNITY HOSPITALS
- Pediatric Community Hospitals in California have different requirements from primary care clinics, which include the following:
- "Furniture size, including beds, decor, waiting area activities, and reading materials shall be developmentally and age appropriate for the infants, children, and adolescents being served."
- "The patient room arrangements shall have the capability to provide isolation and separation by age and/or sex."
- "Provisions shall be made for monitoring pediatric patients based on patient acuity, age, medical requirements, and security issues."
- "Facilities shall be available which minimize the spread of infection."
- "The play area... should be large enough to accommodate both ambulatory patients and those in beds and wheelchairs. Adolescents should have a separately designated area. Play materials should be sturdy, safe, and washable. Items appropriate for children of all ages served should be included. For those patients unable to come to the play room, there shall be developmentally appropriate toys available to be brought to the bedside."
- "There shall be space available within, adjacent to, or in close proximity to the pediatric service/department for a parent waiting room, confidential professional/family discussions, and team conferences, case presentations, and other staff meetings."
- "There shall be standardized and calibrated equipment to provide anthropometric measurements appropriate for age and physical condition."
- "An emergency cart containing age appropriate equipment, medication, and supplies needed to assure the effective resuscitation of patients regardless of age or body size shall be available within the pediatric service/department."
- "Clinical laboratory services... shall be available on a 24-hour basis."
- "Diagnostic imaging procedures and the consultation services necessary to support the level of care provided shall be available on a 24-hour basis."
- "There shall be immediate access to appropriately staffed operating rooms."
Proposed next steps:
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As the initial research found that there does not appear to be a distinction between the architecture, plumbing, and mechanical specifications for adult primary care facilities and pediatric primary care facilities, we suggest continuing research into the steps involved in opening a pediatric primary care facility in California.