by Glenn Gall, AIA, AAH
Senate Bill 1228 (Chapter 671, Statutes of 2012) added a new subcategory of skilled nursing facilities in California, the small house skilled nursing facility (SHSNF). See Health and Safety Code (HSC) section 1250(c)(2).
That same legislation added Article 7.2 to the HSC, commencing with section 1323.5, to establish the Small House Skilled Nursing Facilities (SHSNF). Pilot Program The stated purpose of the pilot program is to allow the California Department of Public Health (CDPH or the Department) to authorize the development and operation of up to ten SHSNFs that are licensed to provide skilled nursing care and supportive care to patients in small, homelike, residential settings that incorporate emerging patient-centered health care concepts.
The long-range goal of the pilot program is to evaluate the models developed under the pilot program to determine if each model improves patient satisfaction and clinical outcomes in a cost-effective manner.
On 12/29/17 California Department of Public Health issued the finalized standards and requirements for participation in the pilot with the issuance of two All Facilities Letters (AFLs);
| AFL-17-29 | All Health Care Facilities | Small House Skilled Nursing Facilities Pilot Program: Application Procedures and Request for Applications (RFA) |
12/29/2017 |
| AFL-17-30 | All Health Care Facilities | Small House Skilled Nursing Facilities Pilot Program: Standards |
12/29/2017 |
Compliance with State Building Regulations
Applicable building standards for these facilities were adopted into the California Building Standards Code (CBSC) previously, well in advance the pilot announcement and based on the CBC 1225.5.2 HOUSEHOLD MODEL standards.
OSHPD regulations for these SHSNF are based on California Building Standards Code, Title 24 Skilled Nursing Facility (OSHPD 2) requirements, specifically; 2016 CBC Section
1225.1 Scope. The provisions of this section shall apply to skilled nursing and intermediate-care facilities, including distinct part skilled nursing and intermediate-care services on a general acute-care or acute psychiatric hospital license, provided either is in a separate unit or a freestanding building. Skilled nursing facilities and intermediate-care facilities shall provide all common elements and support services. The required services for skilled nursing and intermediate-care facility licensure: dietary, pharmacy services, and activity program shall be provided. At the option of the provider, the medical model or the household model may be used.
1225.1.1 Small house skilled nursing facilities. Skilled nursing facilities participating in the Small House Nursing Facilities Pilot Program established by and in conformance with Section 1323.5 of the California Health and Safety Code, shall meet all the provisions of Section 1225.4 Common Elements and Section 1225.5.2 Household Model applicable to small house skilled nursing facilities.
1225.2 Application. New buildings and additions, alterations or repairs to existing buildings subject to licensure shall comply with applicable provisions of the California Electrical Code, California Mechanical Code, California Plumbing Code, California Fire Code (Parts 3, 4, 5 and 9 of Title 24), and this section.
It is important to understand that these standards in conjunction with the pilot program allow for a wide variety of designs and contexts for SHSNF proposals. As stipulated in the Pilot Program standards;
(a) Each pilot facility may include one or more homes.
(b) The physical layout of pilot facilities should be innovative and non-traditional, provided that all applicable codes are followed. The design may include, for example, any of the following types of homes:
(1) freestanding houses or cottages arranged in a group or cluster that meets the standard for “neighborhoods” in the CBSC (CCR Title 24, Part 2) section 1225.5.2.2;
(2) multiple apartments in a larger structure;
(3) more than one home within a larger structure;
(4) whole or partial floors in a multi-story structure;
(5) a distinct area within, or attached to, an existing SNF provided that the home:
(A) otherwise meets the definition of a SHSNF,
(B) is physically separate and distinguishable from the remainder of the SNF, and
(C) has a distinct entry with no through traffic of staff, residents, or visitors who are not affiliated with the SHSNF;
(6) a DP SHSNF of a GACH or an APH, provided that the home:
(A) otherwise meets the definition of a SHSNF,
(B) is physically separate and distinguishable from the acute care facility, and
(C) has a distinct entry with no through traffic of staff, residents, or visitors who are not affiliated with the SHSNF; and
(7) one or more homes integrated into a CCRC.
Further information on this program can be found at;
Small House SNF Pilot Program: Application Procedures & Request for Applications
Small House SNF Pilot Program: Application Evaluation Criteria
Statement of Understanding and Agreement to Participate in the Small House SNF Pilot Program