Va Form 10-0388-3 - State Home Construction Grant Program Space Program Analysis - Nursing Home & Domiciliary Page 2

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TOTAL VA
TOTAL VA
PROPOSED BY
PROPOSED BY
PROPOSED BY
VA CRITERIA
VA CRITERIA
1. SUPPORT FACILITIES (Continued)
ALLOWED
ALLOWED
STATE
STATE
STATE
BARBER AND / OR BEAUTY
140
MAIL ROOM
120
JANITORS CLOSET
40
15/BED
MULTIPURPOSE ROOM
6/EMPLOYMENT
EMPLOYEE LOCKERS # EMPL.
LOUNGE
120
TOILETS
25/FIXTURE
CHAPEL
450
PHYSICAL THERAPY
5/BED
OFFICE, IF REQUIRED
120
OCCUPATIONAL THERAPY
5/BED
OFFICE, IF REQUIRED
120
LIBRARY
1.5/BED
BUILDING MAINTENANCE STORAGE
2.5/BED
RESIDENT STORAGE
6/BED
(medical, dietary)
GENERAL WAREHOUSE STORAGE
6/BED
GENERAL LAUNDRY
AR
AS REQUIRED
AR
SUPPORT FACILITIES SUB-TOTAL; (No "As Required" Areas)
AS REQUIRED
AS REQUIRED AREAS:
AR
AR
2. BED UNITS
ONE #
ROOMS X
150
@
=
TWO #
=
245
ROOMS X
@
LARGE 2 #
ROOMS X
@
305
= (2 Unit Max)
THREE #
370
ROOMS X
=
@
ROOMS X
FOUR #
=
460
@
LOUNGE AREAS:
RESIDENT LOUNGE W /STORA GE
8/BED
RESIDENT QUIET ROOM
3/BED
CLEAN UTILITY
120
SOILED UTILITY
105
LINEN STORAGE
150
100
GENERAL STORA GE
260
NURSES STATION, WARD SECRETARY
75
MEDICATION ROOM
EXAMINATION / TREATMENT ROOM
140
WAITING AREA
50
UNIT SUPPLY AND EQUIPMENT
50
STAFF TOILET
25 /FIXTURE
STRETCHER / WHEELCHAIR STORAGE
100
KITCHENETTE
120
10-0388-3
VA FORM
Page 2 of 4
MAR 2005

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