CMS SOM App. W, Tag C-0912

The CAH is constructed, arranged, and maintained to ensure access to and safety of

patients, and provides adequate space for the provision of services.

Interpretive Guidelines §485.623(a)

The CAH’s physical facilities must be constructed, designed and maintained such that

patients are always accessible and the safety of patients is assured. The CAH’s

construction must be in accordance with applicable Federal, State and local law, as

determined by the authorities having jurisdiction to enforce such law.

The CAH’s physical plant must provide sufficient space to support those services the

CAH provides on-site. There must also be adequate space to support all additional

services the CAH offers.

Survey Procedures §485.623(a)

• Verify through observation that the physical facilities are large enough for the scope

of services the CAH is required to provide on-site, as well as any additional services

it offers on-site or at a provider-based, off-site location. The adequacy of the space

depends on both the nature of the services provided and the number of patients to

whom the CAH typically provides those services.

• Verify through observation that the CAH’s building(s) is/are maintained in a manner

to ensure the safety and well being of patients (e.g., condition of ceilings, walls, and

floors, presence of patient hazards, etc.).

• Verify through observation that the design of the CAH assures that staff can reach

patients readily.