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Montgomery Meadows Residential Health Care Facility
2002 Feasibility Study: Physical Plant

Physical Plant:

(A review of the existing physical plant and the repairs, improvements, renovations, additions, and/or replacements that may be required.)

    1. Maintenance and/or replacements necessary to maintain the status quo, including associated costs:

Replace roof

    • Lyle received an estimate of $250,000 for the main section of the building (does not include the wings)
    • Tremco�s 5 May 1998 estimate for entire building was $400,000.00
    • Roof replacement should incorporate renovation changes

Replace or update phone, speaker, and paging system

    • Use pagers instead of speaker system so as not to disturb residents and prevent possible privacy issues (quality of life issue)
    • Have classical music on speaker system
    • Have voice mail
    • Have combination of phone pagers to allow voice communication

Replace old windows with insulated glass windows

Replace nurse call system

    • Some critical parts are no longer available from manufacturer (Dukane)
    • Lyle is trying to obtain used parts as a stop-gap measure
    • Replacement cost utilizing existing wiring is approximately $100,000.00
    • Should be done as part of renovation, which would most likely involve new wiring

Replace damaged front sidewalk

Housekeeping Department recommends that all replacement of resilient flooring be seamless

    1. Additions and renovations required for operations and programs, including associated costs:

Adult Day Care

Internal or with connecting corridor

Child Day Care

    • In association with others
    • Independent firm operated on site � Preferred
    • With connecting corridor
    • Opportunities for inter-generational programming

Outdoor smoking room

Outdoor Activities:

    • Safe environment.
    • Resident population formerly spent more time outdoors (more alert)
    • Enclosed courtyard for dementia residents
    • Gardening areas
    • Raised planters for resident access
    • Dining and picnics with covered area
    • Outdoor activities (school concerts, etc.)
    • Areas conducive to rehabilitation sessions
    • Family visiting
    • Change lighting so that it does not shine in bedrooms

Air conditioning for employee areas in lower level and ventilation of storage areas

    • A facility must take care of its staff, to take care of the residents. Staff satisfaction � key to quality of care
    • Smoke from smoking lounge could be smelled in non-smoking areas
    • Renovations to laundry area may supply sufficient air and air conditioning to other areas of the lower level
    • Relocate both laundry and staff lounges to main floor

New lobby and covered entrance

    • Create a welcoming environment for residents and family
    • Have a welcome sign and flower garden at the entrance road
    • Have canopy extend half way into driveway to create a covered area for drop-off and pick-up, and a by-pass lane beyond the canopy
    • Expand the park and garden setting on both sides of the main entrance and include the center of the circle
    • The existing lounge is very nice but should be extended through the adjacent office and men�s locker room
    • The wall between the lounge and the lobby entrance should be removed
    • Vault the ceiling in the lobby
    • Move the vestibule closer to the driveway to enlarge lobby
    • Create an atmosphere of "Light and Life" with indoor planter with skylights beside the new vestibule that is open to the lobby
    • New reception desk that is open to the lobby
    • Find a way to hide the view of the dish room from the lobby and entrance
    • Suggested revision plan was reviewed at the meeting

Solarium or lounge at each nursing station and in the dining room

    • Gathering place for residents and family

Make dining room more attractive

    • Create a solarium on the exterior side of the dining room
    • Install new folding partition where old partition was installed
    • Build in versatility into room scheme (alcoves, smaller areas) to allow multiple uses for space to meet individual programming needs of population
    • Allow for multiple small group activities to enhance individual choice of programs
    • Vault ceiling to incorporate skylights
    • Install mood-lighting (chandeliers and sconces)
    • Suggested revision plan was reviewed at the meeting

Meditation Room

    • Does not need windows
    • Offers privacy to residents and family
    • Meeting place for individual counselors and pastoral care personnel

Meeting rooms

    • Staff
    • Community � open facility doors to community to maintain resident ties with areas of interests
    • Could be in clinic/day care addition
    • If laundry and break rooms are relocated to main floor, convert area to air-conditioned meeting rooms

Primary Medical Practice Clinic/Doctors� offices

    • There does not appear to be any need for independent doctors� offices
    • Check with local providers to see if they are interested in locating a clinic on site

Outpatient physical therapy and pool (CORF)

    • An exercise room should be included for both residents and staff.
    • Travel distance could be a problem � we may require a secondary area for some resident programs

Cafeteria

    • Was closed before � staff must support it, if it is reopened
    • Have a "good" coffee machine for break times
    • Should be adjacent to kitchen
    • Should be adjacent to break room
    • Problem with existing vending machines (run-out, touchy)
    • Increase number of vending machines

Store/gift shop/snack bar

    • Should be located near lobby
    • Should be located near cafeteria
    • Resident access for individual purchase choices and for family use.
    • Create "Community Square" atmosphere, which recognizes residents as consumers

New lock and key system

Dutch doors in resident areas

Resident bathroom changes

    • Offer individual resident access and services where supplies are readily available to staff in service area � resulting in more individual attention to resident needs
    • Increase privacy and efficiency of care
    • Find way of storing bedpans in resident bathrooms
    • New medicine cabinets that residents can reach
    • Have roll-in showers in each room
    • Have lockable cabinet for linen storage

Build at least one new state-of-the-art resident wing

    • Will facilitate renovating of other wings
    • Design all rooms large enough to accommodate sub-acute care � medical gasses could be installed at a later date.
    • Increase size of bedrooms to accommodate higher acuity resident need and equipment
    • Opposite head walls with separate windows for each resident
    • More private rooms
    • Behavior related to dementia
    • Infection control
    • Privacy issues related to mental health needs and coping strategies
    • Individual choice related to lifestyle patterns
    • Privacy for couples
    • Private rooms should have roll-in showers
    • All resident rooms with roll-in showers
    • Some residents may not want a private room
    • All private rooms, with a few double rooms
    • At resident council meeting all residents who responded preferred private rooms.
    • Private rooms with roll-in showers would save staff time and preserve resident dignity
    • Central nurses station and services (like Green Manor)
    • If market study supports 80 adult home beds, build two new SNF wings and convert existing wings to adult home

Have nurses station central to unit with all services in close proximity

    • Enable supervision while maintaining privacy
    • Have visibility to every resident door
    • Have a break and charting room
    • Have head nurse office adjacent to nurses station
    • Ideal layout cannot be achieved with present wing configuration
    • Have larger medication rooms to allow for cart storage
    • Locate solarium adjacent to nurses station
    • Have large storage area for wheelchairs, stretchers, and other equipment
    • Clear nurses station area of staff who can perform job duties in separate but accessible areas
    • Offer supervision without infringing on resident privacy or creating "institutional environment"

Administration/Business Office

    • Enlarge offices by constructing an addition
    • A new Administrator�s Office with meeting area
    • Toilet Room
    • Personnel Office
    • Separate Personnel Office required
    • Locate with business offices
    • Locate at new employee entrance
      • Separate from main entrance which should be reserved for residents, families and visitors
    • Have interconnecting door with Administrator�s Office
    • Offer private area for staff to address personnel issues.
    • Locate at a distance from resident care environment.
    • Business Office
    • Relocate to this office
    • Increase privacy for financial discussions
    • Reception
    • Create a new reception desk in present alcove
      • Greet families and visitors
      • Information center
      • Direct visitors
      • Security purposes
    • Include a way to close up at night
    • Close up both reception windows
    • Mail/copy/storage room
    • Have adjacent to reception room with one-way decorative mirror
    • Maintain secure area for confidentially of resident information.
    • Eliminate staff congestion in front office area

Separate employee entrance with time clock

    • Locate at end of corridor near A-wing
    • Relocate locker rooms to this location
    • Locate as an addition near service entrance (preferred)

Medical Service Offices

    • Have offices adjacent to resident area, but separate from resident living area
    • Offices to include:
      • Medical Director and Physician�s Assistant
      • Director of Nurses
      • Assistant Director of Nurses
      • Medical Records
      • Have adjacent to Medical Director
      • Need approximately 400 Sq. Ft. for record storage and clerk�s desk
      • Conference Room
      • Space for clerk-typist, copy and fax machines
    • Enables clustering of central medical service functions
    • Enhances communication
    • Offers central "spot" for residents
    • A more home-like environment

Other resident service offices

    • Residents need more direct access to these services
    • Should be separate from Medical Service Offices
    • Should be located adjacent or in resident area, but separate from living area.
    • The following offices are independent, but may be located near each other.
    • Social Service � two offices, or three, if Adult home is included in renovation.
    • Patient Agent � relocate from front of building to be closer to residents
    • In-service/restorative nursing
    • Nursing Supervisor
    • Create "home-like" atmosphere

Aviary, fish tanks and fireplaces

    • "Light and Life" theme

Nice employee lounge

    • A happy staff is a large part of "quality of life" for residents
    • Part of cafeteria
    • Should be in an area separate from residents.
    • Should not be in the basement

Decentralize heating system so that a major problem would not necessitate evacuation

    • Retains residents in their "homes"
    • Replace old roof top units with gas fired self-contained HVAC units
    • New or renovated boilers to be dual fuel (oil and gas)

Re-work perimeter hot water heating to have individual controls in each room

    • Have air system temperatures at lower end of resident comfort range
    • Use perimeter heating as re-heat to increase room temperatures to individual requirements
    • Importance of individual choice
    • Link to private rooms and lifestyle patterns

Correct and balance ventilation in laundry

    • Enclose dryers and have separate unconditioned make up air supply
    • Rearrange laundry to have a separate soiled room, and wash room, with each having 10 air changes of exhaust
    • Supply 10 air changes of air-conditioned air to the clean area, which should balance with the exhaust air
    • Enables better facility control to ensure resident linen needs is met efficiently and in a timely manner

Expand in-service training room

    • Maintaining quality education and training needs of staff better insures quality of care for residents
    • Size should be approximately the size of the existing conference room
    • Should have bed set-up
    • Should have space for CPR training
    • Should have classroom space
    • Have folding or stacking chairs
    • Size should be approximately 400-500 sq. ft.
    • If in-service training room is located in the lower level, then a main floor office will also be required in the resident area of the facility

Replace present fire alarm system with digital system

Have larger janitor closets

    • Have enough room for 3 carts and work and storage space
    • De-clutter facility environment
    • De-institutionalize atmosphere

Have large housekeeping room

    • Electrical and plumbing
    • Storage for supplies
    • Storage for equipment and machines
    • Locate on main floor
    • Housekeeping Office should be adjacent
    • Enhance communication to insure efficiency of service to residents

Material handling

    • Ensure more efficient transport of materials to decrease amount of time and foster a "home-like" atmosphere
    • Increase size of loading dock
    • Increase width of doors at end of service corridor
    • Increase the width of elevator doors so that elevators can handle a pallet
    1. The costs associated with replacing the entire facility:

      Based on preliminary studies, it does not appear that replacing the entire facility would be cost effective.

    2. A comparison and evaluation of the merits of proceeding with A and B (above), or with C (above).

See the Report section for further detail

 

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