Does An Alteration Trigger Changes to Non-Accessible Casework?

[arwat23]

California using 2022 CBC / 2010 ADAS. Got a project where the client want to replace lighting, flooring, doors and frames, and ceiling throughout the entire suite, and modify / replace some millwork. I understand that anything they touch or anything new would need to be accessible as applicable, but what about sinks / lavs that aren't being altered?

CBC requires that all lavatories in a professional office of a healthcare provider be accessible (11B-805.6). Most of the exam rooms have lavs that are too high. The lavs aren't being altered, neither is the casework their installed in. Everything else in the room is being altered.

Would we need to alter the casework and lavs too? Or, since we're not touching them, can we leave them?

 

[Yankee Chronicler]

Does California have the 20% cost limitation? If so, is at least 20% of the construction cost being expended on other accessibility improvements? If the lavatories are in toilet rooms serving an area in which alterations are being made, by definition (unless CA changed it) the toilet rooms are part of the accessible route serving the altered areas and must be brought into compliance. (Unless you're spending 20% elsewhere.)

 

[arwat23]

Does California have the 20% cost limitation? If so, is at least 20% of the construction cost being expended on other accessibility improvements?

Yes, but that's for path of travel improvements, which I don't believe this wouldn't fall under.

CBC 11B-202.4
When alterations or additions are made to existing buildings or facilities, an accessible path of travel to the specific area of alteration or addition shall be provided. The primary accessible path of travel shall include:

1. A primary entrance to the building or facility,
2. Toilet and bathing facilities serving the area,
3. Drinking fountains serving the area,
4. Public telephones serving the area, and
5. Signs.

Edit: wait... maybe I'm wrong... Would exception 8 apply here, namely item 6? The definition of "path of travel" in CBC doesn't include lavs or sinks other than those in restrooms (the lavs are in the exam rooms), so I would think it wouldn't apply, but the way the exception is worded makes me conflicted...

A portion of CBC 11B-202.4, Exception 8:
For the purposes of this exception, the adjusted construction cost of alterations, structural repairs or additions shall not include the cost of alterations to path of travel elements required to comply with Section 11B-202.4.
In choosing which accessible elements to provide, priority should be given to those elements that will provide the greatest access in the following order:

1. An accessible entrance;
2. An accessible route to the altered area;
3. At least one accessible restroom for each sex or one accessible unisex (single-user or family) restroom;
4. Accessible telephones;
5. Accessible drinking fountains; and
6. When possible, additional accessible elements such as parking, signs, storage and alarms.

 

[Yankee Chronicler]

Yes, but that's for path of travel improvements, which I don't believe this wouldn't fall under.

CBC 11B-202.4
When alterations or additions are made to existing buildings or facilities, an accessible path of travel to the specific area of alteration or addition shall be provided. The primary accessible path of travel shall include:

1. A primary entrance to the building or facility,
2. Toilet and bathing facilities serving the area,
3. Drinking fountains serving the area,
4. Public telephones serving the area, and
5. Signs.

Your citation highlights "path of travel" as a defined term. Did you read the definition?

PATH OF TRAVEL. [DSA-AC] An identifiable accessible route within an existing site, building or facility by means of which a particular area may be approached, entered and exited, and which connects a particular area with an exterior approach (including sidewalks, streets and parking areas), an entrance to the facility, and other parts of the facility. When alterations, structural repairs or additions are made to existing buildings or facilities, the term "path of travel" also includes the toilet and bathing facilities, telephones, drinking fountains and signs serving the area of work.

 

[arwat23]

Your citation highlights "path of travel" as a defined term. Did you read the definition?

Yeah, and exam room lavs (well, lavs in general) aren't listed. Only toilet and bathing room lavs would be affected by path of travel improvements by this definition.

I edited my previous comment too. The way the exception is worded makes me think that maybe the 20% limitation could apply to items other than what's listen in the definition.

 

[arwat23]

What's making me question if we need to bring these exam room lavs and casework up to current code is the following:

11B-202.3 Alterations​

Where existing elements or spaces are altered, each altered element or space shall comply with the applicable requirements of Division 2, including Section 11B-202.4.

11B-202.3.3 Alteration of Single Elements​

If alterations of single elements, when considered together, amount to an alteration of a room or space in a building or facility, the entire room or space shall be made accessible.



We're not altering the casework, but we are touching basically everything else in the rooms.

 

[RLGA]

Typically, sinks in exam rooms solely for the use of staff and physicians are not required to be accessible. The link below addresses medical exam rooms, but it does not address the sink. The focus is on providing access to the room, maneuvering space within the room, and means of getting the patient on the examination table or other medical device.

Access to Medical Care for Individuals with Mobility Disabilities

This document provides guidance for medical care providers on the requirements of the ADA in medical settings with respect to people with mobility disabilities.

www.ada.gov

 

[arwat23]

Typically, sinks in exam rooms solely for the use of staff and physicians are not required to be accessible. The link below addresses medical exam rooms, but it does not address the sink. The focus is on providing access to the room, maneuvering space within the room, and means of getting the patient on the examination table or other medical device.

Access to Medical Care for Individuals with Mobility Disabilities

This document provides guidance for medical care providers on the requirements of the ADA in medical settings with respect to people with mobility disabilities.

www.ada.gov

Unfortunately, California makes it a requirement, at least for new sinks:

11B-223.4 Professional Offices of Health Care Providers​

Professional offices of health care providers shall comply with Section 11B-805.

11B-805.6 Hand Washing Fixtures, Lavatories and Sinks​

All hand washing fixtures, lavatories and sinks shall comply with Section 11B-606.
Exception: Scrub sinks, as defined in California Plumbing Code Section 221.0, shall not be required to comply with Section 11B-606.

 

[JPohling]

We would include the exam room sinks under the 20% rule for sure. Exam room sinks need to be accessible to patients. I am guessing you may be close to the threshold for 100% compliance. It comes fast.

 

[arwat23]

We would include the exam room sinks under the 20% rule for sure. Exam room sinks need to be accessible to patients. I am guessing you may be close to the threshold for 100% compliance. It comes fast.

Is there a code section that would address items like this that aren't part of the scope of work? I'll need to point to something if I'm going to "force" my client to do work they don't want to.

I would assume it's part of CBC 11B-202.4, exception 8 (since you mentioned the 20%). But what if I don't use that exception? Then I just need to make the following compliant, right?

1. A primary entrance to the building or facility,
2. Toilet and bathing facilities serving the area,
3. Drinking fountains serving the area,
4. Public telephones serving the area, and
5. Signs.

None of the above seem, to my eyes, to be related to exam room sinks.

Sorry if I'm being hard. I just want something concrete that I can point to in code. Something like "you're altering a room, so make the room accessible", just worded better.

 

[JPohling]

The exam room sink is for handwashing. like bathing your hands. it does not get a scrub sink exemption.

look at 11B-805.2.1

 

[arwat23]

The exam room sink is for handwashing. like bathing your hands. it does not get a scrub sink exemption.

look at 11B-805.2.1

Yes, but do I need to bring non-compliant items up to code if they aren't within the scope of work?

The plan, currently, is to leave the exam room lavs and associated casework completely untouched. I know any new lavs or any lavs / casework we alter (within the scope) need to be made accessible, but what about existing to remain lavs?

 

[JPohling]

Arwat, I am not sure I understand precisely what is being altered in the exam rooms. It sounds like it is only finishes? If that is the case then I would say......... you would need to spend at least 20% of the permit amount towards accessibility improvements. If you are over the threshold then 100% compliance on items that are not in compliance. Are doors and frames being replaced due to insufficient size? If so, I would include that towards your 20%. If not then that goes towards your threshold amount. Sink accessibility you can try to go with 5% compliance per 11B.202.3, but it really does not work in the health care situation as you are unsure just who may actually end up needing that accommodation. also see:


I fortunately never need to drill down to deep to see what is truly the minimum code required as our clients are large and always looking to provide maximum access as well as avoid superfluous lawsuits. YMMV

 

[arwat23]

Arwat, I am not sure I understand precisely what is being altered in the exam rooms. It sounds like it is only finishes? If that is the case then I would say......... you would need to spend at least 20% of the permit amount towards accessibility improvements.

The 20% is specific to path of travel improvements, no?

11B-202.4 Path of Travel Requirements in Alterations, Additions and Structural Repairs​

When alterations or additions are made to existing buildings or facilities, an accessible path of travel to the specific area of alteration or addition shall be provided. The primary accessible path of travel shall include:

1. A primary entrance to the building or facility,
2. Toilet and bathing facilities serving the area,
3. Drinking fountains serving the area,
4. Public telephones serving the area, and
5. Signs.

Doesn't exception 8, the 20% requirement, only relate the 5 items listed above? Other than restroom lavatories (toilet and bathing rooms), hand washing fixtures aren't listed as being required to be upgraded unless part of the scope of work.

Edit for clarity:

Exception 8 (small portion of the exception):
When the adjusted construction cost, as defined, is less than or equal to the current valuation threshold, as defined, the cost of compliance with Section 11B-202.4 shall be limited to 20 percent of the adjusted construction cost of alterations...


Is my understanding of this incorrect?

 

[Paul Sweet]

I have never had to wash my hands when I was a patient in an examination room, and I haven't seen the sink used very often. I can see making 5% or at least one accessible in case the doctor or nurse is in a wheelchair, but not every single sink. However, OP is in California so their accessibility code might be trying to make it as difficult as possible.

 

[steveray]

Like Ron said in post 7...It is basically an employee work area and exempt.....YCMV, VWP, SEA

 

[arwat23]

Like Ron said in post 7...It is basically an employee work area and exempt.....YCMV, VWP, SEA

Not exempt in California in professional offices of a healthcare provider. My question is, since these aren't within the scope of work, do I need to bring these up to current code. Exam rooms would be considered "public use" spaces as defined in CBC.

11B-805.1 General​

Medical care facilities (Note: this includes medical offices) and long-term care facilities shall comply with Section 11B-805. All common use spaces and public use spaces in medical care facilities and long-term care facilities shall comply with this chapter.

11B-805.6 Hand Washing Fixtures, Lavatories and Sinks​

All hand washing fixtures, lavatories and sinks shall comply with Section 11B-606.
Exception: Scrub sinks, as defined in California Plumbing Code Section 221.0, shall not be required to comply with Section 11B-606.

 

[arwat23]

I have never had to wash my hands when I was a patient in an examination room, and I haven't seen the sink used very often. I can see making 5% or at least one accessible in case the doctor or nurse is in a wheelchair, but not every single sink. However, OP is in California so their accessibility code might be trying to make it as difficult as possible.

We don't have that 5% rule in CA as far as I know. Can't keep things simple here.

Correction: we do, but that doesn't apply to healthcare facilities. CBC 11B-805.6 says "all" common use and public use hand washing fixtures must be accessible.

 

[JPohling]

Arwat. You are correct. The primary goal is to increase accessibility of the path of travel. But if you look further you will see there is a mechanism to have plan reviewers request additional items to be ungraded for compliance. 20% can be spent on many things and it is a bit open ended. #6 can be used for many things.
Such as ...................but not limited too. also the 5% rule does occur in CA. here is an example.
An exam room is not just an employee work area. the public uses it and many patients do wash their hands within them.

 

[JPohling]

I have never had to wash my hands when I was a patient in an examination room, and I haven't seen the sink used very often. I can see making 5% or at least one accessible in case the doctor or nurse is in a wheelchair, but not every single sink. However, OP is in California so their accessibility code might be trying to make it as difficult as possible.

However, OP is in California so their accessibility code might be trying to make it as ACCESSIBLE as possible. fixed it for ya!
I am licensed in VA as well and the accessibility of existing facilities there is tragic.

 

[arwat23]

also the 5% rule does occur in CA. here is an example.

Good to know. I missed that section. Thanks!

Isn't 11B-212 is specific to "sink", not "lavatories", both of which have CBC definitions. But, let's assume 5% is allowed. Does that override 11B-805.6 for "all handwashing" fixtures?

Arwat. You are correct. The primary goal is to increase accessibility of the path of travel. But if you look further you will see there is a mechanism to have plan reviewers request additional items to be ungraded for compliance. 20% can be spent on many things and it is a bit open ended. #6 can be used for many things.

Okay, so what happens if I have a fully compliant accessible path of travel? Items 1-5 (entrance, toilet room, drinking fountain, telephones, and signs) are accounted for and are fully accessible. Still doesn't make the exam room lavs accessible, and 11B-202.4 won't apply since the path of travel is fully compliant, so the 20% exception wouldn't apply. Do I need to upgrade the lavs in this situation?

 

[arwat23]

Arwat. You are correct. The primary goal is to increase accessibility of the path of travel. But if you look further you will see there is a mechanism to have plan reviewers request additional items to be ungraded for compliance. 20% can be spent on many things and it is a bit open ended. #6 can be used for many things.

Also, the language in that exception (specifically item 6) doesn't seem super clear to me. The exception states over and over again that you're spending 20% on compliance with 11B-202.4 (just path of travel items). So why does item 6 include stuff that isn't directly related to path of travel?

 

[JPohling]

I would say due to the vague language in #6 it is open to interpretation by plan reviewers. Most will not request it and few will. Often times these non compliant items are not easily determined by the plans submitted and not even seen or noticed. But when the inspector notices it and requests that it goes back for plan review and comment that is when things get sticky. Our clients are typically all over voluntary barrier removal so we just identify the issues up front and address them. We try to eliminate last minute changes due to inspector requests as well. It is a grey area at best. We error on the side of increased accessibility.

 

[arwat23]

I would say due to the vague language in #6 it is open to interpretation by plan reviewers. Most will not request it and few will. Often times these non compliant items are not easily determined by the plans submitted and not even seen or noticed. But when the inspector notices it and requests that it goes back for plan review and comment that is when things get sticky. Our clients are typically all over voluntary barrier removal so we just identify the issues up front and address them. We try to eliminate last minute changes due to inspector requests as well. It is a grey area at best. We error on the side of increased accessibility.

I agree that's the best course of action. Normally, this client would be all for upgrading their existing facilities. For whatever reason (budget cuts probably), they want to minimize work as much as possible.