Current through Reg. 49, No. 38; September 20, 2024
(a)
Nurses' station.
(1) All resident bedroom
corridors must be observable by direct line of sight or by mechanical means
from a designated nurses' station or auxiliary station. There must be at least
one nurses' station per floor in multi-story buildings.
(2) If all resident bedroom corridors are
observable by direct line of sight from inside the nurses' station or from
within 24 inches of the counter or hall of the nurses' station, no auxiliary
stations are required, even if resident bedrooms are more than 150 feet from
the nurses' station.
(3) When
resident bedrooms are more than 150 feet from the nurses' station and the
adjacent corridors are not observable from the station by direct line of sight,
an auxiliary station must be established and used.
(4) All corridors adjacent to resident
bedrooms that are more than 150 feet from a designated nurses' station or
auxiliary station must be observable by direct line of sight from the
designated nurses' station or auxiliary station. Corridors located in the
service area of an auxiliary station must be observable, as described in
paragraphs (2) and (3) of this subsection, at the auxiliary station.
(5) The 150-foot limitation described in
paragraphs (2) - (4) of this subsection may be increased to 165 feet in
facilities or additions to facilities completed before August 10,
1983.
(6) In addition to the
required normal and emergency illumination, the facility must keep on hand and
readily available to night staff no less than one working flashlight at each
nurses' station.
(b)
Auxiliary station. Each auxiliary station must include a work area in which
nursing personnel can document and maintain resident data, even if the
facility's initial decision is to maintain clinical records at the nurses'
station.
(1) Auxiliary stations must be
staffed by nursing personnel during all shifts.
(2) More than one auxiliary station may be
assigned to a designated nurses' station, regardless of the distance between
stations. More than one corridor may be observed by mechanical means from a
designated nurses' station or auxiliary station.
(3) A nurse call system for resident
corridors monitored by an auxiliary station must register calls at the
auxiliary station.
(4) Each
auxiliary station must have an emergency electrical source adequate to power
lights at the station.
(5)
Medications and clinical records may be maintained at an auxiliary
station.
(6) If a required
auxiliary station does not already exist and the facility must establish a new
auxiliary station, all applicable standards, particularly those pertaining to
the physical plant and NFPA 101, must be observed. All renovations and
structural changes require prior approval from HHSC.
(7) All new construction completed after
August 10, 1983, must allow direct line-of-sight observation of all resident
bedroom corridors from the nurses' station or auxiliary station.
(c) Mechanical means for resident
observation.
(1) The nursing facility may use
closed-circuit television or mirrors to observe residents in the
facility.
(2) Closed-circuit
television monitoring systems must meet the following criteria:
(A) The camera must be placed to view the
entire corridor length, without any "blind spots."
(B) The camera must be capable of providing
recognizable images, in minimum and maximum light levels, for the complete
viewing area.
(C) The monitor must
be installed and be clearly visible to persons in the nurses' station or
auxiliary station who are assigned to the area monitored by the
camera.
(D) The system must be
supplied with emergency power that enables the system to function during
electrical service failures.
(E)
Each camera must have its own separate monitor.
(F) If the system performs the minimum basic
functions specified in subparagraphs (A) - (D) of this paragraph, television
monitoring systems installed before March 1984 may remain in service until the
equipment is replaced or the system is expanded. Replacement systems or new
component equipment must satisfy subparagraphs (A) - (E) of this
paragraph.
(3) Mirrors
must meet the following criteria:
(A) The
mounting height of the mirror must be no less than six feet and eight inches
from the floor to the bottom of the mirror.
(B) The mirror must not extend more than
3-1/2 inches from the face of the corridor wall, unless the bottom of the
mirror is more than seven feet and six inches above the floor.
(C) The mirror image must be clear enough
that individuals can be recognized, in minimum and maximum light levels,
throughout the viewing area.
(4) The monitoring systems described in this
section must not be used to deny privacy to staff or residents.
(d) Nurse call system. Each
nurses' station must be equipped to register residents' calls through a
communication system from resident areas.
(e) Medication storage area. A medication
storage area must include a sufficient, lockable, enclosed medicine storage
spaces, medicine room, or medication cart. The medication storage area must be
furnished with a refrigerator. There must be sufficient space available for a
medication preparation area equipped with a sink having hot and cold water.
When not in use, a medication cart must be secured in a designated area. Only
authorized personnel must have access to the lockable, enclosed medicine
storage area, medication room, or the medication cart. Medication storage areas
and preparation areas must be adequately ventilated and temperature
controlled.
(f) Clean utility room.
A clean utility room must be provided and must contain a sink with hot and cold
water. It must be part of a system for storage and distribution of clean and
sterile supply materials and equipment.
(g) Soiled utility room. A soiled utility
room must be provided and contain a flushing fixture and a sink with hot and
cold water. It must be part of a system for collection and cleaning or disposal
of soiled utensils or materials.
(h) Soiled linen room. A soiled linen room
must be provided as needed commensurate with the type of laundry system used.
In relation to adjacent areas, a negative air pressure must be provided with
air exhausted through ducts to the exterior. Air must be exhausted continually
whenever there are soiled linens in the room. A soiled linen room may be
combined with a soiled utility room.
(i) Clean linen storage. Clean linen storage
must be provided, conveniently located to resident bedroom areas.
(j) Kitchens.
(1) Nursing facility kitchens will be
evaluated on the basis of their performance in the sanitary and efficient
preparation and serving of meals. Consideration will be given to planning for
the type of meals served, the overall building design, the food service
equipment, arrangement, and the work flow involved in the preparation and
delivery of food. Evaluation will be based on the number of meals
served.
(2) Kitchen temperature, at
peak load, must not exceed a temperature of 85 degrees Fahrenheit measured at
the five foot level. The facility must provide sufficient heating to maintain
an average temperature of not less than 70 degrees Fahrenheit in winter, with
exhausts operating, at the five-foot level.
(3) The kitchen must have operational
equipment for preparing and serving meals and for refrigerating and freezing of
perishable foods, as well as equipment in, or adjacent to, the kitchen or
dining area for producing ice.
(4)
The kitchen must have facilities for washing and sanitizing dishes and cooking
utensils. These facilities must be adequate for the number of meals served and
the method of serving, such as use of permanent or disposable dishes. The
kitchen must contain a multi-compartment sink large enough to immerse pots and
pans. In all facilities, a mechanical dishwasher is required for sanitizing
dishes. The facility must maintain separation of soiled and clean dish areas,
including air flow and traffic flow.
(5) The kitchen must have an adequate supply
of hot and cold water. Hot water for sanitizing purposes must be 180 degrees
Fahrenheit or the manufacturer's suggested temperature for chemical sanitizers,
as specified for the system in use. For mechanical dishwashers, the temperature
measurement is at the manifold. Hot water for general kitchen use must be 140
degrees Fahrenheit.
(6) A kitchen
must have at least one hand-washing lavatory in the food-preparation area. The
dish washing area must have ready access to a hand-washing lavatory or hand
sanitizing device. Hand-washing lavatories must be provided with hot and cold
running water, a sanitary soap dispenser, and paper towel dispenser or hot air
dryer.
(7) Nonabsorbent smooth
finishes or surfaces must be used on kitchen floors, walls, and ceilings. These
surfaces must be capable of being routinely sanitized to maintain a healthful
environment.
(8) A janitor's closet
with service sink must be easily and readily accessible to the
kitchen.
(9) The kitchen exhaust
hood at cooking equipment and its attached automatic chemical extinguisher must
comply with NFPA 96. HHSC may waive certain details of NFPA 96 for existing
kitchen exhausts at cooking equipment provided that basic function and safety
are not compromised.
(k)
Food storage areas.
(1) Food storage areas
must provide for storage of a seven-day minimum supply of nonperishable staple
foods and a two-day supply of perishable foods at all times.
(2) Shelves and pallets must be moveable
wire, metal, or sealed lumber, and walls must be finished with a nonabsorbent
finish to provide a cleanable surface.
(3) Dry food storage must have a venting
system to provide for reliable positive air circulation.
(4) The maximum room temperature for food
storage must not exceed 85 degrees Fahrenheit. The measurement must be taken at
the five-foot level.
(5) Foods must
not be stored on the floor. Dunnage carts or pallets may be used to elevate
foods not stored on shelving.
(6)
Sealed containers must be provided for storing dry foods after the package seal
has been broken.
(7) Food storage
areas may be located apart from the food preparation area as long as there is
space adjacent to the kitchen for necessary daily usage.
(l) Auxiliary serving kitchens not contiguous
to food preparation and serving areas.
(1)
When service areas other than the kitchen are used to dispense foods, the
facility must designate these service areas as food service areas and must have
equipment for maintaining required food temperatures while serving.
(2) Separate food service areas must have
hand-washing facilities as a part of the food service area.
(3) Finishes of all surfaces except ceilings
must be the same as those required for dietary kitchens.
(m) Administrative and public areas.
Facilities must have administrative areas for normal business transactions and
maintenance of records.
(n)
Laundry.
(1) Laundry facilities must be
located in areas separate from resident rooms. The laundry must be designed,
constructed, and equipped and appropriate procedures must be utilized to ensure
that laundry is handled, cleaned, and stored in a sanitary manner.
(2) Laundry for general linen and clothing
must be arranged so as to separate soiled and clean operations as they relate
to traffic, handling, and air currents. Suitable exhaust and ventilation must
be provided to prevent air flow from soiled to clean areas.
(3) Floors, walls, and ceilings must be
nonabsorbing and easily cleanable.
(4) Soiled linen must be stored and
transported in closed or covered containers. Soiled linen storage or holding
rooms must have a negative air pressure in relation to adjacent areas with air
exhausted through ducts to the exterior.
(5) Laundry areas must have air supply and
ventilation to minimize mildew and odors. Doors must not remain open, for
sanitation and safety reasons.
(6)
Room size, and number and type of appliances must provide efficient, sanitary,
and timely laundry processing to meet the needs of the facility.
(7) The laundry, if located in the facility,
must meet NFPA 101 requirements for separation and construction for hazardous
areas.
(o) Resident-use
laundry. This service, if provided, must be limited to not more than one
residential type washer and dryer per laundry room. This room must be
classified as a hazardous area according to NFPA 101.
(p) Personal grooming area. Space and
equipment must be provided for the hair care and grooming needs of the
residents. Hair care and grooming service will be provided in resident bedrooms
or in designated areas which are not in a way of egress.
(q) Storage rooms. General and specific
storage areas must be provided as needed and required for safe and efficient
operation of the facility. Items must not be stored in inappropriate places
such as corridors or rooms which are not equipped for special hazard
protection.
(r) Janitor closets. In
addition to the janitors' closet called for in certain departments, other
janitors' closets must be provided throughout the facility to maintain a clean
and sanitary environment. All janitor closets must have a negative air pressure
in relation to adjacent areas with air exhausted through ducts to the
exterior.
(s) Disposal facilities.
A policy and procedure for the safe and sanitary disposal of special waste must
be provided. Space and facilities must be provided for the sanitary storage and
disposal of waste, not classified as special, by incineration, mechanical
destruction, compaction, containerization, removal, or contract with outside
resources, or by a combination of these techniques
(t) Maintenance, engineering service, and
equipment areas.
(1) The facility must
provide storage for building equipment, supplies, tools, parts, and yard
maintenance equipment.
(2) Volatile
liquids and supplies must not be kept within the main building housing
residents.
(3) All equipment
requiring periodic maintenance, testing, and servicing must be reasonably
accessible. Necessary equipment to conduct these services, such as ladders,
specific tools, and keys, must be readily available on
site.
(u) Oxygen.
(1) The facility must implement procedures
that ensure the safe and sanitary use and storage of oxygen. Such procedures
must be in compliance with all applicable NFPA standards, including NFPA
99.
(2) Oxygen cylinders and
containers must be in compliance with NFPA 99. Liquid oxygen containers must be
certified by UL or another approved testing laboratory for compliance with NFPA
55 requirements. The storage, handling, assembly, and testing must be in
compliance with all applicable NFPA standards, including NFPA 99 and NFPA 55
requirements. The facility is responsible for defining all potential hazards
both graphically and verbally to all persons involved in the use of liquid
oxygen and ensuring that the liquid-oxygen provider does also.
