Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
Subchapter D - FACILITY CONSTRUCTION
Division 7 - SMALL HOUSE AND HOUSEHOLD FACILITIES
Section 554.345 - Small House and Household Facilities

Universal Citation: 26 TX Admin Code § 554.345

Current through Reg. 49, No. 52; December 27, 2024

(a) This section applies to a small house or household facility that is designed to provide a non-institutional environment to promote resident-centered care. New construction of a small house or household facility, including a conversion of an existing facility, an addition to an existing facility, or rehabilitation of an existing facility, must meet the requirements of this section.

(b) A small house or household facility must comply with this chapter, except it is not required to comply with a requirement in Division 9 of this subchapter (relating to Facilities Licensed On or After April 2, 2018) if HHSC waives the requirement in accordance with subsection (c) of this section or if the requirement is modified by subsection (g) of this section.

(c) HHSC may waive a requirement in Division 9 of this subchapter if HHSC determines a waiver of the requirement would facilitate the implementation of resident-centered care. To request a waiver of a requirement, a facility must submit plans to HHSC according to § 554.344 of this subchapter (relating to Plan Review). The plans must include a statement from an architect identifying which requirements the facility is requesting to be waived and explaining how the waiver would contribute to the goals of resident-centered care.

(d) A small house or household facility must be designed and equipped to provide a homelike environment that promotes resident-centered care.

(e) A small house or a household within a facility must:

(1) have no more than 16 bedrooms as described in subsection (g)(2) of this section;

(2) have living, dining, social, and staffing areas exclusively within and for the house or household; and

(3) have a kitchen that meets the requirements in § 554.354(g)(1) of this subchapter (relating to Architectural Space Planning and Utilization for New Facilities) or a food service area that meets the requirements of an auxiliary serving kitchen in § 554.354(g)(3) of this subchapter, exclusively within and for the house or household.

(f) A small house or household facility must be:

(1) a single small house model, which is a single licensed building having no more than 16 residents that meets the licensing requirements for architectural spaces provided within the same licensed building;

(2) a multiple small house model, which is a single licensed group of two or more small houses located in close proximity to each other on a single contiguous property that meets the licensing requirements for architectural spaces in each house and that may include a stand-alone central building that provides social-diversional space, a treatment area, or an administrative area; or

(3) a household model, which is a single licensed building that contains one or more households having no more than 16 residents each; that may include a central area that provides social-diversional space, a treatment area, or an administrative area; and that must be arranged to avoid travel through the household by persons who are not residing in, visiting, or providing services for the household.

(g) A small house or household facility must comply with the requirements in this section and is not required to request a waiver for an exception described in this subsection.

(1) The outdoor activity, recreational, and sitting spaces required in § 554.352(f) of this subchapter (relating to Location and Site for New Facilities) must include a porch area under a roof with suitable furniture for sitting and space for wheelchairs.

(2) The resident bedroom requirements in § 554.354(a) of this subchapter must be met, except:

(A) a bedroom must be occupied:

(i) by only one resident; or

(ii) by two residents, if they are members of the same family and the bedroom size, furniture, and headboard wall requirements for double occupancy are met;

(B) the toilet requirements in § 554.354(a)(7) of this subchapter must be met, except a bathroom must serve no more than one resident room and must include a lavatory, toilet, and a shower or bathing unit;

(C) the night lighting requirement in § 554.354(a)(5) of this subchapter must be met, except it must be a recessed wall mounted fixture just inside the entry door to the room and must not be obstructed by the door or furniture; and

(D) the electrical receptacle requirements in § 554.354(a)(6) of this subchapter must be met and additional receptacles must be provided to meet the requirements for Dwelling Unit Receptacle Outlets in NFPA 70.

(3) The nursing service area requirements in § 554.354(b) of this subchapter must be met, except:

(A) a nursing staff lounge is not required in a small house facility;

(B) the nursing staff toilet room may also be a toilet room for:

(i) kitchen staff;

(ii) the public; or

(iii) a general bathing room, if the toilet room opens into the general bathing room and common areas; and

(4) Resident bathing and toilet facility requirements in § 554.354(c) of this subchapter must be met, except the door between a bathroom and a resident bedroom:

(A) is not required to be a side-hinged swinging door;

(B) may be an externally mounted by-pass door;

(D) must not be equipped with a bottom door track that is a tripping hazard; and

(E) if it swings open into the bedroom, must not interfere with the swing of any other door that opens into the bedroom.

(5) The living area requirements in § 554.354(e) of this subchapter and dining room requirements in § 554.354(f) of this subchapter must be met, except the distance between the floor and the window sill of a window in the living or dining room must not exceed 36 inches, to allow a view to the outside from a seated position.

(6) The dietary facility requirements in § 554.354(g) of this subchapter must be met, except a kitchen serving 16 or fewer non-employees per meal:

(A) may be open to the facility in compliance with NFPA 101;

(B) must meet the general food service needs of the residents;

(C) must provide for the storage, refrigeration, preparation, and serving of food; for dish and utensil cleaning; and for refuse storage and removal;

(D) must contain a multi-compartment sink, vegetable sink, and hand washing sink;

(E) must provide a supply of hot water that, if used for sanitizing purposes is 180 degrees Fahrenheit or at the manufacturer's suggested temperature for chemical sanitizers;

(F) must provide a supply of cold water;

(G) must have janitorial facilities exclusively for the kitchen and located in close proximity to the kitchen;

(H) must have kitchen floors, walls, and ceilings with nonabsorbent smooth finishes or surfaces that are capable of being routinely cleaned and sanitized to maintain a healthful environment;

(I) must have counter and cabinet surfaces, inside and outside, with smooth, cleanable, relatively nonporous finishes; and

(J) must have a toilet for the kitchen staff that is in close proximity to the kitchen and that may also be a toilet room for the public or the general bathing room.

(7) The exit requirements in § 554.355(3) of this subchapter (relating to Exit Provisions for New Facilities) must be met except for fixed furniture and wheeled equipment as permitted by NFPA 101.

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