Texas Administrative Code, Division 9, Section 554.354 - Architectural Space Planning and Utilization for New Facilities | Texas Administrative Code

(a) Resident bedrooms. Each resident bedroom must meet the following requirements:

(1) The maximum room capacity must be two residents.

(2) Minimum bedroom area, excluding toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules, must be 100 square feet in single occupancy rooms and 80 square feet per bed in multi-bed rooms.

(3) The minimum allowable room dimension is ten feet. The room must be designed to provide at least 36 inches between beds and 24 inches between any bed and the adjacent wall.

(4) Each room must have at least one operable outside window arranged and located so that it can be easily opened from the inside without the use of tools or keys. The maximum allowable sill height must not exceed 36 inches above the floor. All operable windows must have insect screens. The minimum area of window in each bedroom must equal at least 16 square feet or 8.0% of the gross floor area of the room, whichever is larger. Operable window sections may be restricted to not more than six nor less than four inches for security or safety reasons.

(5) Each room must have general lighting, wall-mounted bed reading lights, and night lighting. The night light must be switched just inside the entrance to each resident room with a silent type switch, 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, unless otherwise approved by HHSC. The light providing general illumination must be switchable at the door of the resident room for use of staff and residents. A durable non-glare reading light with an opaque front panel securely anchored to the wall, integrally wired, must be provided above each resident bed. The switch for this reading light must be within reach of a resident in the bed.

(6) The minimum number of power receptacles at a resident bed location shall be determined based on the risk assessment required by NFPA 99 and § 554.300(i) of this subchapter (relating to General Requirements), as follows:

(A) All receptacles must be listed and identified as "hospital grade";

(B) Four of the required receptacles must be provided beside the head of each bed;

(C) No fewer than eight receptacles must be provided within the patient care vicinity, as defined in NFPA 99;

(D) If the failure of patient-care-related electrical equipment is likely to cause major injury or death to a resident, no fewer than fourteen receptacles must be provided within the patient care vicinity.

(E) Additional receptacles, beyond the minimum quantities above, must be provided to ensure the electrical needs of all residents living in the bedroom are met, including power for TV, radio, razors, hairdryers, clocks, or as required by NFPA 99 and NFPA 70.

(7) Each resident bedroom must have direct access to a bathroom without entering the general corridor area. The bathroom must serve no more than one resident room and must include, at least, a lavatory and toilet.

(8) Each resident must have a bed with a comfortable mattress, a bedside stand with at least two enclosed storage spaces, a dresser, and closet or wardrobe space providing privacy for clothing and personal belongings. Private clothes storage space must provide at least 22 inches of lineal hanging space per bed and have closable doors. Chairs and space must be provided for use by residents and visitors.

(9) Each room must open onto an exit corridor and must be arranged for convenient resident access to dining, living, and bathing areas. To ensure a direct view from nurses' stations, resident room doors must not be recessed into the corridor wall more than four feet. Alcoves must meet applicable accessibility standards for a front approach to the door, and handrails must be provided in the alcove. If an alcove exceeds four feet in depth, it is a corridor and must meet all requirements for corridors, including direct view from a nurses' station, minimum width of the corridor, and provisions for handrails.

(10) Visual privacy, such as cubicle curtains, must be available for each resident in multi-bed bedrooms. Design for privacy must not restrict resident access to the entry, lavatory, or toilet, nor may it restrict bed evacuation or obstruct sprinkler flow coverage.

(11) At least one noncombustible wastebasket must be provided in each bedroom.

(12) See the requirements in § 554.361(d)(4) of this subchapter (relating to Electrical Requirements for New Facilities) for nurse call systems.

(13) Bedrooms must be identified with a raised or recessed unique number placed on or near the door. Refer to TAS for information about signs.

(14) Locks on bedroom doors are permitted when they meet definite resident needs.

(A) Situations in which locks may be necessary include the following:

(i) married couples whose rights of privacy could be infringed upon unless bedroom door locks are permitted; and

(ii) residents for whom the attending physician wants bedroom door locks to enhance the residents' sense of security.

(B) In situations such as those listed in subparagraph (A) of this paragraph, the following guidelines must be met:

(i) bedroom door locks must be of the type which the occupant can unlock at will from inside the room;

(ii) all bedroom door locks must be of the type which can be unlocked from the corridor side;

(iii) attendants must carry keys which will permit ready access to the locked bedrooms when entrance becomes necessary;

(iv) locking of bedroom doors by residents for privacy or security will not be permitted except when specifically included in the attending physician's written orders or authorized by the nursing facility administrator.

(15) Vacant bedrooms must not be used for hazardous activities or hazardous storage, unless specifically approved by HHSC in writing.

(b) Nursing service areas. A nursing service area includes a nurses' station and other areas described in this subsection and must be located in or readily available to each nursing unit. The size and disposition of each service area will depend upon the number and types of beds to be served. Each service area may be arranged and located to serve more than one nursing unit, but at least one service area must be provided on each nursing floor. The maximum allowable distance from a resident room door to a nurses' station is 150 feet. The following requirements are applicable to services areas:

(1) Nurses' stations must be provided with space for nurses' charting, doctors' charting, and storage for administrative supplies. Nurses' stations must be located to provide a direct view of resident corridors. A nurses' station has a direct view of a resident corridor if a person can see down the corridor from a point within 24 inches of the outside of the nurses' station counter or wall. When a nurses' station does not provide a direct view of a resident corridor, an auxiliary station complying with the following guidelines must be provided.

(A) The auxiliary station must be staffed by nursing personnel during all shifts.

(i) More than one auxiliary station may be assigned to a designated nurses' station, regardless of the distance between stations.

(ii) The nurse call system for resident corridors monitored by the auxiliary station must report to the auxiliary station.

(iii) Each auxiliary station must meet the emergency electrical requirements for a nurse's station, including electrical receptacles and emergency lighting.

(iv) 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.

(B) 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.

(2) Lounge and toilet room must be provided for nursing staff.

(3) Lockers or security compartments must be provided for the safekeeping of personal effects of staff. These must be located convenient to the duty station of personnel or in a central location.

(4) A clean utility room must contain a work counter, sink with high-neck faucet with lever controls, and storage facilities and must be part of a system for storage and distribution of clean and sterile supply materials.

(5) A soiled utility room must contain a water closet or equivalent flushing rim fixture, a sink large enough to submerge a bedpan with spray hose and high-neck faucet with lever controls, work counter, waste receptacle, and linen receptacle. A soiled utility room must be part of a system for collection and cleaning or disposal of soiled utensils or materials. A separate hand-washing sink must be provided if the bedpan disinfecting sink cannot normally be used for hand-washing.

(6) Provision must be made for convenient and prompt 24-hour distribution of medication to residents. The medication preparation room must be under the nursing staff's visual control and contain a work counter, refrigerator, sink with hot and cold water, and locked storage for biologicals and drugs and must have a minimum area of 50 square feet. The minimum dimension allowed is five feet six inches. An appropriate air supply must be provided to maintain adequate temperature and ventilation for safe storage of medications. For purposes of storage of unrefrigerated medications, the room temperature must be maintained between 59 degrees and 86 degrees Fahrenheit.

(7) Provision must be made for separate closets or room for clean linens. Corridors must not be used for folding or cart storage. Storage rooms must be located and distributed in the building for efficient access to bedrooms.

(8) A soiled linen rooms must meet the requirements in subsection (l)(2)(A) of this section.

(9) A nourishment station is required and must contain a sink equipped for hand-washing, equipment for serving nourishment between scheduled meals, refrigerator, and storage cabinets. Ice for residents' service and treatment must be provided only by icemaker units. This station may be furnished in a clean utility room.

(10) An equipment storage room must be provided for equipment such as intravenous stands, inhalators, air mattresses, and walkers.

(11) Parking spaces for stretchers and wheelchairs must be located out of the path of normal traffic.

(c) Residents' bathing and toilet facilities. The following requirements are applicable to bathing and toilet facilities:

(1) Bathtubs or showers must be provided at the rate of one for each 20 beds which are not otherwise served by bathing facilities within residents' rooms. At least one bathing unit must be provided in each nursing unit. Each tub or shower must be in an individual room or enclosure which provides space for the private use of the bathing fixture, for drying and dressing, including an accessible dressing bench, and for a wheelchair and an attendant. Each general-use bathing room must be provided with at least one water closet in a stall, room, or area for privacy, and one lavatory. A bathing room must be located conveniently to the bedroom area it serves and must not be more than 100 feet from the farthest bedroom.

(2) At least 50% of bathrooms and toilet rooms, fixtures, and accessories must be designed and provided to meet criteria under the Americans with Disabilities Act for individuals with disabilities, unless otherwise approved by HHSC.

(3) All rooms containing bathtubs, sitz baths, showers, and water closets, used by residents must be equipped with doors and hardware that permits access from the outside in any emergency.

(4) Bathing areas must be provided with safe and effective auxiliary or supplementary heating. Bathing areas must be free of drafts and must have adequate exhaust ducted to the outside to minimize excess moisture retention and resulting mold and mildew problems.

(5) Tubs and showers must be provided with slip-proof bottoms.

(6) Lavatories and hand-washing facilities must be securely anchored to withstand an applied downward load of not less than 250 pounds on the front of the fixtures.

(7) Provision must be made for sanitary hand drying and toothbrush storage at lavatories. There must be paper towel dispensers or separate towel racks and separate toothbrush holders.

(8) Mirrors must be arranged for convenient use by residents in wheelchairs as well as by residents in a standing position, and the minimum size must be 15 inches in width by 30 inches in height, or tilt type.

(9) Rooms with toilets must be provided with effective forced air exhaust ducted to the exterior to remove odors. Ducted manifold systems are recommended.

(10) Floors, walls, and ceilings must have nonabsorbent surfaces, be smooth, and be easily cleanable.

(d) 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 of waste by incineration, mechanical destruction, compaction, containerization, removal, or by a combination of these techniques.

(e) Resident living areas. The following requirements are applicable to resident living areas:

(1) Social-diversional spaces such as living rooms, dayrooms, lounges, and sunrooms, must be provided on a sliding scale as follows:

Attached Graphic

(2) If a required way of exit, or a service way, is through a living or dining area, a pathway equal to the corridor width must be deducted for calculation purposes and discounted from that area. These exit pathways must be kept clear of obstructions.

(3) Each resident living room and dining room must have at least one outside window. The window area must be equal to at least 8.0% of the total room floor area. Sky-lighting may be used to fulfill one-half of the 8.0% minimum area.

(4) Open or enclosed seating space must be provided within view of the main nurses' station that will allow furniture or wheelchair parking that does not obstruct the corridor way of egress.

(f) Dining space. Dining space must be adequate for the number of residents served, but no less than ten square feet per resident bed.

(g) Dietary facilities. The following requirements are applicable to dietary facilities:

(1) A main or dietary kitchen must be as follows:

(A) A kitchen will be evaluated on the basis of its performance in the sanitary and efficient preparation and serving of meals to residents. Consideration will be given to planning for the type of meals served, the overall building design, the food service equipment, the arrangement, and the work flow involved in the preparation and delivery of food. Plans must include a large-scale detailed kitchen layout designed by a registered or licensed dietitian or architect having knowledge in the design of food service operations.

(B) Kitchens must be designed so that room temperature at summertime peak load will not exceed a temperature of 85 degrees Fahrenheit measured at the five-foot level. The amount of supply air must take into account the large quantities of air that may be exhausted at the range hood and dishwashing area.

(C) Operational equipment must be provided as planned and scheduled by the facility consultants 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.

(D) Facilities for washing and sanitizing dishes and cooking utensils must be provided. These facilities must be designed based on the number of meals served and the method of serving, that is, use of permanent or disposable dishes. The kitchen must contain a multi-compartment sink large enough to immerse pots and pans. A mechanical dishwasher is required for washing and sanitizing dishes. Separation of soiled and clean dish areas must be maintained, including air flow.

(E) A vegetable preparation sink must be provided, and it must be separate from the pot sinks.

(F) A supply of hot and cold water must be provided. Hot water for sanitizing purposes must be 180 degrees Fahrenheit or the manufacturer's suggested temperature for chemical sanitizers. For mechanical dishwashers, the temperature measurement is at the manifold.

(G) A kitchen must be provided with a hand-washing lavatory in the food preparation area with hot and cold water, soap, paper towel dispenser, and waste receptacle. The dish room area must have ready access to a hand-washing lavatory.

(H) Staff rest room facilities with lavatory must be directly accessible to kitchen staff without traversing resident use areas. A facility must provide a vestibule so the rest room door does not open directly into the kitchen.

(I) Janitorial facilities must be provided exclusively for the kitchen and must be located in the kitchen area.

(J) Nonabsorbent smooth finishes or surfaces must be used on kitchen floors, walls, and ceilings. These surfaces must be capable of being routinely cleaned and sanitized to maintain a healthful environment. Counter and cabinet surfaces, inside and outside, must also have smooth, cleanable, relatively nonporous finishes.

(K) Operable windows must have insect screens provided.

(L) Doors between kitchen and dining or serving areas must have a safety glass view panel.

(M) A garbage can or cart washing area with drain and hot water must be provided.

(N) Floor drains must be provided in the kitchen and dishwashing areas.

(O) Vapor removal from cooking equipment must be designed and installed in accordance with NFPA 101.

(P) Grease traps must be provided in compliance with local plumbing code or other nationally recognized plumbing code.

(2) Food storage areas must be as follows:

(A) Food storage areas must provide for storage of a seven-day minimum supply of nonperishable foods at all times.

(B) Shelves must be adjustable wire type. Walls and floors must have a nonabsorbent finish to provide a cleanable surface. No foods may be stored on the floor; dollies, racks, or pallets may be used to elevate foods not stored on shelving.

(C) Dry food storage must have an effective venting system to provide for positive air circulation.

(D) The maximum room temperature for food storage must not exceed 85 degrees Fahrenheit at any time. The measurement must be taken at the highest food storage level but not less than five feet from the floor.

(E) 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.

(3) An auxiliary serving kitchen not contiguous to a food preparation or serving area must be as follows:

(A) If a service area other than the kitchen is used to dispense food, it must be designated as a food service area and must have equipment for maintaining required food temperatures while serving.

(B) Separate food service areas must have hand-washing facilities as a part of the food service area.

(C) Finishes of all surfaces, except ceilings, must be the same as those required for dietary kitchens or comparable areas. See paragraph (1)(J) of this subsection.

(h) Administrative and public areas.

(1) The following elements must be provided in the public area:

(A) The entrance must be at grade level, sheltered from the weather, and able to accommodate wheelchairs. A drive-under canopy must be provided for the protection of residents or visitors entering or leaving a vehicle. The drive-under canopy may be a secondary entrance.

(B) The lobby, which may also be designed to satisfy a portion of the minimum area required for resident living room space, must include:

(i) storage space for wheelchairs if more than one is kept available;

(ii) a reception or information area, which may be adjacent to the lobby if the location is obvious;

(iii) waiting space;

(iv) public toilet facilities for individuals with disabilities, which may be adjacent to the lobby;

(v) at least one public access telephone, installed to meet standards under the Americans with Disabilities Act; and

(vi) a drinking fountain, which may be provided in a common public area and at least one of which must be installed to meet standards under the Americans with Disabilities Act.

(2) The following must be provided in the administrative area:

(A) General or individual offices must be provided for business transactions, medical and financial records, administrative and professional staff, and for private interviews relating to social service, credit, and admissions.

(B) A multipurpose room must be provided for conferences, meetings, and health education purposes including facilities for showing visual aids.

(C) Storage and work area for office equipment and supplies must be provided and accessible to the staff using such items.

(3) Toilet facilities for the disabled must be available in the building.

(i) Physical therapy facilities.

(1) Physical therapy facilities must be provided if required by the treatment program. The facilities stated in subparagraph (B) of this paragraph and paragraph (2)(C) - (E) of this subsection may be planned and arranged for shared use by occupational therapy residents and staff if the treatment program reflects this sharing concept. Physical therapy facilities must include the following:

(A) Provision for privacy at each individual treatment area; hand-washing facilities, one lavatory or sink may serve more than one cubicle; and facilities for the collection of soiled linen and other material that may be used in the therapy.

(B) Residents' dressing areas with accessible benches, showers, lockers, and toilet rooms if the therapy is such that these would be needed at the area.

(2) Physical therapy facilities may also include the following:

(A) treatment areas with space and equipment for the therapies provided;

(B) an exercise area;

(C) storage for clean linen, supplies, and equipment used in therapy;

(D) service sink located near therapy area; and

(E) wheelchair and stretcher storage.

(j) Occupational therapy facilities. Occupational therapy facilities must be provided if required by the treatment program.

(1) An activities area with a sink or lavatory and facilities for collection of waste products prior to disposal must be provided.

(2) Storage for supplies and equipment used in the therapy must be provided.

(k) Personal grooming area, such as a barber or beauty shop. A separate room with appropriate equipment must be provided for hair care and grooming needs of residents in facilities with over 60 beds.

(l) Laundry and linen services.

(1) On-site processing must be as follows:

(A) Because of the high incidence of fires in laundries, it is highly recommended that the laundry be in a separate building 20 feet or more from the main building. If the laundry is located within the main building it must be separated by minimum one-hour fire resistance-rated construction to structure above, and sprinklered, and must be located in a remote area away from resident sleeping areas. Access doors must be from the exterior or interior nonresident use area, such as a service corridor, that is separated from the resident area.

(B) If linen is to be processed on the site, the following must be provided:

(i) A soiled linen receiving, holding, and sorting room with a rinse sink. This area must have a floor drain and forced exhaust to the exterior which must operate at all times there is soiled linen being held in the area.

(ii) A laundry processing room with equipment which can process seven days' worth of laundry within a regularly scheduled work week. Hand-washing facilities must be provided. The washer area must have:

(I) a floor drain;

(II) storage for laundry supplies;

(III) a clean linen inspection and mending room or area and a folding area;

(IV) a clean linen storage, issuing, or holding room or area;

(V) a janitors' closet containing a floor receptor or service sink and storage space for housekeeping equipment and supplies; and

(VI) sanitizing and washing facilities and a storage area for carts.

(C) Soiled and clean operations must be planned to maintain sanitary flow of functions as well as air flow. If carts containing soiled linens from resident rooms are not taken directly to the laundry area, intermediate holding rooms must be provided and located convenient to resident bedroom areas.

(D) Laundry areas must have adequate air supply and ventilation for staff comfort without having to rely on opening a door that is part of the fire wall separation.

(E) Provisions must be made to exhaust heat from dryers and to separate dryer make-up air from the habitable work areas of the laundry.

(2) For off-site linen processing, the following must be provided on the premises:

(A) a soiled linen holding room with adequate forced exhaust ducted to the exterior;

(B) clean linen receiving, holding, inspection, sorting or folding, and storage rooms; and

(C) sanitizing facilities and storage area for carts.

(3) Resident-use laundry, 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.

(m) General storage. The following requirements are applicable to general storage facilities:

(1) A general storage room must be provided as needed to accommodate the facility's needs. It is recommended that a general storage area provide at least two square feet per resident bed. This area would be for items such as extra beds, mattresses, appliances, and other furnishing and supplies.

(2) Storage space with provisions for locking and security control must be provided for residents' personal effects which are not kept in their rooms.

(n) Janitors' closet. In addition to the janitors' closet called for in certain departments, a sufficient number of janitors' closets must be provided throughout the facility to maintain a clean and sanitary environment. These must contain a floor receptor or service sink and storage space for housekeeping equipment and supplies.

(o) Maintenance, engineering service, and equipment areas. Space and facilities for adequate preventive maintenance and repair service must be provided. The following spaces are needed and it is suggested that these be part of a separate laundry building or area:

(1) A storage area for building and equipment maintenance supplies, tools, and parts must be provided.

(2) A space for storage of yard maintenance equipment and supplies, including flammable liquids bulk storage, must be provided separate from the resident-occupied facility.

(3) A maintenance and repair workshop of at least 120 square feet and equipment to support usual functions is recommended.

(4) A suitable office or desk space for the maintenance staff is recommended. This space may be located within the repair shop area with space for catalogs, files, and records.

(p) Oxygen. The storage and use of oxygen and oxygen equipment must meet applicable NFPA standards for gas equipment, including NFPA 99. Piped medical gas and vacuum systems must comply with § 554.360(e) of this subchapter (relating to Mechanical Requirements for New Facilities).