| (9) Nourishment stations are usually required in all
but the smaller facilities 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, 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. See requirements in subsection (a)(8) of this
section for resident toilets at bedrooms.
(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, subject to occupancy by residents, must be equipped
with swinging doors and hardware which will permit 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 help remove odors. Ducted
manifold systems are recommended for some multiple-type installations.
(10) Floors, walls, and ceilings must have nonabsorbent
surfaces, be smooth, and 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, sunrooms, must be provided on a sliding scale as
follows:
Attached Graphic
(2) Where a required way of exit or a service way is
through a living or dining area, a pathway equal to the corridor width
will normally 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 nurse 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 not less than ten square feet
per resident bed.
(g) Dietary facilities. The following requirements
are applicable to dietary facilities:
(1) Main or dietary kitchens must be as follows:
(A) Kitchens will be evaluated on the basis of their
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, 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 over the room 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. As a minimum, the kitchen
must contain a multi-compartment sink large enough to immerse pots
and pans. In all facilities, 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. The rest room door must not open directly into the kitchen,
that is, provide a vestibule.
(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 96.
(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 foods storage must have an effective venting
system to provide for positive air circulation.
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