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TITLE 25HEALTH SERVICES
PART 1DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 117END STAGE RENAL DISEASE FACILITIES
SUBCHAPTER HPHYSICAL PLANT AND CONSTRUCTION REQUIREMENTS
RULE §117.102Construction Requirements for a New End Stage Renal Disease Facility

(a) Any proposed new ESRD facility shall be easily accessible to the community and to service vehicles such as delivery trucks, ambulances, and fire protection apparatus. No building may be converted for use as an ESRD facility which, because of its location, physical condition, state of repair, or arrangement of facilities, would be hazardous to the health and safety of the patients.

  (1) An ESRD facility shall have at least two exits remotely located in accordance with National Fire Protection Association (NFPA) 101, Life Safety Code, 2003 Edition (NFPA 101), §20.2.4.1. When a required means of egress from the ESRD facility is through another portion of the building, that means of egress shall comply with the requirements of NFPA 101 which are applicable to the occupancy of that other building. Such means of egress shall be open, available, unlocked, unrestricted, and lighted at all times during the ESRD facility hours of operation. All documents published by National Fire Protection Association (NFPA) as referenced in this section may be obtained by writing or calling the NFPA at the following address or telephone number: National Fire Protection Association, 1 Batterymarch Park, Quincy, Massachusetts 02269-9101 or (800) 344-3555.

  (2) Hazardous locations.

    (A) A new ESRD facility or an addition to an existing ESRD facility shall not be constructed within 150 feet of easement boundaries or setbacks of hazardous underground locations including but not limited to liquid butane or propane, liquid petroleum or natural gas transmission lines, high pressure lines, and not within the easement of high voltage electrical lines. Municipality's main natural gas lines in right-of-ways serving dwellings and gas lines on property servicing gas meter(s) under this provision are not consider natural high pressure lines.

    (B) A new ESRD facility and an addition to an existing ESRD facility shall not be built within 300 feet of above ground or underground storage tanks containing liquid petroleum or other flammable liquids used in connection with a bulk plant, marine terminal, aircraft refueling, bottling plant of a liquefied petroleum gas installation, or near other hazardous or hazard producing plants.

  (3) Undesirable locations.

    (A) In lieu of local codes, a new ESRD facility shall not be located closer than 1500 feet to nuisance producing industrial sites, feed lots, sanitary landfills, or manufacturing plants producing excessive noise or air pollution.

    (B) Flood plains.

      (i) When a new ESRD facility is constructed in a designated 100-year flood plain, the building finished floor elevation shall be one foot above the set base flood plain elevation. The building shall meet all local flood code ordinances and local flood control requirements.

      (ii) To obtain a license as an ESRD facility, a previously licensed ESRD facility and an existing building or a portion of an existing building located in a designated 100-year flood plain shall meet the requirement of clause (i) of this subparagraph.

      (iii) ESRD facility required functional components shall be constructed above the designated flood plain in a new addition to an existing ESRD facility located in a designated 100-year flood plain. The new addition shall meet the requirement of clause (i) of this subparagraph.

      (iv) Currently licensed ESRD facilities located within a designated 100-year flood plain are exempt from these requirements for renovations and repairs.

(b) The ESRD facility site shall include paved roads, walkways, and parking in accordance with the requirements set out in this subsection.

  (1) Paved roads and walkways.

    (A) Paved roads shall be provided within lot lines for access from public roads to the main entrance and to service entrances.

    (B) Finished surface walkways shall be provided for pedestrians. When public transportation or walkways serve the site, finished surface walkways or paved roads shall extend from the public conveyance to the building entrance.

  (2) Parking and disability requirements.

    (A) Off-street parking shall be available for visitors, employees, and staff. Parking structures directly accessible from an ESRD facility shall be separated with two-hour fire rated noncombustible construction. When used as required means of egress for ESRD facility occupants, parking structures shall comply with National Fire Protection Association 88A, Standard for Parking Structures, 2002 edition. This requirement does not apply to freestanding parking structures. All documents published by National Fire Protection Association (NFPA) as referenced in this section may be obtained by writing or calling the NFPA at the following address or telephone number: National Fire Protection Association, 1 Batterymarch Park, P.O. Box 9101, Quincy, MA 02269-9101 or (800) 344-3555.

    (B) In the absence of local code, one parking space shall be provided for each staff member on duty, plus one space for each four treatment stations, and one visitor's space for every five treatment stations. This ratio may be reduced in an area convenient to a public transportation system or to public parking facilities. Parking facilities shall be increased accordingly when the size of existing facilities is increased.

    (C) When on-street parking is available and acceptable to the local authorities having jurisdiction, the numbers of parking spaces may be reduced accordingly and shall meet the requirement of subparagraph (B) of this paragraph.

    (D) Special considerations benefiting disabled staff, visitors, and patients shall be provided. Each ESRD facility shall comply with the Americans with Disabilities Act (ADA) of 1990, Public Law 101 - 336, 42 United States Code, Chapter 126, and Title 36 Code of Federal Regulations, Part 1191, Appendix A, Accessibility Guidelines for Buildings and Facilities or 16 Texas Administrative Code, Part 4, Chapter 68, §68.20 (relating to Buildings and Facilities Subject to Compliance with the Texas Accessibility Standards), Texas Accessibility Standards (TAS), April 1, 1994 edition, issued by the Texas Department of Licensing and Regulation, under the Texas Architectural Barriers Act, Texas Government Code, Chapter 469.

(c) Every building and every portion thereof shall be designed and constructed to sustain all dead and live loads in accordance with accepted engineering practices and standards and the local governing building codes. Where there is no local governing building code, the ESRD facility shall be constructed in accordance with the International Building Code, 2003 edition, published by the International Code Council, 500 New Jersey Avenue, Northwest, 6th Floor, Washington, District of Columbia 20001-2070, (800) 344-3555.

  (1) All new construction, including conversion of an existing building to an ESRD facility or establishing a separately licensed ESRD facility within another existing building, shall comply with NFPA 101, Chapter 20, New Ambulatory Health Care Occupancies, of the National Fire Protection Association 101, Life Safety Code, 2003 edition (NFPA 101), and subchapters G and H of this chapter (relating to Fire Prevention and Safety Requirements, and Physical Plant and Construction Requirements, respectively). Construction documents shall be submitted to the department in accordance with §117.104 of this title (relating to Preparation, Submittal, Review and Approval of Plans, and Retention of Records).

    (A) Construction types for multiple building occupancy.

      (i) When an ESRD facility is part of a larger building which complies with NFPA 101, §20.1.6, Minimum Construction Requirements for (fire resistance) construction type, the designated ESRD facility shall be separated from the remainder of the building with a minimum of one-hour fire rated construction.

      (ii) When an ESRD facility is located in a multistory building of two or more stories, the entire building shall meet the construction requirements of NFPA 101, §20.1.6.3. An ESRD facility shall not be located in a multistory building which does not comply with the minimum construction requirements of NFPA 101, §20.1.6.3.

      (iii) When an ESRD facility is part of a one-story building that does not comply with the construction requirements of NFPA 101, §20.1.6.2, the ESRD facility shall be separated from the remainder of the building with a 2-hour fire rated construction. The designated ESRD facility portion shall have the construction type upgraded to comply with NFPA 101, §20.1.6.2.

    (B) Special provisions shall be made in the design of a facility if located in a region where local experience shows loss of life or extensive damage to buildings resulting from hurricanes, tornadoes, or floods.

  (2) A physical environment that protects the health and safety of patients, personnel, and the public shall be provided in each facility. The physical premises of the facility and those areas of the facility's physical structure that are used by the patients (including all stairwells, corridors, and passageways) shall meet the local building and fire safety codes and the requirements of this chapter.

  (3) The more stringent standard, code or requirement shall apply when a difference in requirements for construction exists.

  (4) Nothing in this subchapter shall be construed to prohibit a better type of building construction, more exits, or otherwise safer conditions than the minimum requirements specified in this subchapter.

  (5) Nothing in this subchapter is intended to prevent the use of systems, methods, or devices of equivalent or superior quality, strength, fire resistance, effectiveness, durability, safety to health and welfare of individuals, and safety to those prescribed by this subchapter, provided technical documentation which demonstrates equivalency is submitted to the department for approval.

  (6) Separate freestanding buildings for nonpatient use such as the heating plant, boiler plant, laundry, repair workshops, or general storage may be of unprotected noncombustible construction, protected noncombustible construction, or fire-resistive construction and be designed and constructed in accordance with other occupancy classifications requirements listed in NFPA 101.

(d) Spatial requirements.

  (1) Administration and public areas.

    (A) Patient entrances shall be located at grade level, be accessible to individuals with disabilities, and provide exterior covered protection against inclement weather. The minimum exterior protection covering shall be no smaller than 4 feet by 6 feet wide. A covered area for patients in wheelchairs shall be provided next to the opening area of the door swing and door swing shall not interfere within this area. When an ESRD is located on a floor above grade level, elevators shall be accessible and shall meet the requirements of §117.103 of this title (relating to Elevators, Escalators, and Conveyors).

    (B) A waiting area or lobby shall be provided within the ESRD facility and include having the following rooms and items:

      (i) public toilet facilities; and

      (ii) telephone(s) for public use.

    (C) A designated reception area with desk or counter shall be provided.

    (D) Space shall be provided for private interviews for family members relating to social services, credit, or admission.

    (E) An office(s) shall be provided for business transactions, records, and administrative and professional staff.

    (F) The facility shall provide an area for storage of clinical records which is separate from all patient treatment areas, and shall be secured from unauthorized access. The facility shall store the active clinical record of each patient currently treated by the facility on site.

    (G) A general storage room with a minimum of 2 square feet per treatment station shall be provided. General storage may be located in one or more rooms or closets, and shall be located outside of the patient treatment areas.

    (H) Storage space for wheelchairs shall be provided, and shall be out of the direct line of traffic.

  (2) Equipment rooms with adequate space shall be provided for mechanical and electrical equipment. These areas shall be separate from public, patient, and staff areas.

  (3) An exam room shall be provided for medical examinations. The room shall have a minimum clear floor space of 80 square feet area exclusive of fixed cabinets and shelves and contain a counter for writing and a hand washing sink with hands-free operable controls.

  (4) When a patient is hepatitis B positive, the treatment shall be in a separated dedicated isolation room. All treatment in the isolation room shall be for hepatitis B patients only.

    (A) A single hepatitis B patient isolation room shall be a minimum of 120 square feet clear area exclusive of fixed and movable cabinets and shelves.

    (B) When multiple-treatment stations for hepatitis B patients are treated in a single isolation room, each individual patient treatment area shall be 80 square feet with a minimum of 8 feet clear dimension exclusive of fixed or wall mounted cabinets and built-in shelves. The clearance between the side of a station/chair and a wall/partition shall be a minimum of 3 feet. The clearance between sides of stations/chairs shall be a minimum of 4 feet.

    (C) The isolation treatment room shall include a work counter and a hand washing sink with hands-free operable controls, and space for patient care supplies and equipment. The fixed and moveable cabinets and shelves shall not encroach upon the patient treatment station/chair clear floor space/area.

    (D) The isolation treatment room shall have viewing panels in doors and/or walls for continuous direct visual monitoring of the patient in the room.

Cont'd...

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