| (a) Large facilities.
(1) Ancillary resident space. The minimum total ancillary
resident-use space must be not less than 35 square feet per resident.
Ancillary space includes areas for living, dining, recreation, therapy,
training, and other such program areas. It does not include bedrooms,
passageways, offices, kitchens, or laundries (more than 35 square
feet per resident is usually needed in facilities with less than 60
residents). A facility which has large proportions (approximately
65 percent or greater) of nonambulatory or bedfast residents must
provide at least 50 square feet of ancillary space per resident unless
otherwise approved by HHSC. An area providing less space than called
for in this paragraph cannot be approved except on an individual basis
where clearly justified.
(2) Resident bedrooms.
(A) A bedroom must be arranged and equipped for adequate
personal care and for comfort and privacy. A bedroom must have full
height walls that extend from floor to ceiling with doors. (Partial
partitions or furnishings are not a substitute.) An exception is that
an existing facility constructed prior to October 3, 1988, that has
partial partitions in lieu of full-height walls, need not install
the full-height walls unless there are major renovations or conversions.
(B) A bedroom must provide at least 80 square feet
for a single occupancy (one resident) and 60 square feet per resident
for multiple occupancy. (Note: room configuration and usability are
taken into consideration and there may be instances where the minimum
square footage will not be acceptable.) The minimum room dimension
must be at least eight feet for a single resident room and at least
ten feet for a multiple-resident room, unless otherwise approved by
HHSC. An exception is that a multi-occupancy bedroom for persons in
wheelchairs must have 70 square feet per resident.
(C) No more than four residents may be in any one bedroom.
An exception is HHSC may grant a variance from the limit of four residents
per room only if a physician who is a member of the IDT and who is
a qualified intellectual disability professional (QIDP):
(i) certifies that each resident to be placed in a
bedroom accommodating more than four residents is so severely medically
impaired as to require direct and continuous monitoring during sleeping
hours; and
(ii) documents the reasons why accommodating in a room
of only four or fewer residents would not be medically feasible.
(D) In the bedroom and for each resident there must
be a bed with a comfortable mattress and appropriate bedding, functional
furniture appropriate to residents' needs, and closet space providing
security and privacy for clothing and personal belongings. Closet
space must provide at least 24 inches of lineal hanging space per
resident (in certain cases, such as for infants, exceptions may be
made). Married couples may share a bed.
(E) Each bedroom must have at least one outside wall
with an operable window giving outside exposure. Unless approved otherwise
by the HHSC, the window sill of the required window must be no higher
than 44 inches from the floor and must be at or above outside grade
level. Other window requirements must be as called for in NFPA 101.
The window area for a bedroom must be equal to at least 10 percent
of the total room floor area.
(F) If a bedroom is below grade level, it must have
a window that is usable as a second means of escape by a resident
occupying the room. The window must be no more than 44 inches (measured
to the window sill) above the floor.
(G) A resident bedroom must open onto an exit corridor,
living area, or public area and must be arranged for convenient resident
access to dining, living, and bathing areas.
(3) Social-diversional spaces.
(A) A living room, a day room, a lounge, or other social-diversional
space, must be provided on a sliding scale as follows (as part of
the minimum required ancillary space):
Attached Graphic
(B) Where a required way of exit is through a living
area, a pathway equal to the corridor width will normally be deducted
from that area. Such exit pathways must be kept clear of obstructions.
(C) Each living room and dining room must have at least
one outside window. Normally, a resident classroom and a training
area must also have an outside window unless otherwise approved by
HHSC.
(4) Dining space. Dining space must provide at least
15 square feet per resident for single-shift feeding. If procedure
is approved for feeding in two shifts, at least eight square feet
per resident must be provided.
(5) Training spaces including academic, behavioral,
occupational, physical, and speech therapy spaces. Classroom type
space is anticipated for most training activities. The number and
size of such spaces will be evaluated on an individual facility basis
and according to program policies and procedures. Generally, a training
room must provide at least 20 square feet per resident trainee within
the room except that no training room may be less than 80 square feet.
For purposes of calculation, space must be provided for at least one-third
of the total population at any one time (i.e., plan space for 33 residents
in a 100-resident facility).
(6) Kitchens (main/dietary).
(A) A kitchen must be evaluated based on its performance
in the sanitary and efficient preparation and serving of meals to
residents. Consideration must 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 for construction of new facilities must contain a detailed
kitchen layout prepared by, or under the direction of, a registered
or licensed dietitian.
(B) A kitchen must be designed so that room temperature,
at peak load, must not exceed an average 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 exhausted
at the range hood and dishwashing area.
(C) A kitchen must be provided with operational equipment
as planned and scheduled by the facility's consultants for preparing
and serving meals and for refrigerating and freezing perishable foods,
as well as equipment in, or adjacent to, the kitchen or dining area
for producing ice.
(D) A kitchen must be provided with facilities for
washing and sanitizing dishes and cooking utensils. Such facilities
will be provided for the number of meals served and the method of
serving (permanent or disposable dishes, etc.). The kitchen must contain
a compartmented sink large enough to immerse pots and pans. Separation
of soiled and clean dish areas must be maintained, including air flow.
(i) A mechanical dishwasher must be used to sanitize
dishes and utensils and must meet the requirements specified under
25 TAC Chapter 228; or
(ii) Dishes and utensils must be manually sanitized
in accordance with 25 TAC Chapter 228 prior to placement in the dishwasher.
(E) A kitchen must be provided with a 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 a mechanical dishwasher,
the temperature measurement is at the manifold.
(F) A kitchen must be provided with at least one hand-washing
lavatory or hand-sanitizing device. A hand-washing lavatory must be
provided with hot and cold running water, soap, and individual towels,
preferably paper towels; common use towels must not be used.
(G) In new construction, a staff restroom facility
with a lavatory must be accessible to kitchen staff without traversing
resident use areas. The restroom door must not open directly into
the kitchen, e.g., provide a vestibule.
(H) In new construction, a janitorial facility must
be provided exclusively for the kitchen and must be located in and
entered from the kitchen.
(I) Nonabsorbent smooth finishes or surfaces must be
used on kitchen floors, walls, and ceilings. Such surfaces must be
capable of being sanitized to maintain a healthful environment.
(J) All operable window openings must be screened.
A door opening to the outside of the building must have self-closing
devices.
(7) Food storage areas (main/kitchen).
(A) In new construction, a food storage area must be
planned based on the number and type of resident meals to be served.
The size and layout of dry foods storage must be prepared by or designed
under the direction of a licensed or registered dietitian.
(B) Food storage areas must provide for storage of
a four-day minimum supply of nonperishable foods at all times.
(C) Shelves must be movable metal or sealed lumber,
and walls must be finished with a nonabsorbent finish to provide a
cleanable surface.
(D) Dry food storage must have an approved venting
system to provide for positive air circulation.
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