|(a) Nurses' station.
(1) All resident bedroom corridors must be observable
by direct line of sight or by mechanical means from a designated nurses'
station or auxiliary station. There must be at least one nurses' station
per floor in multi-story buildings.
(2) If all resident bedroom corridors are observable
by direct line of sight from inside the nurses' station or from within
24 inches of the counter or hall of the nurses' station, no auxiliary
stations are required, even if resident bedrooms are more than 150
feet from the nurses' station.
(3) When resident bedrooms are more than 150 feet from
the nurses’ station and the adjacent corridors are not observable
from the station by direct line of sight, an auxiliary station must
be established and used.
(4) All corridors adjacent to resident bedrooms that
are more than 150 feet from a designated nurses’ station or
auxiliary station must be observable by direct line of sight from
the designated nurses’ station or auxiliary station. Corridors
located in the service area of an auxiliary station must be observable,
as described in paragraphs (2) and (3) of this subsection, at the
(5) The 150-foot limitation described in paragraphs
(2) - (4) of this subsection may be increased to 165 feet in facilities
or additions to facilities completed before August 10, 1983.
(6) 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’
(b) Auxiliary station. Each auxiliary station must
include a work area in which nursing personnel can document and maintain
resident data, even if the facility's initial decision is to maintain
clinical records at the nurses’ station.
(1) Auxiliary stations must be staffed by nursing personnel
during all shifts.
(2) More than one auxiliary station may be assigned
to a designated nurses’ station, regardless of the distance
between stations. More than one corridor may be observed by mechanical
means from a designated nurses’ station or auxiliary station.
(3) A nurse call system for resident corridors monitored
by an auxiliary station must register calls at the auxiliary station.
(4) Each auxiliary station must have an emergency electrical
source adequate to power lights at the station.
(5) Medications and clinical records may be maintained
at an auxiliary station.
(6) 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. All renovations and structural
changes require prior approval from HHSC.
(7) All new construction completed after August 10,
1983, must allow direct line-of-sight observation of all resident
bedroom corridors from the nurses’ station or auxiliary station.
(c) Mechanical means for resident observation.
(1) The nursing facility may use closed-circuit television
or mirrors to observe residents in the facility.
(2) Closed-circuit television monitoring systems must
meet the following criteria:
(A) The camera must be placed to view the entire corridor
length, without any "blind spots."
(B) The camera must be capable of providing recognizable
images, in minimum and maximum light levels, for the complete viewing
(C) The monitor must be installed and be clearly visible
to persons in the nurses’ station or auxiliary station who are
assigned to the area monitored by the camera.
(D) The system must be supplied with emergency power
that enables the system to function during electrical service failures.
(E) Each camera must have its own separate monitor.
(F) If the system performs the minimum basic functions
specified in subparagraphs (A) - (D) of this paragraph, television
monitoring systems installed before March 1984 may remain in service
until the equipment is replaced or the system is expanded. Replacement
systems or new component equipment must satisfy subparagraphs (A)
- (E) of this paragraph.
(3) Mirrors must meet the following criteria:
(A) The mounting height of the mirror must be no less
than six feet and eight inches from the floor to the bottom of the
(B) The mirror must not extend more than 3-1/2 inches
from the face of the corridor wall, unless the bottom of the mirror
is more than seven feet and six inches above the floor.
(C) The mirror image must be clear enough that individuals
can be recognized, in minimum and maximum light levels, throughout
the viewing area.
(4) The monitoring systems described in this section
must not be used to deny privacy to staff or residents.
(d) Nurse call system. Each nurses’ station
must be equipped to register residents' calls through a communication
system from resident areas.
(e) Medication storage area. A medication storage area
must include a sufficient, lockable, enclosed medicine storage spaces,
medicine room, or medication cart. The medication storage area must
be furnished with a refrigerator. There must be sufficient space available
for a medication preparation area equipped with a sink having hot
and cold water. When not in use, a medication cart must be secured
in a designated area. Only authorized personnel must have access to
the lockable, enclosed medicine storage area, medication room, or
the medication cart. Medication storage areas and preparation areas
must be adequately ventilated and temperature controlled.
(f) Clean utility room. A clean utility room must be
provided and must contain a sink with hot and cold water. It must
be part of a system for storage and distribution of clean and sterile
supply materials and equipment.
(g) Soiled utility room. A soiled utility room must
be provided and contain a flushing fixture and a sink with hot and
cold water. It must be part of a system for collection and cleaning
or disposal of soiled utensils or materials.
(h) Soiled linen room. A soiled linen room must be
provided as needed commensurate with the type of laundry system used.
In relation to adjacent areas, a negative air pressure must be provided
with air exhausted through ducts to the exterior. Air must be exhausted
continually whenever there are soiled linens in the room. A soiled
linen room may be combined with a soiled utility room.
(i) Clean linen storage. Clean linen storage must be
provided, conveniently located to resident bedroom areas.
(1) Nursing facility kitchens will be evaluated on
the basis of their performance in the sanitary and efficient preparation
and serving of meals. 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. Evaluation will be based on the number of meals
(2) Kitchen temperature, at peak load, must not exceed
a temperature of 85 degrees Fahrenheit measured at the five foot level.
The facility must provide sufficient heating to maintain an average
temperature of not less than 70 degrees Fahrenheit in winter, with
exhausts operating, at the five-foot level.
(3) The kitchen must have operational equipment 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.
(4) The kitchen must have facilities for washing and
sanitizing dishes and cooking utensils. These facilities must be adequate
for the number of meals served and the method of serving, such as
use of permanent or disposable dishes. The kitchen must contain a
multi-compartment sink large enough to immerse pots and pans. In all
facilities, a mechanical dishwasher is required for sanitizing dishes.
The facility must maintain separation of soiled and clean dish areas,
including air flow and traffic flow.
(5) The kitchen must have an adequate 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 mechanical dishwashers,
the temperature measurement is at the manifold. Hot water for general
kitchen use must be 140 degrees Fahrenheit.
(6) A kitchen must have at least one hand-washing lavatory
in the food-preparation area. The dish washing area must have ready
access to a hand-washing lavatory or hand sanitizing device. Hand-washing
lavatories must be provided with hot and cold running water, a sanitary
soap dispenser, and paper towel dispenser or hot air dryer.
(7) Nonabsorbent smooth finishes or surfaces must be
used on kitchen floors, walls, and ceilings. These surfaces must be
capable of being routinely sanitized to maintain a healthful environment.
(8) A janitor's closet with service sink must be easily
and readily accessible to the kitchen.
(9) The kitchen exhaust hood at cooking equipment and
its attached automatic chemical extinguisher must comply with NFPA
96. HHSC may waive certain details of NFPA 96 for existing kitchen
exhausts at cooking equipment provided that basic function and safety
are not compromised.
(k) Food storage areas.
(1) Food storage areas must provide for storage of
a seven-day minimum supply of nonperishable staple foods and a two-day
supply of perishable foods at all times.
(2) Shelves and pallets must be moveable wire, metal,
or sealed lumber, and walls must be finished with a nonabsorbent finish
to provide a cleanable surface.
(3) Dry food storage must have a venting system to
provide for reliable positive air circulation.
(4) The maximum room temperature for food storage must
not exceed 85 degrees Fahrenheit. The measurement must be taken at
the five-foot level.
(5) Foods must not be stored on the floor. Dunnage
carts or pallets may be used to elevate foods not stored on shelving.
(6) Sealed containers must be provided for storing
dry foods after the package seal has been broken.
(7) 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.
(l) Auxiliary serving kitchens not contiguous to food
preparation and serving areas.
(1) When service areas other than the kitchen are used
to dispense foods, the facility must designate these service areas
as food service areas and must have equipment for maintaining required
food temperatures while serving.
(2) Separate food service areas must have hand-washing
facilities as a part of the food service area.
(3) Finishes of all surfaces except ceilings must be
the same as those required for dietary kitchens.
(m) Administrative and public areas. Facilities must
have administrative areas for normal business transactions and maintenance
(1) Laundry facilities must be located in areas separate
from resident rooms. The laundry must be designed, constructed, and
equipped and appropriate procedures must be utilized to ensure that
laundry is handled, cleaned, and stored in a sanitary manner.
(2) Laundry for general linen and clothing must be
arranged so as to separate soiled and clean operations as they relate
to traffic, handling, and air currents. Suitable exhaust and ventilation
must be provided to prevent air flow from soiled to clean areas.
(3) Floors, walls, and ceilings must be nonabsorbing
and easily cleanable.
(4) Soiled linen must be stored and transported in
closed or covered containers. Soiled linen storage or holding rooms
must have a negative air pressure in relation to adjacent areas with
air exhausted through ducts to the exterior.
(5) Laundry areas must have air supply and ventilation
to minimize mildew and odors. Doors must not remain open, for sanitation
and safety reasons.
(6) Room size, and number and type of appliances must
provide efficient, sanitary, and timely laundry processing to meet
the needs of the facility.
(7) The laundry, if located in the facility, must meet
NFPA 101 requirements for separation and construction for hazardous
(o) Resident-use laundry. This service, 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.
(p) Personal grooming area. Space and equipment must
be provided for the hair care and grooming needs of the residents.
Hair care and grooming service will be provided in resident bedrooms
or in designated areas which are not in a way of egress.
(q) Storage rooms. General and specific storage areas
must be provided as needed and required for safe and efficient operation
of the facility. Items must not be stored in inappropriate places
such as corridors or rooms which are not equipped for special hazard