| (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.
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