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RULE §554.318Other Rooms and Areas

(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 auxiliary station.

  (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’ station.

(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 area.

    (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 mirror.

    (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.

(j) Kitchens.

  (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 served.

  (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.


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