SECTION 506.92. Minimum Spatial Requirements for New Facilities

(a) Administration and public suite.

(1) Entrance. Entrances shall be located at grade level, be accessible to individuals with disabilities, and protected against inclement weather. When an SCF is located on a floor above grade level, elevators shall be accessible and shall meet the requirements of §125.93 of this title (relating to Elevators).

(2) Waiting area. A waiting area or foyer shall be provided which includes having access to the following rooms and items:

(A) public toilet facilities; and

(B) telephone(s) for public use.

(3) General or individual office(s). An office(s) shall be provided for business transactions, records, and administrative and professional staff.

(4) Resident records area. Resident record storage space shall be located within a secure designated area under direct visual supervision of administrative staff.

(b) Dietary suite. In addition to the requirements of §125.32(d) of this title (relating to Resident Care and Services), the facility shall provide the following.

(1) Dining area for ambulatory patients, staff, and visitors. A dining area for ambulatory patients, staff, and visitors with a minimum floor space of 15 square feet per person to be seated shall be provided. The footage requirement does not include serving area. The dining area and service areas shall be separate from the food preparation and distribution area.

(2) Food service for a 50-bed residence or more. The food service for a 50-bed residence or more shall be provided by an on-site food preparation system or an off-site food service system or a combination of the two. The following minimum functional elements shall be provided on-site regardless of the type of dietary services.

(A) Receiving area. A receiving area shall be provided and shall have direct access to the outside for incoming dietary supplies or off-site food preparation service and shall be separate from the general receiving area. The receiving area shall contain a control station and an area for breakout for loading, unloading, uncrating, and weighing supplies. The entrance area to the receiving area shall be covered from the weather.

(B) Storage spaces. Storage spaces shall be convenient to receiving area and food preparation area and shall be located to exclude traffic through the food preparation area. Regardless of the type of food services provided, the facility shall provide storage of food for emergency use for a minimum of four calendar days.

(i) Storage space(s) shall be provided for bulk, refrigerated, and frozen foods.

(ii) A cleaning supply storage room or closet shall be provided to store non-food items that might contaminate edibles. This storage area may be combined with the housekeeping room.

(C) Counter space. Counter space shall be provided for food prep work, equipment, and an area to assemble trays for distribution for patient meals.

(D) Hand washing fixtures. Hand washing fixtures with hands-free operable controls shall be conveniently located at all food preparation area and serving areas.

(E) Cart distribution system. When a cart distribution system is provided, space shall be provided for storage, loading, distribution, receiving, and sanitizing of the food service carts. The cart traffic shall be designed to eliminate any danger of cross-circulation between outgoing food carts and incoming soiled carts, and the cleaning and sanitizing process. Cart circulation shall not be through food processing areas.

(F) Ware washing room. A ware washing room equipped with commercial type dishwasher equipment shall be located separate from the food preparation and serving areas. Space shall be provided for receiving, scraping, sorting, and stacking soiled tableware and for transferring clean tableware to the using areas. Hand washing facilities with hands-free operable controls shall be located within the soiled dish wash area. A physical separation to prevent cross traffic between "dirty side and "clean side" of the dish wash areas shall be provided.

(G) Three-compartmented sink. A three-compartmented sink of adequate size for pot washing shall be provided convenient to the food preparation area. It shall have direct access to the SCF waste collection and disposal facilities.

(H) Food waste storage room. A food waste storage room shall be conveniently located to the food preparation and ware washing areas but not within the food preparation area. It shall have direct access to the SCF waste collection and disposal facilities.

(I) Storage areas and sanitizing facilities. Storage areas and sanitizing facilities for garbage or refuse cans, carts, and mobile tray conveyors shall be provided. All containers for trash storage shall have tight-fitting lids.

(J) Housekeeping room. A housekeeping room shall be provided for the exclusive use of the dietary department. Where hot water or steam is used for general cleaning, additional space within the room shall be provided for the storage of hoses and nozzles.

(K) Dietary office. An office shall be provided for the use of the food service manager or the dietary service manager. In smaller facilities, a designated alcove may be located in an area that is part of the food preparation area.

(L) Toilet room. A toilet room shall be provided for the exclusive use of the dietary staff. Toilets shall not open directly into the food preparation areas, but must be in a close proximity to them. For larger facilities, a locker room or space for lockers shall be provided for staff belongings.

(M) Additional service areas, rooms and facilities. When an on-site food preparation system is used, in addition to the items required in subparagraphs (A) - (L) of this paragraph, the following service areas, rooms, and facilities shall be provided.

(i) When food preparation systems are provided, there shall be space and equipment for preparing, cooking, and baking.

(ii) A patient tray assembly and distribution area shall be located within close proximity to the food preparation and distribution areas.

(iii) When food is prepared on-site, the storage room shall be adequate to accommodate food for a seven-calendar day menu cycle.

(iv) An additional room(s) shall be provided for the storage of clean cooking wares, extra trays, flatware, plastic and paper products, and portable equipment.

(v) Provisions shall be made for drying and storage of pots and pans from the pot washing room or area.

(N) Details.

(i) Food storage shelves shall not be less than four inches above the finished floor and the space below the bottom shelf shall be closed in and sealed tight for ease of cleaning.

(ii) Operable windows and doors not equipped with automatic closing devices shall be equipped with insect screens.

(iii) Food processing areas in the central dietary kitchen shall have ceilings height not less than nine feet. In a facility classified as a RBCF, ceiling height shall not be less then eight feet. Ceiling mounted equipment shall be supported from rigid structures located above the finished ceilings.

(iv) Mirrors shall not be installed at hand washing fixtures in the food preparation areas.

(O) Finishes.

(i) Floors in areas used for food preparations, food assembly, and soiled and clean ware cleaning shall be water-resistance and greaseproof. Floor surfaces, including tile joints, shall be resistant to food acids.

(ii) Wall bases in food preparation, food assembly, soiled and clean ware cleaning and other areas which are frequently subject to wet cleaning methods shall be made integral and coved with the floor, tightly sealed to the wall, constructed without voids that can harbor insects, retain dirt particles, and be impervious to water.

(iii) In the dietary and food preparation areas, the wall construction, finishes, and trims, including the joints between the wall and the floor, shall be free of voids, cracks, and crevices.

(iv) The ceiling in food preparation and food assembly areas shall be washable. Smooth moisture impervious materials such as painted lay-in gypsum wallboard or vinyl faced acoustic tile in a metal grid.

(v) The ceiling in the soiled and clean ware cleaning area shall be monolithic from wall to wall (painted solid gypsum wallboard), smooth and without fissures, open joints, or crevices and with a washable and moisture impervious finish.

(c) Laboratory suite. When a laboratory is located on-site the following minimum items shall be provided:

(1) a room with work counter, utility sink, and storage cabinets or closet(s); and

(2) specimen collection facilities. For dip stick urinalysis, urine collection rooms shall be equipped with water closet and lavatory. Blood collection facilities shall have space for a chair, work counter and hand washing facilities.

(d) Laundry and linen storage and processing suite. Clean linen shall be available in a quantity sufficient to meet the needs of the residents. Clean linens shall be stored in clean linen storage areas.

(1) The SCF shall provide an area or room with a washer and dryer for resident use.

(2) In a facility classified as a large RBCF or a LCF, soiled and clean processing operations shall be separated and arranged to provide a one-way traffic pattern from soiled to clean areas. The following rooms and items shall be provided:

(A) a soiled linen processing room which includes areas for receiving, holding, sorting, and washing;

(B) a clean linen processing room which includes areas for drying, sorting, folding, and holding prior to distribution;

(C) supply storage cabinets in the soiled and clean linen processing rooms;

(D) hand washing facilities within the soiled linen processing room; and

(e) Medication room. The medication room shall be in compliance with the spatial and security requirements under §125.32(c)(7)(D) of this title.

(f) Resident bedroom suite.

(1) Bedrooms shall be arranged and equipped for adequate delivery of services and for comfort and privacy.

(2) Useable bedroom clear floor space shall be not less than 80 square feet for a one-bed room and not less than 60 square feet (40 square feet where bassinets or cribs are used) per bed for a multiple-bed room. Larger rooms are recommended for those residents needing nursing care. A bedroom shall be not less than eight feet in the smallest dimension.

(3) No more than four beds shall be in any bedroom.

(4) In the bedrooms and for each resident there shall be a bed, chair, table, dresser, and closet space or wardrobe providing security and privacy for clothing and personal belongings.

(5) Each resident bedroom shall have at least one operable outside window that can be readily opened from the inside without the use of tools. The height of the windowsill shall not exceed 36 inches from the floor. Operable window sections may be restricted for security or safety reasons, but the required one operable section shall not be restricted to less than six inches. Each window shall be provided with a flame-retardant shade, curtain, or blind.

(6) All resident rooms shall open upon an egress corridor leading to an exterior exit either by stairway or a door opening to the exterior.

(7) All resident rooms shall be arranged for convenient and sheltered resident access to living or public areas, restrooms, and dining facilities.

(g) Resident toilet and bathing facilities.

(1) If the SCF houses both male and female residents, all bedrooms shall have separate private, connecting, or general toilet rooms for each sex. The general toilet room or bathing room shall be accessible from a corridor or public space. A lavatory shall be readily accessible to each water closet. The facility shall provide at least one full bath on each resident sleeping floor.

(2) One water closet and one lavatory shall be provided for each four residents or fraction thereof. One tub or one shower shall be provided for each six residents or fraction thereof.

(3) Privacy partitions and shields shall be provided at water closets and bathing units in rooms for multi-resident use.

(4) A public or staff toilet, commode and lavatory, complying with accessibility standards, is required for every facility up to and including 50 beds. Facilities over 50 beds must have separate public toilets and staff toilets (this is in addition to the staff toilet(s) required for the dietary staff).

(5) All bathrooms, toilet rooms, and other odor-producing rooms shall be ventilated with operable windows or powered exhaust to the exterior for order control.

(6) Soap and towel dispensers shall be provided at all hand washing facilities.

(h) Recreation, living, or day room.

(1) Recreation, living, or day room space and furniture shall be provided to allow seating of residents. Each facility shall have at least one space of not less than 144 square feet. A facility with a capacity of nine or more residents shall provide a space of 10 square feet more per resident in addition to the 144 square feet minimum.

(2) At least one of the recreation, living, or day room areas shall have exterior windows providing a view to the outside.

(i) Additional service areas.

(1) Janitor's closet. A sufficient number of janitor closets shall be provided throughout the facility to maintain a clean and sanitary environment. The closet shall contain a floor receptor or service sink and storage space for housekeeping supplies and equipment.

(2) Storage room. A resident storage room shall be a minimum of 50 square feet per six resident beds or fraction thereof.

(3) Medical gas storage room. When provided or required by National Fire Protection Association 101, (NFPA 101), Code for Safety to Life from Fire in Buildings and Structures, 2000 edition, a medical gas storage room shall comply with the requirements of NFPA 99, Chapter 4-4, Gas and Vacuum Systems. All documents published by the ASME/ANSI as referenced in this section may be obtained by writing the ANSI, 25 West 43rd Street, New York, N.Y. 10036. All documents published by NFPA as referenced in these rules may be obtained by writing or calling the NFPA, 1 Batterymarch Park, Quincy, MA 02169-7471, or [phone].

(4) Area for emergency crash cart, if provided. An area or alcove located out of traffic and conveniently located near medication room or similar staff control room shall be provided for an emergency crash cart.

(5) Medical waste processing. Space and facilities shall be provided for the safe storage and disposal of waste as appropriate for the material being handled and in compliance with all applicable rules and regulations.

Source Note: The provisions of this §506.92 adopted to be effective July 25, 2004, 29 TexReg 6911; transferred effective June 1, 2019, as published in the Texas Register May 17, 2019, 44 TexReg 2467