SECTION 554.318. Other 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.

(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 of records.

(n) Laundry.

(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 areas.

(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 protection.

(r) Janitor closets. In addition to the janitors' closet called for in certain departments, other janitors' closets must be provided throughout the facility to maintain a clean and sanitary environment. All janitor closets must have a negative air pressure in relation to adjacent areas with air exhausted through ducts to the exterior.

(s) 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 and disposal of waste, not classified as special, by incineration, mechanical destruction, compaction, containerization, removal, or contract with outside resources, or by a combination of these techniques

(t) Maintenance, engineering service, and equipment areas.

(1) The facility must provide storage for building equipment, supplies, tools, parts, and yard maintenance equipment.

(2) Volatile liquids and supplies must not be kept within the main building housing residents.

(3) All equipment requiring periodic maintenance, testing, and servicing must be reasonably accessible. Necessary equipment to conduct these services, such as ladders, specific tools, and keys, must be readily available on site.

(u) Oxygen.

(1) The facility must implement procedures that ensure the safe and sanitary use and storage of oxygen. Such procedures must be in compliance with all applicable NFPA standards, including NFPA 99.

(2) Oxygen cylinders and containers must be in compliance with NFPA 99. Liquid oxygen containers must be certified by UL or another approved testing laboratory for compliance with NFPA 55 requirements. The storage, handling, assembly, and testing must be in compliance with all applicable NFPA standards, including NFPA 99 and NFPA 55 requirements. The facility is responsible for defining all potential hazards both graphically and verbally to all persons involved in the use of liquid oxygen and ensuring that the liquid-oxygen provider does also.

Source Note: The provisions of this §554.318 adopted to be effective July 1, 1996, 21 TexReg 4408; amended to be effective March 22, 2018, 43 TexReg 1646; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871