(a) Large facilities.
  (1) Ancillary resident space. The minimum total ancillary resident-use space must be not less than 35 square feet per resident. Ancillary space includes areas for living, dining, recreation, therapy, training, and other such program areas. It does not include bedrooms, passageways, offices, kitchens, or laundries (more than 35 square feet per resident is usually needed in facilities with less than 60 residents). A facility which has large proportions (approximately 65 percent or greater) of nonambulatory or bedfast residents must provide at least 50 square feet of ancillary space per resident unless otherwise approved by HHSC. An area providing less space than called for in this paragraph cannot be approved except on an individual basis where clearly justified.
  (2) Resident bedrooms.
    (A) A bedroom must be arranged and equipped for adequate personal care and for comfort and privacy. A bedroom must have full height walls that extend from floor to ceiling with doors. (Partial partitions or furnishings are not a substitute.) An exception is that an existing facility constructed prior to October 3, 1988, that has partial partitions in lieu of full-height walls, need not install the full-height walls unless there are major renovations or conversions.
    (B) A bedroom must provide at least 80 square feet for a single occupancy (one resident) and 60 square feet per resident for multiple occupancy. (Note: room configuration and usability are taken into consideration and there may be instances where the minimum square footage will not be acceptable.) The minimum room dimension must be at least eight feet for a single resident room and at least ten feet for a multiple-resident room, unless otherwise approved by HHSC. An exception is that a multi-occupancy bedroom for persons in wheelchairs must have 70 square feet per resident.
    (C) No more than four residents may be in any one bedroom. An exception is HHSC may grant a variance from the limit of four residents per room only if a physician who is a member of the IDT and who is a qualified intellectual disability professional (QIDP):
      (i) certifies that each resident to be placed in a bedroom accommodating more than four residents is so severely medically impaired as to require direct and continuous monitoring during sleeping hours; and
      (ii) documents the reasons why accommodating in a room of only four or fewer residents would not be medically feasible.
    (D) In the bedroom and for each resident there must be a bed with a comfortable mattress and appropriate bedding, functional furniture appropriate to residents' needs, and closet space providing security and privacy for clothing and personal belongings. Closet space must provide at least 24 inches of lineal hanging space per resident (in certain cases, such as for infants, exceptions may be made). Married couples may share a bed.
    (E) Each bedroom must have at least one outside wall with an operable window giving outside exposure. Unless approved otherwise by the HHSC, the window sill of the required window must be no higher than 44 inches from the floor and must be at or above outside grade level. Other window requirements must be as called for in NFPA 101. The window area for a bedroom must be equal to at least 10 percent of the total room floor area.
    (F) If a bedroom is below grade level, it must have a window that is usable as a second means of escape by a resident occupying the room. The window must be no more than 44 inches (measured to the window sill) above the floor.
    (G) A resident bedroom must open onto an exit corridor, living area, or public area and must be arranged for convenient resident access to dining, living, and bathing areas.
  (3) Social-diversional spaces.
    (A) A living room, a day room, a lounge, or other social-diversional space, must be provided on a sliding scale as follows (as part of the minimum required ancillary space):
Attached Graphic
    (B) Where a required way of exit is through a living area, a pathway equal to the corridor width will normally be deducted from that area. Such exit pathways must be kept clear of obstructions.
    (C) Each living room and dining room must have at least one outside window. Normally, a resident classroom and a training area must also have an outside window unless otherwise approved by HHSC.
  (4) Dining space. Dining space must provide at least 15 square feet per resident for single-shift feeding. If procedure is approved for feeding in two shifts, at least eight square feet per resident must be provided.
  (5) Training spaces including academic, behavioral, occupational, physical, and speech therapy spaces. Classroom type space is anticipated for most training activities. The number and size of such spaces will be evaluated on an individual facility basis and according to program policies and procedures. Generally, a training room must provide at least 20 square feet per resident trainee within the room except that no training room may be less than 80 square feet. For purposes of calculation, space must be provided for at least one-third of the total population at any one time (i.e., plan space for 33 residents in a 100-resident facility).
  (6) Kitchens (main/dietary).
    (A) A kitchen must be evaluated based on its performance in the sanitary and efficient preparation and serving of meals to residents. Consideration must 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. Plans for construction of new facilities must contain a detailed kitchen layout prepared by, or under the direction of, a registered or licensed dietitian.
    (B) A kitchen must be designed so that room temperature, at peak load, must not exceed an average temperature of 85 degrees Fahrenheit measured over the room at the five-foot level. The amount of supply air must take into account the large quantities of air exhausted at the range hood and dishwashing area.
    (C) A kitchen must be provided with operational equipment as planned and scheduled by the facility's consultants for preparing and serving meals and for refrigerating and freezing perishable foods, as well as equipment in, or adjacent to, the kitchen or dining area for producing ice.
    (D) A kitchen must be provided with facilities for washing and sanitizing dishes and cooking utensils. Such facilities will be provided for the number of meals served and the method of serving (permanent or disposable dishes, etc.). The kitchen must contain a compartmented sink large enough to immerse pots and pans. Separation of soiled and clean dish areas must be maintained, including air flow.
      (i) A mechanical dishwasher must be used to sanitize dishes and utensils and must meet the requirements specified under 25 TAC Chapter 228; or
      (ii) Dishes and utensils must be manually sanitized in accordance with 25 TAC Chapter 228 prior to placement in the dishwasher.
    (E) A kitchen must be provided with a 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 a mechanical dishwasher, the temperature measurement is at the manifold.
    (F) A kitchen must be provided with at least one hand-washing lavatory or hand-sanitizing device. A hand-washing lavatory must be provided with hot and cold running water, soap, and individual towels, preferably paper towels; common use towels must not be used.
    (G) In new construction, a staff restroom facility with a lavatory must be accessible to kitchen staff without traversing resident use areas. The restroom door must not open directly into the kitchen, e.g., provide a vestibule.
    (H) In new construction, a janitorial facility must be provided exclusively for the kitchen and must be located in and entered from the kitchen.
    (I) Nonabsorbent smooth finishes or surfaces must be used on kitchen floors, walls, and ceilings. Such surfaces must be capable of being sanitized to maintain a healthful environment.
    (J) All operable window openings must be screened. A door opening to the outside of the building must have self-closing devices.
  (7) Food storage areas (main/kitchen).
    (A) In new construction, a food storage area must be planned based on the number and type of resident meals to be served. The size and layout of dry foods storage must be prepared by or designed under the direction of a licensed or registered dietitian.
    (B) Food storage areas must provide for storage of a four-day minimum supply of nonperishable foods at all times.
    (C) Shelves must be movable metal or sealed lumber, and walls must be finished with a nonabsorbent finish to provide a cleanable surface.
    (D) Dry food storage must have an approved venting system to provide for positive air circulation.
Cont'd...