The facility must be designed, constructed, equipped, and maintained to protect the health and ensure the safety of residents, personnel, and the public.
  (1) Life safety from fire.
    (A) The facility must meet the applicable provisions of NFPA 101 as designated by the federal law and regulations.
    (B) After consideration of the findings of HHSC, CMS may waive specific provisions of NFPA 101 which, if rigidly applied, would result in unreasonable hardship on the facility, but only if the waiver does not adversely affect the health and safety of residents or personnel.
  (2) Emergency power.
    (A) An emergency electrical power system must supply power adequate at least for lighting all entrances and exits; equipment to maintain the fire detection, alarm, and extinguishing systems; and any systems or equipment whose failure is likely to cause major injury or death to a resident if the normal electrical supply is interrupted.
    (B) When systems or equipment whose failure is likely to cause major injury or death to a resident are used, the facility must provide emergency electrical power with an emergency generator defined in NFPA 99 located on the premises.
  (3) Space and equipment. The facility must:
    (A) provide sufficient space and equipment in dining, health services, recreation, living, and program areas to enable staff to provide residents with needed services as required by these standards and as identified in each resident's assessment and plan of care;
    (B) maintain all essential mechanical, electrical, and patient care equipment in safe operating condition; and
    (C) conduct regular inspections of all bed frames, mattresses, and bed rails, if any, as part of a regular maintenance program to identify areas of possible entrapment. When bed rails and mattresses are used and purchased separately from the bed frame, the facility must ensure that the bed rails, mattress, and bed frame are compatible.
  (4) Resident rooms. Resident rooms must be designed and equipped for adequate nursing care, comfort, and privacy of residents.
    (A) Bedrooms must:
      (i) accommodate no more than four residents for a facility that receives approval of construction or reconstruction plans by state and local authorities or are newly certified before November 28, 2016;
      (ii) accommodate no more than two residents for a facility that receives approval of construction or reconstruction plans by state and local authorities or are newly certified on or after November 28, 2016;
      (iii) measure at least 80 square feet per resident in multiple resident bedrooms and at least 100 square feet in single resident rooms;
      (iv) have direct access to an exit corridor;
      (v) be designed or equipped to ensure full visual privacy for each resident;
      (vi) in facilities initially certified after March 31, 1992, except in private rooms, have ceiling-suspended curtains for each bed, which extend around the bed to provide total visual privacy, in combination with adjacent walls and curtain;
      (vii) have at least one window to the outside; and
      (viii) have a floor at or above grade level.
    (B) The facility must provide each resident with:
      (i) a separate bed of proper size and height for the safety and convenience of the resident;
      (ii) a clean, comfortable mattress;
      (iii) bedding appropriate to the weather and climate; and
      (iv) functional furniture appropriate to the resident's needs and individual private closet space in the resident's bedroom with clothes racks and shelves accessible to the resident.
    (C) HHSC may permit variations in requirements specified in paragraph (1)(A) and (B) of this section relating to rooms in individual cases when the facility demonstrates in writing that the variations:
      (i) are required by the special needs of the residents; and
      (ii) will not adversely affect residents' health and safety.
  (5) Bathroom. Each resident room must be equipped with or located near toilet and bathing facilities. For a facility that receives approval of construction from state and local authorities or are newly certified on or after November 28, 2016, each resident room must have its own bathroom equipped with at least a commode and sink.
  (6) Nurse call system. The facility must be adequately equipped to allow residents to call for staff assistance through a communication system which relays the call directly to a staff member or to a centralized staff work area:
    (A) before November 28, 2019, from each resident’s room;
    (B) beginning November 28, 2019, from each resident’s beside; and
    (C) from toilet and bathing facilities.
  (7) Dining and resident activities. The facility must provide one or more rooms designated for resident dining and activities. These rooms must be:
    (A) well-lighted;
    (B) well ventilated, with nonsmoking areas identified;
    (C) adequately furnished; and
    (D) sufficiently spacious to accommodate all activities.
  (8) Other environmental conditions. The facility must provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public. The facility must:
    (A) establish procedures to ensure that water is available to essential areas when there is a loss of normal water supply;
    (B) have adequate outside ventilation by means of windows, mechanical ventilation, or a combination of the two;
    (C) equip corridors with firmly secured handrails on each side; and
    (D) maintain an effective pest control program so that the facility is free of pests and rodents.
    (E) establish policies, according to applicable federal, state, and local laws and regulations, regarding smoking, smoking areas, and smoking safety that also take into account non-smoking residents.

Source Note: The provisions of this §554.1701 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