(a) The facility must be designed, constructed, equipped, and maintained to protect the health and ensure the safety of residents, personnel, and the public.

(b) If children are admitted to the facility, accommodations, furnishings, and equipment appropriate to children must be provided, including the following;

(1) The facility must provide indoor and outdoor recreation areas designed to encourage exploration within the children's capabilities.

(2) The facility must provide pediatric equipment and supplies in appropriate sizes for the age and development level of the children. Pediatric emergency supplies and equipment must be readily available for use.

(3) The environment must be the least restrictive allowable while remaining within the parameters of safety. All areas of the facility accessible to children must be "child proof" for safety hazards. This type of safety proofing is above the normal level of hazard control maintained for adult residents and includes the addition of safety covers on electrical outlets not in use that are accessible to children.

(4) Pediatric resident's rooms must be decorated and furnished in accordance with the age and developmental level of the children and as an expression of their individual preferences.

(c) HHSC may grant a waiver for certain provisions regarding the physical plant and environment that, in the opinion of HHSC, would be impractical for the facility to meet. In granting the waiver, HHSC must determine that granting the waiver has no adverse effect on resident health and safety and the requirement, if not waived, would impose an unreasonable hardship on the facility. HHSC may require offsetting or equivalent provisions in granting a waiver.

(d) The requirements of this subchapter are applicable to nursing facilities as follows:

(1) All nursing facilities must comply with division 3 of this subchapter (relating to Provisions Applicable to All Facilities).

(2) A nursing facility or a portion of a nursing facility licensed before September 11, 2003, and continually operated as a licensed nursing facility, must comply with division 2 of this subchapter (relating to Facilities Licensed Before September 11, 2003).

(3) A nursing facility or a portion of a nursing facility licensed or constructed, on or after September 11, 2003, but before April 2, 2018, and continuously operated as a licensed nursing facility, must comply with division 5 of this subchapter (relating to Facilities Licensed On or After September 11, 2003 and Before April 2, 2018).

(4) A nursing facility or a portion of a nursing facility licensed or constructed on or after April 2, 2018, must comply with division 9 of this subchapter (relating to Facilities Licensed On or After April 2, 2018).

(5) A small house or household facility is a facility that is designed to provide a non-institutional environment to promote resident-centered care and that meets the requirements of §554.345 of this subchapter (relating to Small House and Household Facilities). New construction of a small house or household facility must meet the requirements of §554.345 of this subchapter.

(e) A facility must comply with NFPA 101; NFPA 99, except Chapters 7, 8, 12, and 13; and a Tentative Interim Amendment (TIA) issued by NFPA, including the TIAs listed in paragraphs (1) and (2) of this subsection. A facility must also comply with other NFPA publications referenced in NFPA 101 or in this chapter, unless otherwise approved by HHSC.

(1) The following TIAs have been issued for NFPA 101: (A) TIA 12-1, issued August 11, 2011; (B) TIA 12-2, issued October 30, 2012; (C) TIA 12-3, issued October 22, 2013; and (D) TIA 12-4, issued October 22, 2013.

(2) The following TIAs have been issued for NFPA 99: (A) TIA 12-2, issued August 11, 2011; (B) TIA 12-3, issued August 9, 2012; (C) TIA 12-4, issued March 7, 2013; (D) TIA 12-5, issued August 1, 2013; (E) TIA 12-6, issued March 3, 2014; (F) TIA 12-7, issued December 1, 2016; and (G) TIA 12-8, issued April 10, 2018.

(f) Building rehabilitation on existing buildings shall be classified in accordance with NFPA 101 and shall comply with NFPA 101 and §554.350 of this subchapter (relating to Building Rehabilitation).

(g) Buildings, or portions of buildings, may be occupied during construction, repair, alterations, or additions only when required means of egress and required fire protection features are in place and continuously maintained for the portion occupied, or when alternative life safety measures acceptable to HHSC are in place.

(h) No existing life safety feature shall be removed or reduced when the feature is a requirement for new construction. Life safety features and equipment that have been installed in existing buildings, if not required by NFPA 101, must continue to be maintained or may be completely removed if prior approval is obtained from HHSC.

(i) The facility must perform a risk assessment in accordance with NFPA 99.

(1) The risk assessment must follow and document the defined risk assessment procedure used.

(2) The results of the assessment procedure must be documented and records retained.

(3) A building system required by NFPA 99 shall be designed to meet the risk categories determined for each system as part of this assessment. At a minimum, any new systems or equipment must be designed to meet the requirements for Category 2 risk, as defined in NFPA 99.

(4) The assessment must be reviewed and a new assessment performed, if necessary, on an annual basis and when the facility identifies changes in resident care needs that cannot be met by the currently installed systems and equipment.

(5) In addition to the requirements of NFPA 99 based on the risk assessment, a facility must also meet all applicable requirements of this subchapter.

(j) A wing or area that is separated from the rest of the facility by locked doors, or a facility that is locked in its entirety, for the purpose of securing residents must meet the requirements of §554.2208(a)(6) and (c)(1) - (10) of this chapter (relating to Standards for Certified Alzheimer's Facilities).

Source Note: The provisions of this §554.300 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; amended to be effective January 2, 2022, 46 TexReg 9037