PROPOSED RULES Before an agency may permanently adopt a new or amended section or repeal an existing section, a proposal detailing the action must be published in the Texas Register at least 30 days before action is taken. The 30-day time period gives interested persons an opportunity to review and make oral or written comments on the section. Also, in the case of substantive action, a public hearing must be granted if requested by at least 25 persons, a governmental subdivision or agency, or an association having at least 25 members. Symbology in proposed amendments. New language added to an existing section is indicated by the use of bold text. [Brackets] indicate deletion of existing material within a section. TITLE 16. ECONOMIC REGULATION Part VI. Texas Motor Vehicle Commission Chapter 101. Practice and Procedure 16 TAC sec.101.63 The Motor Vehicle Board of the Texas Department of Transportation proposes an amendment to sec.101.63, concerning filing of documents for consideration by board members. The amendments require an original and six copies of any document submitted for board consideration be filed with the Motor Vehicle Division 17 days prior to the meeting. Brett Bray, Director, Motor Vehicle Division, has determined that for the first five-year period the sections are in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the sections. There will be no significant impact on local economies or overall employment as a result of enforcing or administering the sections. Mr. Bray also has determined that for each year of the first five years the amendments are in effect the public benefit anticipated as a result of enforcing the section will be the more effective scheduling and decision making in contested cases by the Board. Comments on the proposed rules (ten copies) may be submitted to Brett Bray, Director, Motor Vehicle Division, P.O. Box 2293, Austin, Texas 78768. The Texas Motor Vehicle Board will conduct a public hearing to consider the proposed rules at its meeting on March 7, 1996. The deadline for receipt of comments on the proposed new sections will be 5:00 p.m., on February 21, 1996. The amendment is proposed under the Texas Motor Vehicle Commission Code, sec.3.06, which provides the Board with authority to adopt rules necessary and convenient to effectuate the provisions of the Act. sec.101.63. Filing of Documents for Consideration by Commission Members. Any document filed in a
    [by a party to a] contested case for consideration by the members of the commission in their decision of the case must be filed with the commission at least 17
      [15] days prior to the date of the commission meeting at which the case is scheduled for consideration and decision. Any document not filed within such time will not be considered by the members of the commission at that meeting. No contested case will be scheduled for consideration and decision so as to preclude any party from filing any document required or permitted to be filed in a contested case by law or under the commission's rules, in compliance with the previous filing requirement. For good cause shown, the commission may waive or shorten the time
        requirement for [the] filing of a document
          [all documents] prior to any commission meeting. Any document filed for consideration by the members of the commission must include six copies along with the original. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601525 Brett Bray Director, Motor Vehicle Division Texas Motor Vehicle Commission Proposed date of adoption: April 11, 1996 For further information, please call: (512) 505-5102 TITLE 22. EXAMINING BOARDS Part XIV. Texas Optometry Board Chapter 275. Continuing Education 22 TAC sec.275.1, sec.275.2 The Texas Optometry Board proposes amendments to sec.275.1 and sec.275.2, to inform licensees and sponsors of continuing education of the procedures to be followed in submitting proof of hours to the Board Office, and to remove the requirement of optometric sponsorship for individual providers of continuing education. Lois Ewald, executive director of the Texas Optometry Board, has determined that for the first five-year period the rules are in effect there will be no fiscal implications for state and local governments as a result of enforcing or administering the rules. Ms. Ewald also has determined that for each of the first five years the rules are in effect the public benefit anticipated as a result of enforcing the rules is that licensees will be able to obtain ongoing education from a number of sources enabling each to maintain a license to practice optometry and enhance their practice techniques. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the rules as proposed. Comments on the proposal may be submitted to Lois Ewald, Executive Director, Texas Optometry Board, 333 Guadalupe Street, Suite 2-420, Austin, Texas 78701- 3942. The deadline for furnishing comments is March 15, 1996. The amendments are proposed under the Texas Optometry Act, Texas Civil Statutes, Article 4552, sec.2.14 and sec.4.01B, which provides the Texas Optometry Act with the authority to promulgate rules. The Texas Optometry Board interprets sec.2.14 as authorizing it to adopt procedural and substantive rules for the regulation of the optometric profession. The Board interprets sec.4.01B as authorizing it to interpret the continuing education requirements established by the Act. sec.275.1. General Requirements. (a) The Act requires each optometrist licensed in this state to take 16 hours of continuing education per calendar year with at least six hours in the diagnosis or treatment of ocular disease.
            The calendar year is considered to begin January 1 and run through December 31. (b) The board accepts for continuing education credit all courses sponsored by any board-accredited college or schools of optometry and such other programs or courses of other organizations as are approved by the board upon recommendation from the Continuing Education Committee, appointed by the Board Chair. The Continuing Education Committee will consider, among other things in its discretion, the following criteria in approving courses: (1)-(2) (No change.) (3) courses meeting evaluation standards and receiving approval of [the American Optometric Association Commission on Continuing Optometric Education or]the International Association of Boards of Examiners in Optometry will be granted automatic approval; (4)-(6) (No change.) [(7) courses sponsored by or given by a contact lens or optical manufacturer or by a commercial concern may be given approval provided that a synopsis of the courses and names and results of the lecturers be provided to the board for approval in sufficient time to receive approval 90 days in advance of the scheduled date of the courses;] (7)
              [(8)] courses sponsored by individual providers may be approved but must supply the committee with a synopsis of the lecture material to be presented, as well as resumes of the lecturers.
                [Individual continuing education providers seeking approval of courses must be sponsored by an optometric group and must supply the committee with a synopsis of the lecture material to be presented, as well as a resume.] (c)-(e) (No change.) (f) Written proof of attendance and completion of approved courses must be supplied by the licensed optometrist to the board in conjunction with the renewal application for an optometry license. If the licensed optometrist is practicing in Texas, the licensee should submit the original proof of attendance or the approved sponsors of continuing education may submit to the board written proof of attendance and completion of approved courses on behalf of the licensed optometrist. Information such as the following will be required: sponsoring organizations; location and dates; course names; instructors; names of attendee; number of education hours completed; and any other information deemed necessary by the board. Proof of attendance supplied by the sponsor should contain at least one signature of the sponsor's designee.
                  [Forms must be properly signed by the education chairman or an education session assistant verifying attendance at the particular course. Applicable forms will be available from the Texas Optometry Board office.] sec.275.2. Required Education. (a)-(f) (No change.) (g) Diagnostic or therapeutic are required
                    education courses. [Beginning January 1, 1993, a minimum of six hours of the mandatory sixteen hours will be required per calendar year in diagnostic or therapeutic continuing education.] This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 31, 1996. TRD-9601396 Lois Ewald Executive Director Texas Optometry Board Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 305-8500 Chapter 277. Practice and Procedure 22 TAC sec.277.1 The Texas Optometry Board proposes an amendment to sec.277.1, to inform the licensees that a biomicroscopy examination described by the Texas Optometry Act, Texas Civil Statutes, Article 4552, sec.5.12, requires the use of a slit lamp. Lois Ewald, executive director of the Texas Optometry Board, has determined that for the first five-year period the rule is in effect there will be no fiscal implications for state and local governments as a result of enforcing or administering the rule. Ms. Ewald also has determined that for each of the first five years the rule is in effect the public benefit anticipated as a result of enforcing the rule will be to obtain quality eye examinations established as a basic competency requirement of optometrists. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the rule as proposed. Comments on the proposal may be submitted to Lois Ewald, Executive Director, Texas Optometry Board, 333 Guadalupe Street, Suite 2-420, Austin, Texas 78701- 3942. The deadline for furnishing comments is March 15, 1996. The amendment is proposed under Texas Civil Statutes, Article 4552, sec.2.14 and sec.5.12, which provide the Texas Optometry Board with the authority to promulgate rules. The Texas Optometry Board interprets sec.2.14 as authorizing it to adopt procedural and substantive rules for the regulation of the optometric profession. The Board interprets sec.5.12 as authorizing it to determine that a biomicroscopy examination requires the use of a slit lamp. sec.277.1. Complaint Procedures. (a)-(b) (No change.) (c) Investigation-Enforcement Committee. (1)-(3) (No cChange.) (4) Basic Competence Violations. (A) The omission of a single, essential finding shall be reason for an investigational hearing or informal conference. The following findings are essential in the initial examination of a patient: (i) Biomicroscopy slit lamp
                      examination (lids, cornea, sclera, etc.); (ii)-(iv) (No change.) (B)-(D) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 31, 1996. TRD-9601393 Lois Ewald Executive Director Texas Optometry Board Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 305-8500 Chapter 279. Interpretations 22 TAC sec.279.5 The Texas Optometry Board proposes an amendment to sec.279.5, to inform the licensees that a biomicroscopy examination described by the Texas Optometry Act, Texas Civil Statutes, Article 4552, sec.5.12, requires the use a slit lamp. Lois Ewald, executive director of the Texas Optometry Board, has determined that for the first five-year period the rule is in effect there will be no fiscal implications for state and local governments as a result of enforcing or administering the rule. Ms. Ewald also has determined that for each of the first five years the rule is in effect the public benefit anticipated as a result of enforcing the rule will be to obtain quality eye examinations established as a basic competency requirement of optometrists. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the rule as proposed. Comments on the proposal may be submitted to Lois Ewald, Executive Director, Texas Optometry Board, 333 Guadalupe Street, Suite 2-420, Austin, Texas 78701- 3942. The deadline for furnishing comments is March 15, 1996. The amendment is proposed under Texas Civil Statutes, Article 4552, sec.2.14 and sec.5.12, which provide the Texas Optometry Board with the authority to promulgate rules. The Texas Optometry Board interprets sec.2.14 as authorizing it to adopt procedural and substantive rules for the regulation of the optometric profession. The Board interprets sec.5.12 as authorizing it to determine that a biomicroscopy examination requires the use of a slit lamp. sec.279.5. Board Interpretation Number Five. (a)-(d) (No change.) (e) The optometrist or therapeutic optometrist shall, in the initial examination of the patient, make and record, if possible, the following findings of the condition of the patient, but not necessarily limited to the following findings: (1) biomicroscopy slit lamp
                        examination (lids, cornea, sclera, etc.) (2)-(6) (No change.) (f) (No change) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 31, 1996. TRD-9601394 Lois Ewald Executive Director Texas Optometry Board Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 305-8500 22 TAC sec.279.7 The Texas Optometry Board proposes an amendment to sec.279.7, to inform the licensees that a biomicroscopy examination described by the Texas Optometry Act, Texas Civil Statutes, Article 4552, sec.5.12, requires the use of a slit lamp. Lois Ewald, executive director of the Texas Optometry Board has determined that for the first five-year period the rule is in effect there will be no fiscal implications for state and local governments as a result of enforcing or administering the rule. Ms. Ewald also has determined that for each of the first five years the rule is in effect the public benefit anticipated as a result of enforcing the rule will be to obtain quality eye examinations established as a basic competency requirement of optometrists. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the rule as proposed. Comments on the proposal may be submitted to Lois Ewald, Executive Director, Texas Optometry Board, 333 Guadalupe Street, Suite 2-420, Austin, Texas 78701- 3942. The deadline for furnishing comments is March 15, 1996. The amendment is proposed under Texas Civil Statutes, Article 4552, sec.2.14 and sec.5.12, which provide the Texas Optometry Board with the authority to promulgate rules. The Texas Optometry Board interprets sec.2.14 as authorizing it to adopt procedural and substantive rules for the regulation of the optometric profession. The Board interprets sec.5.12 as authorizing it to determine that a biomicroscopy examination requires the use of a slit lamp. sec.279.7. Board Interpretation Number Seven. (a) In order to insure an adequate examination of a patient for whom an optometrist or therapeutic optometrist prescribes contact lenses, in the initial examination of the patient, the optometrist or therapeutic optometrist shall make and record, if possible, the following findings of the condition of the patient: (1)-(2) (No change) (3) biomicroscopy slit lamp
                          examination (lids, cornea, sclerla, etc.); (4)-(10) (No change.) (b)-(f) (No change) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 31, 1996. TRD-9601395 Lois Ewald Executive Director Texas Optometry Board Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 305-8500 Part XX. Texas Board of Private Investigators and Private Security Agencies Chapter 435. Training Programs 22 TAC sec.435.3 The Texas Board of Private Investigators and Private Security Agencies proposes an amendment to sec.435.3, concerning Certificate of Completion. This amendment clearly defines the requirements for certificates of completion for Level One, Two, and Three training courses which are required for various members of the private security and private investigation industry. The Board has determined that this amendment is necessary in order to ensure that sufficient training records are kept on all private security and private investigation registrants. Clema D. Sanders, executive director, has determined that for the first five- year period the section is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the section. Ms. Sanders also has determined that for each year of the first five years the section is in effect the public benefit anticipated as a result of enforcing the section will be to ensure that all registrants in the private security and private investigation industry have received adequate training. There will be minimal effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the section as proposed. Comments on the proposal may be submitted to Clema D. Sanders, Texas Board of Private Investigators and Private Security Agencies, P.O. Box 13509, Austin, Texas 78711. The amendment is proposed under Texas Civil Statutes, Article 4413(29bb), sec.11(a)(3), which provide the Texas Board of Private Investigators and Private Security Agencies with the authority "to promulgate all rules and regulations necessary in carrying out the provisions of this Act." The following is the statute that is affected by this amendment: Texas Civil Statutes, Article 4413(29bb). sec.435.3. Certificate of Completion. (a) There shall be four
                            [two] separate certificates of completion[, one] for the [basic firearm] training course , one for each level of training,
                              and one for the firearm requalification course. (b) All
                                [Both] certificates of completion shall contain the: (1)-(5) (No change.) (c) The basic course certificate shall contain both the dates of final completion of the entire course and the specific date of firearm qualification on Level Three certificates
                                  . (d) The Level One
                                    course certificate shall contain the words "has successfully completed the Level One
                                      [basic security officer] training course approved by the Texas Board of Private Investigators and Private Security Agencies". (e) The Level Two course certificate shall contain the words "has successfully completed the Level Two training course approved by the Texas Board of Private Investigators and Private Security Agencies". (f) The Level Three course certificate shall contain the words "has successfully completed the Level Three training course approved by the Texas Board of Private Investigators and Private Security Agencies". (g)
                                        [(e)] The firearm requalification certificate shall contain the words "has successfully completed the firearms requalification training course approved by the Texas Board of Private Investigators and Private Security Agencies". This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 30, 1996. TRD-9601381 Clema D. Sanders Executive Director Texas Board of Private Investigators and Private Security Agencies Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 463-5545 Chapter 447. Advertisements 22 TAC sec.447.1 The Texas Board of Private Investigators and Private Security Agencies proposes an amendment to sec.447.1, concerning Address Shown in Advertisements. This amendment will allow licensees the option of using their mailing address in advertisements. The Board has determined that this amendment is necessary because many licensees use their homes as their principal place of business. Requiring these licensees to use their home address in advertisements could place them and their families in jeopardy. Clema D. Sanders has determined that for the first five-year period the section is in effect there will be no fiscal implications for state and local government as a result of enforcing or administering the section. Ms. Sanders also has determined that for each year of the first five years the section is in effect the public benefit anticipated as a result of enforcing the section will be to help ensure the safety of licensees and their families while still providing an address where consumers can contact them. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the section as proposed. Comments on the proposal may be submitted to Clema D. Sanders, Texas Board of Private Investigators and Private Security Agencies, P.O. Box 13509, Austin, Texas 78711. The amendment is proposed under Texas Government Code, Article 4413(29bb), sec.11(a)(3), which provides the Texas Board of Private Investigators and Private Security Agencies with the authority "to promulgate all rules and regulations necessary in carrying out the provisions of this Act." The following is the statute that is affected by this amendment: Texas Civil Statutes, Article 4413(29bb). sec.447.1. Address Shown in Advertisements. The address shown in advertisements shall be the principal place of business, mailing address
                                          or a licensee's branch office. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 30, 1996. TRD-9601380 Clema D. Sanders Executive Director Texas Board of Private Investigators and Private Security Agencies Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 463-5545 Part XXII. Texas State Board of Public Accountancy Chapter 501. Professional Conduct Client Records 22 TAC sec.501.32 The Texas State Board of Public Accountancy proposes an amendment to sec.501.32, concerning Records. The proposed amendment recognizes that computer format information may be client records. William Treacy, executive director, has determined that for the first five-year period the section is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the section. Mr. Treacy also has determined that for each year of the first five years the section is in effect the public benefit anticipated as a result of enforcing the section will be a clear understanding that computer records may be client records. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the section as proposed. Comments on the proposal may be submitted to J. Randel (Jerry) Hill, General Counsel, 333 Guadalupe, Tower III, Suite 900, Austin, Texas 78701-3900. The amendment is proposed under Texas Civil Statutes, Article 41a-1, sec.6, which provide the Texas State Board of Public Accountancy with the authority to make such rules as may be necessary or advisable to carry in effect the purposes of the law. The amendment implements Texas Civil Statutes, Article 41a-1, sec.6. sec.501.32. Records. (a) Upon request, regardless of the status of the client or former client's account, a certificate or registration holder shall provide to the client or former client any accounting or other records, whether in the form of hard copy or computer readable format,
                                            belonging to, or obtained from or on behalf of, the client that
                                              [which] the certificate or registration holder removed from the client's premises or received on behalf of the client. The
                                                [, but the] certificate or registration holder may make and retain copies of such records
                                                  [documents] when they form the basis of
                                                    [for] work done by him. For a reasonable charge, a certificate or registration holder shall furnish to his client or former client, upon request made within a reasonable time after original issuance of the document in question: (1)-(3) (No change.) (b)-(c) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 18, 1996. TRD-9601506 William Treacy Executive Director Texas State Board of Public Accountancy Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 505-5566 22 TAC sec.501.33 The Texas State Board of Public Accountancy proposes an amendment to sec.501.33, concerning Working Papers. The proposed amendment recognizes that computer format information may also be working papers. William Treacy, executive director, has determined that for the first five-year period the section is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the section. Mr. Treacy also has determined that for each year of the first five years the section is in effect the public benefit anticipated as a result of enforcing the section will be a clear understanding that computer records may be client records. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the section as proposed. Comments on the proposal may be submitted to J. Randel (Jerry) Hill, General Counsel, 333 Guadalupe, Tower III, Suite 900, Austin, Texas 78701-3900. The amendment is proposed under Texas Civil Statutes, Article 41a-1, sec.6, which provide the Texas State Board of Public Accountancy with the authority to make such rules as may be necessary or advisable to carry in effect the purposes of the law. The amendment implements Texas Civil Statutes, Article 41a-1, sec.6. sec.501.33. Working Papers. (a) (No change.) (b) Working papers, whether in the form of hard copy or computer readable format,
                                                      are those papers developed by the certificate or registration holder incident to the performance of his/her engagement which do not result in changes to the client's records or are not in themselves part of the records ordinarily maintained by the client. (c)-(f) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 18, 1996. TRD-9601505 William Treacy Executive Director Texas State Board of Public Accountancy Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 505-5566 Other Responsibilities and Practices 22 TAC sec.501.41 The Texas State Board of Public Accountancy proposes an amendment to sec.501.41, concerning Discreditable Acts. The proposed amendment forbids a certificate holder in industry practice from disclosing information to a new employer which a previous employer has not authorized the employee to disclose. William Treacy, executive director, has determined that for the first five-year period the section is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the section. Mr. Treacy also has determined that for each year of the first five years the section is in effect the public benefit anticipated as a result of enforcing the section will be a clearer description of an act considered discreditable by the Board. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the section as proposed. Comments on the proposal may be submitted to J. Randel (Jerry) Hill, General Counsel, 333 Guadalupe, Tower III, Suite 900, Austin, Texas 78701-3900. The amendment is proposed under Texas Civil Statutes, Article 41a-1, sec.6, which provide the Texas State Board of Public Accountancy with the authority to make such rules as may be necessary or advisable to carry in effect the purposes of the law. The amendment implements Texas Civil Statutes, Article 41a-1, sec.6. sec.501.41. Discreditable Acts. (1)-(15) (No change.) (16) public allegations of a lack of mental capacity of a client which can not be supported in fact; [and] (17) causing a breach in the security of the CPA examination ; and
                                                        [.] (18) voluntarily disclosing information communicated to the certificate holder by an employer, past or present, or through the certificate holder's employment in connection with accounting services rendered to the employer, except: (A) by permission of the employer; (B) pursuant to the Government Code, Chapter 554 (commonly referred to as the "Whistle Blowers Act"); (C) in a court proceeding; (D) in an investigation or proceeding by the board under the Public Accountancy Act; or (E) in an ethical investigation conducted by a professional organization of certified public accountants. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 18, 1996. TRD-9601504 William Treacy Executive Director Texas State Board of Public Accountancy Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 505-5566 Chapter 511. Certification as CPA Experience Requirements 22 TAC sec.511.124 The Texas State Board of Public Accountancy proposes an amendment to sec.511.124, concerning Acceptable Supervision. The proposed amendment eases one current restriction and allows supervision from someone not physically located in the office of the applicant. William Treacy, executive director, has determined that for the first five-year period the section is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the section. Mr. Treacy also has determined that for each year of the first five years the section is in effect the public benefit anticipated as a result of enforcing the section will be the easing of some current restrictions and allowing for methods of supervision other than from someone physically located in the office of the applicant. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the section as proposed. Comments on the proposal may be submitted to J. Randel (Jerry) Hill, General Counsel, 333 Guadalupe, Tower III, Suite 900, Austin, Texas 78701-3900. The amendment is proposed under Texas Civil Statutes, Article 41a-1, sec.6, which provide the Texas State Board of Public Accountancy with the authority to make such rules as may be necessary or advisable to carry in effect the purposes of the law; and sec.12, which requires applicants to satisfy experience requirements. The amendment implements Texas Civil Statutes, Article 41a-1, sec.6 and sec.12. sec.511.124. Acceptable Supervision. (a) Acceptable supervision must be performed by an individual holding an active license or permit in this state or another state. (1) Supervision is provided whenever the person being supervised reports to, is instructed by, is reviewed by, and is evaluated directly by the supervisor
                                                          . The supervisor in this capacity may [not be an outside auditor, but may] be in an intermediate level of supervision above the applicant or may be a CPA in any registered accounting firm if the following conditions are met: (A) the CPA firm is engaged to provide supervision, review, and evaluation of work; and (B) the supervision, review, and evaluation of work is performed on a routine and recurring basis to permit the CPA firm or other supervisor to provide documentation of work experience. [(2) Supervision is not diminished by short absences from the work site by the licensee/supervisor. For example, absences for meal time, coffee breaks, continuing education programs, vacations, and short-term illness are acceptable.] (2)
                                                            [(3)] Telecommunications equipment and computers may be used to facilitate
                                                              [enhance] supervision[; however, these devices may not be used in lieu of supervision on a full-time basis.] The board requires detailed documentation if such
                                                                devices are used to facilitate
                                                                  [enhance] supervision. (b) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 18, 1996. TRD-9601503 William Treacy Executive Director Texas State Board of Public Accountancy Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 505-5566 Chapter 523. Continuing Professional Education Continuing Professional Education Standards 22 TAC sec.523.32 The Texas State Board of Public Accountancy proposes an amendment to sec.523.32, concerning Ethics Course. The proposed amendment states what the board expects of ethics courses and ethics instructors. William Treacy, executive director, has determined that for the first five-year period the section is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the section. Mr. Treacy also has determined that for each year of the first five years the section is in effect the public benefit anticipated as a result of enforcing the section will be more focused and pertinent ethics courses for CPAs. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the section as proposed. Comments on the proposal may be submitted to J. Randel (Jerry) Hill, General Counsel, 333 Guadalupe, Tower III, Suite 900, Austin, Texas 78701-3900. The amendment is proposed under Texas Civil Statutes, Article 41a-1, sec.6, which provide the Texas State Board of Public Accountancy with the authority to make such rules as may be necessary or advisable to carry in effect the purposes of the law; and sec.15A, which requires licensees to complete continuing professional education. The amendment implements Texas Civil Statutes, Article 41a-1, sec.6 and sec.15A. sec.523.32. Ethics Course. (a) General. Each
                                                                    [Effective January 1, 1995, each] certificate or registration holder, unless granted retired or permanent disability status or other exemption, is required every three years to successfully complete a four- hour course of comprehensive study on the Rules of Professional Conduct of the board, offered through a board-registered provider of continuing professional education. [Before a provider of continuing professional education can offer this course, the contents of the course must be submitted to the continuing professional education committee of the board for prior approval. The court must be claimed as a non-technical course when reporting continuing professional education hours.] (b) Course content and board approval. Before a provider of continuing professional education can offer this course, the content of the course must be submitted to the continuing professional education committee of the board for prior approval. Course content shall be approved only after demonstrating, either in a live instructor format or in a self-study format, that the course contains the underlying intent established in the following criteria. (1) The course shall encourage the certificate or registration holder to educate himself or herself in the ethics of the profession, specifically the Rules of Professional Conduct of the board. (2) The course shall convey the intent of the board's Rules of Professional Conduct in the certificate or registration holder's performance of professional services, and not mere technical compliance. A certificate or registration holder is expected to apply ethical judgment in interpreting the rules and determining the public interest. The public interest should be placed ahead of self interest, even if it means a loss of job or client. (3) The primary objectives of a continuing professional education ethics course shall be to: (A) emphasize the ethical standards of the profession, as described in this section; and (B) review and discuss the board's Rules of Professional Conduct and their implications for certificate or registration holders in a variety of practices, including: (i) a certificate or registration holder engaged in the client practice of public accountancy who performs attest and non-attest services, as defined in sec.501.2 of this title (relating to Definitions); (ii) a certificate or registration holder employed in industry who provides internal accounting and auditing services; and (iii) a certificate or registration holder working in education or in government accounting or auditing. (4) An ethics course shall meet the requirements of the board's continuing professional education rules as described in Chapter 523 of this chapter (relating to Continuing Professional Education). Effective June 1, 1996, prior to offering and scheduling an ethics course, a sponsor shall: (A) insure that the instructor has completed the board's ethics training program at least every three years or as required by the board; (B) insure that the instructor's professional license has never been suspended or revoked for violation of the Rules of Professional Conduct; and (C) provide its advertising materials to the board's CPE Committee for approval. Such advertisements shall: (i) avoid commercial exploitation; (ii) identify the primary focus of the course; and (iii) be professionally presented and consistent with the intent of sec.501.43 of this title (relating to Advertising). (c) Evaluation. At the conclusion of each course, the sponsor shall administer testing procedures to determine whether the program participants have obtained a basic understanding of the course content, including the need for a high level of ethical standards in the accounting profession. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 18, 1996. TRD-9601493 William Treacy Executive Director Texas State Board of Public Accountancy Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 505-5566 Chapter 527. Quality Review 22 TAC sec.527.9 The Texas State Board of Public Accountancy proposes new s527.9, concerning Procedures for a Sponsoring Organization. The proposed section states what the board expects of its quality reviews and quality reviewers. William Treacy, executive director, has determined that for the first five-year period the section is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the section. Mr. Treacy also has determined that for each year of the first five years the section is in effect the public benefit anticipated as a result of enforcing the section will be more focused quality reviews which should result in improved performance by CPAs. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the section as proposed. Comments on the proposal may be submitted to J. Randel (Jerry) Hill, General Counsel, 333 Guadalupe, Tower III, Suite 900, Austin, Texas 78701-3900. The new section is proposed under Texas Civil Statutes, Article 41a-1, sec.6, which provide the Texas State Board of Public Accountancy with the authority to make such rules as may be necessary or advisable to carry in effect the purposes of the law; and sec.15B, which requires licensees to undergo quality reviews of their work and work product. The new section implements Texas Civil Statutes, Article 41a-1, sec.15B. sec.527.9. Procedures for a Sponsoring Organization. (a) To qualify as a sponsoring organization, an entity must submit a quality review administration plan to the board for review and approval by the Quality Review Oversight Board (QROB). The plan of administration must: (1) establish a quality review report committee (QRRC) and subcommittees as needed, and provide professional staff as needed for the operation of the quality review program; (2) establish a program to communicate to firms participating in the quality review program the latest developments in quality review standards and the most common findings in the quality reviews conducted by the sponsoring organization; (3) establish procedures for resolving any disagreement which may arise out of the performance of a quality review; (4) establish procedures to resolve matters which may lead to the dismissal of a firm from the quality review program, and conduct hearings pursuant to those procedures; (5) establish procedures to evaluate and document the performance of each reviewer, and conduct hearings which may lead to the disqualification of a reviewer who does not meet the AICPA standards; (6) require the maintenance of records of quality reviews conducted under the program in accordance with the records retention rules of the AICPA; and (7) provide for periodic reports to the QROB on the results of the quality review program. (b) A sponsoring organization is subject to review by the board and the QROB. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 18, 1996. TRD-9601502 William Treacy Executive Director Texas State Board of Public Accountancy Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 505-5566 22 TAC sec.527.10 The Texas State Board of Public Accountancy proposes new s527.10, concerning Quality Review Report Committees. The proposed new rule creates a committee and a mechanism for accepting quality review reports. William Treacy, executive director, has determined that for the first five-year period the section is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the section. Mr. Treacy also has determined that for each year of the first five years the section is in effect the public benefit anticipated as a result of enforcing the section will be closer supervision and review of quality review reports. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the section as proposed. Comments on the proposal may be submitted to J. Randel (Jerry) Hill, General Counsel, 333 Guadalupe, Tower III, Suite 900, Austin, Texas 78701-3900. The new section is proposed under Texas Civil Statutes, Article 41a-1, sec.6, which provide the Texas State Board of Public Accountancy with the authority to make such rules as may be necessary or advisable to carry in effect the purposes of the law; and sec.15B, which requires licensees to undergo quality reviews of their work and work product. The new section implements Texas Civil Statutes, Article 41a-1, sec.6 and sec.15B. sec.527.10. Quality Review Report Committee. A quality review report committee (QRRC) is comprised of CPAs practicing public accountancy and formed by a sponsoring organization for the purpose of accepting quality review reports submitted by firms on quality review engagements. (1) Each member of a QRRC must be active in the practice of public accountancy at a supervisory level in the accounting or auditing function while serving on the committee. The member's firm must be enrolled in an approved practice monitoring program and have received an unqualified report on its most recent quality review. A majority of the committee members must satisfy the qualifications required of on-site peer review team captains as established and reported in the AICPA Standards for Performing and Reporting on Peer Reviews, paragraph 76. (2) Each member of the QRRC must be approved for appointment by the governing body of the sponsoring organization. (3) In determining the size of the QRRC, the requirement for broad industry experience, and the likelihood of some members needing to recuse themselves during the consideration of some reviews a result of the members' close association to the firm or having performed the review, shall be considered. (4) No more than one QRRC member may be from the same firm. (5) The QRRC members' terms shall be staggered to provide for continuity and should not exceed three years, subject to annual review, except for the governing body's appointment of the committee's chair or for filling a vacancy on the committee. (6) A QRRC member may not concurrently serve as: (A) a member of his state's board of accountancy; or (B) a member of his state's CPA society's ethics committee. (7) A QRRC member may not participate in any discussion or have any vote with respect to a reviewed firm when the committee member lacks independence as defined in sec.501.11 of the board's Rules of Professional Conduct of this title (relating to Independence) or has a conflict of interest. Examples of conflicts of interest include, but are not limited to: (A) the member's firm has performed the most recent quality review of the reviewed firm's accounting and auditing practice; (B) the member served on the review team which performed the current or the immediately-preceding review of the enrolled firm; (C) the member serves on the state board of accountancy or state society ethics committee of any state in which any office of the enrolled firm is located; and (D) the member believes he cannot be impartial or objective. (8) Each QRRC member must comply with the confidentiality requirements of sec.15B(c) of the Public Accountancy Act of 1991. The sponsoring organization may annually require its QRRC members to sign a statement acknowledging their appointments and the responsibilities and obligations of their appointments. (9) A QRRC decision to accept a report must be made by not fewer than three members who satisfy the above criteria. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 18, 1996. TRD-9601501 William Treacy Executive Director Texas State Board of Public Accountancy Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 505-5566 22 TAC sec.527.11 The Texas State Board of Public Accountancy proposes new s527.11, concerning Responsibilities of Quality Review Report Committees. The proposed new section explains the responsibilities of a new committee. William Treacy, executive director, has determined that for the first five-year period the section is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the section. Mr. Treacy also has determined that for each year of the first five years the section is in effect the public benefit anticipated as a result of enforcing the section will be closer supervision and review of quality review reports. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the section as proposed. Comments on the proposal may be submitted to J. Randel (Jerry) Hill, General Counsel, 333 Guadalupe, Tower III, Suite 900, Austin, Texas 78701-3900. The new section is proposed under Texas Civil Statutes, Article 41a-1, sec.6, which provide the Texas State Board of Public Accountancy with the authority to make such rules as may be necessary or advisable to carry in effect the purposes of the law, and sec.15B. The new section implements Texas Civil Statutes, Article 41a-1, sec.6 and sec.15B. sec.527.11. Responsibilities of Quality Review Report Committee. (a) The QRRC shall establish and administer the sponsoring organization's quality review program in accordance with the AICPA Standards for Performing and Reporting on Peer Reviews. (b) The QRRC shall, when necessary in reviewing reports on quality reviews, prescribe actions designed to assure correction of the deficiencies in the reviewed firm's system of quality control policies and procedures. (c) The QRRC shall monitor the prescribed remedial and corrective actions to determine compliance by the reviewed firm. (d) The QRRC shall resolve instances in which there is a lack of cooperation and disagreement between the committee and review teams or reviewed firms in accordance with the sponsoring organization's adjudication process. (e) The QRRC shall act upon requests from firms for changes in the timetable of their reviews. (f) The QRRC shall appoint members to subcommittees and task forces as necessary to carry out its functions. (g) The QRRC shall establish and perform procedures for insuring that reviews are performed and reported on in accordance with the AICPA Standards for Performing and Reporting on Peer Reviews. (h) The QRRC shall establish a report acceptance process which facilitates the exchange of viewpoints among committee members. (i) The QRRC shall communicate to the governing body of the sponsoring organization on a recurring basis: (1) problems experienced by the enrolled firms in their systems of quality control as noted in the quality reviews conducted by the sponsoring organization; (2) problems experienced in the implementation of the quality review program; and (3) a summary of the historical results of the quality review program. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 18, 1996. TRD-9601500 William Treacy Executive Director Texas State Board of Public Accountancy Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 505-5566 TITLE 25. HEALTH SERVICES Part I. Texas Department of Health Chapter 229. Food and Drug Administrative or Civil Penalties 25 TAC sec.229.261 The Texas Department of Health (department) proposes an amendment to sec.229.261, concerning assessment of administrative penalties authorized under Texas Health and Safety Code, Chapter 431 (Texas Food, Drug, and Cosmetic Act), Chapter 432 (Texas Food, Drug, Device, and Cosmetic Salvage Act), Chapter 437 (Regulation of Food Service Establishments, Retail Food Stores, Mobile Food Units, and Roadside Food Vendors), Chapter 466 (Regulation of Narcotic Drug Treatment Programs), Chapter 145 (Tanning Facility Regulation Act), and Chapter 146 (Tattoo Studio Act). The amendment will adjust the penalty ranges for each severity level and will include new examples of violations for each level. The amendments will also permit adjustments to penalties based upon successful implementation of an effective Hazard Analysis and Critical Control Point Plan or successful completion of an accredited Food Protection Management Course. Robert D. Sowards, Jr., Director, Manufactured Foods Division, has determined that for the first five-year period the proposed rule is in effect there would be minimal fiscal implications as a result of enforcing or administering the section as proposed. The effect on state government will be an increase in revenue occurring only as a result of enforced administrative penalties. There will be no fiscal implications to local governments. Mr. Sowards, Jr., has also determined that for each year of the first five years the section as proposed is in effect, the public benefit will be that public injury and illness will be reduced through more effective penalties and strategies to eliminate adulterated and misbranded foods, drugs, medical devices, and cosmetics from the market. There is no anticipated economic cost to small businesses or persons who may be required to comply with the section, unless they are in violation of these rules. There will be no effect on local employment. Comments on the proposal may be submitted to Robert D. Sowards, Jr., Director, Manufactured Foods Division, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756, (512) 719-0243. Comments will be accepted for 30 days from the date of publication of this proposal. The amendment is proposed under Texas Codes Annotated, the Health and Safety Code sec.sec.431.241, 432.011, 437.056, 466.004, 145.011, 146.015, and 12. 001, which provides the Texas Board of Health with the authority to adopt rules for the performance of every duty imposed by law on the Texas Board of Health, the Texas Department of Health, and the commissioner of health. The amendment affects Health and Safety Code, Chapters 431, 432, 437, 466, 145, and 146. sec.229.261. Assessment of Administrative or Civil Penalties. (a) Proposals for assessment of administrative or civil penalties. The department shall propose to assess administrative or civil penalties in accordance with the requirements of the Texas Health and Safety Code, Chapters 431, 432, 437, 466, 145, and 146
                                                                      [of the Texas Food, Drug and Cosmetic Act, Texas Civil Statutes, Article 4476-5; the Texas Food, Drug, Device, and Cosmetic Salvage Act, Texas Civil Statutes, Article 4476-5e; and the Synthetic Narcotic Drug Act, Texas Civil Statutes, Article 4476-11]. (b) Assessment of administrative or civil penalties and conduct of hearings. The department shall assess administrative or civil penalties and conduct hearings pursuant to those administrative penalties in accordance with the appropriate statute in subsection (a) of this section and rules adopted under it; the Administrative Procedure and Texas Register Act, Texas Civil Statutes, Article 6252-13a; and the department's formal hearing procedures in sec.sec.1.21-1.34
                                                                        [sec.sec.1.21-1.33] of this title (relating to Formal Hearing Procedures). (c) (No change.) (d) Severity levels. (1) Violations. The violation shall be categorized by one of the following severity levels. (A) Severity Level I covers violations that are most significant and have a significant
                                                                          [direct] negative impact on the public health and safety including, but not limited to, adulteration, misbranding, or false advertising that results in fraud. (B)-(E) (No change.) (2) (No change.) (3) Examples of severity levels. Several examples are set out in subsection (h)
                                                                            [(g)] of this section. (e) Levels of penalties. Except as provided for in subsection (f) of this section relating to tattoo studios, the
                                                                              [The] department will impose different levels of penalties for different severity level violations as follows: (1) Level I-$15,000-25,000
                                                                                [10,000]; (2) Level II-10,000-15,000
                                                                                  [7,500]; (3) Level III-5,000-10,000
                                                                                    [5,000]; (4) Level IV-2,500-5,000
                                                                                      [2,500]; and (5) Level V-1,000-2,500
                                                                                        [1,250]. (f) Levels of penalties for tattoo studios. The department will impose different levels of penalties for different severity level violations for tattoo studios as follows: (1) Level I-$4,000-5,000; (2) Level II-3,000-4,000; (3) Level III-2,000-3,000; (4) Level IV-1,000-2,000; and (5) Level V-250-1,000. (g)
                                                                                          [(f)] Adjustments to penalties. The department may make adjustments to the penalties listed in subsection (e) or (f)
                                                                                            of this section for any one of the following factors. (1) Previous violations. The department may consider previous violations. The penalty may be reduced or increased within the specified range of each severity level
                                                                                              [by as much as 50%] for past performance. Past performance involves the consideration of the following factors: how similar the previous violation was; how recent the previous violation was; the number of previous violations; and the violator's response to previous violation(s) in regard to correction of the problem. (2) Demonstrated good faith. The department may consider demonstrated good faith. The [base] penalty may be reduced within the specified range of each severity level
                                                                                                [as much as 50%] if good faith efforts to correct a violation have been, or are being made. Good faith effort will have to be determined on a case-by-case basis and be fully documented. (3) Hazard to the health and safety of the public. The department may consider the hazard to the health and safety of the public. The [base] penalty may be increased within the specified range of each severity level
                                                                                                  [by as much as 50%] when a direct hazard to the health and safety of the public is involved. It shall take into account, but need not be limited to, the following factors: whether any disease or injuries have occurred from the violation; whether any existing conditions contribute to a situation that could expose humans to a health hazard; whether a hazard to various segments of the population such as children, surgical patients, and the elderly exists; whether the consequences would be of an immediate or long-range hazard. (4) Implementation of a Hazard Analysis Critical Control Point (HACCP) Plan.
                                                                                                    [Adjustments to the values in paragraphs (1)-(3) of this subsection may not exceed the limitations in the appropriate statutes described in subsection (a) of this section.] (A) The department may consider implementation of a Hazard Analysis and Critical Control Point (HACCP) plan. The penalty may be reduced within the specified range of each severity level if the firm implements a HACCP plan which is effective in correcting the violations. The HACCP plan is a written document based on the principles of HACCP, a food safety control system, which delineates the procedures to be followed to assure the control of a specific process or procedure. The HACCP plan shall include: (i) an analysis of biological, chemical, or physical hazards that may cause a food to be unsafe for consumption and a list of steps in the process where significant hazards occur with descriptions of the preventive measures; (ii) identification of the critical control points (CCPs) in the process at which control can be applied and a food safety hazard can be prevented, eliminated, or reduced to acceptable levels; (iii) critical limits or specifications which must be met for each preventive measure associated with each identified CCP; (iv) CCP monitoring requirements and procedures for using the results to adjust the process and maintain control; (v) corrective actions to be taken when monitoring indicates there is a deviation from established critical limit; (vi) effective record-keeping procedures that document the HACCP system; and (vii) procedures for verification that the HACCP system is working correctly. (B) Correction of violations through implementation of the HACCP plan will be determined on a case-by-case basis. The HACCP plan and all required HACCP records shall be provided for review and copying upon request of an authorized agent of the Commissioner. All required HACCP records shall be maintained at the plant for two years or longer if the product remains in distribution. (5) Requirement of food manager training. The department may consider requirement of attendance and successful completion of a Food Protection Manager Certification course accredited by the department. The penalty may be reduced within the range specified for each severity level upon completion of such course by all managers of a food service or retail food store operation. (6) Adjustments. Adjustments to the values in paragraphs (1)-(5) of this subsection may not exceed the limitations in the appropriate statutes described in subsection (a) of this section. (h)
                                                                                                      [(g)] Examples of severity levels. The following examples of severity levels are neither exhaustive nor controlling. They reflect only the seriousness of the violation and not the history of previous violations, the hazard to the health and safety of the public, or the demonstrated good faith. (1) Severity I-most significant violations. (A) A foodborne disease outbreak occurs at a food establishment. Laboratory tests confirm a bacterial agent frequently associated with poor sanitary conditions. Investigation reveals the firm continued operating during a major sewage back-up in the food processing area.
                                                                                                        [A bakery manufacturers a food product that results in a foodborne illness requiring hospitalization for a large number of people. Laboratory results confirm that the product manufactured by the bakery caused the illness. An inspection of the bakery reveals poor sanitary practices]. (B) A foodborne disease outbreak occurs at a food establishment. Epidemiologic analysis identifies the food as the source of the illness. Follow- up investigation at the establishment reveals food temperature violations that posed a critical health hazard.
                                                                                                          [A firm markets a frozen orange juice concentrate. Laboratory results revealed that the product contains only a small amount of orange juice. Several million dollars worth of the product have been produced and sold.] (C) (No change.) (D) A firm manufactures an unapproved drug/medical device that is associated with an injury.
                                                                                                            [A manufacturer of drugs introduces into commerce a drug product which falsely claims that it is a cure for cancer.] (E) A firm distributes an unapproved drug/medical device that is associated with an injury, i.e. "cancer cure", "AIDS cure." (F) A narcotic treatment program's failure to conform to federal and state regulations is associated with the death or permanent injury of a patient. (G) A tattoo studio does not have an approved sterilizer and has complaints of infection associated with the application of tattoos. (H) A tanning facility replaces ultraviolet lamps in its tanning device with higher intensity, non-equivalent lamps or installs a timer for its tanning device which causes the device to exceed the maximum allowable exposure time determined by the manufacturer. Either of these changes result in second or third degree burns to a user of a device, requiring the user to seek medical attention. (I) A tanning facility fails to provide protective eyewear to a user of its tanning device which results in the user suffering corneal burns or other injuries to the eye. (2) Severity II-very significant violations. (A) Inspection
                                                                                                              [An inspection] of a [large volume] chocolate candy manufacturer reveals very poor sanitary practices. Laboratory results reveal the presence of pathogenic microorganisms in the candy. No cases of illness that could be traced to the candy have yet been reported. (B) Inspection of a food establishment reveals food temperature violations posing a potential health hazard. Laboratory tests confirm the food is contaminated with pathogenic microorganisms. No reported foodborne outbreaks have been reported to have occurred at the facility
                                                                                                                [A wholesale distributor of drugs holds for sale or sells a counterfeit drug]. (C) Inspection of a food establishment reveals the presence of plumbing violations possibly causing contamination of the facility's water supply. Laboratory analysis indicates the water supply is contaminated
                                                                                                                  [A manufacturer of drugs introduces into commerce a drug which has not been shown to be safe and effective and which has not received new drug approval]. (D) A grain dealer has distributed tons of corn for human consumption. Laboratory tests confirm the corn contains aflatoxin exceeding the tolerance. (E) A firm is distributing counterfeit drugs/medical devices. (F) A firm is manufacturing a potentially harmful drug/medical device. (G) A firm diverts dangerous drugs and/or controlled substances outside legal distribution channels or fails to take adequate steps to prevent illegal distribution. (H) A narcotic treatment program admits a patient or patients into maintenance treatment who does not meet the minimum standards for admission. (I) Evidence is discovered that a tattoo studio is tattooing minors. (J) A tanning facility replaces ultraviolet lamps in its tanning device with higher intensity, non-equivalent lamps or installs a timer on its tanning device which causes the device to exceed the maximum allowable exposure time determined by the manufacturer. No injuries were reported to have occurred as a result of either of these changes. (3) Severity III-significant violations. (A) Inspection of a food establishment reveals the presence of pooled sewage near the water well. There is no indication the water supply is contaminated, but there is a great potential for occurrence
                                                                                                                    [A restaurant owner continues to operate after being warned of potential contamination to the water system through back siphonage problems and sewage accumulation on floor near the dishwasher. No contamination has occurred, but there is a great potential for occurrence]. (B) Inspection of a food establishment reveals food ingredients contaminated by pests. None of the contaminated ingredients has been used for food
                                                                                                                      [Rodents have gained access to a bakery and burrowed into bags of flour and have built nests. Other lots of raw materials have also been rodent defiled in terms of urine stains detected on the outer bagging. Droppings are detected throughout the building and on pieces of equipment. None of the contaminated product was used in the production of food]. (C) A bottling plant has repeatedly produced soft drinks [in returnable containers] that contain foreign objects such as cigarette packages, tooth brushes, and other matter. (D) Inspection of a food establishment reveals the firm is operating without hot water
                                                                                                                        [An applicant for registration as a wholesale distributor of drugs falsified information required on the registration statement]. (E) Inspection of a food establishment reveals employees touching ready- to-eat foods with unclean hands. (F) Inspection of a food establishment reveals unclean, unsanitized food contact surfaces of equipment. (G) The operator of an establishment refuses to permit an authorized agent to conduct an inspection, collect samples, or otherwise perform his official duties. (H) A firm fails to comply with the current good manufacturing practices for finished pharmaceuticals/medical devices. (I) An applicant has falsified information on the wholesale drug/medical device application. (J) A narcotic treatment program delivers narcotic drugs to a patient without a physician's order. (K) A narcotic treatment program fails to perform any laboratory test. (L) A firm diverts over the counter drugs outside legal distribution channels or fails to take adequate steps to prevent illegal distribution. (M) A tattoo facility operator fails to report an injury or illness associated with a tattoo. (N) A tanning facility operator allows a consumer to be exposed to ultraviolet radiation from its tanning device more than once in a 24-hour period. (O) A sanitizer used to sanitize the body contact surfaces of a tanning device was tested and found to have an active ingredient concentration that is lower than recommended by the manufacturer. The body contact surfaces of a tanning device are tested and found to be positive for human pathogenic bacteria. No injuries to users were reported to have occurred as a result of this incident. (P) A tanning facility fails to report to the Texas Department of Health, injuries or illnesses associated with one of its tanning devices. (4) Severity IV-violations. (A) A frozen shrimp processor has failed to declare sodium bisulfite
                                                                                                                          [bisulphite] on the labeling of his five-pound
                                                                                                                            [five pound] and ten- pound
                                                                                                                              [ten pound] boxes of shrimp tails. (B) A cannery discovered a defective part on a closing machine which has resulted in the improper sealing of 360,000 cases of cut green beans. The entire lot has been shipped to five midwestern states. To date, no complaints have been received regarding any part of the lot. (C) Inspection of a food establishment reveals evidence of current pest activity, but no contaminated foods are identified
                                                                                                                                [A food manufacturer, after receiving notification, has refused to register]. (D) A firm is distributing drugs/medical devices that have been held outside of recommended storage temperatures. (E) A firm is distributing damaged and expired drugs/medical devices. (F) A firm is distributing drugs/medical devices labeled only in a foreign language. (G) An applicant has falsified information on a tattoo/tanning application or a drug/device salvage application. (H) A physician is administering or dispensing a narcotic drug to treat opiate addiction outside a licensed narcotic treatment program or detoxification hospital, not including addiction treatment performed as an incidental adjunct to medical or surgical treatment of conditions other than addiction. (I) The work surfaces in a tattoo studio are not properly cleaned and disinfected. (J) A tanning facility falsifies or fails to maintain information required to be kept in individual consumer records such as ultraviolet radiation exposure times, frequency of ultraviolet radiation exposures, or informed consent for minors. (5) Severity V-minor violations. (A)-(B) (No change.) (C) A food manufacturer fails to label or misbrands a product resulting in minor public health or fraudulent significance
                                                                                                                                  [Laboratory analyses of numerous samples of a particular lot of a vitamin product reveal subpotency in several ingredients]. (D) A firm has failed to obtain a required license or permit from the department
                                                                                                                                    [A methadone program fails to collect and test urine samples for the presence of illicit drug]. (E) A firm is distributing drugs/medical devices with inaccurate and misleading ingredient statements
                                                                                                                                      [The medical director of a methadone program fails to sign required patient records]. (F) A narcotic treatment program is not providing required counseling services for patients. (G) An inspection of a tattoo studio shows it to be unsanitary and in general disrepair. (H) Warning signs required to be posted in a tanning facility do not conform to Texas Department of Health size, design, and content standards for warning signs. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 31, 1996. TRD-9601402 Susan K. Steeg General Counsel Texas Department of Health Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 458-7236 Chapter 229. Food and Drug Licensure of
                                                                                                                                        Tanning Facilities 25 TAC sec.sec.229.341-229.343, 229.345-229.352, 229.354-229. 357 The Texas Department of Health (department) proposes amendments to sec.sec.229.341-229.343, sec.sec.229.345-229.352, and sec.sec.229.354-229.357, concerning the tanning facility licensure standards. Specifically these sections cover purpose; applicable laws and regulations; and definitions; licensing of tanning facilities; licensing fees; revocation, cancellation, suspension and probation of a license; report of changes; advertising; warning signs; tanning devices; protective eyewear; records; injury reports; sanitation; and enforcement and penalties. The amendments update language to bring the sections into conformance with the statutory amendments passed during the 74th Texas Legislature. The amendments establish new licensure fees to allow the department to recover the costs associated with inspecting tanning facilities and administering the program. In addition, the amendments will prohibit the department from issuing or renewing tanning facility licenses to persons who operate sexually oriented businesses. The amendments will also allow the department to seek civil and administrative penalties for violations of Health and Safety Code, Chapter 145 (Tanning Facility Regulation Act). Cynthia T. Culmo, R.Ph., Director, Drugs and Medical Devices Division, Bureau of Food and Drug Safety, has determined that for the first five-year period the sections are in effect there will be fiscal implications as a result of enforcing or administering these sections as proposed. The effect on state government will be an estimated annual gain of $160,000 in fee-generated revenue. The administrative cost resulting from the increase in monitoring activities will be partially offset by the additional revenue generated by licensure fees. There are no anticipated fiscal implications for local government. Ms. Culmo has also determined that for each year of the first five years the sections are in effect the public benefit will be increased monitoring of tanning facilities resulting in the prevention of serious injuries to consumers from the use of misbranded and adulterated tanning devices. The anticipated economic cost to persons or small businesses who are required to comply with the sections as proposed will be an additional $115 annually in licensure fees. The increase in fees is necessary in order for the department to comply with recent statutory amendments which require the department to recover at least 50% of the costs associated with inspecting and administering the tanning facility licensure program. There will be no effect on local employment. Comments on the proposed amendments may be submitted to Thomas E. Brinck, Drugs and Medical Devices Division, Bureau of Food and Drug Safety, Texas Department of Health, 1100 West 49th Street, Austin, Texas, 78756. Telephone inquiries may also be made to Mr. Brinck, at (512) 719-0237. Comments will be accepted for 30 days following the date of publication of this proposal in the Texas Register. In addition, a public hearing on the proposed amendments will be scheduled prior to the close of the comment period and will be announced in the Texas Register . The amendments are proposed under Health and Safety Code, sec.145.011, which provides the department with the authority to adopt necessary regulations pursuant to the enforcement of this Chapter; and sec.12.001, which provides the Texas Board of Health with the authority to adopt rules for the performance of every duty imposed by law on the Texas Board of Health, the Texas Department of Health, and the Commissioner of Health. The amendments will affect Health and Safety Code, Chapter 145. sec.229.341. Purpose. These sections provide for the licensing
                                                                                                                                          [permitting] and regulation of tanning facilities using ultraviolet lamps as required by applicable federal and State laws and regulations. sec.229.342. Applicable Laws and Regulations. (a) (No change.) (b) Tanning devices are both electronic products and [medical] devices as defined by the Federal Food, Drug and Cosmetic Act, 21 United States Code, et seq. and as such are subject to the provisions of that act as well as those of the Texas Food, Drug, and Cosmetic Act, Health and Safety Code, Chapter 431, which requires the Texas Department of Health to adopt rules regulating devices, i.e. tanning devices. (c)-(f) (No change.) (g) Copies of these laws and rules are indexed and filed in the office of the Drugs and Medical Devices
                                                                                                                                            Division [of Food and Drugs], Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756, and are available for inspection during normal working hours. sec.229.343. Definitions. The following words and terms, when used in these sections, shall have the following meanings, unless the context clearly indicates otherwise. Adulterated-Has the meaning given in the Texas Food, Drug, and Cosmetic Act, Health and Safety Code, sec.431.111
                                                                                                                                              [Chapter 431], as interpreted in the rules of the board and judicial decision. Misbranded-Has the meaning given in the Texas Food, Drug, and Cosmetic Act, Health and Safety Code, sec.431.112
                                                                                                                                                [Chapter 431], as interpreted in the rules of the board and judicial decision. Reconditioning-Has the meaning given in the Texas Food, Drug, Device, and Cosmetic Salvage Act, Health and Safety Code, sec.432. 003
                                                                                                                                                  [Chapter 432], as interpreted in the rules of the board in s229.192 of this title (relating to Definitions
                                                                                                                                                    [Regulation of Food, Drug, Device and Cosmetic Salvage Establishments and Brokers]) and judicial decision. Tanning device -A device, as defined in the Texas Food, Drug, and Cosmetic Act, Health and Safety Code, s431.002
                                                                                                                                                      [Chapter 431], that emits electromagnetic radiation with wavelengths in the air between 200 and 400 nanometers and that is used for tanning of human skin, including a sunlamp, tanning booth, or tanning bed. A tanning device is also classified as a [medical] device, as defined in the Federal Food, Drug and Cosmetic Act and the applicable Code of Federal Regulations. The term also includes any accompanying equipment, including protective eyewear, timers, and handrails. Tanning facility -A business that provides persons access to or use of
                                                                                                                                                        tanning devices. sec.229.345. Licensing [Permitting] of Tanning Facilities. (a) A person shall
                                                                                                                                                          [may] not operate a tanning facility without a current and valid license
                                                                                                                                                            [permit] to operate the facility that is issued by the Texas Department of Health (department). A separate license is required for each tanning facility. (b) The license
                                                                                                                                                              [permit] shall be displayed in an open public area of the tanning facility. (c) Each person acquiring or establishing a tanning facility after the effective date of these sections shall apply to the department for a license
                                                                                                                                                                [permit] of such facility prior to beginning operation. (d) Unless the department revokes or suspends a license
                                                                                                                                                                  [permit] as provided in sec.229.347 of this title (relating to Revocation, Cancellation, Suspension and Probation of a License
                                                                                                                                                                    [Permit]), the initial license
                                                                                                                                                                      [permit] shall be valid for one year from the date of issuance which becomes the anniversary date. (e) The renewal license
                                                                                                                                                                        [permit] shall be valid for one year from the anniversary date. (f) Licenses
                                                                                                                                                                          [Permits] shall not be transferable from one person to another or from one tanning facility to another. (g) The initial
                                                                                                                                                                            application required in subsections (c) and (h) of this section shall be completed on forms provided by the department and shall contain all the information required by such forms and any accompanying instructions. (h) Each tanning facility shall provide the following information upon initial
                                                                                                                                                                              application for a license
                                                                                                                                                                                [permit]: (1)-(7) (No change.) (8) copies of the informed
                                                                                                                                                                                  consent forms and statements which the consumer, parent or legal guardian will sign as required in s229.354 of this title (relating to Records); (9) procedures which the operator(s) will be required to follow for the correct use of tanning device(s), to include: (A)-(E) (No change.) (F) handling of complaints of injury or illness
                                                                                                                                                                                    from consumers; (G) (No change.) (10) signature of the owner verifying all information on the initial
                                                                                                                                                                                      application form. (i) Failure to complete the initial
                                                                                                                                                                                        application form may result in the denial of a license
                                                                                                                                                                                          [permit]. (j) The department will not issue a license under this section with respect to a facility that: (1) is operated under a license or permit as a sexually oriented business issued in accordance with Local Government Code, s243.007; (2) offers, as its primary business, a service or the sale, rental, or exhibition of a device or other item that is intended to provide sexual stimulation or sexual gratification to a customer; or (3) is owned or operated by a person who has been convicted of an offense under Penal Code, Chapter 21 or 43; or Penal Code, sec.71.02(a)(3). sec.229.346. Licensing [Permitting] Fees. (a) All tanning facilities in Texas shall pay an initial license
                                                                                                                                                                                            [permit] fee of $150
                                                                                                                                                                                              [$50]. (b) All tanning facilities shall pay an annual renewal fee of $150
                                                                                                                                                                                                [$35] each year following issuance of the initial license
                                                                                                                                                                                                  [permit]. (c) All tanning facilities shall pay a $100
                                                                                                                                                                                                    [$25] delinquency fee if the license
                                                                                                                                                                                                      [permit] renewal fee
                                                                                                                                                                                                        [application] is paid
                                                                                                                                                                                                          [filed] after the expiration date of the current license
                                                                                                                                                                                                            [permit]. sec.229.347. Revocation, Cancellation, Suspension and Probation of a License [Permit]. (a) The Texas Department of Health (department) may revoke, cancel, suspend, suspend on an emergency basis,
                                                                                                                                                                                                              or probate by an emergency order of the commissioner, or the commissioner's designee
                                                                                                                                                                                                                a license
                                                                                                                                                                                                                  [permit] to operate a tanning facility if the facility has: (1) failed to pay a license
                                                                                                                                                                                                                    [permit] fee or an annual renewal fee for a license
                                                                                                                                                                                                                      [permit]; (2) obtained or attempted to obtain a license
                                                                                                                                                                                                                        [permit] by fraud or deception; (3)-(4) (No change.) (b) The department shall revoke a license issued with respect to a facility if the license may not be renewed under sec.229.345(j) of this title (relating to licensing of Tanning Facilities). (c)
                                                                                                                                                                                                                          [(b)] Prior to revoking, canceling, suspending or probating a license
                                                                                                                                                                                                                            [permit], the department shall give the license
                                                                                                                                                                                                                              [permit] holder written notice of the proposed action, including the reasons and an opportunity for a hearing. (d)
                                                                                                                                                                                                                                [(c)] Any hearing for the revoking, canceling, suspending, or probating of a license
                                                                                                                                                                                                                                  [permit] shall be in accordance with the department's formal hearing procedures in Chapter 1 of this title (relating to Texas Board of Health). (e)
                                                                                                                                                                                                                                    [(d)] A license
                                                                                                                                                                                                                                      [permit] issued under these sections shall be returned to the department if the tanning facility: (1) ceases business or otherwise ceases operation on a permanent basis; (2) relocates; [or] (3) changes the name of the business under which the tanning facility operates; or (4)
                                                                                                                                                                                                                                        [(3)] changes ownership. For a corporation, an ownership change is deemed to have occurred, resulting in the necessity to return the license
                                                                                                                                                                                                                                          [permit] to the department, when 5.0% or more of the share of stock of a corporation is transferred from one person to another. sec.229.348. Report of Changes. The permit holder shall notify the Texas Department of Health (department) in writing within ten days of any change which would render the information contained in the initial
                                                                                                                                                                                                                                            application for the licensing
                                                                                                                                                                                                                                              [permitting], reported pursuant to sec.229.345 of this title (relating to Licensing
                                                                                                                                                                                                                                                [Permitting] of Tanning Facilities), no longer accurate. Failure to inform the department within ten days of a change in the information required in the initial
                                                                                                                                                                                                                                                  application for a license
                                                                                                                                                                                                                                                    [permit] may result in a suspension or revocation of the license
                                                                                                                                                                                                                                                      [permit]. This requirement shall not apply for changes involving replacement of designated original equipment lamp types with lamps which have been certified with the United States Food and Drug Administration (FDA) as "equivalent" lamps under the FDA regulations and policies applicable at the time of replacement of the lamps. The facility operator shall maintain lamp manufacturer's labeling at the facility, demonstrating the equivalence of any replacement lamps. sec.229.349. Advertising. (a) No person, in any advertisement, shall refer to the fact that the person or the person's facility is licensed
                                                                                                                                                                                                                                                        [permitted] with the Texas Department of Health (department) pursuant to the provisions of sec.229.345 of this title (relating to Licensing
                                                                                                                                                                                                                                                          [Permitting] of Tanning Facilities), and no person shall state or imply that any activity under such license
                                                                                                                                                                                                                                                            [permit] has been approved by the department. (b) A tanning facility shall
                                                                                                                                                                                                                                                              [may] not claim, or distribute promotional materials that claim, that using a tanning device is safe or free from risk or that using the device will result in medical or health benefits. The only claims that may be made for tanning are cosmetic. (c) A business described in sec.229.345(j) shall not use the word "tan" or "tanning" in a sign or any other form of advertising. sec.229.350. Warning Signs. (a) A tanning facility operator shall post a warning sign in a conspicuous location where it is readily visible by persons entering the establishment. The sign shall have [dimensions of no less than 36 inches to a side and shall have] the following wording and appearance.
                                                                                                                                                                                                                                                                FIGURE 1: 25 TAC sec.229.350(a) (b) A tanning facility operator shall post a warning sign, one sign for each tanning device, in a conspicuous location that is readily visible to a person about to use the device. The sign shall have [dimensions of no less than 24 inches to a side and shall have] the following wording and appearance.
                                                                                                                                                                                                                                                                  FIGURE 2: 25 TAC sec.229.350(b) (c) Warning signs shall meet the following requirements.
                                                                                                                                                                                                                                                                    [The lettering on each warning sign shall be red on white background. Letters shall be at least ten millimeters high for all words shown in capital letters and at least five millimeters high for all lower case letters.] (1) The sign shall be printed on white 80 pound gloss coated cover stock and shall be 17 inches wide by 22 inches long. (2) The lettering on each warning sign shall be brilliant red (Pantone 185) or equivalent on white background. (3) The major sign heading entitled "DANGER" shall be a minimum of Helvetica Bold 110 point or equivalent. (4) The subheading entitled "ULTRAVIOLET RADIATION" shall be a minimum of Helvetica Bold 100 point or equivalent. (5) Body copy shall be Helvetica 35 point or equivalent. (6) Remaining capitalized copy shall be a minimum of Helvetica Bold 70 point or equivalent. (d) Camera ready copies of each sign shall be available for reproduction purposes upon written request to: Texas Department of Health, Drugs and Medical Devices Division, 1100 West 49th Street, Austin, Texas 78756-3182. (e) The Texas Department of Health shall include with a license application a description of the design standards required for signs in this section. sec.229.351. Tanning Devices (a)-(e) (No change.) (f) The [facility] operator shall control the temperature of the consumer contact surfaces of a tanning device and the surrounding area so that it will
                                                                                                                                                                                                                                                                      [may] not exceed 100 degrees Fahrenheit. (g)-(l) (No change.) sec.229.352. Protective Eyewear. (a) Each consumer shall be provided with protective eyewear and instructions for their use. The operator shall
                                                                                                                                                                                                                                                                        [may] not allow a person to use a tanning device if that person does not use [the] protective eyewear that meets the requirements of the United States Food and Drug Administration
                                                                                                                                                                                                                                                                          . (b) (No change.) (c) Protective eyewear shall be located in the immediate proximity of each tanning device and shall be provided without charge to each user of a tanning device
                                                                                                                                                                                                                                                                            . (d) (No change.) sec.229.354. Records. (a) (No change.) (b) Signed warning statement. (1) Each time a customer who is 18 years of age or older
                                                                                                                                                                                                                                                                              uses a tanning facility device for the first time and
                                                                                                                                                                                                                                                                                [or] each time a person executes or renews a contract to use a tanning facility device
                                                                                                                                                                                                                                                                                  , the person shall sign and date a written statement acknowledging that the person has read and understood the required warnings in sec.229.350 of this title (relating to Warning Signs) before using the device and agrees to use [the] protective eyewear. (2) Before any person under the age of 18 years uses a tanning facility
                                                                                                                                                                                                                                                                                    device for the first time
                                                                                                                                                                                                                                                                                      , the person shall give the tanning facility operator a written informed consent
                                                                                                                                                                                                                                                                                        statement signed and dated by the person's parent or legal guardian stating that the parent or legal guardian has read and understood the warnings given by the tanning facility operator, consents to the minor's use of a tanning device, and agrees that the minor will use [the] protective eyewear. In addition, when,
                                                                                                                                                                                                                                                                                          [When] a person under 14 years of age is using a tanning device, a parent or legal guardian must remain
                                                                                                                                                                                                                                                                                            [be present] at the tanning facility while the person under 14 years of age is using a tanning device
                                                                                                                                                                                                                                                                                              . (3) (No change.) (c) Individual consumer records
                                                                                                                                                                                                                                                                                                [Consumer log information]. An individual record shall be kept by the facility operator of each consumer's total number of tanning visits, exposure lengths in minutes, times and dates of the exposures, [and] any injuries or illnesses resulting from the use of a tanning device, and any written informed consent statement required to be signed in this section
                                                                                                                                                                                                                                                                                                  . The operator must ensure that no individual is allowed to use a tanning device more than once every 24 hours. (d) Record retention. All records required by this section shall be maintained at the tanning facility at least until the third anniversary of the date of the consumer's last use of a tanning device
                                                                                                                                                                                                                                                                                                    [for a minimum of three years]. (e)-(g) (No change.) sec.229.355. Injury Reports.
                                                                                                                                                                                                                                                                                                      A written report of any [tanning] injury or illness associated with a tanning device
                                                                                                                                                                                                                                                                                                        shall be forwarded to the Texas Department of Health (department) within five working days of its occurrence or knowledge thereof. The report shall include: (1)-(2) (No change.) (3) the date of the injury or illness
                                                                                                                                                                                                                                                                                                          ; (4) the nature of the injury or illness
                                                                                                                                                                                                                                                                                                            ; (5) identification of the tanning device involved in the injury or illness
                                                                                                                                                                                                                                                                                                              , including brand and model; (6) (No change.) (7) the name of the operator on duty at the time of injury or illness
                                                                                                                                                                                                                                                                                                                ; and (8) (No change.) sec.229.356. Sanitation. (a)-(b) (No change.) (c) The operator shall clean and properly sanitize the body contact surfaces of a tanning device after each use
                                                                                                                                                                                                                                                                                                                  [All tanning device surfaces that come in contact with human skin shall be sanitized after each use] with a sanitizer registered with the USEPA. (d)-(i) (No change.) sec.229.357. Enforcement and Penalties. (a) (No change.) (b) Administrative penalties. Administrative penalties, as provided in Health and Safety Code, sec.145.0122, and in sec.229.261 of this title (relating to Assessment of Administrative or Civil Penalties), may be assessed for violation of these sections. (c)
                                                                                                                                                                                                                                                                                                                    [(b)] Criminal penalty. (1) A person, other than a customer, commits an offense if the person [knowingly or recklessly] violates the Act or rules adopted under the Act. (2) Except as provided by paragraph (3) of this subsection, an
                                                                                                                                                                                                                                                                                                                      [An] offense under the Act is a Class A
                                                                                                                                                                                                                                                                                                                        [C] misdemeanor. (3) An offense under sec.229.349(c) of this title (relating to Advertising) is a Class C misdemeanor, unless it is shown on the trial of an offense under this subsection that the person has previously been convicted of an offense under this subsection, then the offense is a Class A misdemeanor. (d)
                                                                                                                                                                                                                                                                                                                          [(c)] Civil penalty;
                                                                                                                                                                                                                                                                                                                            Injunction. If it appears that a person has violated or is violating Health and Safety Code, Chapter 145, or an order issued or a rule adopted under authority of Health and Safety Code, sec.145.011, the commissioner may request the attorney general or the district or county attorney or the municipal attorney of a municipality in the jurisdiction where the violation is alleged to have occurred or may occur to institute a civil suit for: (1) an order enjoining the violation; (2) a permanent or temporary injunction, a temporary restraining order, or other appropriate remedy if the department shows that the person has engaged in or is engaging in a violation; (3) the assessment and recovery of a civil penalty; or (4) both injunctive relief and a civil penalty. [(1) If the Commissioner, an authorized agent, or a health authority finds that a person has violated, or is violating or threatening to violate the Act and that the violation or threat of violation creates an immediate threat to the health and safety of the public, the Commissioner, authorized agent, or health authority may petition the district court for a temporary restraining order to restrain the violation or threat of violation. [(2) If a person has violated, or is violating or threatening to violate the Act, the Commissioner, an authorized agent, or a health authority may petition the district court for an injunction to prohibit the person from continuing the violation or threat of violation. [(3) On application for injunctive relief and a finding that a person is violating or threatening to violate the Act, the district court shall grant any injunctive relief warranted by the facts.] (e)
                                                                                                                                                                                                                                                                                                                              [(d)] Venue. Venue for a suit brought under the Act shall be in the county in which the violation or the threat of violation is alleged to have occurred or in Travis County. (f)
                                                                                                                                                                                                                                                                                                                                [(e)] Adulterated or misbranded tanning device. If the Texas Department of Health (department) identifies an adulterated or misbranded tanning device, the department may enforce the applicable provisions of Subchapter C of the Texas Food, Drug, and Cosmetic Act (Health and Safety Code, Chapter 431) including, but not limited to: detention, condemnation, civil penalties, criminal enforcement, and/or administrative penalties, using the Severity Levels set out in sec.229.261 of this title (relating to Assessment of Administrative or Civil Penalties). (g) Emergency order. The commissioner or the commissioner's designee may issue an emergency order relating to the operation of a tanning facility in the department's jurisdiction if the commissioner or the commissioner's designee determines: (1) operation of the tanning facility creates or poses an immediate and serious threat to human life or health; and (2) other procedures available to the department to remedy or prevent the threat will result in unreasonable delay. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601441 Susan K. Steeg General Counsel Texas Department of Health Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 458-7236 Chapter 241. Shellfish Sanitation Molluscan Shellfish 25 TAC sec.241.51, sec.241.55 The Texas Department of Health (department) proposes amendments to sec.241. 51 and sec.241.55, concerning Texas molluscan shellfish. Specifically, the sections cover growing area classification and harvesting and handling of shellstock. The amendments will implement the requirements and guidelines established in the 1995 National Shellfish Sanitation Program Manual of Operations, Part I, dealing with a harvest control to reduce risk of illness attributable to a naturally occurring organism, Vibrio vulnificus. The proposed amendments establish definitions and standards for a time-to-refrigeration matrix which will reduce the amount of time shellfish remain unrefrigerated after harvest and before the harvest boats are unloaded. Richard E. Thompson, Director, Seafood Safety Division, has determined that for the first five-year-period the sections, as proposed, are in effect there would be minimal fiscal implications for state government. The effect on state government will occur only as a result of enforced administrative penalties. There will be no fiscal implications to local governments. Mr. Thompson has also determined that for each year of the first five years the sections are in effect the public benefit anticipated as a result of enforcing the sections, as proposed, will be better assurance that molluscan shellfish processed in or imported into Texas will be free of disease or other health hazards transmissible by these products. There is no anticipated economic cost to persons or small businesses who are required to comply with the sections. Cost will only occur as a result of administrative penalties assessed against molluscan shellfish businesses who do not comply. There will be no effect in local employment. Comments on the proposal may be submitted to Richard E. Thompson, R.S., Director, Seafood Safety Division, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756, (512) 719-0215. Comments will be accepted for 30 days from the date of publication of this proposal. The amendments are proposed under Texas Parks and Wildlife Code, sec.76.203, which authorizes the Texas Board of Health to adopt rules concerning the regulation of Texas molluscan shellfish; and the Health and Safety Code, sec.12. 001, which provides the Texas Board of Health with the authority to adopt rules for the performance of every duty imposed by law on the Texas Board of Health, the Texas Department of Health, and the commissioner of health. The amendments affect Texas Parks and Wildlife Code, sec.76.203. sec.241.51. Growing Area Classification. (a)-(e) (No change.) (f) The authority provided to the commissioner of health by the Health and Safety Code, sec.436.101 has been delegated to the bureau chief of the Bureau of Food and Drug Safety or his/her designee
                                                                                                                                                                                                                                                                                                                                  under the provisions of the Health and Safety Code, sec.436.003(a). The bureau chief shall: (1)-(2) (No change.) sec.241.55. Harvesting and Handling Shellstock. (a) Boats and trucks. (1)-(11) (No change.) (12) Commercial harvesters shall be responsible for control of their shellstock until acceptance by a certified dealer. Commercial harvesters shall be required to deliver shellstock to a certified dealer within the day the shellstock is harvested. For this purpose a day shall be considered to be midnight to midnight. Delivery of the shellstock is considered to be the packing of the shellstock into an approved container, transfer of the shellstock from the boat to a certified location
                                                                                                                                                                                                                                                                                                                                    [the dock] and acceptance of the shellstock by the certified dealer. Commercial harvesters shall sell their shellstock only to a currently certified shellfish dealer. It is illegal for commercial harvesters to sell shellstock directly to the public. (13) Mechanical refrigeration facilities shall be required for purposes of dealer certification at each certified location. Mechanical refrigeration which is mobile shall be immobilized or designated, in writing to the SSD, as the shellfish storage facility. Removal of immobilized or designated refrigeration shall constitute voluntary surrender of certification by the certified dealer for that certified location. Shellstock shall be placed under mechanical refrigeration at air temperatures between 45 degrees Fahrenheit and 35 degrees Fahrenheit within two hours of unloading from the boat. Shellstock shall not be allowed to remain on a dock unrefrigerated for more than two hours. During the period April 1 through April 30
                                                                                                                                                                                                                                                                                                                                      [October 31], shellstock shall not be harvested before 6:00 a.m. and shall be placed under mechanical refrigeration by 8:00 p.m. each day. Mechanical refrigeration facilities shall be adequate in size and cooling capacity to refrigerate all shellstock on the premises. Each facility shall be equipped with an automatic temperature regulating control (thermostat) and an indicating thermometer installed to accurately measure, within three degrees, the temperature in the warmest location in the storage compartment. (14) During the period May 1 through October 31, shellfish which may be intended for consumption raw, directly from the shell, shall be refrigerated as designated in paragraph (13) of this subsection, within the times established for each month by the bureau chief of the Bureau of Food and Drug Safety. Each harvester shall maintain records for each date shellfish are harvested that show the time the first shellfish are harvested; the time harvesting ends; and the time the shellfish are unloaded from the boat. (A) The time from first harvest to refrigeration shall be established based on the average monthly maximum water temperature (AMMWT) and shall be in effect from 12:01 a.m. of the first day of the month until 11:59 p. m. of the last day of the month. The time shall be based on the following AMMWT ranges: (i) AMMWT 65 degrees Fahrenheit - 74 degrees Fahrenheit, 14 hours; (ii) AMMWT 74 degrees Fahrenheit - 84 degrees Fahrenheit, 12 hours; and (iii) AMMWT 84 degrees Fahrenheit, 6 hours. (B) Any shellfish which may be held without refrigeration for periods of time longer than those established in subparagraph (A) of this paragraph shall not be harvested before 6:00 a.m. and shall be placed under refrigeration as designated in paragraph (13) of this subsection by 8:00 p.m. each day and shall be identified, stored, and processed separately from shellfish that are refrigerated within the time periods. (i) Shellfish harvested and held exempt under this paragraph shall be tagged with a harvester tag meeting all requirements that shall be neon green in color. This neon green harvester tag shall be placed on each container of shellfish at the conclusion of harvesting of these exempt shellfish and before harvesting of any other shellfish. The neon green harvester's tag shall remain attached to each container until the shellfish are shucked. (ii) If shellfish are harvested and held exempt under this paragraph, the harvester records required shall also include the time that harvesting of these exempt shellfish stops and the time that harvesting of other shellfish begins. (iii) Shellfish harvested, and held exempt under this paragraph, shall not be commingled with any other shellfish and shall be stored separately on harvest boats and at any certified location. (iv) Shellfish harvested, and held exempt under this paragraph, shall be shucked and placed in containers bearing the consumer information language adopted by the Interstate Shellfish Sanitation Conference, or an equivalent approved in writing by the SSD prior to use, unless the invoice and bill of lading for shipment of these exempt shellstock to another certified dealer both contain the following statement: "These shellfish shall be shucked and placed in a container bearing the consumer information statement adopted by the Interstate Shellfish Sanitation Conference." (15)
                                                                                                                                                                                                                                                                                                                                        [(14)] Refrigerated shellstock shall be maintained at internal temperatures between 45 degrees Fahrenheit and 35 degrees Fahrenheit. After initial refrigeration, shellstock removed from refrigeration shall not be permitted to remain in air temperatures above 45 degrees Fahrenheit for more than two hours. The internal air temperature in trailers shall be at or below 45 degrees Fahrenheit when shellstock loading begins. (16)
                                                                                                                                                                                                                                                                                                                                          [(15)] Trucks used to transport shellstock shall have the storage area constructed of a nontoxic, smooth, impervious material so as to protect the shellfish from contamination and shall be kept clean. Shellstock shall be transported on land by harvesters, certified dealers, or any distributor in mechanically refrigerated trucks that can maintain an air temperature between 45 degrees Fahrenheit and 35 degrees Fahrenheit, shall be palletized, and shall be arranged to allow maximum air circulation. Shellstock storage areas shall be similarly constructed. (17)
                                                                                                                                                                                                                                                                                                                                            [(16)] Dogs, cats, or other animals shall not be permitted on vessels, in vehicles, or in any other area where shellstock is held or transported. (b)-(c) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on January 31, 1996. TRD-9601403 Susan K. Steeg General Counsel Texas Department of Health Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 458-7236 TITLE 40. SOCIAL SERVICES AND ASSISTANCE Part I. Texas Department of Human Services Chapter 19. Nursing Facility Requirements for Licensure and Medicaid Certification The Texas Department of Human Services (DHS) proposes the repeal of sec.sec.19.300-19.315, concerning facility construction, the repeal of sec.19.1612, concerning Texas Index for Level of Effort (TILE) Assessments, repeal of sec.sec.19.1701-19.1727, concerning physical plant and environment, and the repeal of sec.19.2105, concerning Safe Medical Devices Act of 1990; amendments to sec.sec.19.202, concerning building approval, 19.204, concerning applicant disclosure requirements, 19.402, concerning exercise of rights, 19.416, concerning personal property, 19.1210, concerning certification and recertification requirements in Medicaid-certified facilities, 19.1807, concerning rate setting methodology, 19.1918, concerning disclosure of ownership, 19.1921, concerning general requirements for a nursing facility, 19. 2208, concerning standards for certified Alzheimer's facilities, 19.2324, concerning selection and contracting procedures for adding beds in high- occupancy areas, 19. 2326, concerning Medicaid swing bed program for rural hospitals, and 19.2403, concerning utilization review process; and proposes new sec.sec.19.300-19.326 and sec.sec.19.330-19.343, concerning facility construction, and new sec.19.1701, concerning physical environment, new s19. 2412, concerning Texas Index for Level of Effort (TILE) Assessments, in its Nursing Facility Requirements for Licensure and Medicaid Certification chapter. The purpose of the repeal of sec.sec.19.300-19.315 is to modify the facility construction requirements. The purpose of the repeal of sec.19.1612 is to delete rules incorrectly placed in this subchapter and which are now being correctly placed in new sec.19.2412. The purpose of the repeal of sec.19.1701-19. 1727 is to transfer the facility construction requirements to sec.sec.19.300-19. 326. The purpose of the repeal of sec.19.2105 is to delete outdated rules. The purpose of the amendments is to correct references and clarify the rules through other minor corrections. The purpose of the new sections is to combine the physical plant and environment requirements with the facility construction requirements. Burton F. Raiford, commissioner, has determined that for the first five-year period the sections are in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the proposal. Mr. Raiford also has determined that for each year of the first five years the sections are in effect the public benefit anticipated as a result of enforcing the proposal will be clear and correct rules. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the proposal. Questions about the content of this proposal may be directed to Susan Syler at (512) 438-3111 in DHS's Long Term Care Policy Section. Written comments on the proposal may be submitted to Nancy Murphy, Media and Policy Services-313, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register. Subchapter C. Nursing Facility Licensure Application Process 40 TAC sec.19.202, sec.19.204 The amendments are proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provides the Health and Human Services Commission with the authority to administer federal medical assistance funds. The amendments implement the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.19.202. Building Approval.
                                                                                                                                                                                                                                                                                                                                              All applications for license must include written approval of the local fire authority that the facility and its operation meet local fire ordinances. (1)-(4) (No change.) [(5) Inspection and Plan Review. Any existing building being considered for licensure must either submit a plan for review and approval or request a feasibility inspection to be performed by a representative of DHS to determine construction or renovation requirements. The fees for inspection and/or plan reviews must be in accordance with sec.19.301 of this title (relating to Fees for Plan Reviews, Construction Inspection Services, and Feasibility Inspection Services).] sec.19.204. Applicant Disclosure Requirements. (a)-(d) (No change.) (e) Required ownership and management information for the past two years. (1)-(4) (No change.) (5) The information required by this section must be provided to DHS upon initial application for licensure, and changes in the information must be provided to DHS upon renewal
                                                                                                                                                                                                                                                                                                                                                [on an annual basis], except that a licensee must notify DHS within 30 days of any change of the facility's administrator or management services. (f) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601423 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter D. Facility Construction 40 TAC sec.sec.19.300-19.315 (Editor's note: The text of the following sections proposed for repeal will not be published. The sections may be examined in the offices of the Texas Department of Human Services or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.) The repeals are proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The repeals implement the Human Resources Code, sec.sec.22.001-22.024 and sec.sec.32.001-32.042. sec.19.300. Plans, Approvals, and Construction Procedures. sec.19.301. Fees for Plan Reviews, Construction Inspection Services, and Feasibility Inspection Services. sec.19.302. Construction and Initial Survey of Completed Construction. sec.19.303. Construction Standards for Additions, Remodeling, and New Nursing Facilities. sec.19.304. Location and Site. sec.19.305. General Considerations. sec.19.306. Architectural Space Planning and Utilization. sec.19.307. Exit Provisions. sec.19.308. Smoke Compartmentation (Subdivision of Building Spaces). sec.19.309. Fire Protection Systems. sec.19.310. Hazardous Areas. sec.19.311. Structural Requirements. sec.19.312. Mechanical Requirements. sec.19.313. Electrical Requirements. sec.19.314. Miscellaneous Details. sec.19.315. Elevators. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601424 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 40 TAC sec.sec.19.300-19.326, 19.330-19.343 The new sections are proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The new sections implement the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.19.300. General Requirements. (a) The facility must be designed, constructed, equipped, and maintained to protect the health and ensure the safety of residents, personnel, and the public. If children are admitted to the facility, accommodations, furnishings, and equipment appropriate to children must be provided. (b) The requirements of this subchapter are applicable to new and existing nursing facilities unless otherwise stated. Refer to sec.sec.19.330-19.343 of this title (relating to Facility Construction) for additional requirements for new construction, conversions of existing unlicensed buildings, remodeling, and additions. An existing unlicensed building is defined as any building (or portion thereof) which is not presently licensed as a nursing home. sec.19.301. Applicable Codes and Standards. (a) The facility must meet the applicable provisions of the 1985 edition of the Life Safety Code of the National Fire Protection Association (NFPA). The Life Safety Code is available for inspection at the Office of the Federal Register
                                                                                                                                                                                                                                                                                                                                                  Information Center, Washington, D.C. Copies may be obtained from the NFPA, Batterymarch Park, Quincy, Massachusetts 02200. The New Health Care Occupancies chapter of the Life Safety Code is applicable to new construction, conversions of existing unlicensed buildings, remodeling, and additions. The Existing Health Care Occupancies chapter of the Life Safety Code is applicable to existing nursing homes. Life safety features and equipment that have been installed in existing buildings which are now in excess of that required by the Life Safety Code must continue to be maintained or may be completely removed if prior approval is obtained from the Texas Department of Human Services (DHS). (b) In addition to the Life Safety Code, facilities must meet any other codes and standards of the NFPA referenced by the Life Safety Code and those listed in this chapter, except as may be otherwise approved or required by DHS. (c) The following codes, standards, or guidelines generally govern their subject areas for existing construction: (1) If the municipality has a building code and a plumbing code, those codes govern. (2) In the absence of municipal codes, nationally recognized codes must be used. To assure continuity, all nationally recognized codes, when used, must be publications of the same group or organization. (3) Heating, ventilating, and air-conditioning systems must be designed and installed in accordance with NFPA 90A and the Heating, Ventilating, and Air- Conditioning Guide of the American Society of Heating, Refrigeration, and Air- Conditioning Engineers (ASHRAE), except as may be modified in this subchapter. (4) Electrical and illumination systems must be designed and installed in accordance with NFPA 70 and the Lighting Handbook of the Illuminating Engineering Society (IES) of North America, except as may be modified in this subchapter. (5) Accessibility for individuals with disabilities must be designed and installed in accordance with the following laws: the Americans with Disabilities Act of 1990 (Public Law 101-336; Title 42, United States Code, Chapter 126); Title 28, Code of Federal Regulations, Part 35; Texas Civil Statutes, Article 9102; and Title 16, Texas Administrative Code, Chapter 68. Plans for new construction, substantial renovations, modifications, and alterations must be submitted to the Texas Department of Licensing and Regulation (Attention: Elimination of Architectural Barriers Program) for accessibility approval under Texas Civil Statutes, Article 9102. (6) Every building and portion thereof must be capable of sustaining all dead and live loads in accordance with accepted engineering practices and standards. (7) Each building must be classified as to building construction type for fire resistance rating purposes in accordance with NFPA 220 and the Life Safety Code. (8) Building insulation materials, unless sealed on all sides and edges in an approved manner with noncombustible material, must have a flame-spread rating of 25 or less when tested in accordance with NFPA 255 and NFPA 258. sec.19.302. Waivers. The Texas Department of Human Services (DHS) may grant a waiver for certain provisions of the physical plant and environment which, in DHS's opinion, would be impractical for the facility to meet. In granting the waiver, DHS will determine that there will be no adverse effect on resident health and safety and the requirement, if not waived, would impose an unreasonable hardship on the facility. DHS may require offsetting or equivalent provisions in granting a waiver. sec.19.303. 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 life-support systems if the normal electrical supply is interrupted. Emergency electrical services by generator or battery must be provided to comply with the provisions of the National Fire Protection Association (NFPA) 70. Battery systems must be capable of sustaining power for a duration of at least one and one-half hours. (1) Life safety systems must include: (A) illumination for means of egress, nurse stations, medication rooms, dining and living rooms, and areas immediately outside of exit doors; (B) exit signs and exit directional signs required by the Life Safety Code; (C) alarm systems, including fire alarms activated by manual stations, water flow alarm devices of sprinkler systems, fire and smoke detecting systems, and alarms required for nonflammable medical gas systems if installed (where hospital-type functions are included in the nursing home facility, applicable standards apply); (D) task illumination and selected receptacles at any required or provided generator set location; (E) selected duplex receptacles, including receptacles in resident corridors, each resident-bed location where patient-care-related electrical appliances are utilized, nurse stations, medication rooms, including biological refrigerator, if a generator is required or provided; (F) nurse calling systems; (G) resident room night lights where required; (H) elevator cab lighting, control, and communication systems; (I) all facility telephone equipment; and (J) those paging or speaker systems that are necessary for the communication plan for an emergency. Radio transceivers that are necessary for emergency use must be capable of operating for at least one hour upon total failure of both normal and emergency power. (2) Where critical systems are provided, there must be a delayed automatic connection. (3) The emergency lighting must be automatically in operation within ten seconds after the interruption of normal electric power supply. Emergency service to receptacles and equipment may be a delayed automatic connection. Receptacles connected to emergency power must be of a uniform and distinctive color. Stored fuel capacity must be sufficient for not less than four-hour operation of required generator. (4) Emergency motor generator, if required or provided, must meet the following standards: (A) any emergency generator must be installed in accordance with NFPA 37 and NFPA 99; (B) generators located on the exterior of the building must be provided with a noncombustible protective cover or be protected as per manufacturer's recommendations; and (C) motor generators fueled by public utility natural gas must have the capacity to be manually or automatically switched to an alternate fuel source, as specified in NFPA 70. (5) Wiring for the emergency system must be in accordance with NFPA 70. (b) When life support systems are used, the facility must provide emergency electrical power with an emergency generator (as defined in NFPA 99, Health Care Facilities) located on the premises. sec.19.304. Space and Equipment. (a) The facility must: (1) provide sufficient space and equipment in dining, health services, recreation, and program areas to enable staff to provide residents with needed services as required by these standards and as identified in each resident's plan of care; and (2) maintain all essential mechanical, electrical, and patient care equipment in safe operating condition. (b) A wing or area which is separated from the rest of the facility by locked doors for the purpose of securing residents must meet the requirements of sec.19.2208(a)(6) and (c)(1)-(10) of this title (relating to Standards for Certified Alzheimer's Facilities). (c) If children are residents of the facility, the facility must provide: (1) indoor and outdoor recreation areas designed to encourage exploration within the children's capabilities; and (2) pediatric equipment and supplies in appropriate size for the age and development level of the children. Pediatric emergency supplies and equipment must be readily available for use. sec.19.305. Resident Rooms.
                                                                                                                                                                                                                                                                                                                                                    Resident rooms must be designed and equipped for adequate nursing care, comfort, and privacy of residents. (1) Bedrooms must: (A) accommodate no more than four residents. The total number of beds in ward rooms with three or more beds must not exceed 50% of the total facility capacity in existing facilities unless approved by the Texas Department of Human Services (DHS). (B) measure at least 80 square feet per resident in multiple resident bedrooms and at least 100 square feet in single resident rooms. (C) have direct access to an exit corridor. (D) be designed or equipped to assure full visual privacy for each resident. Appropriate measures must be taken through the use of cubicle curtains, screens, or procedures to protect the privacy and dignity of the residents. Curtains and screens must be rendered and maintained flame-retardant. (E) 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 (see paragraph (4) of this section) . (F) have at least one operable window to the outside which can readily be opened from the inside without the use of tools. The height of the window sill (opening) must not exceed 36 inches above the floor. The minimum area of windows in each bedroom must equal at least 8.0% of the room area. Operable window sections may be restricted to not more than six nor less than four inches for security or safety reasons if approved in writing by DHS. Each window must be provided with a flame-retardant shade, curtain, or blind. (G) have a floor at or above grade level. (2) The facility must provide each resident with: (A) a separate bed of proper size and height for the convenience of the resident. The bed will be a minimum of 36 inches wide with a headboard of sturdy construction, a clean, comfortable mattress with a moisture-proof cover, and a comfortable pillow. Each bed must be provided with suitable bedspreads and blankets to assure the comfort and warmth of each resident, and must not be passed from resident to resident without first being laundered. The bed of each resident with physician's orders for bedrails must have bedrails affixed to both sides of the bed; (B) a clean, comfortable mattress; (C) bedding appropriate to the weather and climate; and (D) functional furniture appropriate to the resident's needs including a comfortable chair, bedside cabinet, and individual closet space in the resident bedroom with at least 16 inches of hanging space, shelves for personal belongings accessible to the resident, and closeable door(s). Each bedroom must be provided with at least one noncombustible wastebasket. (3) DHS 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: (A) are required by the special needs of the residents; and (B) will not adversely affect residents' health and safety. (4) The width and length of bedrooms and the arrangement of furniture must assure appropriate resident circulation, especially in relation to emergency evacuation and to usual wheelchair movement. Bedrooms should not be less than ten feet in the smallest dimension. There must be at least 36 inches between beds and should be at least 18 inches between any bed and the adjacent parallel wall that restricts access by the resident (that is, bed sides should not have to be placed against a wall to meet other spacing requirements). Beds must not extend into the bedroom door opening, nor must any other piece of furnishing or equipment be located where it might preclude or inhibit the removal of any bed or closing and latching of the bedroom door in an emergency. (5) Each bed must have access to a nurse-call device that is part of an electrical nurse-call system. (6) Each bed must be provided with an appropriate, safe, durable, nonglare, permanently bed-mounted or wall-mounted reading-light fixture. The fixture must be wired in accordance with National Fire Protection Association (NFPA) 70. These fixtures should be mounted at least five feet, six inches above the floor. The switch must be within reach of a resident in the bed. (7) At least one duplex receptacle must be provided for each bed. Other duplex receptacles must be provided as needed and/or as required by NFPA 70. (8) Each bedroom must be assured of having general lighting, either by means of appropriate combination reading light or by means of separate fixture. (9) For emergency separation from fire and smoke, bedroom doors must be maintained to close completely without dragging or binding, to latch securely, and to fit reasonably tight in the frame. The gap between the floor and the bottom of the closed door must not exceed 3/4 inch. (10) Vacant bedrooms may not be used for hazardous activities or hazardous storage, unless specifically approved by DHS in writing. (11) Bedrooms must be identified with a raised or recessed unique number placed on or near the door. Refer to sec.19. 319(c) of this title (relating to Provisions for Persons with Disabilities) and sec.19.301(c)(5) of this title (relating to Applicable Codes and Standards). (12) Residents must be permitted and encouraged to have personal possessions in their rooms that do not interfere with their care, treatment, or well-being, or that of other residents. Pediatric resident's rooms should be decorated and furnished in accordance with the age and developmental level of the children and as an expression of their individual preferences. (13) Locks on bedroom doors are permitted when they meet definite patient needs, including the following situations: (A) married couples whose rights of privacy could be infringed upon unless bedroom door locks are permitted; (B) residents for whom the attending physician wants bedroom door locks to enhance their sense of security; and (C) residents for whom restraint through confinement to their own rooms is necessary for their own and/or other persons' safety. (14) In situations such as those listed in paragraph (13) of this section, the following guidelines must be met: (A) bedroom door locks for other than restraining purposes must be of the type which the occupant can unlock at will from inside the room; (B) all bedroom door locks must be of the type which can be unlocked from the corridor side; (C) attendants must carry keys which will permit ready accessibility to the locked bedrooms when entrance becomes necessary; (D) bedroom doors which are locked for resident restraining purposes must be dutch-doors, with only the lower section locked. The upper part of the doorway must be open to permit visual supervision of the residents from the corridor. The dutch door should be easily unlocked by nurses and attendants. Resident restraints of any nature cannot be applied without orders from the attending physician. See sec.19.601 of this title (relating to Resident Behavior and Facility Practice). (E) locking of bedroom doors by residents for privacy or security or by nursing facility staff for restraint (dutch door) will not be permitted except when specifically included in the attending physician's written orders or authorized by the nursing facility administrator. sec.19.306. Toilet Facilities.
                                                                                                                                                                                                                                                                                                                                                      Each resident room must be equipped with or located near toilet and bathing facilities. (1) Bedrooms not provided with their own (or shared) direct-access toilets and baths must have general-use baths and toilets conveniently located for each sex. (2) Bathtubs or showers must be provided at minimum rate of one for each 20 beds which are not otherwise served by bathing facilities directly accessible from resident bedrooms. (3) In toilet facilities designed for multi-resident use, water closets must be separated in such a manner that they can be used independently and afford privacy. Toilet paper in a suitable dispenser must be provided within reach of each toilet. (4) Water closets and lavatories must be provided at a minimum rate of one for each eight beds which are not otherwise served by fixtures directly accessible from resident bedrooms. A lavatory must be provided in or adjacent to each area having a water closet. (5) Lavatories must be equipped with a mixer faucet and hot and cold water. Resident-use hot water must be provided within the temperature guidelines specified in sec.19.322(g) of this title (relating to Plumbing). (6) There must be a sufficient number of toilet rooms and bathing areas designed to accommodate residents in wheelchairs, including sufficient space in or around fixtures. Proper heights, locations, and installations must be made for grab bars, and any mirrors and accessories provided. (7) Grab bars and lavatories must be substantially anchored to withstand sustained and repeated downward and outward pressure. Grab bars must be provided at all resident water closets and bathing fixtures. New grab bar installations must meet the requirements of the Texas Department of Licensing and Regulation, Elimination of Architectural Barriers Section. (8) Floors, walls, and ceilings must have a nonabsorbent, cleanable surface. Floors and tub or shower standing surfaces must be slip resistant. (9) Doors to bathing and toilet facilities must be wide enough for safe and easy passage of residents in wheelchairs. Folding or sliding doors must not be used unless it can be established that no safety hazard exists. (10) Keys to resident baths or toilets with privacy locks must be kept readily available to staff. (11) Provision must be made for sanitary hand washing and drying by staff, visitors, or residents at each lavatory. (12) Bathrooms and toilets rooms must have a negative air pressure in relation to adjacent areas with air exhausted through ducts to the exterior. (13) Bathing areas must be provided with safe heating. (14) Bathtubs, showers, and lavatories must be kept clean and in proper working order. They must not be used for laundering or for storage of soiled materials or for the cleaning of mops or brooms. (15) Nurse-call devices must be provided at resident-use baths and toilets and be within easy reach of residents. (16) Electrical outlets in wet areas must be provided with ground fault interrupters, excluding toilet rooms where there are no bathing units. sec.19.307. Resident Call System. (a) The nurse's station must be equipped to receive resident calls through a communication system from: (1) resident rooms; and (2) toilet and bathing facilities. (b) The call cord does not have to be accessible in all parts of the room, but must be accessible to the resident. The system must be connected to on and off switches operable at each bed, toilet unit, and bathing unit. (c) Each call entered into the system must activate a corridor dome light above the bedroom, bathroom, or toilet corridor door that opens onto a corridor. (d) A visual signal at the nurses station must indicate the room from which the call was placed with an audible signal of sufficient amplitude to be clearly heard by nursing staff. The amplitude or pitch of the audible signal must not be irritating to residents or visitors. (e) The system must be designed so calls entered into the system may be canceled only at the calling station. Intercom-type systems which meet this requirement are acceptable. sec.19.308. Dining and Resident Activities. (a) Requirements. The facility must provide one or more rooms designated for resident dining and activities. These rooms must be: (1) well-lighted; (2) well ventilated, with nonsmoking areas identified; (3) adequately furnished; and (4) sufficiently spacious to accommodate all activities. (b) Resident living areas. (1) Resident living areas such as living rooms, dayrooms, lounges, recreation rooms, and sunrooms must be provided to meet the needs of the residents' comfort. Combined living and dining areas should be not less than 19 square feet per bed, but must not be less than ten square feet per bed. (2) No single room less than 100 square feet will be included as part of the acceptable total area required. (3) At least one living area must have an outside window. (4) Living areas must be provided with comfortable furniture of substantial construction and be appropriately decorated to provide a pleasant and comfortable environment for residents and visitors. Furnishings and decorations must not obstruct exits or ways of egress. (5) Nonsmoking areas must be provided and identified. (c) Dining areas. Dining space must be provided to adequately serve needs of the residents and provide an efficient, sanitary, and pleasant environment for dining. sec.19.309. Other Environmental Conditions. The facility must provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public. (1) 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) maintain an effective pest control program so that the facility is free of pests and rodents and must be mounted 33 to 36 inches from the floor; and (D) equip corridors with firmly secured handrails on each side on all walls 18 inches or greater. These rails must be substantially anchored to withstand downward force. (2) No occupancies or activities undesirable to the health, safety, or well- being of residents will be located in the facility. (3) For pediatric residents, 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 which are accessible to children. (4) In operations where there is a chance of cross-contamination, clean and soiled operations must be separated to lessen the chance of cross-contamination by facility employees, residents, and others. This separation must be in relation to traffic flow, air currents, air exhaust, water flow, vapors, and other conditions. (5) An electric water cooler or water fountain must be accessible to residents. When new drinking fountains are provided, at least one must be installed to be accessible to persons in wheelchairs. (6) Public toilet(s) with sanitary handwashing and drying provisions must be provided or designated. (7) If deodorant is used for air-freshening purposes, the following procedures must apply: (A) deodorants or air fresheners are permitted provided the dispensing device is located where it is inaccessible to residents and patients; (B) these products are not used to cover odors resulting from poor housekeeping practices or unsanitary conditions; (C) these products are not used in excess; (D) there is no contra-indication on the label of the product indicating that the product should not be used in the presence of aged or ill persons; and (E) devices, such as ozone generators, ultra-violet generators, and smoke eliminators, must be approved by the Texas Department of Human Services. sec.19.310. Site and Grounds. (a) Site grades must provide for positive surface water drainage so that there will be no ponding or standing water at or near the building that would present a hazard to health or provide a breeding site or harborage for carriers of disease. (b) Outdoor activity, recreational, and sitting spaces must be provided for residents as space permits. (c) Each facility must have parking spaces to satisfy the needs of residents, employees, staff, and visitors. Provisions must be made for handicapped parking and access into the building. (d) Protection must be provided for resident safety from traffic or other site hazards by the use of appropriate methods, such as fences, hedges, retaining walls, railings, or other landscaping. This protection must not inhibit the free emergency egress to a safe distance away from the building. (e) Auxiliary buildings located on the site within 20 feet of the main licensed structure and which contain hazardous operations or contents, such as laundries or storage buildings, must meet the same code requirements for safety as the main licensed structure. (f) Other buildings on the site must meet the appropriate occupancy section or separation requirements of the Life Safety Code. (g) All outside areas, grounds, and adjacent buildings on the site must be maintained in good condition and kept free of rubbish, garbage, and untended growth that may constitute a fire or health hazard. (h) Enclosed exterior spaces, such as fenced areas, that are in a means of egress to a public way must meet the requirements of sec.19. 2208(a)(6) of this title (relating to Standards for Certified Alzheimer's Facilities). sec.19.311. Fire Service and Access. (a) The facility must be served by a paid or volunteer fire department. The fire department must provide written assurance to the licensing agency that the fire department can respond to an emergency at the facility within an appropriately prompt time for the travel conditions involved. (b) The facility must be served by an adequate water supply that is satisfactory and accessible for fire department use as determined by the fire department serving the facility and by the Texas Department of Human Services (DHS). (c) There must be at least one approved, readily accessible fire hydrant located within 300 feet of the building. The hydrant must be on a minimum six- inch service line, or else there must be an approved equivalent, such as a storage tank. The hydrant, its location, and service line, or equivalent must be approved by the local fire department and DHS. (d) The building must have suitable fire lanes for access as required by local fire authorities and DHS. sec.19.312. Means of Egress. (a) Corridors and other means of egress must be kept clear of obstructions and must not be used for any purpose which would interfere with its use as an exit, such as for storage, vending machines, seating, or similar purposes. The corridor width must be maintained at all times. (b) Ways of egress and exit signs must be illuminated at all times. (c) 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 per nurses station. (d) Doors within the means of egress must not be equipped with a latch or lock which requires the use of a key or tool to open from the inside of the building. A latch or other fastening device on a door must be provided with a knob, handle, panic bar, or other simple type of releasing device with an obvious method of operation, even in darkness. (e) A hold-open device must be installed on each exit door. sec.19.313. Interior Finishes-Walls, Ceilings, and Floors. (a) Interior finishes of walls and ceilings must have limited flame-spread rating as required by the Life Safety Code. Where new interior finishes of walls, ceilings, or floors are applied to existing facilities, the new finishes must meet the requirements for flame-spread ratings for new construction. Fire retardant paints or solutions must not be applied to new materials in an effort to meet flame-spread requirements for new construction. This description of interior finishes does not apply to furniture or accessories. (b) Floors of the facility must be level, smooth, and free of any irregularities which might affect safety. (c) Walls and ceilings not specifically described elsewhere in this chapter must be cleanable, maintained attractively, and in good repair. (d) Walls and floors must be kept free of cracks. The joint between the walls and floors is to be maintained so as to be free of spaces which might harbor insects, rodents, or vermin. sec.19.314. Fire Alarms, Detection Systems, and Sprinkler Systems. Fire alarms, detection systems, and sprinkler systems must be as required by the Life Safety Code, the National Fire Protection Association (NFPA) 72, and NFPA 13. (1) Components must be compatible and laboratory listed for the use intended. (2) Wiring and circuitry for alarm systems must meet the applicable requirements for NFPA standards, including NFPA 70, for these systems. (3) Fire alarm systems must be installed, maintained, and repaired by an agent having a current certificate of registration with the State Fire Marshal's Office of the Texas Commission on Fire Protection, in accordance with state law. A fire alarm installation certificate must be provided as required by the Office of the State Fire Marshal. (4) The fire alarm system must be designed so that whenever the general alarm is sounded by activation of any device (such as manual pull, smoke sensor, sprinkler, or kitchen range hood extinguisher) the following will occur automatically: (A) smoke and fire doors which are held open by an approved device must be released to close; (B) air handlers (air conditioning/heating distribution fans) serving three or more rooms or any means of egress must shut down immediately; (C) smoke dampers must close; and (D) the alarm-initiating location must be clearly indicated on the fire alarm control panel(s) and all auxiliary panels. (5) Consistent fire alarm bells or horns must be located throughout the building for audible coverage. Flashing alarm lights (visual alarms) must be installed to be visible in corridors and public areas including dining rooms and living rooms. (6) A master control panel which indicates location of alarm and trouble conditions (by zone or device) must be visible at the main nurse station. All control panels must be listed in accordance with the provisions of the Underwriters Laboratories, Inc. (UL) for intended use, such as manual, automatic, and water-flow activation. Alarm and trouble zoning must be by smoke compartments and by floors in multi-story facilities. (7) Remote annunciator panels, indicating location of alarm initiation by zone or device and common trouble signals, must be located at auxiliary or secondary nurses stations on each floor or major subdivision of single story facilities and indicate the alarm condition of adjacent zones and the alarm conditions at all other nurse stations. (8) Manual pull stations must be provided at all exits, living rooms, dining rooms, and at or near the nurse stations. (9) The NFPA 13 sprinkler system must be monitored for flow and tamper conditions by the fire alarm system. (10) The kitchen range hood extinguisher must be interconnected with the fire alarm system. This interconnection may be a separate zone on the panel or combined with other initiating devices located in the same zone as the range hood is located. (11) Partial sprinkler systems provided only for hazardous areas must be interconnected to the fire alarm system and comply with the Life Safety Code. Each partial system must have a valve with a supervisory switch to sound a supervisory signal, water-flow switch to activate the fire alarm, and an end-of- line test drain. sec.19.315. Portable Fire Extinguishers. Portable fire extinguishers must be provided and maintained to comply with the provisions of the National Fire Protection Association (NFPA) 10. This includes type of extinguishers (A, B, or C), location and spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer. (1) Extinguishers in resident corridors must be spaced so that travel distance is not more than 75 feet. The minimum size of extinguishers must be either 2 1/2 gallon for water type or five pound for ABC type. (2) Extinguishers must be installed on supplied hangers or brackets or be mounted in cabinets approved by the Texas Department of Human Services (DHS). (3) Extinguishers must be surface wall-mounted or recessed in cabinets where they are not subject to physical damage or dislodgement. (4) Extinguishers having a gross weight not exceeding 40 pounds must be installed so that the top of the extinguisher is not more than five feet above the floor. Extinguishers with a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than 3-1/2 feet above the floor. The clearance between the bottom of the extinguisher and the floor must not be less than four inches. (5) Portable extinguishers provided in hazardous rooms must be located as close as possible to the exit door opening and on the latch (knob) side. (6) Staff must be appropriately trained in the use of each type of extinguisher in the facility. sec.19.316. Subdivision of Building Spaces-Smoke Barriers. (a) Subdivision of building spaces must be as required by the Life Safety Code. (b) The facility must maintain the integrity of smoke barrier walls, including those parts of walls in attics and other concealed spaces. (c) The facility must maintain the integrity of smoke dampers in air ducts. (d) Ducts with smoke dampers must have maintenance panels for inspection. The maintenance panels must be removable without tools. Means of access must also be provided in the ceiling or side wall to facilitate smoke damper inspection readily and without obstruction. Location of dampers must be identified on the wall or ceiling of the occupied area below. sec.19.317. Elevators and Escalators. Elevators must comply with the provisions of the Life Safety Code and American National Standard Institute Safety Code for Elevators and Escalators (ANSI/ASME A17.1). Elevators are required for buildings having residents' facilities, such as bedrooms, dining, or recreation areas; or services, such as diagnostic or therapy, located on other than the main entrance floor. Passenger elevators and escalators must be inspected by a qualified agent at least every six months. Freight elevators must be inspected every 12 months. sec.19.318. Other Rooms and Areas. (a) Nurses station. A nurses station is an area designated as the focal point on all shifts for the administration and supervision of resident-care activities for a designated number of resident bedrooms. (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-storied 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 paragraphs (2)-(4) of this subsection may be increased to 165 feet in facilities or additions to facilities completed before August 10, 1983. (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, located in the service area or a designated auxiliary station, must register calls at the nurses station to which it is assigned. (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 plan and the Life Safety Code, must be observed. All renovations and structural changes require prior approval from the Texas Department of Human Services (DHS). (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 mechanical means, such as closed-circuit television and mirrors, to observe residents in the facility. (2) Closed-circuit television monitoring systems must meet the following criteria: (A) The camera(s) must be placed to view the entire corridor length, without any "blind spots." (B) The camera(s) must be capable of providing recognizable images, in minimum and maximum light levels, for the complete viewing area. (C) The monitor(s) 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 they perform 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(s) 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) Resident call system. Each nurses station must be equipped to register residents' calls through a communication system from resident areas. See sec.19.307 of this title (relating to Resident Call System) for specific requirements. (e) Medication storage area. There must be 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, the medication cart must be secured in a designated area. Only authorized personnel must have access to the medication storage area and the medication cart. Medication storage and preparation areas must be adequately ventilated and temperature controlled. See sec.19.1501 of this title (relating to Pharmacy Services). (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. Soiled linen rooms 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 over the room at the five foot level. Sufficient heating must be provided 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, and/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. Separation of soiled and clean dish areas must be maintained, 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 handwashing lavatory in the food- preparation area. The dish washing area must have ready access to a handwashing lavatory or hand sanitizing device. Handwashing 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) Kitchen exhaust hood at cooking equipment and its attached automatic chemical extinguisher must comply with National Fire Prevention Association (NFPA) 96. DHS 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 at all times. 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 (those not contiguous to food preparation and serving areas). (1) Where service areas other than the kitchen are used to dispense foods, these must be designated as food service areas and must have equipment for maintaining required food temperatures while serving. (2) Separate food service areas must have handwashing 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 area(s) 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 assure 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/or 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 Life Safety Code 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 the Life Safety Code. (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/or 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. The facility must comply with Texas Department of Health requirements as described in 25 TAC sec.sec.1.131-1.137 (relating to Definitions and Treatment of Special Waste from Health Care Related Facilities). The facility must also comply with Texas Natural Resource Conservation Commission requirements for medical waste management, as specified in 30 TAC Chapter 330, Subchapter Y. 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, keys) must be readily available on site. (u) Oxygen. (1) The facility must implement procedures that assure the safe and sanitary use and storage of oxygen. (2) Liquid oxygen containers must be certified by Underwriters Laboratory (UL) or other approved testing laboratory for compliance with NFPA 50 requirements. The storage, handling, assembly, and testing must be in compliance with all applicable NFPA standards, including NFPA 99 and NFPA 50 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. sec.19.319. Provisions for Persons with Disabilities. New facilities and additions must meet the requirements of the Texas Department of Licensing and Regulation, Elimination of Architectural Barriers Section. Existing facilities must meet the requirements of the Americans with Disabilities Act and must, at a minimum, comply with the following: (1) The facility must provide and mark at least one parking space for persons with disabilities. (2) The facility must provide wheelchair access into the building by use of ramps and curb breaks. Ramps must not slope more than 1:12 (one unit of rise to 12 units of run). (3) Room identification signs or letters must be installed four feet six inches to five feet above finished floor and located on the corridor walls adjacent to the latch side of the door jamb. Letters or numbers on signs must be raised or recessed at least 1/32 inch minimum. Characters must be at least 5/8 inch in height and no higher than two inches. (4) Grab bars at toilet and bathing units must be 1/4 inch to 1/2 inch in diameter. (5) Toilet facilities must be available and of sufficient size to accommodate wheelchairs. There must be at least one public wheelchair-accessible restroom. (6) Water closet seat height in toilet facilities for persons with disabilities must be 17 to 19 inches from floor. (7) Mirrors and dispensers for persons with disabilities must be no higher than 40 inches above the floor. (8) Drinking fountains or coolers must meet American National Standards Institute (ANSI) A117.1 (that is, up front spout and controls no more than 36 inches from floor maximum). Fountains existing at the time of this publication do not have to be altered. (9) Public telephones, if provided, must meet ANSI A117.1. Mounting height must not exceed 48 inches to coin slot. sec.19.320. Lighting and Illumination. Current recommendations of the Illumination Engineering Society of North America must be followed to achieve proper illumination characteristics and lighting levels throughout the facility. Minimum illumination must be ten foot candles in resident rooms and 20 foot candles in corridors, nurses stations, dining rooms, lobbies, toilets, bathing facilities, laundries, stairways, and elevators. Illumination requirements for these areas apply to lighting throughout the space and should be measured at approximately 30 inches above the floor anywhere in the room. Minimum illumination for overbed reading lamps, medication preparation or storage areas, kitchens, and nurse's station desks must be 50 foot candles. Illumination requirements for these areas apply to the task performed and should be measured on the task. sec.19.321. Heating, Ventilating, and Air-conditioning Systems (HVAC). (a) The heating system must be capable of maintaining a temperature of not less than 71 degrees Fahrenheit at the resident level in all resident-use areas. Auxiliary heating devices permanently installed, such as heat strips in ducts, electric ceiling-mounted heating units, and electric baseboards, may be used to augment a central heating system as approved by the Texas Department of Human Services (DHS). See sec.19.705 of this title (relating to Environment). (b) The cooling system must be capable of maintaining a temperature suitable for the comfort of the residents in resident-use areas. (c) Air flow must be directed or adjusted so that a resident is not in direct drafts that could be harmful to the health and comfort of the resident. (d) Unvented heating units and portable heaters are prohibited. (e) The facility must be well ventilated through the use of windows, mechanical ventilation, or a combination of both. Rooms and areas which do not have outside windows and which are used by residents or personnel must be provided with functioning mechanical ventilation to change the air on a basis commensurate with the room usage. Air systems must provide for the induction and mixing of at least 10% outside fresh air into the facility unless otherwise approved by DHS; that is, 100% continuous recirculation of interior air in most areas is not acceptable. When certain rooms or areas are dependent on a central air system for proper ventilation, including exhaust, that central air system fan must run continuously. (f) Operable outside windows must be provided with insect screens. Outside doors must be self-closing to control entry of insects. All exterior doors must be effectively weather stripped. (g) Heating and air conditioning systems must be provided with clean and effective air filters. (h) Ducts and piping subject to surface condensation must be insulated to prevent condensation at least in areas which may affect sanitation or cause building deterioration. (i) A comfortable temperature for residents when bathing must be provided. (j) Heating, ventilating, and air conditioning systems must comply with the provisions of applicable National Fire Prevention Association (NFPA) standards. Ducts are to be of a Class A material (noncombustible). Combustion air for gas- fired equipment must be ducted from the exterior. (k) Air flow must be designed to prevent cross contamination within any area where applicable, such as laundries and kitchens, as well as the system or facility as a whole. (l) In relation to adjacent areas, a positive air pressure must be provided for clean utility rooms, clean linen rooms, and medication rooms. Conditioned supply air must be introduced into these rooms. (m) In relation to adjacent areas, a negative air pressure must be provided for soiled utility rooms, soiled laundry rooms, bathrooms, toilets, and other odor-producing rooms. Air from these rooms must not be recirculated, but instead must be exhausted through ducts to the exterior by effective means. (n) Facility temperature must be maintained for the comfort of residents. sec.19.322. Plumbing. (a) If the municipality has a plumbing code, that code must be used as a basis for determining the correctness of plumbing installation. In the absence of a municipal code, a nationally recognized plumbing code must be used. (b) The water supply must be of safe, sanitary quality, suitable for use, and adequate in quantity and pressure. The water must be obtained from a water supply system, the location, construction, and operation of which are approved by the Texas Natural Resource Conservation Commission. (c) Sewage must be discharged into a state-approved sewerage system or the sewage must be collected, treated, and disposed of in accordance with applicable Texas Natural Resource Conservation Commission rules and regulations. (d) The wastewater drainage and sewage system must assure that sanitation is maintained for residents. Wastewater or sewage must not be discharged on the surface of the ground. Traps must not be allowed to lose their seal. Appliances must have air gaps as required for connections to the sewerage system. Venting must assure a rapid flow of wastewater in the sewage system. (e) The interior cold water supply system and piping must be so placed or so insulated as to prevent condensation drip in habitable areas and in storage areas. (f) Backflow preventers or vacuum breakers must be installed with any water supply fixture where the outlet or attachments may be submerged. (g) Resident-use hot water must be reliably controlled, such as by thermostatic or mixing valves, to not exceed 110 degrees Fahrenheit and not less than 100 degrees Fahrenheit at each fixture. (h) Hot water for other usages must be provided at the temperatures required for the appliance or fixture or for the operation involved, such as dishwashing and laundry. (i) The supply quantity of hot water must be adequate for normal peak load usage. Facilities which continue to experience a shortage of hot water must remedy the situation by such means as adding storage tanks, adding or increasing the size of water heaters, or other approved means. (j) Water heaters must be equipped with pressure temperature relief valves. sec.19.323. Housekeeping Services. (a) The facility must provide sufficient housekeeping and maintenance personnel, equipment, and supplies to maintain the interior, exterior, and grounds of the facility in a safe, clean, orderly, and attractive manner. In a nursing facility, an employee must be designated as responsible for housekeeping services. (b) Occupied resident rooms must be cleaned and put in order at least daily. (c) Storage areas must be kept safe and free from accumulations of extraneous materials such as refuse, discarded furniture, and newspapers. Combustibles, such as cleaning rags and compounds, must be kept in closed metal containers and labeled. (d) Attics, mechanical rooms, boiler rooms, and other similar areas must not be used for storage purposes. (e) All bleaches, detergents, disinfectants, insecticides, and other poisonous substances must be kept in a safe place accessible only to employees. They must not be kept in containers previously containing food or medicine. Containers must be labeled. sec.19.324. Pest Control. (a) An effective, safe, and continuing pest control system against insects, rodents, and vermin must be in operation in the facility. Pest control services must be provided by nursing facility personnel or by contract with a licensed pest control company. Care must be taken to use the least toxic and least flammable effective insecticides and rodenticides. These compounds must be stored in nonfood preparation and storage areas. Poisons must be under lock. (b) The facility must protect against harborages and entrances for insects, rodents, and vermin. Outside doors must be self-closing to control entry of pests. (c) Garbage and trash must be stored in enclosed containers, protected against leakage, contact with disease carriers, and access to animals. It must be stored in areas separate from those used for the preparation and storage of food and must be removed from the premises in conformity with state and local practices. Garbage and trash containers must be maintained free of accumulations and coatings of garbage. Garbage storage areas must be kept clean and in a state of good repair. sec.19.325. Linen. (a) The nursing facility must have available at all times a quantity of linen essential for the proper care and comfort of residents. Linens must be handled, stored, and processed so as to control the spread of infection. (b) Linen will be maintained in good repair. (c) Linen must be washed, dried, stored, and transported in a manner which will produce hygienically clean linen. The washing process must have a mechanism for soil removal and bacteria kill. (d) Clean linen must be stored in a clean linen area easily accessible to the personnel. (e) Clean towels and washcloths must be provided to each resident as needed or desired. Towels and washcloths must be stored in a sanitary manner between uses by the resident and must not be used by more than one resident between launderings. (f) Soiled linen and clothing must be stored separately from clean linen and clothing. Soiled linen and clothing must be stored in well ventilated areas, and must not be permitted to accumulate in the facility. Soiled linen and clothing must be transported in accordance with procedures consistent with universal precautions. Bags or containers must not be reused to transport or store clean items. (g) Soiled linen must not be sorted, laundered, rinsed, or stored in bathrooms, resident rooms, corridors, kitchens, or food storage areas, except soiled linen and clothing which is not contaminated with blood may be rinsed in a resident's bathroom water closet. (h) Resident's personal clothing that is not soiled with body wastes may be stored in a closed container in the resident's closet. The clothing must be collected and cleaned at least weekly. (i) Facility staff must wash their hands both after handling soiled linen and before handling clean linen. sec.19.326. Safety Operations. (a) The facility must have a written plan with procedures to be followed in an internal or external disaster and for the care of casualties. Plans dealing with natural disasters, such as hurricanes, floods, and tornadoes, must be coordinated with the local emergency management coordinator. Information about the local emergency management coordinator may be obtained from the office of the local mayor or county judge. (1) The facility must maintain the plan and procedures at the nurses station and with department managers within the facility. The facility must ensure that the plan and procedures are reviewed at least annually. Changes in administrator, construction, or emergency phone numbers will require the facility to review and possibly modify the disaster plan. All reviews of disaster plans must be documented. (2) The facility must include in the disaster plan, evacuation routes and procedures to be followed in the event of fire, explosion, or other disaster. The plan must also include procedures for the prompt transfer of casualties, clinical records, medications, and notification of appropriate persons. (3) All employees must be familiar with the disaster plan and must be instructed in the location and use of the facility's alarm systems, fire- fighting equipment, and procedures. The facility must post fire and explosion evacuation routes prominently throughout the facility. The facility must have a fire safety plan within the disaster plan. The fire safety plan must be rehearsed quarterly on each shift with at least one rehearsal conducted each month. A comprehensive fire drill report form must be completed for each rehearsal of the fire safety plan. (4) In smaller, simple, one story buildings where all exits are obvious, the Texas Department of Human Services (DHS) may not require the posting of evacuation routes. (5) The facility must have an emergency contingency plan to ensure the residents' comfort and safety, including the provision of potable water. (6) Emergency telephone numbers must be clearly posted on or near each phone. Emergency telephone numbers must include the local fire department, ambulance, and police. (b) The facility must report all fires to DHS on the Fire Report for Long Term Care Facilities Form within 15 days after the fire. The facility must immediately notify DHS by phone of disasters or any fires which caused death or serious injury. Telephone reports must be followed by written reports. Failure of the fire alarm, emergency power, or sprinkler system will require that all facility staff be informed of conditions, and the facility must take special precautions such as establishing a fire watch, appropriate to the situation. These situations must be reported to the local fire authority. (c) Severe weather drills and other emergency drills must be held as needed and as called for by the facility's policy and procedure manual. (d) The fire alarm and sprinkler systems must be inspected and tested at least once every three months by a licensed agent. Each quarterly inspection and test must be of the complete system, including smoke dampers and individual sprinkler heads. A standard report form of the inspection must be completed by the agent and kept on file by the facility. The report must include the signature of the person making the inspection and the date of the inspection. The facility must maintain a current contract on file for the services of the inspecting company. (e) The facility may, at its own discretion, make simple periodic tests of the basic fire alarm system, such as by activating a manual-pull station, particularly when conducting required fire drills. At any time the facility staff verifies or suspects some malfunction of the system, the condition must be immediately investigated and corrected. (f) Emergency generators, if required or provided, must be maintained in operating condition at all times. These must be inspected and run, under load, for at least 30 minutes each week. A signed or initialed record or log must be kept on file by the facility. The condition and proper operation of the emergency egress lighting should also be checked at this time. (g) A functional test must be conducted on every required battery emergency lighting system at 30-day intervals for a minimum of 1/2 hour. An annual test must be conducted for a one and 1/2 hour duration. Equipment must be fully operational for the duration of the test. Written records of testing must be kept in the facility for inspection by the authority having jurisdiction. (h) Automatic, fixed, dry-chemical extinguishers mounted in kitchen range hoods must be inspected and serviced by a licensed agent (type A license with the State Fire Marshal's office) at least once every six months. A written, signed report must be left on file with the facility. The hood, exhaust ducts, and filters must be kept clean and free of accumulated grease. (i) Portable fire extinguishers must be visually inspected monthly by facility staff and must have maintenance provided annually by a licensed agent in accordance with National Fire Prevention Association (NFPA) 10. A record of the annual maintenance must be kept in the facility. Portable extinguishers must be protected from damage and must be kept on their mounting brackets or in cabinets at all times. (j) Facilities using gas must have the gas piping lines from the meter and appliances tested for leaks annually by a qualified person. A written, signed report must be made of these tests and kept on file. Any unsatisfactory conditions must be noted and corrected promptly. (k) Smoking policies must be formulated and adopted by the facility. The policies must comply with all applicable codes, regulations, and standards, including local ordinances. The facility is responsible for informing residents, staff, visitors, and other affected parties of smoking policies through distribution and/or posting. The facility is responsible for enforcement of smoking policies which must include at least the following provisions: (1) Smoking tobacco, matches, lighters, or other smoking paraphernalia are not permitted to be kept or stored in a resident's room or in their possession without supervision. (2) Smoking by residents on the premises is permitted only when supervised by staff of the facility or visitors. The type of supervision (individual versus group supervision) will be determined by the resident's medical condition. The resident must be within direct view of the smoking supervisor, in reasonably close proximity of the supervisor, and the supervisor must be able to quickly respond in the event of an emergency. Additionally, the supervisor, whether staff or visitor, must be aware of these responsibilities. A facility may establish a no-smoking policy for any public areas of the facility. (3) Smoking is prohibited in any room, ward, or compartment where flammable liquids, combustible gas, or oxygen are used or stored and in any other hazardous locations. These areas must be posted with "No Smoking" signs. (l) No storage is permitted in rooms with gas-fired equipment. Bulk storage of volatile or flammable liquids or materials is not allowed anywhere within the building. (m) Medical equipment, carts, wheelchairs, tables, furniture, dispensing machines, and similar physical objects, must not be stored in corridors or other ways of egress. (n) Smoke doors, fire doors, and doors to hazardous rooms must be kept closed and must not be propped or wedged open. Only approved devices such as alarm- activated electromagnetic hold-open devices may be used to hold these doors open, except doors to rooms classified as severe hazard. (o) Electrical extension cords must not be used on a permanent or semi- permanent basis as a substitute for approved wiring methods. Approved electrical receptacles must be provided in quantity and location for the normal use of appliances. (p) All abandoned utilities such as electrical wiring, ducts, and pipes, must be removed from the facility when no longer usable. sec.19.330. Construction and Initial Survey of Completed Construction. (a) Construction phase. (1) The Texas Department of Human Services (DHS), Architectural Section in Austin, Texas, must be notified in writing of construction start. (2) All construction must be done in accordance with minimum licensing requirements. It is the sponsor's responsibility to employ qualified personnel to prepare the contract documents for construction of a new facility or remodeling of an existing facility. Contract documents for additions and remodeling and for the construction of an entirely new facility must be prepared by an architect licensed by the Texas State Board of Architectural Examiners. Drawings must bear the seal of the architect. Certain parts of final plans, designs, and specifications must bear the seal of a registered professional engineer approved by the State Board of Registration for Professional Engineers to operate in Texas. These certain parts include sheets and sections covering structural, electrical, mechanical, and sanitary engineering. (A) Remodeling is the construction, removal, or relocation of walls and partitions, the construction of foundations, floors, or ceiling-roof assemblies, the expanding or altering of safety systems (including, but not limited to, sprinkler, fire alarm, and emergency systems), or the conversion of space in a facility to a different use. (B) General maintenance and repairs of existing material and equipment, repainting, applications of new floor, wall, or ceiling finishes, or similar projects are not included as remodeling, unless as a part of new construction. DHS must be provided flame spread documentation for new materials applied as finishes. (b) Contract documents. (1) Site plan documents must include grade contours; streets (with names); north arrow; fire hydrants; fire lanes; utilities, public or private; fences; unusual site conditions, such as ditches, low water levels, other buildings on- site; and indications of buildings five feet or less beyond site property lines. Site plan documents for nursing facilities may include the developed landscaping plan for resident use as called for in sec.19.332(f) of this title (relating to Location and Site) . (2) Foundation plan documents must include general foundation design and details. (3) Floor plan documents must include room names, numbers, and usages; resident care areas; doors (numbered) including swing; windows; legend or clarification of wall types; dimensions; fixed equipment; plumbing fixtures; and kitchen basic layout; and identification of all smoke barrier walls (outside wall to outside wall) or fire walls. (4) For both new construction and additions or remodeling to existing buildings, an overall plan of the entire building must be drawn or reduced to fit on an 8-1/2 inch by 11 inch sheet. (5) Schedules must include door materials, widths, types; window materials, sizes, types; room finishes; and special hardware. (6) Elevations and roof plan must include, but is not limited to, exterior elevations, including material note indications and any roof top equipment, roof slopes, drains, and gas piping, and interior elevations where needed for special conditions. (7) Details must include wall sections as needed (especially for special conditions); cabinet and built-in work, basic design only; cross sections through buildings as needed; and miscellaneous details and enlargements as needed. (8) Building structure documents must include structural framing layout and details (primarily for column, beam, joist, and structural frame building); roof framing layout (when this cannot be adequately shown on cross section); cross sections in quantity and detail to show sufficient structural design and structural details as necessary to assure adequate structural design, also calculated design loads. (9) Electrical documents must include electrical layout, including lights, convenience outlets, equipment outlets, switches, and other electrical outlets and devices; service, circuiting, distribution, and panel diagrams; exit light system (exit signs and emergency egress lighting); emergency electrical provisions (such as generators and panels); fire alarm and similar systems (such as control panel, devices, and alarms); a nurse call system; and sizes and details sufficient to assure safe and properly operating systems. (10) Plumbing documents must include plumbing layout with pipe sizes and details sufficient to assure safe and properly operating systems, water systems, sanitary systems, gas systems, other systems normally considered under the scope of plumbing, fixtures, and provisions for combustion air supply. (11) Heating, ventilation, and air-conditioning (HVAC) documents must include sufficient details of HVAC systems and components to assure a safe and properly operating installation including, but not limited to, heating, ventilating, and air-conditioning layout, ducts, protection of duct inlets and outlets, combustion air, piping, exhausts, and duct smoke and/or fire dampers; and equipment types, sizes, and locations. (12) Sprinkler system documents must include plans and details of National Fire Protection Association (NFPA) designed systems; plans and details of partial systems provided only for hazardous areas; electrical devices interconnected to the alarm system. (13) Other layouts, plans, or details as may be necessary for a clear understanding of the design and scope of the project; including plans covering private water or sewer systems must be reviewed by the local health or wastewater authority having jurisdiction. (14) Specifications must include installation techniques, quality standards and/or manufacturers, references to specific codes and standards, design criteria, special equipment, hardware, painting, and any others as needed to amplify drawings and notes. (c) Initial survey of completed construction. (1) Upon completion of construction, including grounds and basic equipment and furnishings, a final construction inspection (initial survey) of the facility, including additions or remodeled areas, is required to be performed by DHS's architectural section prior to occupancy. A minimum of three weeks advance notice is needed. The completed construction must have the written approval of the local authorities having jurisdiction, including the fire marshal and building inspector. (2) After the completed construction has been surveyed by a representative of DHS's architectural section and found acceptable, this information will be conveyed to the licensing officer as part of the information needed to issue a license to the facility. In the case of additions or remodeling of existing facilities, a revision or modification to an existing license may be necessary. Note that the building, grades, drives, parking, and grounds must be essentially 100% complete at the time of this initial survey visit for occupancy approval and licensing, including basic furnishings and operational needs. (3) The following documents must be provided to DHS's architectural inspecting surveyor at the time of the survey of the completed building: (A) written approval of local authorities as called for in paragraph (1) of this subsection; (B) written certification of the fire alarm system by the installing agent (the Texas State Fire Marshal's Fire Alarm Installation Certificate); (C) documentation of materials used in the building which are required to have a specific limited fire or flame spread rating including, but not limited to, special wall finishes or floor coverings, flame retardant curtains (including cubicle curtains), and rated ceilings. This must include a signed letter from the installer verifying that the material installed, such as carpeting, is the same material named in the laboratory test document; (D) approval of the completed sprinkler system installation by the Texas Department of Insurance or the designing engineer. A copy of the material list and test certification must be available; (E) service contracts for maintenance and testing of systems, including, but not limited to, alarm systems and sprinkler systems; (F) a copy of gas test results of the facility's gas lines from the meter; (G) a written statement from an architect and/or engineer stating that he certifies that the building was constructed to meet NFPA 101, Life Safety Code, and all locally applicable codes, and that the facility is in substantial conformance with minimum licensing requirements; and (H) the contract documents specified in subsection (b) of this section. (d) Nonapproval of new construction. (1) If, during the survey of completed construction, the surveyor finds certain basic requirements not met, DHS will not license the facility or approve it for occupancy. Such basic items may include the following: (A) construction which does not meet minimum code or licensure standards for basic requirements such as corridor widths being less than eight feet clear width, ceilings installed at less than the minimum seven feet six inches height, resident bedroom dimensions less than required width, and other similar features which would disrupt or otherwise adversely affect the residents and staff if corrected after occupancy; (B) no written approval by local authorities; (C) fire protection systems not completely installed or not functioning properly including, but not limited to, fire alarm systems, emergency power and lighting, and sprinkler systems; (D) required exits are not all usable according to Life Safety Code requirements; (E) telephone not installed or not properly working; (F) sufficient basic furnishings, essential appliances and equipment are not installed or not functioning; and (G) any other basic operational or safety feature which the surveyor, as the authority having jurisdiction, encounters which in his judgment would preclude safe and normal occupancy by residents on that day. (2) If the surveyor encounters deficiencies that do not affect the health and safety of the residents, licensure may be recommended based on an approved written plan of correction by the facility's administrator. (3) Copies of reduced size floor plan on an 8-1/2 inch by 11 inch sheet must be submitted in duplicate to DHS for record and/or file use and for the facility to use in evacuation planning and fire alarm zone identification. The plan must contain basic legible information such as overall dimensions, room usage names, actual bedroom numbers, doors, windows, and any other pertinent information. sec.19.331. Construction Standards for Additions, Remodeling, and New Nursing Facilities. (a) This subchapter is written for, and applies to, new construction, including conversions, additions, and remodelings. The requirements of the Life Safety Code, Standard 101 of the National Fire Protection Association (NFPA), as required under Health and Safety Code, sec.242.039, and other applicable NFPA codes and standards referenced in NFPA 101 will apply unless otherwise noted or modified in this subchapter. The provisions of the chapter or subchapter and the provisions of the New Health Care Occupancies of the Life Safety Code are applicable. (1) Life Safety Code, NFPA 101, is a registered trademark of the National Fire Protection Association, Inc., Quincy, Massachusetts 02269. (2) The definitions listed in sec.19.101 of this title (relating to Definitions) also apply to this subchapter. (3) In addition to the Life Safety Code and the standards referenced therein, this subchapter is subject to the codes, standards, and requirements established by the following: Underwriters Laboratories, Inc.; the American National Standards Institute, Inc. (ANSI) ; the National Electrical Code (NFPA 70); the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE); and the American Society for Testing Materials (ASTM). Various references to these entities will be made throughout these sections. (b) All applicable local, state, or national codes and ordinances must be met as determined by the authority having jurisdiction for those codes and ordinances and by the Texas Department of Human Services (DHS). Any conflicts must be made known to DHS for appropriate resolution. (c) The design of structural systems must be done by or under the direction of a professional engineer who is currently registered by the Texas State Board of Registration for Professional Engineers. (d) If an existing licensed facility plans building additions or remodeling which includes construction of additional resident beds, then the ratio of bathing units must be reevaluated to meet minimum standards and the square footage of dining and living areas must be reevaluated by DHS at a minimum of 19 square feet per bed. Conversion of existing living, dining, or activity areas to resident bedrooms must not reduce these functions to a total area of less than 19 square feet per bed. The dietary department must be evaluated by the facility's registered or licensed dietitian or architect having knowledge in the design of food service operations. This evaluation must be provided to DHS. (e) No building may be occupied by residents prior to inspection and approval to occupy by DHS. (f) The words "shall" or "must" are requirements. The word "should" is a recommendation which is expected to be followed unless there is valid reason not to do so. (g) Nothing in sec.sec.19.332-19.343 of this title ((relating to Location and Site, General Considerations, Architectural Space Planning and Utilization, Exit Provisions, Smoke Compartmentation (Subdivision of Building Spaces), Fire Protection Systems, Hazardous Areas, Structural Requirements, Mechanical Requirements, Electrical Requirements, Miscellaneous Details, and Elevators)) may be construed as prohibiting a better type of building or construction, more space, services, features, or greater degree of safety than the minimum requirements. sec.19.332. Location and Site. (a) Site approval is normally required of the local building department and fire marshal having jurisdiction. Any conditions considered to be a fire, safety, or health hazard will be grounds for disapproval of the site by the Texas Department of Human Services (DHS). New facilities may not be built in an area designated as a floodplain of 100 years or less. (b) Site grades must provide for positive surface water drainage so that there will be no ponding or standing water on the designated site. This does not apply to local government requirements for engineered controlled run-off holding ponds. (c) A new building (or addition) must be set back at least ten feet from the property lines except as otherwise approved by DHS. (d) Exit doors from the building must not open directly onto a drive for vehicular traffic, but must be set back at least six feet from the edge of the drive (measured from the end of the building wall in the case of a recessed door) to prevent accidents due to lack of visual warning. (e) Walks must be provided as required from all exits and must be of non-slip surfaces free of hazards. Walks must be at least 48 inches wide except as otherwise approved. Ramps should be used in lieu of steps where possible for the handicapped and to facilitate bed or wheelchair removal in an emergency. (f) Outdoor activity, recreational, and sitting spaces must be provided and appropriately designed, landscaped, and equipped. Some shaded and/or covered outside areas are needed. These areas must be designed to accommodate residents in wheelchairs. (g) Each facility must have parking space to satisfy the needs of residents, employees, staff, and visitors. In the absence of a formal parking study, each facility must provide for a ratio of at least one parking space for every four beds in the facility. This ratio may be reduced slightly in areas convenient to public parking facilities. Space must be provided for emergency and delivery vehicles. No parking space may block or inhibit egress from the outside exit doors. Parking spaces and drives must be at least ten feet away from windows in bedrooms, dining, and living areas. (h) Barriers must be provided for resident safety from traffic or other site hazards by the use of appropriate methods such as fences, hedges, retaining walls, railings, or other landscaping. These barriers must not inhibit the free emergency egress to a safe distance away from the building. (i) Open or enclosed courts with resident rooms or living areas opening upon them must not be less than 20 feet in the smallest dimension unless otherwise approved by DHS. Exceptions would be as follows: (1) Nonparallel wings forming an acute angle may have a maximum of two windows each side less than 20 feet but not less than ten feet. (2) Windows may be separated by a distance equal to the depth of the court but not less than ten feet. (3) For unusual or unique site conditions, courts with resident rooms opening upon them on one side only must be not less than ten feet in the smallest dimension, provided that the opposite wing does not contain a hazardous area, and the wall has no openings which could permit fire to reach the resident room side. (j) Auxiliary buildings located within 20 feet of the main building and which contain hazardous areas such as laundry and storage buildings must meet the applicable Life Safety Code requirements for separation and construction. (k) Other buildings on the site must meet the appropriate occupancy section or separation requirements of the Life Safety Code. (l) Fire service and access must be as follows: (1) The facility must be served by a paid or volunteer fire department. The fire department must provide written assurance to DHS that the fire department can respond to an emergency at the facility within an appropriately prompt time for the travel conditions involved. (2) The facility must be served by an adequate water supply that is satisfactory and accessible for fire department use as determined by the fire department serving the facility and by DHS. (3) There must be at least one readily accessible fire hydrant located within 300 feet of the building. The hydrant must be on a minimum six inch service line, or else there must be an approved equivalent, such as a storage tank. The hydrant, its location, and service line, or equivalent must be as approved by the local fire department and DHS. (4) The building must have suitable all-weather fire lanes for access as required by local fire authorities and DHS. As a minimum, there must be access to two sides of the building by an all-weather lane at least ten feet wide. Fire lanes must have at least 14 feet in clearance width above grade (two feet each side of the ten-foot roadbed) and be kept free of obstructions at all times. All-weather access lanes must be no less than a properly constructed gravel lane. sec.19.333. General Considerations. (a) Services. Nursing facilities must either contain the elements described in this section or the provider must indicate the manner in which the needed services are to be made available. Each element provided in the facility must comply with the requirements of this subchapter. Appropriate modifications or deletions in space requirements may be made when services are shared or purchased. (b) Sizes. The sizes of the various departments will depend upon program requirements and organization of services within the facility. Some functions requiring separate spaces or rooms in these minimum requirements may be combined provided that the resulting plan will not compromise the best standards of safety and of medical and nursing practices. (c) Shared or combined services. Nursing facilities may be operated together with hospitals and may share administration, food service, recreation, janitor service, and physical therapy facilities, but must otherwise have clearly identifiable physical separations such as a separate wing or floor. Nursing facilities with different levels of care will require identifiable physical separations. Combined attendant or nurse stations and medication room areas will require some separating construction features. (d) Exterior finishes. Unless otherwise approved by the Texas Department of Human Services (DHS), the exterior finish material of buildings classified (per the National Fire Protection Association (NFPA 220)) as fire resistive or protected noncombustible must be Class A in the Life Safety Code. All others must be Class A or B in the Life Safety Code. Items of trim may be of combustible material subject to approval by DHS. Roofing must be Underwriter Laboratories listed as Class A or B. (e) Interior finishes. (1) Interior finish of walls, ceilings, and floors must meet the Life Safety Code requirements for new construction. (2) Documentation of finishes, including, but not limited to, copies of lab test reports and material labels is required. (f) Corridor travel distance. Corridor travel from the nurse station to the farthest resident room must assure prompt service to the resident. The normal travel for nursing efficiency is considered to be not over 85 feet and must not exceed 150 feet. (g) Accessibility for individuals with disabilities. The facility must meet the provisions and requirements concerning accessibility for individuals with disabilities in the following laws: the Americans with Disabilities Act of 1990 (Public Law 101-336; Title 42, United States Code, Chapter 126); Title 28, Code of Federal Regulations, Part 35; Texas Civil Statutes, Article 9102; and Title 16, Texas Administrative Code, Chapter 68. Plans for new construction, substantial renovations, modifications, and alterations must be submitted to the Texas Department of Licensing and Regulation (Attention: Elimination of Architectural Barriers Program) for accessibility approval under Article 9102. (h) Handrails. Handrails must be provided on each side of all resident-use corridors. Handrails for other areas should be provided as needed to facilitate resident movement or egress. Design of handrails must be in accordance with the American National Standards Institute (ANSI) A117.1. These handrails may extend into the minimum required corridor width without widening the corridor (that is, in an eight-foot-wide corridor, handrails may project up to 3 1/2 inches on each side). Reference sec.19.342(a)(8) and (9) of this title (relating to Miscellaneous Details) for handrail details. sec.19.334. Architectural Space Planning and Utilization. (a) Resident bedrooms. Each resident bedroom must meet the following requirements: (1) The maximum room capacity must be four residents. (2) No more than 25% of the total licensed beds may be in bedrooms with more than two beds each. (3) Minimum bedroom area, excluding toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules, must be 100 square feet in single occupancy rooms and 80 square feet per bed in multi-bed rooms. (4) The minimum allowable room dimension is ten feet. The room must be designed to provide at least 36 inches between beds and 24 inches between any bed and the adjacent (parallel) wall. (5) Each room must have at least one operable outside window arranged and located so that it can be easily opened from the inside without the use of tools or keys. The maximum allowable sill height (to opening) must not exceed 36 inches above the floor. All operative windows must have insect screens. The minimum area of window(s) in each bedroom must equal at least 16 square feet or 8.0% of the room area, whichever is larger. (6) Each room must have general lighting, bed reading lights, and night lighting. The night light must be switched just inside the entrance to each resident room with a silent type switch unless otherwise approved by the Texas Department of Human Services (DHS). The light providing general illumination must be switchable at the door of the resident room for use of staff and residents. A durable nonglare (opaque front panel) reading light securely anchored to the wall, integrally wired, must be provided for each resident bed. The switch must be within reach of a resident in the bed. (7) Two duplex or a fourplex grounding type receptacles must be provided beside the head of each bed. Other walls must have duplex receptacles as needed for TV, radio, razors, hairdryers, clocks, and/or as required by the National Electrical Code, National Fire Protection Association (NFPA 70), which is a registered trademark of the National Fire Protection Association, Inc., Quincy, Massachusetts 02269. (8) Each resident must have access to a toilet room without entering the general corridor area. One toilet room must serve no more than two resident rooms. The toilet room must contain a water closet and a lavatory. The lavatory may be omitted from a toilet room which serves two bedrooms if each resident room contains a lavatory. See subsection (c)(1) of this section for baths and other toilet facility requirements. (9) Each resident must have a bed with a comfortable mattress, a bedside stand with at least two enclosed storage spaces, a dresser, and closet or wardrobe space providing privacy for clothing and personal belongings. Clothes storage space must provide at least 22 inches of lineal hanging space per bed and have closable doors. Chairs and space must be provided for use by residents and/or visitors. (10) All beds must have castors with wheel-locking devices. (11) Each room must open onto an exit corridor and must be arranged for convenient resident access to dining, living, and bathing areas. (12) Visual privacy (such as cubicle curtains) must be available for each resident in multi-bed rooms. Design for privacy must not restrict resident access to entry, lavatory, or toilet, nor may it restrict bed evacuation or obstruct sprinkler flow coverage. (13) At least one noncombustible wastebasket must be provided in each bedroom. (14) See the requirements in sec.19.341(d)(4) of this title (relating to Electrical Requirements) for nurse call systems. (b) Nursing service areas. The service areas described in this subsection must be located in or readily available to each nursing unit. The size and disposition of each service area will depend upon the number and types of beds to be served. Each service area may be arranged and located to serve more than one nursing unit, but at least one service area must be provided on each nursing floor. The maximum allowable distance from a resident room door to a nurse station is 150 feet. The following requirements are applicable to services areas: (1) Nurse stations must be provided with space for nurses' charting, doctors' charting, and storage for administrative supplies. Nurses stations must be located to provide a direct view of resident corridors. A direct view of resident corridors is acceptable if a person can see down the corridors from a point within 24 inches of the outside of the nurse station counter or wall. (2) Lounge and toilet room(s) must be provided for nursing staff. (3) Lockers and/or security compartments must be provided for the safekeeping of personal effects of staff. These must be located convenient to the duty station of personnel or in a central location. (4) Clean utility room(s) must contain a work counter, sink with high-neck faucet with lever controls, and storage facilities and must be part of a system for storage and distribution of clean and sterile supply materials. (5) Soiled utility room(s) must contain a water closet or equivalent flushing rim fixture, a sink large enough to submerge a bedpan with spray hose and high- neck faucet with lever controls, work counter, waste receptacle, and linen receptacle. These utility rooms must be part of a system for collection and cleaning or disposal of soiled utensils or materials. A separate handwash sink must be provided if the bedpan disinfecting sink cannot normally be used for handwashing. (6) Provision must be made for convenient and prompt 24-hour distribution of medication to residents. The medication preparation room must be under the nursing staff's visual control and contain a work counter, refrigerator, sink with hot and cold water, and locked storage for biologicals and drugs and must have a minimum area of 50 square feet. The minimum dimension allowed is five feet six inches. An appropriate air supply must be provided to maintain adequate temperature and ventilation for safe storage of medications. For purposes of storage of unrefrigerated medications, the room temperature must be maintained between 59 degrees and 86 degrees F. (7) Provision must be made for separate closets or room for clean linens. Corridors must not be used for folding or cart storage. Storage rooms must be located and distributed in the building for efficient access to bedrooms. (8) Soiled linen rooms must be provided as required in subsection (l) of this section. (9) A nourishment station(s) is usually required in all but the smaller facilities and must contain a sink equipped for handwashing, equipment for serving nourishment between scheduled meals, refrigerator, and storage cabinets. Ice for residents' service and treatment must be provided only by icemaker units. This station may be furnished in a clean utility room. (10) An equipment storage room must be provided for equipment such as intravenous stands, inhalators, air mattresses, and walkers. (11) Parking spaces for stretchers and wheelchairs must be located out of the path of normal traffic. (c) Residents' bathing and toilet facilities. The following requirements are applicable to bathing and toilet facilities: (1) Bathtubs or showers must be provided at the rate of one for each 20 beds which are not otherwise served by bathing facilities within residents' rooms. At least one bathing unit must be provided in each nursing unit. Each tub or shower must be in an individual room or enclosure which provides space for the private use of the bathing fixture, for drying and dressing, and for a wheelchair and an attendant. Each general-use bathing room (those not directly serving adjoining bedrooms) must be provided with at least one water closet (in a stall, room, or area for privacy) and one lavatory. These bathing room(s) must be located conveniently to the bedroom area it serves and must not be more than 100 feet from the farthest bedroom. See requirements in subsection (a)(8) of this section for resident toilets at bedrooms. Each facility must provide at least one whirlpool tub unit as one of the required bathing units. (2) At least 50% of bathrooms and toilet rooms, fixtures, and accessories must be designed and provided to meet criteria under the Americans with Disabilities Act of 1990 for individuals with disabilities unless otherwise approved by DHS. (3) All rooms containing bathtubs, sitz baths, showers, and water closets, subject to occupancy by residents, must be equipped with swinging doors and hardware which will permit access from the outside in any emergency. (4) Bathing areas must be provided with safe and effective auxiliary or supplementary heating. Bathing areas must be free of drafts and must have adequate exhaust ducted to the outside to minimize excess moisture retention and resulting mold and mildew problems. (5) Tubs and showers must be provided with slip-proof bottoms. (6) Lavatories and handwashing facilities must be securely anchored to withstand an applied downward load of not less than 250 pounds on the front of the fixtures. (7) Provision must be made for sanitary hand drying and toothbrush storage at lavatories. There must be paper towel dispensers or separate towel racks and separate toothbrush holders. (8) Mirrors must be arranged for convenient use by residents in wheelchairs as well as by residents in a standing position, and the minimum size must be 15 inches in width by 30 inches in height, or tilt type. (9) Rooms with toilets must be provided with effective forced air exhaust ducted to the exterior to help remove odors. Ducted manifold systems are recommended for some multiple-type installations. (10) Floors, walls, and ceilings must have nonabsorbent surfaces, be smooth, and easily cleanable. (d) Disposal facilities. Space and facilities must be provided for the sanitary storage of waste by incineration, mechanical destruction, compaction, containerization, removal, or by a combination of these techniques. (e) Resident living areas. The following requirements are applicable to resident living areas: (1) Social-diversional spaces such as living rooms, dayrooms, lounges, sunrooms, must be provided on a sliding scale as follows:
                                                                                                                                                                                                                                                                                                                                                        See Figure 1 for 40 TAC sec.19.334(e)(1) (2) Where a required way of exit (or a service way) is through a living (or dining) area, a pathway equal to the corridor width will normally be deducted for calculation purposes and discounted from that area. These exit pathways must be kept clear of obstructions. (3) Each resident living room and dining room must have at least one outside window. The window area must be equal to at least 8.0% of the total room floor area. Skylighting may be used to fulfill one-half of the 8.0% minimum area. (4) See sec.19.331(d) of this title (relating to Construction Standards for Additions, Remodeling, and New Nursing Facilities) for capacity increases to existing facilities. (5) Open or enclosed seating space must be provided within view of the main nurse station that will allow furniture or wheelchair parking that does not obstruct the corridor way of egress. (f) Dining space. Dining space must be adequate for the number of residents served, but no less than ten square feet per resident bed. See sec.19.331(d) of this title (relating to Construction Standards for Additions, Remodeling, and New Nursing Facilities) for bed capacity increases to existing facilities. (g) Dietary facilities. The following requirements are applicable to dietary facilities: (1) Kitchens (main/dietary) must be as follows: (A) Kitchens will be evaluated on the basis of their performance in the sanitary and efficient preparation and serving of meals to residents. 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. Plans must include a large-scale detailed kitchen layout designed by a registered or licensed dietitian or architect having knowledge in the design of food service operations. (B) Kitchens must be designed so that room temperature at peak load (summertime) will not exceed a 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 that may be exhausted at the range hood and dishwashing area. (C) Operational equipment must be provided as planned and scheduled by the facility consultants for preparing and serving meals and for refrigerating and freezing of perishable foods, as well as equipment in, and/or adjacent to, the kitchen or dining area for producing ice. (D) Facilities for washing and sanitizing dishes and cooking utensils must be provided. These facilities must be designed based on the number of meals served and the method of serving, that is, use of permanent or disposable dishes. As a minimum, the kitchen must contain a multi-compartment sink large enough to immerse pots and pans. In all facilities, a mechanical dishwasher is required for washing and sanitizing dishes. Separation of soiled and clean dish areas must be maintained, including air flow. (E) A vegetable preparation sink must be provided, and it must be separate from the pot sinks. (F) A supply of hot and cold water must be provided. Hot water for sanitizing purposes must be 180 degrees Fahrenheit or the manufacturer's suggested temperature for chemical sanitizers. For mechanical dishwashers the temperature measurement is at the manifold. (G) A kitchen must be provided with a hand-washing lavatory in the food preparation area with hot and cold water, soap, paper towel dispenser, and waste receptacle. The dish room area must have ready access to a handwashing lavatory. (H) Staff rest room facilities with lavatory must be directly accessible to kitchen staff without traversing resident use areas. The rest room door must not open directly into the kitchen (that is, provide a vestibule). (I) Janitorial facilities must be provided exclusively for the kitchen and must be located in the kitchen area. (J) Nonabsorbent smooth finishes or surfaces must be used on kitchen floors, walls, and ceilings. These surfaces must be capable of being routinely cleaned and sanitized to maintain a healthful environment. Counter and cabinet surfaces, inside and outside, must also have smooth, cleanable, relatively nonporous finishes. (K) Operable windows must have insect screens provided. (L) Doors between kitchen and dining or serving areas must have a safety glass view panel. (M) A garbage can or cart washing area with drain and hot water must be provided. (N) Floor drains must be provided in the kitchen and dishwashing areas. (O) Vapor removal from cooking equipment must be designed and installed in accordance with NFPA 96. (P) Grease traps must be provided in compliance with local plumbing code or other nationally recognized plumbing code. (Q) See sec.19.331(d) of this title (relating to Construction Standards for Additions, Remodeling, and New Nursing Facilities) for bed capacity increases to existing facilities. (2) Food storage areas must be as follows: (A) Food storage areas must provide for storage of a seven-day minimum supply of nonperishable foods at all times. (B) Shelves must be adjustable wire type. Walls and floors must have a nonabsorbent finish to provide a cleanable surface. No foods may be stored on the floor; dollies, racks, or pallets may be used to elevate foods not stored on shelving. (C) Dry foods storage must have an effective venting system to provide for positive air circulation. (D) The maximum room temperature for food storage must not exceed 85 degrees F at any time. The measurement must be taken at the highest food storage level but not less than five feet from the floor. (E) 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. (3) Auxiliary serving kitchens (not contiguous to food preparation/serving area) must be as follows: (A) Where service areas other than the kitchen are used to dispense foods, these must be designated as food service areas and must have equipment for maintaining required food temperatures while serving. (B) Separate food service areas must have hand-washing facilities as a part of the food service area. (C) Finishes of all surfaces, except ceilings, must be the same as those required for dietary kitchens or comparable areas. See paragraph (1)(J) of this subsection. (h) Administrative and public areas. (1) The following elements must be provided in the public area: (A) The entrance must be at grade level, sheltered from the weather, and able to accommodate wheelchairs. A drive-under canopy must be provided for the protection of residents or visitors entering or leaving a vehicle. The latter may be a secondary entrance. (B) The lobby must include: (i) storage space for wheelchairs (if more than one is kept available); (ii) a reception and/or information area (may be obviously adjacent to lobby); (iii) waiting space(s); (iv) public toilet facilities for individuals with disabilities (may be adjacent to lobby); (v) at least one public access telephone(s), installed to meet standards under the Americans with Disabilities Act; and (vi) drinking fountain(s). These may be provided in a common public area and at least one must be installed to meet standards under the Americans with Disabilities Act; and (C) A lobby may also be use-designed to satisfy a portion of the minimum area required for resident living room space. (2) The following must be provided in the administrative area: (A) General or individual offices(s) for business transactions, medical and financial records, administrative and professional staff, and for private interviews relating to social service, credit, and admissions. (B) A multipurpose room for conferences, meetings, and health education purposes including facilities for showing visual aids. (C) Storage and work area for office equipment and supplies must be provided and accessible to the staff using such items. (3) Toilet facilities for the disabled must be available in the building. (i) Physical therapy facilities. (1) Physical therapy facilities must be provided if required by the treatment program. The facilities stated in subparagraph (B) of this paragraph and paragraph (2)(C) -(E) of this subsection may be planned and arranged for shared use by occupational therapy residents and staff if the treatment program reflects this sharing concept. Physical therapy facilities must include the following: (A) Provision for cubicle curtains around each individual treatment area; handwashing facility(ies) (one lavatory or sink may serve more than one cubicle); and facilities for the collection of soiled linen and other material that may be used in the therapy. (B) Residents' dressing areas, showers, lockers, and toilet rooms if the therapy is such that these would be needed at the area. (2) Physical therapy facilities may also include the following: (A) treatment area(s) with space and equipment for thermotherapy, diathermy, ultrasonics, and hydrotherapy; (B) an exercise area; (C) storage for clean linen, supplies, and equipment used in therapy; (D) service sink located near therapy area; and (E) wheelchair and stretcher storage. (j) Occupational therapy. Occupational therapy facilities must be provided if required by the treatment program. (1) An activities area with a sink or lavatory and facilities for collection of waste products prior to disposal must be provided. (2) Storage for supplies and equipment used in the therapy must be provided. (k) Personal grooming area (barber/beauty shop). A separate room with appropriate equipment must be provided for hair care and grooming needs of residents in facilities with over 60 beds. (l) Laundry and linen services. (1) On-site processing must be as follows: (A) Because of the high incidence of fires in laundries, it is highly recommended that the laundry be in a separate building 20 feet or more from the main building. If the laundry is located within the main building it must be separated by minimum one-hour fire construction to structure above, and sprinklered, and must be located in a remote area away from resident sleeping areas. Access doors must be from the exterior or interior nonresident use area such as a service corridor (not required exit) which is separated from the resident area. (B) If linen is to be processed on the site, the following must be provided: (i) A soiled linen receiving, holding, and sorting room with a rinse sink. This area must have a floor drain and forced exhaust to the exterior which must operate at all times there is soiled linen being held in the area. (ii) A laundry processing room with equipment which can process seven days needs within a regularly scheduled work week. Hand-washing facilities must be provided. The washer area must have (I) a floor drain; (II) storage for laundry supplies; (III) a clean linen inspection and mending room or area and a folding area; (IV) a clean linen storage, issuing, or holding room or area; (V) a janitors' closet containing a floor receptor or service sink and storage space for housekeeping equipment and supplies; and (VI) sanitizing (washing) facilities and a storage area for carts. (C) Soiled and clean operations must be planned to maintain sanitary flow of functions as well as air flow. If carts containing soiled linens from resident rooms are not taken directly to the laundry area, intermediate holding rooms must be provided and located convenient to resident bedroom areas. (D) Laundry areas must have adequate air supply and ventilation for staff comfort without having to rely on opening a door that is part of the fire wall separation. (E) Provisions must be made to exhaust heat from dryers and to separate dryer make-up air from the habitable work areas of the laundry. (2) For off-site linen processing, the following must be provided on the premises: (A) a soiled linen holding room (provided with adequate forced exhaust ducted to the exterior); (B) clean linen receiving, holding, inspection, sorting or folding, and storage room(s); and (C) sanitizing facilities and storage area for carts. (3) Resident-use laundry, 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 as in accordance with the Life Safety Code. (m) General storage. The following requirements are applicable to general storage facilities: (1) A general storage room(s) must be provided as needed to accommodate the facility's needs. It is recommended that a general storage area provide at least two square feet per resident bed. This area would be for items such as extra beds, mattresses, appliances, and other furnishing and supplies. (2) Storage space with provisions for locking and security control should be provided for residents' personal effects which are not kept in their rooms. (n) Janitors' closet. In addition to the janitors' closet called for in certain departments, a sufficient number of janitors' closets must be provided throughout the facility to maintain a clean and sanitary environment. These must contain a floor receptor or service sink and storage space for housekeeping equipment and supplies. (o) Maintenance, engineering service, and equipment areas. Space and facilities for adequate preventive maintenance and repair service must be provided. The following spaces are needed and it is suggested that these be part of a separate laundry building or area: (1) A storage area for building and equipment maintenance supplies, tools, and parts must be provided. (2) A space for storage of yard maintenance equipment and supplies, including flammable liquids bulk storage, must be provided separate from the resident- occupied facility. (3) A maintenance and/or repair workshop of at least 120 square feet and equipment to support usual functions is recommended. (4) A suitable office or desk space for the maintenance person(s) is recommended (possibly located within the repair shop area) with space for catalogs, files, and records. (p) Oxygen. The storage and use of oxygen and equipment must meet applicable NFPA standards for oxygen, including NFPA 56F. sec.19.335. Exit Provisions.
                                                                                                                                                                                                                                                                                                                                                          Exit provisions, including doors, corridors, stairways, and other exitways, locks, and other applicable items must conform to the requirements of the Life Safety Code concerning means of egress and of this section in order to assure that residents can be rapidly and easily evacuated from the building at all times, or from one part of the building to a safe area of refuge in another part of the building. Exit provisions are as follows: (1) Bedroom space arrangement and doors and corridors must be designed for evacuation of bedfast residents by means of rolling the bed to a safe place in the building or to the outside. (2) Public assembly, common living rooms, dining rooms, and other rooms with a capacity of 50 or more persons or greater than 1,000 square feet must have two means of exit remote from each other. Outswinging doors with panic hardware must be provided for these exits. (3) Exit doors and ways of egress must be maintained clear and free for use at all times. Furnishings, equipment, carts, and other obstacles must not be left to block egress at any time. (4) Steps in interior ways of egress are prohibited. If changes of elevation are necessary within ways of egress, approved ramps with maximum slope of 1:12 (one unit of rise to 12 units of run) must be used. (5) Any remodeling of, construction on, and/or additions to occupied buildings which involve exitways and exit doors must be accomplished without compromising the exits or creating a dead end situation at any time. Acceptable alternate temporary exits may be approved, or resident(s) in the area involved may have to be relocated until construction blocking the exit is completed. Other basic safety features such as fire alarms, sprinkler systems, and emergency power must also remain operational. (6) Doors in means of egress must be as follows: (A) Locking hardware or devices which are capable of preventing or inhibiting immediate egress must not be used in any room or area that can be occupied. (B) A latch or other fastening device on an exit door must be provided with a knob, handle, panic bar, or similar releasing device. The method of operation must be obvious in the dark, without use of a key, and operable by a well known one-action operation that will easily operate with normal pressure applied to the door or to the device toward the exterior. Locking hardware which prevents unauthorized entry from the outside (only) is permissible. Permanently mounted hold-open devices to expedite emergency egress and prevent accidental lock-out must be provided for exterior exit doors as well as self-closing devices. (C) No screen or storm door may swing against the direction of exit travel where main doors are required to swing out. (D) To aid in control of wandering residents, buzzers or other sounding devices may be used to announce the unauthorized use of an exit door. Other methods include approved emergency exit door locks or fencing with a gate outside of exit doors which enclose a space large enough to allow the space to be an exterior area of egress and refuge away from the building. (E) Inactive leaves of double doors may have easily accessible and easily operable bolts if the active leaf is 44 inches wide. Center mullions are prohibited. (F) Resident baths or toilets having privacy locks will require that keys or devices for opening the doors are kept readily available to the staff. (G) Folding or sliding doors must not be used in exit corridors or exitways. Sliding glass doors may be used as secondary doors from residents' bedrooms to grade or to a balcony, or as secondary doors in certain other areas where the primary designated exit door requirements are met. Doors to bathroom and other resident-use areas must be the side-hinged swinging type. Corridor doors to rooms must swing into the room or be recessed so as not to extend into the corridor when open; however, doors ordinarily kept closed may be excepted. Corridor door frames must be steel in accordance with the Life Safety Code. (7) Horizontal exits, if provided, must be according to the Life Safety Code. (8) Areas outside of exterior exit doors (exit discharge) must be as follows: (A) Provision must be made to accommodate and facilitate continuation of emergency egress away from a building for a reasonable distance beyond the outside exit door, especially for movement of nonambulatory residents in wheelchairs and beds. Any condition which may retard or halt free movement and progress outside the exit doors will not be allowed. Ramps must be used outside the exit doors in lieu of steps whenever possible. (B) The landing outside of each exit door must be essentially the same elevation as the interior floor and level for a distance equal to the door width plus at least four feet. Generally, the difference in floor elevation at an exterior door must not be over 1/2 inch with the outside slope not to exceed 1/4 inch per foot sloping away from the door for drainage on the exterior. In locations north of the +20 Fahrenheit Isothermal Line as defined in the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) Handbook of Fundamentals, the landing outside of all exit doors must be protected from ice build-up which would prohibit the door from opening and be a slip hazard. (C) Emergency egress lighting immediately outside of exit doors is required as a part of the building emergency lighting system. Photocell devices may be used to turn lights off during daylight hours. (9) The requirements of an emergency lighting system must be in accordance with sec.19. 341 of this title (relating to Electrical Requirements). (10) Requirements for interior finishes of ways of egress (flame spread of floor, walls, and ceiling finishes) must be in accordance with the Life Safety Code. The interior finishes of other areas must be in accordance with sec.19. 333(e) of this title (relating to General Considerations). sec.19.336. Smoke Compartmentation (Subdivision of Building Spaces). (a) Smoke compartmentation must be as described in the Life Safety Code and in this section. (b) An exit sign must be provided on each side of corridor smoke doors unless otherwise directed by the Texas Department of Human Services (DHS). (c) The metal frames for the wire glass view panels in smoke doors must be steel, unless otherwise approved by DHS. The bottom of the view panel must not be higher than 54 inches above the floor. Pairs of opposite (double egress) swinging smoke doors in corridors must have push/pull hardware. The door leaves must align in the closed position. (d) Smoke barrier walls in concealed spaces such as attics, must have prominent signs on each side that read: "Warning: Smoke/fire barrier. Properly seal all openings." (e) Provisions must be made for reasonable access to concealed smoke barrier walls for maintaining smoke dampers and so that walls and dampers can be visually checked periodically for conformance by facility staff, service persons, and inspectors. Access must provide for visual inspection of both sides of the wall, and of all parts (end-to-end and top-to-bottom). Ceiling access panels must be prefabricated metal panel, or its equivalent, and be at least 20 inches by 20 inches with no obstructions above (such as ducts) to hamper entrance, and it must be fire rated if required to maintain ceiling-roof or ceiling-floor fire rating. Access must be provided for both sides of the wall. (f) Air systems should be designed to avoid having ducts which penetrate smoke barrier walls, thus eliminating the need for smoke dampers which are often a problem to maintain in proper working condition. sec.19.337. Fire Protection Systems. (a) Fire protection systems include detection, alarm, and communication systems; fixed automatic extinguishment systems; and portable extinguishers. These systems must meet the requirements of the Life Safety Code, and of this section. Components must be compatible and laboratory listed for the use intended. (b) Fire protection systems must meet the requirements of all applicable National Fire Protection Association (NFPA) standards, such as NFPA 72 for alarm systems, as referenced in the Life Safety Code. Wiring and circuitry for alarm systems must meet the applicable requirements of NFPA standards including the NFPA 70 for these systems. (c) Requirements of emergency electrical systems must be in accordance with sec.19.341 of this title (relating to Electrical Requirements). Requirements for sprinkler systems must be in accordance with sec.19.340(d) of this title (relating to Mechanical Requirements). (d) Partial sprinkler systems (those provided only for hazardous areas) must be interconnected with the fire alarm and comply with the Life Safety Code. Each partial system must have a valve with a supervisory switch to sound a trouble signal, water flow switch to activate the fire alarm, and an end-of-line test drain. (e) Fire alarm systems must be installed, maintained, and repaired by an agent having a current certificate of registration with the State Fire Marshal's office of the Texas Commission on Fire Protection, in accordance with state law. A fire alarm installation certificate must be provided as required by the Office of the State Fire Marshal. (f) The fire alarm system must be designed so that whenever the general alarm is sounded by activation of any device (such as manual pull, smoke sensor, sprinkler, or kitchen range hood extinguisher), the following must occur automatically: (1) smoke and fire doors which are held open by approved devices must be released to close; (2) air handlers (air conditioning and/or heating distribution fans) serving three or more rooms or any means of egress must shut down immediately; (3) smoke dampers must close; and (4) the alarm-initiating-device location must be clearly indicated on the fire alarm control panel(s) and all auxiliary panels. (g) Fire alarm bells or horns must be located throughout the building for audible coverage. Flashing alarm lights (visual alarms) must be installed to be visible in corridors and public areas including dining rooms and living rooms in a manner that will identify exit routes. (h) A master control panel indicating the location of all alarm, trouble, and supervisory signals, by zone or device, must be visible at the main nurse station. Fire alarm system components must be laboratory-listed as compatible. Alarm and trouble zoning must be by smoke compartments and by floors in multi- story facilities. (i) Remote annunciator panels, indicating location of alarm initiation, by zone or device, and trouble indication, must be located at auxiliary or secondary nurse stations on each floor, and will indicate the alarm condition of adjacent zones and the alarm conditions at all other nurse stations. (j) Manual pull stations must be provided at all exits, living rooms, dining rooms, and at or near the nurse stations. (k) The sprinkler system must be monitored for flow and tamper conditions by the fire alarm system. (l) The kitchen range hood extinguisher must be interconnected with the fire alarm system. This interconnection may be a separate zone on the panel or combined with other initiating devices located in the same zone as the range hood is located. (m) Portable fire extinguishers must be provided throughout the facility as required by NFPA Standard 10 and as determined by the local fire department and the Texas Department of Human Services. The following requirements are applicable to fire extinguishers: (1) Extinguishers in resident corridors must be spaced so that travel distance is not more than 75 feet. The minimum size of extinguishers must be either 2 1/2 gallon for water type or 5 pound for ABC type. (2) Extinguishers must be installed on hangers or brackets supplied or mounted in approved cabinets. Recessed cabinets are required for extinguishers located in corridors. (3) Extinguishers installed under conditions where they are subject to physical damage must be protected from impact or dislodgement. (4) Extinguishers having a gross weight not exceeding 40 pounds must be installed so that the top of the extinguisher is not more than five feet above the floor. Extinguishers having a gross weight greater than 40 pounds must be installed so that the top of the extinguisher is not more than 3-1/2 feet above the floor. In no case may the clearance between the bottom of the extinguisher and the floor be less than four inches. (5) Portable extinguishers provided in hazardous rooms should be located as close as possible to the exit door opening and nearest the latch (knob) side. sec.19.338. Hazardous Areas. (a) Protection from hazardous areas must be as required in the Life Safety Code, except as required or modified in this section. Gas fired equipment must not be located in attic spaces, except under the following conditions: (1) the area around the units must be constructed to be one-hour fire rated; (2) the enclosure must have sprinkler protection; and (3) combustion and venting air must be ducted from the exterior in properly sized metal ducts. (b) Laboratories must be protected in accordance with the National Fire Protection Association (NFPA) 99. (c) Cooking equipment must have exhaust systems designed and installed in accordance with NFPA 96. (d) Doors to hazardous areas must have closers and be kept closed unless provided with an approved hold-open device such as an alarm activated magnetic hold-open device. Doors must be single-swing type with positive latching hardware. View panels at laundry entrances must be provided and be of materials adequate to maintain the integrity of the door as allowed by the Life Safety Code. sec.19.339. Structural Requirements. (a) Every building and every portion thereof must be designed and constructed to sustain all dead and live loads in accordance with accepted engineering practices and standards. (b) Special provisions must be made in the design of buildings in regions where local experience shows loss of life or extensive damage to buildings resulting from hurricanes, tornadoes, earthquakes, or floods. (c) The sponsor is responsible for employing qualified personnel in the preparation of plan designs and engineering and in the construction of the facility to assure that all structural components are adequate, safe, and meet the applicable construction requirements. (d) The design of the structural system must be done by or under the direction of a professional structural engineer who is currently registered by the Texas State Board of Registration for Professional Engineers in accordance with state law. (e) The parts of the plans, details, and specifications covering the structural design must bear the legible seal of the engineer on the original drawings from which the prints are made. (f) If the municipality has a building code, that code must govern the building requirements for the construction involved. The Life Safety Code must be used for fire safety requirements. Should discrepancies between the codes arise, they must be called to the attention of the Texas Department of Human Services for resolution. (g) In the absence of a local building code, a nationally recognized building code must be used with regard to the construction integrity of the building. The Life Safety Code must be used for fire safety requirements. (h) Each building must be classified as to building construction type for fire resistance rating purposes in accordance with the National Fire Protection Association (NFPA) 220 and the Life Safety Code. (i) Enclosures of vertical openings between floors must meet the Life Safety Code. (j) All interior walls, partitions, and roof structure in buildings of fire resistive and noncombustible construction must be of noncombustible or limited combustible materials. (k) Building insulation materials, unless sealed on all sides and edges in an approved manner, must have a flame spread rating of 25 or less when tested in accordance with NFPA 255 and NFPA 258. sec.19.340. Mechanical Requirements.
                                                                                                                                                                                                                                                                                                                                                            The design of the mechanical systems must be done by or under the direction of a registered professional (mechanical) engineer approved by the Texas State Board of Registration for Professional Engineers to operate in Texas, and the parts of the plans and specifications covering mechanical design must bear the legible seal of the engineer. Building services pertaining to utilities; heating, ventilating, and air-conditioning systems; vertical conveyors; and chutes must be in accordance with the Life Safety Code. Required plumbing fixtures must be in accordance with the Life Safety Code and sec.19.334 of this title (relating to Architectural Space Planning and Utilization) in specific use areas. (1) Plumbing. (A) All plumbing systems must be designed and installed in accordance with the requirements of the plumbing code of the municipality. In the absence of a municipal code, a nationally recognized plumbing code must be used. Any discrepancy between an applicable code and these requirements must be called to the attention of the Texas Department of Human Services (DHS) for resolution. (B) Supply systems must assure an adequacy of hot and cold water. An average rule-of-thumb design for hot water for resident usage (at 110 degrees Fahrenheit) is to provide 6-1/2 gallons per hour per resident in addition to kitchen and laundry use. (C) Water supply must be from a system approved by the Water Utility Division, Texas Natural Resources Conservation Commission, or from a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Utility Division, Texas Natural Resources Conservation Commission. (D) The sewage system must connect to a system permitted by the Watershed Management Division, Texas Natural Resources Conservation Commission, or to a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Utility Division, Texas Natural Resources Conservation Commission. (E) The minimum ratio of fixtures to residents shall be as required in sec.19.334(c) of this title (relating to Architectural Space Planning and Utilization). (F) For design calculation purposes, resident-use hot water must not exceed 110 degrees Fahrenheit at the fixture. For purposes of conforming to licensure requirements, an operating system providing water from 100 degrees Fahrenheit to 115 degrees Fahrenheit is acceptable. Hot water for laundry and kitchen use must be normally 140 degrees Fahrenheit except that dish sanitizing, if done by hot water, must be 180 degrees Fahrenheit. (G) Water closets raised to provide a seat height 17 inches to 19 inches from the floor is required for persons with disabilities. (H) Showers for wheelchair residents must not have curbs. Tub and shower bottoms must have a slip-resistant surface. Shower and tub enclosures, other than curtains, must be of tempered glass, plastic, and other safe materials. (I) Drinking fountains must not extend into exit corridors. (J) Fixture controls easily operable by residents must be provided (such as lever type). (K) Plumbing fixtures for residents must be vitreous china or porcelain finished cast iron or steel unless otherwise approved by DHS. Bathing units constructed of class B fire rated fiberglass are acceptable for use. (L) Hand-washing sinks for staff use are required in many areas throughout the facility in accordance with sec.19.334 of this title (relating to Architectural Space Planning and Utilization). Lavatories are required to be provided adjacent to water closets in each area. (M) The soiled utility room must be provided with a flushing device such as a water closet with bedpan lugs, a spray hose with a siphon breaker or similar device, such as a high neck faucet with lever controls and a deep sink that is large enough to submerse a bedpan. A sterilizer for sanitizing may be used in place of a deep sink. (N) Siphon breakers or back-flow preventers must be installed with any water supply fixture where the outlet or attachments may be submerged. (O) Clean-outs for waste piping lines must be provided and located so that there is the least physical and sanitary hazard to residents. Where possible, clean-outs must open to the exterior or areas which would not spread contamination during clean-out procedures. (2) Heating, ventilating, and air-conditioning systems. (A) Heating, ventilating, and air-conditioning systems must be designed and installed in accordance with the Heating, Ventilating, and Air-Conditioning Guide of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE), except as may be modified by this section. (B) Heating, ventilating, and air-conditioning systems must meet the requirements of the Life Safety Code and the National Fire Protection Association (NFPA) 90A. The plans must have a statement verifying that the systems are designed to conform to NFPA 90A. Requirements for conditions related to smoke compartmentation must be in accordance with sec.19.336 of this title (relating to Smoke Compartmentation (Subdivision of Building Spaces)). (C) Systems using liquefied petroleum gas fuel must meet the requirements of the Railroad Commission of Texas and NFPA 54. (D) The heating system must be designed, installed, and functioning to be able to maintain a temperature of at least 75 degrees Fahrenheit for all areas occupied by residents. For all other occupied areas, the indoor design temperature must be at least 72 degrees Fahrenheit. The cooling system must be designed, installed, and functioning to be able to maintain a temperature of not more than 78 degrees Fahrenheit. Occupied areas generating high heat, such as kitchens, must be provided with a sufficient cool air supply to maintain a temperature not exceeding 85 degrees Fahrenheit at the five-foot level. Supply air volume must be approximately equal to the air volume exhausted to the exterior for these areas. (E) Air systems must provide for mixing at least 10% outside air for the supply distribution. Blowers for central heating and cooling systems must be designed so that they may run continuously. (F) Floor furnaces, unvented space heaters, and portable heating units must not be used. Heating devices or appliances must not be a burn hazard (to touch) to residents. (G) A combustion fresh air inlet must be provided to all gas or fossil fuel operated equipment in steel ducts or passages from outside the building in accordance with NFPA 54. Rooms must also be vented to the exterior to exhaust heated ambient air in the room. Combustion air will require one vent within 12 inches of the floor and one vent within 12 inches of the ceiling. (H) The location and design of air diffusers, registers, and return air grilles, must ensure that residents are not in harmful or excessive drafts in their normal usage of the room. (I) In areas requiring control of sanitation, the air flow must be from the clean area to the dirty area. Air supply to food preparation areas must not be from air which has circulated places such as resident bedrooms and baths. (J) Air from unsanitary areas such as janitors closets, soiled linen areas, utility areas, and soiled area of laundry rooms, must not be returned and recirculated to other areas. (K) Intakes for fresh outside air must be located sufficiently distant from exhaust outlets or other areas or conditions which may contaminate or otherwise pollute the incoming fresh air. Fresh air inlets must be appropriately screened to prevent entry of debris, rodents, and animals. Provision must be made for access to such screens for periodic inspection and cleaning to eliminate clogging or air stoppage (see paragraph (3)(C)(i) of this subsection). (L) Systems must be designed as much as possible to avoid having ducts passing through fire walls or smoke barrier walls. All openings or duct penetrations in these walls must be provided with approved automatic dampers. Smoke dampers at smoke partitions must close automatically upon activation of the fire alarm system to prevent the flow of air or smoke in either direction. (M) Ducts with smoke dampers must have maintenance panels for inspections. The maintenance panels must be removable without tools. Means of access must also be provided in the ceiling or side wall to facilitate smoke damper inspection readily and without obstruction. Location of dampers must be identified on the wall or ceiling of the occupied area below. (N) Fusible links are not approved for smoke dampers. (O) Central air supply systems and/or systems serving means of egress must automatically and immediately shut down upon activation of the fire alarm system. (An exception must be approved, engineered smoke-removal systems.) (P) Ducts must be of metal or other approved noncombustible material. Cooling ducts must be insulated against condensation drip. (3) Ventilating and exhaust. (A) General ventilating systems must be in accordance with paragraph (2) of this subsection. (B) Provisions for natural ventilation using windows or louvers must be incorporated into the building design where possible and practical. These windows or louvers must have insect screens. (C) All air-supply and air-exhaust systems must be mechanically-operated. The ventilation rates shown in the table in clause (xi) of this subparagraph must be considered as minimum acceptable rates and must not be construed as precluding the use of higher ventilation rates. (i) Outdoor air intakes must be located as far as practical (but normally not less than ten feet) from exhaust outlets or ventilating systems, combustion equipment stacks, medical vacuum systems, plumbing vent stacks, or from areas which may collect vehicular exhaust and other noxious fumes. (ii) The ventilation systems must be designed and balanced to provide the pressure relationship as shown in the table in clause (xi) of this subparagraph. A final engineered system air balance report will be required for the completed system to be furnished and certified by the installer. (iii) The bottoms of ventilation openings must be not less than three inches above the floor of any room. (iv) Doors protecting corridors or ways of egress must not have air transfer grilles or louvers. Corridors must not be used to supply air to or exhaust air from any room except that air from corridors may be used as make-up air to ventilate small toilet rooms, janitor's closets, and small electrical or telephone closets opening directly on corridors, provided that the ventilation can be accomplished by door undercuts not exceeding 3/4 inches. (v) All exhausts must be continuously ducted to the exterior. Exhausting air into attics or other spaces is not permitted. Duct material must be metal. (vi) All central ventilation or air-conditioning systems must be equipped with filters of sufficient efficiency to minimize dust and lint accumulations throughout the system and building including supply and return plenums and ductwork. Filters with efficiency rating of 80% or greater (based on ASHRAE) are recommended. Filters for individual room units must be as recommended by the equipment manufacturer. Filters must be easily accessible for routine changing or cleaning. (vii) Static pressures of systems must be within limits recommended by ASHRAE and the equipment manufacturer (upstream and downstream). (viii) In geographic locations or interior room areas where extreme humidity levels are likely to occur for extended periods of time, apparatus for controlling humidity levels (preferably between 40-60%) are recommended to be installed as a part of central systems and with automatic humidistat controls. (ix) Exhaust hoods, ducts, and automatic extinguishers for kitchen cooking equipment must be in accordance with NFPA 96. (x) Forced air exhaust must be provided in laundries, kitchens, and dishwashing areas to remove excess heat and moisture and to maintain air flow in the direction of clean to soiled areas. (xi) Ventilation requirements for nursing areas must be according to the following table:
                                                                                                                                                                                                                                                                                                                                                              See Figure 1 for 40 TAC sec.19.340(3)(C)(xi) (xii) With relationship to adjacent areas, a positive air pressure must be provided for clean utility rooms, clean linen rooms, and medication rooms. Conditioned supply air must be introduced into these rooms. (4) Sprinkler systems. The following requirements are applicable to sprinkler systems: (A) Sprinkler systems must be in accordance with NFPA 13 and this subchapter. (B) The design and installation of sprinkler systems must meet any applicable state laws pertaining to these systems and one of the following criteria: (i) The sprinkler system must be designed by a qualified registered professional engineer approved by the Texas State Board of Registration for Professional Engineers to operate in Texas. The engineer must supervise the installation and provide written approval of the completed installation. (ii) The sprinkler system must be planned and installed in accordance with NFPA 13 by firms with certificates of registration issued by the office of the state fire marshal that have at least one full-time licensed responsible managing employee (RME). The RME's license number and signature must be included on the prepared sprinkler drawings. (C) The approved sprinkler plans must be submitted to DHS, Architectural Section, Austin, Texas. (D) Particular attention should be paid to adequate, safe, and reasonable freeze protection for all piping. The design of freeze protection should minimize the need for dependence on staff action or intervention to provide protection. sec.19.341. Electrical Requirements. (a) The design of the electrical systems must be done by or under the direction of a registered professional electrical engineer approved by the Texas State Board of Registration for Professional Engineers to operate in Texas, and the parts of the plans and specifications covering electrical design must bear the legible seal of the engineer. Requirements pertaining to utilities, heating, ventilating, and air-conditioning systems, vertical conveyors, and chutes must be in accordance with the Life Safety Code, Chapter 7, Building Service and Fire Protection Equipment. (b) Requirements for fire protection systems must be in accordance with sec.19.337 of this title (relating to Fire Protection Systems). (c) Electrical systems must meet the requirements of the NFPA 70. (d) Specific requirements for lighting and outlets at resident bedrooms must be in accordance with sec.19.334 of this title (relating to Architectural Space Planning and Utilization). (1) Emergency electrical service. (A) To provide electricity during an interruption of the normal electric supply, an emergency source of electricity must be provided and connected to certain circuits for lighting and power. (B) Emergency electrical connection service must be provided to the distribution systems as required by the Life Safety Code and NFPA 99. (i) Emergency systems must include the following: (I) illumination for means of egress, nurse stations, medication rooms, dining and living rooms, group bathing rooms (those not directly connected to resident bedrooms), and areas immediately outside of exit door (egress lighting must not be switched); (II) exit signs and exit directional signs as required by the Life Safety Code; (III) alarm systems including fire alarms activated by manual stations, water flow alarm devices of sprinkler systems, fire and smoke detecting systems, and alarms required for nonflammable medical gas systems if installed (where hospital-type functions are included in the nursing home facility, applicable standards will apply); (IV) task illumination and selected receptacles at the generator set location; (V) selected duplex receptacles including such areas as resident corridors, each bed location where patient care-related electrical appliances are utilized, nurse stations, and medication rooms including biologicals refrigerator; (VI) nurse calling systems; (VII) resident room night lights; (VIII) a light and receptacle in the electrical and/or boiler room; (IX) elevator cab lighting, control, and communication systems; (X) all facility telephone equipment; and (XI) paging or speaker systems if intended for communication during emergency. Radio transceivers where installed for emergency use must be capable of operating for at least one hour upon total failure of both normal and emergency power. (ii) Critical systems (delayed automatic or manual connections to critical systems) must include the following: (I) Heating equipment must provide heating for general resident rooms. This will not be required if: (-a-) the outside design temperature is higher than 20 degrees Fahrenheit (-6 degrees Celsius); (-b-) the outside design temperature is lower than 20 degrees Fahrenheit (-6 degrees Celsius) and where selected rooms are provided for the needs of all confined residents, then only those rooms need to be heated; or (-c-) the facility is served by a dual source of normal power; and (II) In instances when interruptions of power would result in elevators stopping between floors, throw-over facilities must be provided to allow the temporary operation of any elevator for the release of passengers. (C) The emergency lighting must be automatically in operation within ten seconds after the interruption of normal electric power supply. Emergency service to receptacles and equipment may be delayed automatic or manually connected. Receptacles connected to emergency power must have red face plates. Stored fuel capacity must be sufficient for not less than four-hour operation of required generator. (D) The design and installation of emergency motor generators must be in accordance with NFPA 37, NFPA 99, and NFPA 110. (i) Generators must be a minimum of three feet from the combustible exterior building finish and a minimum of five feet from a building opening if located on the exterior of the building. (ii) Generators located on the exterior of the building must be provided with a noncombustible protective cover or be protected as per manufacturer's recommendations. (iii) Motor generators fueled by public utility natural gas must have the capability to be switched to an alternate fuel source in accordance with NFPA 70. (E) The normal wiring circuit(s) for the emergency system must be kept entirely independent of all other wiring and must not enter the same race-ways, boxes, or cabinets in accordance with NFPA 70. (2) General Lighting Requirements. General lighting requirements are as follows: (A) All spaces occupied by people, machinery, equipment, approaches to buildings, and parking lots must have lighting. (B) All quality, intensity, and type of lighting must be adequate and appropriate to the space and all functions within the space. (C) Minimum lighting levels can be found in the Illuminating Engineering Society (IES) Lighting Handbook, latest edition. Minimum illumination must be 20-foot candles in resident rooms, corridors, nurses' stations, dining rooms, lobbies, toilets, bathing facilities, laundries, stairways, and elevators. Illumination requirements for these areas apply to lighting throughout the space and should be measured at approximately 30 inches above the floor anywhere in the room. Minimum illumination for overbed reading lamps, medication-preparation or storage area, kitchens, and nurse's station desks must be 50 foot candles. Illumination requirements for these areas apply to the task performed and should be measured on the task. (D) Nursing unit corridors must have general illumination with provisions for reduction of light levels at night. (E) Exposed incandescent light bulbs (or other high heat generating lamps) in closets or other similar spaces must be provided with basket wire guards or other suitable shield to prevent contact of combustible materials with the hot bulb and to help prevent breakage. (F) Exposed incandescent or fluorescent bulbs will not be permitted in food service or other areas where glass fragments from breakage may get into food, medications, linens, or utensils. All fluorescent bulbs will be protected with a shield or catcher to prevent bulb drop-out. (3) Receptacles (convenience outlets). (A) Receptacles at bedrooms must be in accordance with sec.19.334(a)(7) of this title (relating to Architectural Space Planning and Utilization). (B) Duplex receptacles for general use must be installed in corridors spaced not more than 50 feet apart and within 25 feet of ends of corridors. (C) Receptacles must be provided for essential needs such as medication refrigerators and life support systems or equipment. At least one outlet in each resident corridor must be provided with emergency electrical service. All receptacles on emergency circuits must be clearly, distinctly, and permanently identified, such as using a red face plate and/or a small label that says "Emergency." (D) Receptacles in the remainder of the building must be sufficient to serve the present and future needs of the residents and equipment. (E) Location of receptacles (horizontally and vertically) should be carefully planned and coordinated with the expected designed use of furnishings and equipment to maximize their accessibility and to minimize conditions such as beds or chests being jammed against plugs used in the outlets. (F) Exterior receptacles must be approved waterproof type. (G) Ground fault interruption protection must be provided at appropriate locations such as at whirlpools and other wet areas in accordance with the National Electrical Code. (4) Nurse call systems. (A) A nurse call system consists of power units, annunciator control units, corridor dome stations, emergency call stations, bedside call stations, and activating devices. The units must be compatible and laboratory listed for the system and use intended. (B) Each resident bedroom must be served by at least one calling station and each bed must be provided with a call switch. Two call switches serving adjacent beds may be served by one calling station. Each call entered into the system must activate a corridor dome light above the bedroom, bathroom, or toilet corridor door, a visual signal at the nurses station which indicates the room from which the call was placed, and a continuous or intermittent continuous audible signal of sufficient amplitude to be clearly heard by nursing staff. The amplitude or pitch of the audible signal must not be such that it is irritating to residents or visitors. The system must be designed so that calls entered into the system may be canceled only at the calling station. Intercom-type systems which meet this requirement are acceptable. (C) Nurse calling systems which provide two-way voice communication must be equipped with an indicating light at each calling station which lights and remains lighted as long as the voice circuit is operating. (D) A nurse call emergency switch(es) must be provided for resident use at each resident's toilet, bath, and shower. These switches must be usable by residents using the fixtures and by a collapsed resident lying on the floor. sec.19.342. Miscellaneous Details. (a) Safety related details. A high degree of safety for the occupants is needed to minimize accidents which are more apt to occur with the elderly and/or infirm residents in a nursing facility. Consideration must be given to the fact that many will have impaired vision, hearing, spatial perception, and ambulation. (1) Hazards such as sharp corners and edges and unexpected steps must be avoided. (2) Items such as drinking fountains, telephone booths, vending machines, and portable equipment must be located so as not to restrict corridor traffic or reduce corridor width. (3) Windows must be designed to prevent residents from accidentally falling through the windows. (4) Doors which normally stay open or are frequently used must not swing out into the corridor unless otherwise needed or required. Alcoves may be provided for doors which must swing outward toward a corridor or way of egress. (5) The proper use of safety glass must be adhered to in applicable locations and conditions. (6) Thresholds and expansion joint covers must be made essentially flush with the floor surface to facilitate use of wheelchairs and carts. See sec.19.340(a)(8) of this title (relating to Mechanical Requirements) for requirements for such items as shower curbs, surfaces, and doors. (7) Grab bars must be provided at all residents' toilets, showers, tubs, and sitz baths. The bars must be 1/4 to 1/2 inches in diameter and must have 1/2 inch clearance to walls. Bars must have sufficient strength and anchorage to sustain a concentrated load of 250 pounds. Grab bar standards must comply with standards adopted under the Americans with Disabilities Act of 1990. (8) Handrails must be provided on both sides of corridors used by residents. A clear distance of 1/2 inches must be provided between the handrail and the wall. Handrails must be securely mounted to withstand downward forces of 250 pounds. Handrails may be omitted on wall segments less than 18 inches. Handrails must be mounted 33 inches to 36 inches above the floor, and must comply with standards adopted under the Americans with Disabilities Act. (9) Ends of handrails and grab bars must be constructed to prevent snagging the clothes of residents (that is, return ends to wall). (10) Ceiling fan blades must be at least seven feet above the floor and be located so as not to interfere with the operation of any ceiling-mounted smoke detectors. (b) General details. (1) Concrete floors, whether finished by sealant, or similar product, must not be used as the finished floor unless specifically approved in writing by the Texas Department of Human Services. An exception is mechanical equipment rooms and maintenance or similar areas. (2) Sound separation must be provided in corridor walls and resident room party walls; Minimum Sound Transmission Coefficient 30 per American Society for Testing Material E-90. (3) Illumination and a safe platform in the attic must be provided at all attic access panels. (4) Attic access must be provided for building maintenance. Access panels must be prime coated steel flush panels where required to maintain fire rating of ceiling-roof/ceiling-floor assemblies. sec.19.343. Elevators. All buildings having residents' facilities (such as bedrooms, dining rooms, or recreation areas) or resident services (such as diagnostic or therapy) located on other than the main entrance floor must have at least one electric or electrohydraulic elevator and must comply with standards adopted under the American National Standards Institute (ANSI) Code, sA17.1. (1) Number of elevators. (A) At least one hospital-type elevator must be installed where one to 60 resident beds are located on any floor other than the main entrance floor. (B) At least two (one of which must be hospital-type) elevators must be installed where 61 to 200 resident beds are located on floors other than the main entrance floor, or where the major inpatient services are located on a floor other than those containing resident beds. Elevator service may be reduced for those floors which provide only partial inpatient services. (C) At least three (one of which must be hospital-type) elevators must be installed where 201 to 350 resident beds are located on floors other than the main entrance floor or where the major inpatient services are located on a floor other than those containing resident beds. Elevator service may be reduced for those floors which provide only partial inpatient services. (D) For facilities with more than 350 resident beds, the number of elevators must be determined from a study of the facility plan and the estimated vertical transportation requirements. (2) Cars and platforms. Cars of hospital-type elevators must have inside dimensions that will accommodate a resident bed and attendants and must be at least five feet wide by seven feet six inches deep. The car door must have a clear opening of not less than three feet eight inches. (3) Leveling. Elevators must be equipped with an automatic leveling device of the two-way automatic maintaining type with an accuracy of 1/2 inch. (4) Operation. Elevators, except freight elevators, must be equipped with a two-way special service switch to permit cars to bypass all landing button calls and be dispatched directly to any floor. (5) Accessibility provisions. Elevator controls, alarm buttons, and telephones, must be accessible to and usable by individuals with disabilities as required under the Americans with Disabilities Act of 1990. (6) Protection from fire. Elevator call buttons, controls, and door safety stops must be of a type that will not be activated by heat or smoke. Door openings must meet the requirements of the Life Safety Code for protection of vertical openings. (7) Field inspection and tests. Inspections and tests must be made and the owner must be furnished written certification that the installation meets the requirements set forth in this section and all applicable safety regulations and codes. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601425 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter E. Resident Rights 40 TAC sec.19.402, sec.19.416 The amendments are proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The amendments implement the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.19.402. Exercise of Rights. (a)-(e) (No change.) (f) Competent adults may issue directives or durable powers of attorney for health care, subject to the requirements of sec.19.419
                                                                                                                                                                                                                                                                                                                                                                [sec.19.418] of this title (relating to Directives and Durable Powers of Attorney for Health Care). (g) (No change.) sec.19.416. Personal Property.
                                                                                                                                                                                                                                                                                                                                                                  The resident has the right to retain and use personal possessions, including some furnishings, and appropriate clothing as space permits, unless to do so would infringe upon the rights or health and safety of other residents. Reasons for any limitations are documented in the resident's clinical record. See sec.19.1921(i)
                                                                                                                                                                                                                                                                                                                                                                    [sec.19.1921(n)] of this title (relating to General Requirements for a Nursing Facility). (1)-(3) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601426 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter M. Physician Services 40 TAC sec.19.1210 The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The amendment implements the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.19.1210. Certification and Recertification Requirements in Medicaid- Certified Facilities. (a) The physician participates in the utilization review process as specified in sec.19.2405
                                                                                                                                                                                                                                                                                                                                                                      [sec.19.2404] of this title (relating to Physicians' Certifications and Recertifications). (b)-(d) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601427 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter Q. Infection Control 40 TAC sec.19.1612 (Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Department of Human Services or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.) The repeal is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The repeal implements the Human Resources Code, sec.sec.22.001-22.024 and sec.sec.32.001-32.042. sec.19.1612. Texas Index for Level of Effort (TILE) Assessments. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601428 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter R. Vendor Payment 40 TAC sec.sec.19.1701-19.1727 (Editor's note: The text of the following sections proposed for repeal will not be published. The sections may be examined in the offices of the Texas Department of Human Services or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.) The repeals are proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The repeals implement the Human Resources Code, sec.sec.22.001-22.024 and sec.sec.32.001-32.042. sec.19.1701. General Requirements. sec.19.1702. Applicable Codes and Standards. sec.19.1703. Waivers. sec.19.1704. Emergency Power. sec.19.1705. Space and Equipment. sec.19.1706. Resident Rooms. sec.19.1707. Toilet Facilities. sec.19.1708. Resident Call System. sec.19.1709. Dining and Resident Activities. sec.19.1710. Other Environmental Conditions. sec.19.1711. Site and Grounds. sec.19.1712. Fire Service and Access. sec.19.1713. Means of Egress. sec.19.1714. Interior Finishes-Walls, Ceilings, and Floors. sec.19.1715. Fire Alarms, Detection Systems, and Sprinkler Systems. sec.19.1716. Portable Fire Extinguishers. sec.19.1717. Subdivision of Building Spaces-Smoke Barriers. sec.19.1718. Elevators and Escalators. sec.19.1719. Other Rooms and Areas. sec.19.1720. Provisions for Persons with Disabilities. sec.19.1721. Lighting and Illumination. sec.19.1722. Heating, Ventilating, and Air-conditioning Systems (HVAC). sec.19.1723. Plumbing. sec.19.1724. Housekeeping Services. sec.19.1725. Pest Control. sec.19.1726. Linen. sec.19.1727. Safety Operations. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601429 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter R. Physical Plant and Environment 40 TAC sec.19.1701 The new section is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provides the Health and Human Services Commission with the authority to administer federal medical assistance funds. The new section implements the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.19.1701. Physical Environment.
                                                                                                                                                                                                                                                                                                                                                                        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 the 1985 edition of the Life Safety Code of the National Fire Protection Association (NFPA) as designated by federal law and regulations (Health and Safety Code, sec.242.039(b)). The Life Safety Code is available for inspection at the Office of the Federal Register Information Center, Washington, D.C. Copies may be obtained from the NFPA, Batterymarch Park, Quincy, Massachusetts 02200. The New Health Care Occupancies chapter of the Life Safety Code is applicable to new construction, conversions of existing unlicensed buildings, remodeling, and additions. The Existing Health Care Occupancies chapter of the Life Safety Code is applicable to existing nursing homes. (B) After consideration of the findings of the Texas Department of Human Services (DHS) for Medicare/Medicaid certified facilities, the Health Care Financing Administration (HCFA) may waive specific provisions of the Life Safety Code 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 life-support systems if the normal electrical supply is interrupted. (B) When life support systems are used, the facility must provide emergency electrical power with an emergency generator (as defined in NFPA 99, Health Care Facilities) located on the premises. (3) Space and equipment. The facility must: (A) provide sufficient space and equipment in dining, health services, recreation, and program areas to enable staff to provide residents with needed services as required by these standards and as identified in each resident's plan of care; and (B) maintain all essential mechanical, electrical, and patient care equipment in safe operating condition. (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. (ii) measure at least 80 square feet per resident in multiple resident bedrooms and at least 100 square feet in single resident rooms; (iii) have direct access to an exit corridor; (iv) be designed or equipped to assure full visual privacy for each resident. (v) 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; (vi) have at least one window to the outside; and (vii) 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 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 closet space in the resident's bedroom with clothes racks and shelves accessible to the resident. (C) DHS 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) Toilet facilities. Each resident room must be equipped with or located near toilet and bathing facilities. (6) Resident call system. The nurse's station must be equipped to receive resident calls through a communication system from: (A) resident rooms; and (B) 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. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601430 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 40 TAC sec.19.1807 The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provides the Health and Human Services Commission with the authority to administer federal medical assistance funds. The amendment implements the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.19.1807. Rate Setting Methodology. (a) (No change.) (b) Rate determination. The Texas Board of Human Services determines general reimbursement rates for medical assistance programs for Medicaid recipients under provisions of the Human Resources Code, Chapter 24 (relating to Reimbursement Methodology). The Texas Board of Human Services determines reimbursement rates for nursing facilities based on consideration of Texas Department of Human Services (DHS) staff recommendations. To develop reimbursement rate recommendations for nursing facilities, DHS staff apply the following procedures. (1)-(3) (No change.) (4) Case-mix classification effective periods. The effective periods of case- mix classifications are defined as follows. (A) A recipient's case-mix classification and associated per diem rate payment remain in effect until the recipient's next required assessment, unless one of the following events takes place: (i) a provider submits an off-cycle assessment [(Purpose Code R)] as specified in sec.19.2412(a) (5)
                                                                                                                                                                                                                                                                                                                                                                          [sec.19.1612(a)(4)] of this title (relating to Texas Index for Level of Effort (TILE) Assessments); (ii) a DHS nurse reviewer revises the recipient's assessment and TILE classification under the provisions of sec.19.2412(b)
                                                                                                                                                                                                                                                                                                                                                                            [ s19.1612(b)] of this title (relating to Texas Index for Level of Effort (TILE) Assessments); (iii) the recipient is discharged from the Medicaid nursing facility vendor payment system for more than 30 days prior to receiving a permanent medical necessity determination. (B) (No change.) (5) (No change.) (c)-(e) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601431 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter T. Administration 40 TAC sec.19.1918, sec.19.1921 The amendments are proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provides the Health and Human Services Commission with the authority to administer federal medical assistance funds. The amendments implement the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.19.1918. Disclosure of Ownership. (a) (No change.) (b) The facility must provide written notice to the Licensing Section of the state office of Long Term Care-Regulatory,
                                                                                                                                                                                                                                                                                                                                                                              Texas Department of Human Services (DHS) at the time of change if a change occurs in: (1)-(4) (No change.) (c) The notice specified in subsection (b) of this section must include the identity
                                                                                                                                                                                                                                                                                                                                                                                [identify] of each new individual or company. (d)-(e) (No change.) sec.19.1921. General Requirements for a Nursing Facility. (a)-(i) (No change.) (j) Criminal History Checks of Certain Employees. Persons convicted of certain crimes may not be employed in nursing facilities. As required by Chapter 250 of the Health and Safety Code and as found in sec.sec.76.101- 76.106 of this title (relating to Criminal History Check of Employees in Facilities for Care of the Aged and Persons with Disabilities)
                                                                                                                                                                                                                                                                                                                                                                                  [40 TAC sec.sec.76.101-76.108], the facility must, prior to an offer of employment, conduct criminal history checks on persons whose positions involve direct contact with residents, unless they are licensed under another law. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601432 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter V. Federal Requirements 40 TAC sec.19.2105 (Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Department of Human Services or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.) The repeal is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provides the Health and Human Services Commission with the authority to administer federal medical assistance funds. The repeal implements the Human Resources Code, sec.sec.22.001-22.024 and sec.sec.32.001-32.042. sec.19.2105. Safe Medical Devices Act of 1990. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601433 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter W. Certification of Facilities for Care of Persons with Alzheimer's Disease and Related Disorders 40 TAC sec.19.2208 The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provides the Health and Human Services Commission with the authority to administer federal medical assistance funds. The amendment implements the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.19.2208. Standards for Certified Alzheimer's Facilities. (a) (No change.) (b) Staff. (1)-(2) (No change.) (3) Specially trained staff will be maintained and assigned exclusively to the Alzheimer's unit. Although emergency scheduling may require substitution of staff, every effort should be made to provide residents with familiar staff members in order to minimize resident confusion. Staff training will meet at least the minimum requirements in subsection
                                                                                                                                                                                                                                                                                                                                                                                    [sec.19.2208] (a)(2) of this section
                                                                                                                                                                                                                                                                                                                                                                                      [title (relating to Standards for Certified Alzheimer's Facilities)]. (4) (No change.) (c) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601434 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter X. Requirements for Medicaid-Certified Facilities 40 TAC sec.19.2324, sec.19.2326 The amendments are proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provides the Health and Human Services Commission with the authority to administer federal medical assistance funds. The amendments implement the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.19.2324. Selection and Contracting Procedures for Adding Beds in High- Occupancy Areas. (a)-(s) (No change.) (t) Providers may request an informal review of DHS actions involving this section and sec.19.2322
                                                                                                                                                                                                                                                                                                                                                                                        [sec.19.2323] of this title (relating to Additional Participation Requirements) by writing to Manager, Certification, Enrollment and Billing Services, Long Term Care-Regulatory, Texas Department of Human Services, Mail Code Y-976, P.O. Box 149030, Austin, Texas 78714-9030. sec.19.2326. Medicaid Swing Bed Program for Rural Hospitals. (a) -(d) (No change.) (e) Applicability of NF Requirements. From day one of the resident's stay, participating rural hospitals must meet the requirements set forth in sec.19.101 of this title (relating to Definitions); [sec.] sec.19.2304(c) of this title (relating to Federal Requirements); sec.sec.19. 1701-19.1715 and 19.1717 of this title (relating to General Requirements; Applicable Codes and Standards; Waivers; Emergency Power; Space and Equipment; Resident Rooms; Toilet Facilities; Resident Call System; Dining and Resident Activities; Other Environmental Conditions; Site and Grounds; Fire Service and Access; Means of Egress; Interior Finishes-Walls, Ceilings, and Floors; Fire Alarms, Detection Systems, and Sprinkler Systems; and Subdivision of Building Spaces-Smoke Barriers); sec.sec.19.1901-19.1914 and sec.19.1917 of this title (relating to Administration; Governing Body; Required Training of Nurse Aides; Proficiency of Nurse Aides; Staff Qualifications; Use of Outside Resources; Medical Director; Laboratory Services; Radiology and Other Diagnostic Services; Clinical Records; Contents of the Clinical Record; Additional Clinical Record Service Requirements; Clinical Records Service Supervisor; Disaster and Emergency Preparedness; and Quality Assessment and Assurance); sec. s19. 2601-19.2608 and sec.19.2610
                                                                                                                                                                                                                                                                                                                                                                                          [sec.sec.19.2601-19.2608] of this title (relating to Subchapter AA,
                                                                                                                                                                                                                                                                                                                                                                                            Vendor Payment); sec. s19.2402-19.2405, and 19. 2407- 19.2413
                                                                                                                                                                                                                                                                                                                                                                                              [sec.sec.19.2402-19.2413] of this title (relating to Subchapter Y,
                                                                                                                                                                                                                                                                                                                                                                                                Medical Review and Re-evaluation); ssec.19.1801 and 19. 1902 of this title (relating to General Reimbursement Information and Cost Reporting Procedures); and Appendix A, General Reimbursement Methodology, of DHS's Long Term Care Nursing Facility Requirements for Licensure and Medicaid Certification. (f) Rural hospital (Medicaid swing bed facility) licensure and certification requirements. Pursuant to the Health and Safety Code sec.sec.222.021, 222.024, and 222.025 relating to the duplication of health care inspections and licensing, a rural hospital participating in the Medicaid swing bed program satisfies licensure and certification requirements referenced in this section
                                                                                                                                                                                                                                                                                                                                                                                                  [at s19.2326 of this title (relating to Medicaid Swing Bed Program for Rural Hospitals)] when it is currently licensed and certified as a hospital by the Texas Department of Health. However, in accordance with sec.32.024 of the Human Resources Code, if the rural hospital's swing beds are used for more than one 30-day length of stay per year, per resident the hospital must comply with the full Nursing Facility Requirements. (g)-(j) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601435 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter Y. Medical Review and Re-evaluation 40 TAC sec.19.2403, sec.19.2412 The amendment and new section are proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provides the Health and Human Services Commission with the authority to administer federal medical assistance funds. The amendment and new section implement the Human Resources Code, sec.sec.22. 001-22.024 and sec.sec.32.001-32.042. sec.19.2403. Utilization Review Process. The Utilization Review Committee determines the need for nursing facility care by evaluating the recipient's medical and/or nursing needs based on facility documentation required by the Texas Department of Human Services (DHS). The medical necessity determination must be made before receiving vendor payment for service delivery, except as provided in sec.19.2408 of this title (relating to Retroactive Medical Necessity Determinations) and s19.2413 of this title (relating to Reconsideration of Medical Necessity Determination (MN) and Effective Dates). (1) (No change.) (2) The review process is initiated when the Utilization Review Committee receives a Texas Nursing Facility Client Assessment, Review, and Evaluation (CARE) form indicating that a Medicaid applicant or recipient is requesting vendor payment for care in a contracted nursing facility. (A)-(B) (No change.) (C) An admission review of a CARE form determines the medical necessity and establishes an authorization for reimbursement and a level of reimbursement. A valid medical necessity determination is an eligibility requirement for Medicaid participation, and vendor payments cannot be made on behalf of recipients who do not have established medical necessity determinations. (i) (No change.) (ii) The CARE form must be received by the Utilization Review Committee in accordance with sec.19.2404
                                                                                                                                                                                                                                                                                                                                                                                                    [sec.19.2406] of this title (relating to Utilization Review Effective Dates). The admission review and determination of medical necessity (MN) remains valid for up to 180 days from date of admission or the stamp-in date when not received by the Utilization Review Committee within 20 days of admission. (iii)-(iv) (No change.) (D)-(E) (No change.) (3) (No change.) sec.19.2412. Texas Index for Level of Effort (TILE) Assessments. (a) Recipient assessment. Facility nurse assessors assess recipients for TILE determination by completing Texas Nursing Facility Client Assessment, Review, and Evaluation (CARE) forms. These assessments establish TILE classifications as described in paragraphs 1-8 of this subsection. Effective April 1, 1995, nurse assessors must have completed a Texas Department of Human Services (DHS) TILE training course and must be registered with the National Heritage Insurance Company (NHIC). (1) Preadmission assessments do not establish a TILE classification. (2) Admissions assessments establish TILE classifications as follows: (A) If the resident has not previously attained a permanent medical necessity, the nurse assessor submits an admission assessment within 20 calendar days of admission, as provided in sec.19.2403 (relating to Utilization Review Process). The admission assessment establishes a medical necessity (MN) and a TILE classification for 180 days. (B) If the resident has previously attained a permanent MN, the admission assessment is completed on an abbreviated form which sets TILE only. (3) One medical necessity review (MNR) is required 180 days after the effective date of the admission assessment. If the MNR indicates a MN for nursing facility care, DHS will notify the facility of the permanent MN. This notification becomes a part of the resident's permanent medical record. A MN will be lost only if a resident is discharged to home for over 30 days. The MNR may also establish a new TILE classification. (4) After the establishment of permanent MN, residents with a 211 TILE require no further assessment unless there is a change in their condition. All other TILE levels require a review every 180 days. (5) If a recipient's medical condition deteriorates to the extent that he qualifies for a different TILE, the provider may submit an off-cycle assessment. Only two off-cycle assessments for any one recipient are permitted per year, one from January through June and one from July through December. The assessment sets a new schedule for submission of forms if permanent MN has been achieved. Prior to permanent MN, the assessment will not set a new schedule for submission of forms. (6) A CARE form may be submitted for the purpose of allowing a provider to correct errors previously made in the assessment portion of the form (Items 30,31, and 50-99). The submission of the correction does not change the schedule for submission of forms or necessarily change the TILE group. Corrections must be submitted within 60 days from the date of assessment. Requests for changes after 60 days will not be accepted. (7) If a recipient experiences a significant change related to mental illness, mental retardation, and/or a related condition which indicates that the recipient might benefit from specialized services, an off-cycle request for a recipient Preadmission Screening and Resident Review (PASARR) must be submitted to the local DHS PASARR office using a CARE form. (8) A facility may submit a request for retroactive payment in the following instances: (A) when a facility provides care for a recipient for a period of time not covered by an effective MN determination at admission or by assessment CARE forms between reviews (see sec.19.2413 of this title (relating to Reconsideration of Medical Necessity Determination and Effective Dates)); or (B) if a recipient is found to be otherwise eligible for Medicaid for the three months prior to the month of his date of application for Medicaid assistance (see sec.19.2408 of this title (relating to Retroactive Medical Necessity Determinations)). (b) Review and appeal of case-mix assessments. DHS nurse reviewers conduct desk reviews and in-depth, on-site reviews of samples of Texas Nursing Facility CARE forms completed by providers to verify TILE and medical necessity information. Forms expired over 12 months will not be reviewed. (1) When a DHS nurse reviewer determines that the TILE classification or permanent MN determination is not substantiated and/or does not accurately reflect the recipient's status, the reviewer will discuss the error and propose corrections with facility staff and make appropriate corrections. The facility administrator will be notified of TILE changes by certified mail or by FAX. (A) DHS recoups funds previously paid to the provider under incorrect TILE classification. DHS pays the nursing facility any increase due to a change in TILE classification. (B) The change in TILE classification and per diem rate is effective retroactively to the "effective date" of the assessment reviewed. (C) The change in MN determination is effective on the date of the review. If discharge results, the procedures in s19.502 of this title (relating to Transfer and Discharge) must be followed. (2) If a DHS nurse reviewer and a facility nurse assessor are unable to agree about an assessment, the facility nurse assessor requests an informal review by a DHS nurse supervisor. If the provider disagrees with the findings of the nurse supervisor, the provider may initiate a formal appeal, as stated in Chapter 79, Subchapter Q, of this title (relating to Contract Appeals Process) by submitting a request to the Director, Hearings Department, Mail Code W-613, Texas Department of Human Services, P.O. Box 149030, Austin, Texas 78714-9030. The TILE classification and associated per diem rate specified by the DHS nurse reviewer remain in effect during any period of informal review or formal contract appeal. If the informal review or contract appeal process establishes that DHS has changed a TILE classification in error, DHS corrects the error retroactively. (3) DHS nurse reviewers notify administrators in advance of their on- site visits regarding the recipients whose medical records will be reviewed, the time period covered by the review, the parts of the record to be reviewed, and the accommodations necessary for the review. If the nurse reviewers are prevented from conducting the review, TILE rates on the recipients chosen for review will be lowered to the default TILE rate until the review can be accomplished. (c) Monitoring. TILE error rates which DHS finds unacceptable may result in a facility's undergoing a monitoring period. Decisions to institute monitoring will be made by the Utilization and Assessment Review (UAR) staff in state office. (1) During the monitoring period, facilities must submit all Texas Nursing Facility CARE forms to DHS nurse reviewers. Forms may not be submitted to NHIC either electronically or by mail. (2) The length of the monitoring period is 60 days. If accuracy of forms is still at an unacceptable level at the end of 60 days, DHS may give a one-time, 30-day extension, if the facility has shown an attempt to improve their accuracy. If forms are not accurate at the end of 90 days, DHS places the facility on compliance. (d) Compliance. (1) A decision to place a facility on compliance will be made by UAR staff in state office. Compliance may result when a facility has a high error rate on the current review and one of the following: (A) an unacceptable level of improvement by the end of a monitoring period; (B) lack of documentation regarding key assessment items; (C) a history of noncompliance; or (D) medical records which contain alterations in areas designed to lower the TILE level and increase the payment. (2) DHS allows a facility a compliance period of 30 days to submit new assessment forms on all recipients not in the original review to DHS nurse reviewers. Facilities may not submit forms to NHIC electronically or by mail. (3) If an acceptable level of improvement has not been achieved by the end of the compliance period, vendor payments to the facility will be held until an acceptable level of improvement is achieved. (4) The facility nurse assessor must attend a DHS TILE training course within 60 days of the beginning of the compliance period. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601436 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 The Texas Department of Human Services (DHS) proposes the repeal of sec.90. 60, concerning plans, approvals, and construction procedures; sec.90.70, concerning fees for plan reviews, construction inspection services, and feasibility inspection services; s90.80, concerning construction and initial survey of completed construction; sec.sec.90.92-90.105, concerning general requirements for facility construction; and sec.90.141, concerning plans, approvals, and construction procedures; and sec.sec.90.323-90.325, concerning procedures for inspection of public records and time periods for processing licenses for long term care facilities. DHS also proposes amendments to sec.90. 12, concerning building approval; sec.90.15, concerning renewal procedures and qualifications; sec.90.42, concerning standards for facilities serving persons with mental retardation or related conditions; sec.90.212, concerning incidents of abuse and neglect reportable by facilities to the Texas Department of Human Services (DHS); and sec.90.327, concerning notice of changes in key personnel. DHS also proposes new sec.sec.90.60-90.74, concerning general requirements for facility construction; new sec.90.231, concerning warning letter, and new sec.90. 323, concerning procedures for inspection of public records in its Intermediate Care Facilities Serving Persons with Mental Retardation or a Related Condition chapter. The purpose of the repeal of sec.sec.90.60, 90.70, 90.80, 90.92-90.105, and 90. 141 is to delete rules addressing discontinued department functions. The purpose of the repeal of sec.sec.90.323-90.325 is to delete rules inadvertently published in two sections. The purpose of the amendments to sec.sec.90.12, 90.15, and 90.42 is to delete out-dated rules, add a definition of timely filed applications, and correct a misspelled word. The purpose of the amendment to sec.90.212 is to delete outdated references to nursing facilities. The purpose of the amendment to sec.90.327 is to delete sections not applicable to Intermediate Care Facilities Serving Persons with Mental Retardation or a Related Condition. The purpose of new sec.sec.90.60-90.74 is to modify the facility construction requirements. The purpose of new sec.90.231 is to provide information about DHS's procedure for warning facilities when their non-compliance with licensure rules places them at risk of licensing actions. The purpose of new sec.90.323 is to provide information on the procedure for the inspection of public records. Burton F. Raiford, commissioner, has determined that for the first five- year period the sections are in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the proposal. Mr. Raiford also has determined that for each year of the first five years the sections are in effect the public benefit anticipated as a result of enforcing the proposal will be clear rules. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the proposed section. Questions about the content of this proposal may be directed to Susan Syler at (512) 438-3111 in DHS's Long Term Care Policy Section. Written comments on the proposal may be submitted to Nancy Murphy, Media and Policy Services-313, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register. Subchapter B. Application Procedures 40 TAC sec.90.12, sec.90.15 The amendments are proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provides the Health and Human Services Commission with the authority to administer federal medical assistance funds. The amendments implement the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.90.12. Building Approval. (a) (No change.) (b) Local health authority. The following procedures allow the local health authority to provide recommendations to DHS concerning licensure of a facility. (1)-(4) (No change.) [(5) Inspection and plan review. An applicant for licensure who has an existing building must submit either a plan for review and approval or request a feasibility inspection to be performed by DHS to determine construction or renovation requirements. The fees for inspection and plan reviews must be in accordance with sec.90.19 of this title (relating to License Fees).] sec.90.15. Renewal Procedures and Qualifications. (a)-(b) (No change.) (c) If the application is postmarked by the filing deadline, the application will be considered to be timely filed if received in the Licensing Section of the state office of Long Term Care-Regulatory, Texas Department of Human Services, within 15 days of the postmark. (d)
                                                                                                                                                                                                                                                                                                                                                                                                      [(c)] The application for renewal must contain the same information required for an original application as well as payment of the annual licensing fees. (e)
                                                                                                                                                                                                                                                                                                                                                                                                        [(d)] The renewal of a license may be denied for the same reasons an original application for a license may be denied. See sec.90.17 of this title (relating to Criteria for Denying a License or Renewal of a License). This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601437 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter C. Standards for Licensure 40 TAC sec.90.42 The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The amendment implements the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.90.42. Standards for Facilities Serving Persons with Mental Retardation or Related Conditions. (a)-(d) (No change.) (e) Additional requirements. (1)-(4) (No change.) (5) Specialized nutrition support (delivery of parenteral
                                                                                                                                                                                                                                                                                                                                                                                                          [parental] nutrients and enteral feedings by nasogastric, gastrostomy, or jejunostomy tubes, etc.) must be given in accordance with physician's orders by a registered or licensed nurse. (6)-(8) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601438 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter D. General Requirements for Facility Construction 40 TAC sec.sec.90.60, 90.70, 90.80, 90.92-90.105, 90.141 (Editor's note: The text of the following sections proposed for repeal will not be published. The sections may be examined in the offices of the Texas Department of Human Services or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.) The repeals are proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The repeals implement the Human Resources Code, sec.sec.22.001-22.024 and sec.sec.32.001-32.042. sec.90.60. Plans, Approvals, and Construction Procedures. sec.90.70. Fees for Plan Reviews, Construction Inspection Services, and Feasibility Inspection Services. sec.90.80. Construction and Initial Survey of Completed Construction. sec.90.92. Introduction, Application, and General Requirements for Facilities Serving Persons with Mental Retardation or Related Conditions. sec.90.93. Site and Grounds. sec.90.94. Fire Service. sec.90.95. Means of Egress. sec.90.96. Fire Alarms, Detection Systems, and Sprinkler Systems. sec.90.97. Portable Fire Extinguishers. sec.90.98. Accessibility Provisions. sec.90.99. Architectural Space Planning. sec.90.100. Storage Requirements (All Facilities). sec.90.101. Electrical, Heating, Ventilating, and Air-conditioning Systems (HVAC)-All Facilities. sec.90.102. Plumbing (All Facilities). sec.90.103. Maintenance (All Facilities). sec.90.104. Environmental Services. sec.90.105. Safety Operations. sec.90.141. Plans, Approvals, and Construction Procedures. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601439 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 40 TAC sec.sec.90.60-90.74 The new sections are proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The new sections implement the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.90.60. Construction and Initial Survey of Completed Construction. (a) Construction phase. (1) The Texas Department of Human Services (DHS), Architectural Section in Austin, Texas, must be notified in writing of construction start. (2) All construction must be done in accordance with minimum licensing requirements. It is the sponsor's responsibility to employ qualified personnel to prepare the contract documents for construction of a new facility or remodeling of an existing facility. Contract documents for additions and remodeling and for the construction of an entirely new facility must be prepared by an architect licensed by the Texas State Board of Architectural Examiners. Drawings must bear the seal of the architect. Certain parts of final plans, designs, and specifications must bear the seal of a registered professional engineer approved by the State Board of Registration for Professional Engineers to operate in Texas. These certain parts include sheets and sections covering structural, electrical, mechanical, and sanitary engineering. (A) Remodeling is the construction, removal, or relocation of walls and partitions; the construction of foundations, floors, or ceiling-roof assemblies; the expanding or altering of safety systems (including, but not limited to, sprinkler, fire alarm, and emergency systems); or the conversion of space in a facility to a different use. (B) General maintenance and repairs of existing material and equipment, repainting, applications of new floor, wall, or ceiling finishes, or similar projects are not included as remodeling, unless as a part of new construction. DHS must be provided flame spread documentation for new materials applied as finishes. (b) Contract documents. (1) Site plan documents must include grade contours; streets (with names); north arrow; fire hydrants; fire lanes; utilities, public or private; fences; unusual site conditions, such as ditches, low water levels, other buildings on- site; and indications of buildings five feet or less beyond site property lines. (2) Foundation plan documents must include general foundation design and details. (3) Floor plan documents must include room names, numbers, and usages; doors (numbered) including swing; windows; legend or clarification of wall types; dimensions; fixed equipment; plumbing fixtures; and kitchen basic layout; and identification of all smoke barrier walls (outside wall to outside wall) or fire walls. (4) For both new construction and additions or remodeling to existing buildings, an overall plan of the entire building must be drawn or reduced to fit on an 8 1/2 inch by 11 inch sheet; submit two reduced plans for file record. See sec.90.80(c)(3) of this title (relating to Construction and Initial Survey of Completed Construction). (5) Schedules must include door materials, widths, types; window materials, sizes, types; room finishes; and special hardware. (6) Elevations and roof plan must include exterior elevations, including material note indications and any roof top equipment; roof slopes, drains, and gas piping, and interior elevations where needed for special conditions. (7) Details must include wall sections as needed (especially for special conditions); cabinet and built-in work, basic design only; cross sections through buildings as needed; and miscellaneous details and enlargements as needed. (8) Building structure documents must include structural framing layout and details (primarily for column, beam, joist, and structural frame building); roof framing layout (when this cannot be adequately shown on cross section); cross sections in quantity and detail to show sufficient structural design and structural details as necessary to assure adequate structural design, also calculated design loads. (9) Electrical documents must include electrical layout, including lights, convenience outlets, equipment outlets, switches, and other electrical outlets and devices; service, circuiting, distribution, and panel diagrams; exit light system (exit signs and emergency egress lighting); emergency electrical provisions (such as generators and panels); fire alarm and similar systems (such as control panel, devices, and alarms); sizes and details sufficient to assure safe and properly operating systems; and a staff communication system. (10) Plumbing documents must include plumbing layout with pipe sizes and details sufficient to assure safe and properly operating systems, water systems, sanitary systems, gas systems, other systems normally considered under the scope of plumbing, fixtures, and provisions for combustion air supply. (11) Heating, ventilation, and air-conditioning (HVAC) documents must include sufficient details of HVAC systems and components to assure a safe and properly operating installation including, but not limited to, heating, ventilating, and air-conditioning layout, ducts, protection of duct inlets and outlets, combustion air, piping, exhausts, and duct smoke and/or fire dampers; and equipment types, sizes, and locations. (12) Sprinkler system documents must include plans and details of NFPA designed systems; plans and details of partial systems provided only for hazardous areas; electrical devices interconnected to the alarm system. (13) Other layouts, plans, or details as may be necessary for a clear understanding of the design and scope of the project; including plans covering private water or sewer systems must be reviewed by the local health or wastewater authority having jurisdiction. If no local authority, then the plans will be reviewed by DHS. (14) Specifications must include installation techniques, quality standards and/or manufacturers, references to specific codes and standards, design criteria, special equipment, hardware, painting, and any others as needed to amplify drawings and notes. (c) Initial survey of completed construction. (1) Upon completion of construction, including grounds and basic equipment and furnishings, a final construction inspection (initial survey) of the facility, including additions or remodeled areas, is required to be performed by DHS (architectural section) prior to occupancy. A minimum of three weeks advance notice is needed. The completed construction must have the written approval of the local authorities having jurisdiction, including the fire marshal, and building inspector. (2) After the completed construction has been surveyed by a representative of the architectural section of DHS and found acceptable, this information will be conveyed to the licensing officer as part of the information needed to issue a license to the facility. In the case of additions or remodeling of existing facilities, a revision or modification to an existing license may be necessary. Note that the building, grades, drives, parking and grounds must be essentially 100% complete at the time of this initial survey visit for occupancy approval and licensing, including basic furnishings and operational needs. (3) The following documents must be available to DHS's surveyor at the time of the survey of the completed building: (A) written approval of local authorities as called for in paragraph (1) of this subsection; (B) written certification of the fire alarm system by the installing agent (Form FML-009 of the Texas State Fire Marshal); (C) documentation of materials used in the building which are required to have a specific limited fire or flame spread rating, including, but not limited to, special wall finishes or floor coverings, flame retardant curtains (including cubicle curtains), and rated ceilings. This must include a signed letter from the installer verifying that the material installed is the same material named in the laboratory test document; (D) approval of the completed sprinkler system installation by the designing engineer. A copy of the material list and test certification must be available; (E) service contracts for maintenance and testing of systems, including, but not limited to, alarm systems and sprinkler systems; (F) a copy of gas test results of the facility's gas lines from the meter; (G) a written statement from an architect/engineer stating that he certifies that the building was constructed to meet NFPA 101, Life Safety Code, and all locally applicable codes, and that the facility is in substantial conformance with minimum licensing requirements; and (H) the contract documents specified in subsection (b) of this section. (d) Non-approval of new construction. (1) If, during the initial on-site survey of completed construction, the surveyor finds certain basic requirements not met, he may recommend to DHS that the facility not yet be licensed and approved for occupancy. Such basic items may include the following: (A) construction which does not meet minimum code or licensure standards for basic requirements such as corridor widths being less than eight feet clear width, ceilings installed at less than the minimum seven feet six inches height, resident bedroom dimensions less than required width, and other such features which would disrupt or otherwise adversely affect the residents and staff if corrected after occupancy; (B) no written approval by local authorities; (C) fire protection systems not completely installed or not functioning properly including, but not limited to, fire alarm systems, emergency power and lighting, and sprinkler systems; (D) required exits are not all usable according to Life Safety Code requirements; (E) telephone not installed or not properly working; (F) sufficient basic furnishings, essential appliances and equipment are not installed or not functioning; and (G) any other basic operational or safety feature which the surveyor, as the authority having jurisdiction, encounters which in his/her judgment would preclude safe and normal occupancy by residents on that day. (2) If the surveyor encounters deficiencies that do not affect the health and safety of the residents, licensure may be recommended based on an approved written plan of correction by the facility's administrator. (3) Copies of reduced size floor plan on an 8 1/2 inch by 11 inch sheet must be submitted in duplicate to DHS for record/file use and for such uses by the facility as evacuation planning and fire alarm zone identification. The plan must contain basic legible information such as overall dimensions, room usage names, actual bedroom numbers, doors, windows, and any other pertinent information. sec.90.61. Introduction, Application, and General Requirements for Facilities Serving Persons with Mental Retardation or Related Conditions. (a) Scope. The requirements of this section are applicable to both new and existing facilities unless stated otherwise. (b) Purpose. (1) The concept of requirements for fire safety with regard to the residents is based on evacuation capability as published by National Fire Protection Association (NFPA) in NFPA 101 Life Safety Code. These standards are written with the premise that the residents will be capable of self-evacuation without continuous staff assistance. Residents that are not normally capable of self- evacuation nor capable of negotiating stairs unassisted shall not be housed above or below the floor of exit discharge unless the facility meets the construction requirements of NFPA 101, Chapter 12 titled "New Health Care Occupancies" for large facilities, or the "impractical" requirements for small facilities as found in NFPA 101, Chapter 21 titled "Residential Board and Care Occupancies." Examples of residents who may not be capable of self-evacuation are as follows: (A) a person with a physical disability of a nature that he/she is not capable of maneuvering in a wheelchair, walker, etc., unaided; (B) a person with a mental disability who will not take or cannot understand instructions from a staff member; or (C) a person that is taking medication before bedtime which will make it difficult for a staff member to arouse the person quickly. (2) The method of determining the evacuation capability of residents under NFPA 101, Chapter 21, is by rating each resident and each staff member to determine an evacuation difficulty score (E-score). If the E-score is 1.5 or less, the evacuation capability of the facility is prompt, greater than 1.5 to five is slow, greater than five is impractical. The worksheets to be completed are located in NFPA 101, 1985 Edition, Appendix F. Intermediate Care Facilities for the Mentally Retarded (ICFs-MR) with 16 beds or less must meet the evacuation requirement for their designated Chapter 21 rating. The ratings and their requirements follow: (A) Impractical rating. (i) The facility must have one evacuation and/or fire drill per shift each calendar quarter (minimum of 12 drills per year). (ii) The facility must actually evacuate clients once a year on each shift. (iii) All facility staff, including relief and substitute staff, must participate in drills as soon as possible after beginning employment on their shift. (iv) For initial certification, one client must be admitted. (v) E-scores are not required for certification under this rating. (B) Slow rating. (i) The facility must have one evacuation and/or fire drill per shift each calendar quarter (minimum of 12 drills per year). (ii) The facility must actually evacuate clients once a year on each shift. (iii) Staff on each shift must participate in drills. (iv) New and/or relief or substitute staff must participate in a drill within ten days of employment on their assigned shift. (v) For initial certification, two clients must be admitted. (vi) E-scores must be calculated as soon as possible, but within ten calendar days of admission. (vii) Initial E-scores are based on four drills, as follows: (I) two conducted during the daytime, and (II) two conducted during the nighttime, after the first 30 minutes and within the first three hours of sleep. (viii) After the initial E-scores are obtained, a worksheet for rating residents must be completed for all newly admitted clients to obtain an E-score. The evacuation capability is calculated as described in clause (vii) of this subparagraph. (ix) E-scores must be updated annually or sooner if significant changes occur in any client's evacuation capability. These updated scores are based on the group's overall performance during fire drills as they are conducted throughout the year. Scores do not have to be calculated in accordance with the drills required for newly admitted clients based on the requirements stated in clause (vii) of this subparagraph. (C) Prompt rating. (i) The facility must have one evacuation and/or fire drill per shift each calendar quarter (minimum of 12 drills per year). (ii) The facility must actually evacuate clients once a year on each shift. (iii) Staff on each shift must participate in drills. (iv) New and/or relief or substitute staff must participate in a drill within ten days of employment on their assigned shift. (v) For initial certification, all six clients must be admitted. (vi) E-scores must be calculated as soon as possible, but within ten calendar days of admission. (vii) Initial E-scores are based on four drills, as follows: (I) two conducted during the daytime, and (II) two conducted during the nighttime, after the first 30 minutes and within the first three hours of sleep. (viii) After the initial E-scores are obtained, a worksheet for rating residents must be completed for all newly admitted clients to obtain an E-score. The evacuation capability is calculated as described in clause (vii) of this subparagraph. (ix) E-scores must be updated annually or sooner if significant changes occur that would affect a client's evacuation capability. These updated scores are based on the group's overall performance during fire drills as they are conducted throughout the year. Scores do not have to be calculated in accordance with the drills required for newly admitted clients based on the requirements stated in clause (vii) of this subparagraph. (3) The "E" score will determine which NFPA 101 features are to be installed and maintained in the facility. These features include construction, fire alarm systems, smoke detector systems, interior finish, sprinkler systems, separation of bedrooms, and egress from the building. (c) Definitions. The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. (1) Addition-The addition of floor space. (2) Large facilities-Facilities with 17 or more resident beds. (3) Department-Texas Department of Human Services. (4) Life safety features-Fire safety components required by NFPA 101 such as building construction, fire alarm systems, smoke detection systems, interior finishes, sizes and thicknesses of doors, exits, emergency electrical systems, sprinkler systems, etc. (5) Remodeling-The altering of the structure, e.g., removal or addition of walls or partitions, floors, ceiling, roof. (6) Renovation-The restoration to a former better state by cleaning, repairing, or rebuilding, e.g., routine maintenance, repairs, equipment replacement, painting. (7) Small facilities-Facilities with 16 or fewer resident beds. (d) Construction. (1) New construction is any construction work which began on or after October 3, 1988. The provisions of NFPA 101, Chapter 12 are applicable for large facilities, and Chapter 21 for small facilities. (2) An existing facility is one which was operating with a license as a facility for persons with mental retardation and related conditions before October 3, 1988, and has not subsequently become unlicensed. The provisions of NFPA 101, Chapter 13 titled "Existing Health Care Occupancies," are applicable for large facilities, and Chapter 21 for small facilities. (3) Alterations or new installations of building services equipment, such as mechanical and electrical systems, generators, fire alarm, and detection systems, etc., must be accomplished in conformance with the requirements for new construction as required by NFPA 101. (4) Site approval, as required by the local health officer, building department, and/or fire marshal having jurisdiction, must be obtained. Any conditions considered to be a fire, safety, or health hazard will be grounds for disapproval of the site by the department unless applied in an arbitrary or discriminating manner. (5) Facilities that renovate must provide documentation for the flame spread rate of any new materials applied as an interior finish. (6) Life safety features and equipment that have been installed in existing buildings and are now in excess of that required by NFPA 101 must continue to be maintained or must be removed at the direction of DHS. (7) When an existing licensed facility plans building additions or remodeling, which includes construction of additional resident beds, then the ratio of bathing units must be reevaluated to meet minimum standards and the square footage of dining and living areas must be reevaluated by DHS. Conversion of existing living, dining, or activity areas to resident bedrooms must not reduce these functions to an area less than required by minimum standards. (8) Buildings must be of recognized permanent type construction. They must be structurally sound with regard to actual or expected dead, live, and wind loads according to applicable building codes. (9) Each building must be classified as to the building construction type for fire resistance rating purposes in accordance with NFPA 220 Standard on Types of Building Construction, and NFPA 101. (e) Applicable codes and standards. Facilities must meet the requirements of NFPA 101, 1985 edition, and any other codes and standards of NFPA listed in this section, except as may be otherwise approved or required by DHS. (1) If the municipality has a building code and a plumbing code, then those codes must govern in those areas of construction. Where local codes or ordinances are applicable, the most restrictive parts concerning the same subject item must apply unless otherwise determined by the authority having jurisdiction for local codes and DHS. (2) In the absence of such governing municipal codes, nationally recognized codes must be used, such as the Standard Building Code and the Standard Plumbing Code, both of the Southern Building Code Congress International, Inc. Such nationally recognized codes, when used, must all be publications of the same group or organization to assure the intended continuity. (3) Heating, ventilating, and air-conditioning systems must be designed and installed in accordance with NFPA 90A Standard for the Installation of Air Conditioning and Ventilating Systems, and NFPA 90B Standard for the Installation of Warm Air Heating and Air Conditioning Systems, as applicable, and the American Society of Heating, Ventilating, and Air-Conditioning Engineers (ASHRAE), except as may be modified in this subchapter. (4) Electrical and illumination system must be designed and installed in accordance with NFPA 70 National Electrical Code, and the Lighting Handbook of the Illuminating Engineering Society of North America (IES) except as may be modified in this subchapter. (5) The facility must meet the provisions and requirements concerning accessibility for individuals with disabilities in the following laws: the Americans with Disabilities Act of 1990 (Public Law 101-336; Title 42, United States Code, Chapter 126); Title 28, Code of Federal Regulations, Part 35; Texas Civil Statutes, Article 9102; and Title 16, Texas Administrative Code, Chapter 68. Plans for new construction, substantial renovations, modifications, and alterations must be submitted to the Texas Department of Licensing and Regulation (Attention: Elimination of Architectural Barriers Program) for accessibility approval under Article 9102. (f) General requirements. (1) The facility must provide and maintain furnishings and decorations that meet the needs of the residents. (2) The building, grounds, and equipment must be maintained in good repair, operational, sanitary, and free of hazards. (3) There must be at least one telephone (other than a pay phone) in the facility, accessible to residents for use in making calls to summon help in case of emergency. (4) The facility must have: (A) floors that are free of irregularities and are substantially level (floor areas may be at different elevations with connecting stairs or ramps); (B) floors that have a resilient, nonabrasive, and slip-resistant surface; (C) nonabrasive carpeting, if the area used by residents is carpeted and serves residents who lie on the floor or ambulate with parts of their bodies, other than feet, touching the floor; and (D) exposed floor surfaces and floor coverings that promote mobility in areas used by residents and promote maintenance of sanitary conditions. (5) Walls and ceilings must be cleanable and in good repair. (6) Walls and floors must be kept free of cracks. The joint between the walls and floors is to be maintained so as to be free of spaces which might harbor insects, rodents, or vermin. (7) An adequate supply of hot water must be provided. The hot water system for resident use must be capable of being regulated to not exceed 110 degrees Fahrenheit at the fixtures. (8) Draperies, curtains (including cubicle curtains), and other similar furnishings and decorations must be flame resistant in accordance with NFPA 701 Standard Methods of Fire Tests for Flame Resistant Textiles and Films. Documentation must be kept on file in the facility. (9) Wastebaskets must be of noncombustible material. (10) An initial pressure test of facility gas lines from the meter must be provided. Additional pressure tests will be required when the facility has major renovations or additions where the gas service is interrupted. All gas heating systems must be checked for proper operation and safety prior to the heating season. Any unsatisfactory conditions must be corrected promptly. (11) The IES recommendations must be followed to achieve proper illumination characteristics and lighting levels throughout the facility. Minimum illumination must be ten foot candles in resident rooms during the day and 20- foot candles in corridors, staff stations, dining rooms, lobbies, toilets, bathing facilities, laundries, stairways, and elevators during the day. Illumination requirements for these areas apply to lighting throughout the space and should be measured at approximately 30 inches above the floor anywhere in the room. Minimum illumination for medication preparation or storage areas, kitchens, and staff station desks must be 50-foot candles during the day. Illumination requirements for these areas apply to the task performed and should be measured on the tasks. (12) In addition to the required illumination (normal and emergency), the facility must keep on hand and readily available to night staff, no less than one working flashlight. (13) Combustible attic areas larger than 3,000 square feet must be divided into compartments not exceeding 3,000 square feet or the attic area must be sprinkled. The separating barrier must be at least one layer of 1/2-inch gypsum board on one side of support members. sec.90.62. Site and Grounds. (a) General (All Facilities). (1) Site grades shall provide for positive surface water drainage so that there will be no ponding or standing water at or near the building such as would present a hazard to health or provide a breeding site or harborage for disease vectors. (2) Outdoor activity, recreational, and sitting spaces shall be provided and be accessible to all residents. (3) Each facility shall have parking space to satisfy the needs of residents, employees, staff, and visitors. (4) Protection shall be provided for resident safety on facility grounds by the use of appropriate methods, such as fences, hedges, retaining walls, railings, or other landscaping. Such protection shall not inhibit the free emergency egress to a safe distance away from the building. (5) All outside areas, grounds, adjacent buildings, etc., on the site shall be maintained in good condition and kept free of rubbish, garbage, untended growth, and other conditions which may constitute a fire or health hazard. (b) Additional site conditions (large facilities only). (1) Auxiliary buildings located on the site within 20 feet of the main licensed structure and which contain hazardous operations or contents, such as laundries or storage buildings, shall meet the same code requirements for safety as the main licensed structure, or the building shall be moved to be 20 feet or farther away from the main building. (2) Other buildings on the site shall meet the appropriate occupancy section or separation requirements of National Fire Protection Association (NFPA) 101 Life Safety Code. (3) A new building (or addition) shall be set back at least ten feet from the property lines except as otherwise approved by DHS. (4) Exit doors from the building shall not open directly onto a drive for vehicular traffic, but shall be set back at least six feet from the edge of such drive (measured from the end of building wall in the case of a recessed door) to prevent accidents due to lack of visual warning. These doors are to have automatic or self-closures. (5) Walks shall be provided from all exits and shall be of non-slip surfaces free of hazards. Walks shall be at least 48 inches wide except as otherwise approved. Ramps should be used in lieu of steps where grade change is 21 inches or less, and where possible, for persons with physical disabilities and/or mobility impairment, and to facilitate bed or wheelchair removal in an emergency. (6) Open or enclosed courts with resident rooms or living areas opening upon them shall not be less than 20 feet in the smallest dimension unless otherwise approved by the department. (7) There shall be at least one approved readily accessible fire hydrant located within 300 feet of the building. The hydrant shall be on a minimum six- inch service line, or else there shall be an approved equivalent (such as a storage tank). The hydrant, its location, and service line, or equivalent shall be approved by the local fire department and the department. (8) The building shall have suitable fire lanes for access as required by local fire authorities and DHS. sec.90.63. Fire Service. (a) The facility shall be served by a paid or volunteer fire department. The fire department must provide written assurance to the department that the fire department can respond to an emergency at the facility. (b) Water supply for fire fighting purposes shall be as required and approved by the fire fighting unit. sec.90.64. Means of Egress. (a) Corridors and other means of egress shall be kept clear of obstructions and shall not be used for any purpose which would interfere with its use as an exit, such as for storage, vending machines, seating, or similar purposes. The corridor width shall be maintained at all times. (b) Doors within the means of egress shall not be equipped with a latch or lock which requires the use of a key or tool to open from the inside of the building. A latch or other fastening device on a door shall be provided with a knob, handle, panic bar, or other simple type of releasing device, the method of operation of which is obvious, even in darkness. An exception is that large facilities are permitted to have doors which are locked, provided that residents can be rapidly removed by the use of remote control of locks or by keying all locks to keys readily available to staff who are in constant attendance. sec.90.65. Fire Alarms, Detection Systems, and Sprinkler Systems. (a) General. Fire alarms, detection systems, and sprinkler systems shall be as required by National Fire Protection Association (NFPA) 101 Life Safety Code, NFPA 72A Standard for the Installation, Maintenance and Use of Local Protective Signaling Systems, NFPA 13 Standard for the Installation of Sprinkler Systems, or NFPA 13-D Standard for the Installation of Sprinkler Systems in One- and Two- Family Dwellings and Mobile Homes, as specified in NFPA 101, Chapter 21 titled "Residential Board and Care Occupancies" and as modified in this section. (1) Each building shall have an approved fire alarm system. (2) Components shall be compatible and laboratory listed for the use intended. (3) Wiring and circuitry for alarm systems shall meet the applicable requirements of NFPA Codes, including NFPA 70 National Electric Code, for such systems. (4) Fire alarm systems shall be installed, maintained, repaired, etc. by an agent having a current certificate of registration with the state fire marshal's office of the Texas Commission on Fire Protection, in accordance with the state law. A fire alarm system installation certificate shall be provided as required by the Office of the State Fire Marshal. An exception is that large facilities who have professional engineers on staff that are qualified in electrical and electronic installations are not required to have a certificate of registration with the state fire marshal's office, provided they do not sell, install, or maintain fire alarm systems commercially. (b) Fire alarm and smoke detection systems for small facilities. (1) A manual alarm initiating system shall be provided and shall be supplemented by an automatic smoke detection and alarm initiation system in accordance with NFPA 101, Chapter 7, Section 7-6, titled "Building Service and Fire Protection Equipment. " (2) Smoke detectors shall be installed in resident bedrooms, corridors, hallways, and common living/dining areas. Service areas such as laundries and kitchens may have heat detectors in lieu of smoke detectors. (3) The fire alarm control panel shall be located to be in view of staff. The primary power source for the complete fire alarm system must be commercial electric. (4) Emergency power source shall be from storage batteries or on-site engine- driven generator set. (5) The operation of any alarm initiating device will sound an audible/visual alarm(s) at the site. (6) The facility shall have a written contract with a fire alarm company or person licensed by the State of Texas to maintain the fire alarm system semiannually. (c) Fire alarm and emergency systems for large facilities. (1) The fire alarm system shall be designed so that whenever the general alarm is sounded by activation of any device (manual pull, smoke sensor, sprinkler, kitchen range hood extinguisher, etc.) the following shall occur automatically. (A) Smoke and fire doors which are held open by approved devices shall be released to close. (B) Air handlers (air conditioning/heating distribution fans) serving three or more rooms or any means of egress shall shut down immediately. (C) Smoke dampers shall close. (D) The proper zone indicating lights shall show on the fire alarm control panel(s), including auxiliary panels. (2) Fire alarm bells or horns shall be located throughout the building for audible coverage. Flashing alarm lights (visual alarms) of proper intensity shall be installed to be visible in corridors and public areas including dining rooms and living rooms. (3) A master control panel shall be visible at the main staff station which has alarm and trouble conditions by zones, power-on lights, and required signal devices for trouble conditions. All control panels must be listed in accordance with the provisions of the Underwriters Laboratories, Inc. (UL) for the intended use, i.e., manual, automatic, and water flow activation. Alarm and trouble zoning shall be by smoke compartments and by floors in multi-story facilities. (4) Remote annunciator panels equipped with alarm by zone and a common trouble signal (both audible and visual) shall be located at auxiliary or secondary staff stations on each floor or major subdivisions of single story facilities, that will indicate the alarm condition of adjacent zones and the alarm conditions at all other staff stations. (5) Manual pull stations shall be provided at all exits, living rooms, dining rooms, and at or near the staff stations. (6) The NFPA 13 sprinkler system shall be interconnected with the fire alarm panel as a separate zone for alarm and trouble. Activation of the tamper switch will provide a trouble condition on the fire alarm panel which will not impair the operation of the alarm. (7) The kitchen range hood extinguisher shall be interconnected with the fire alarm system. This interconnection may be a separate zone on the panel or combined with other initiating devices located in the same zone as the range hood is located. (8) The fire alarm system shall be arranged to transmit an alarm automatically to the fire department legally committed to serve the area in which the facility is located by the most direct and reliable method allowed by NFPA 101. (9) Partial sprinkler systems (those provided only for hazardous areas) shall be interconnected to the fire alarm system and comply with NFPA 101. Each partial system shall have a valve with a supervisory switch to sound a trouble signal, water flow switch to activate the fire alarm, and an end of line test drain. (10) Emergency electrical services shall be provided to comply with the provisions of NFPA 70. This includes such items as emergency power provided by generator or batteries for fire alarm systems, emergency egress lighting, call systems, TV cameras and monitors (if used for corridor observation), life support systems, designated wall receptacles, etc. The system shall comply with NFPA 99 Standard for Health Care Facilities, and NFPA 37 Standard for the Installation and Use of Stationary Combustion Engines and Gas Turbines. (11) Elevators, escalators, and moving walks. Elevators shall comply with the provisions of NFPA 101 and American National Standards Institute (ANSI) Safety Code for Elevators, Dumbwaiters, Escalators, and Moving Walks (ANSI A17.1). Elevators are required for buildings having resident facilities (such as bedrooms, dining, or recreation areas) or services (such as diagnostic or therapy) located on other than the main entrance floor. Passenger elevators, escalators, and walks shall be inspected by a qualified agent at least every six months. Freight elevators and dumbwaiters shall be inspected every 12 months. sec.90.66. Portable Fire Extinguishers. (a) General. Portable fire extinguishers must be provided and maintained to comply with the provisions of the National Fire Protection Association (NFPA) 10 Standard for Portable Fire Extinguishers. This includes such items as type of extinguishers (A, B, or C), location and spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent (with any necessary servicing), and hydrostatic testing as recommended by manufacturer. (b) Types of extinguishers. (1) Extinguishers in resident corridors must be spaced so that travel distance is not more than 75 feet. The minimum size of extinguishers must be either 2 1/2 gallon for water type or five pound for ABC type. (2) Extinguishers must be installed on supplied hangers or brackets or be mounted in cabinets approved by the Texas Department of Human Services (DHS). (3) Extinguishers must be surface wall-mounted or recessed in cabinets where they are not subject to physical damage or dislodgement. (4) Extinguishers having a gross weight not exceeding 40 pounds must be installed so that the top of the extinguisher is not more than five feet above the floor. Extinguishers with a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than 3 1/2 feet above the floor. The clearance between the bottom of the extinguisher and the floor must not be less than four inches. (5) Portable extinguishers provided in hazardous rooms must be located as close as possible to the exit door opening and on the latch (knob) side. (6) Staff must be appropriately trained in the use of each type of extinguisher in the facility. sec.90.67. Accessibility Provisions.
                                                                                                                                                                                                                                                                                                                                                                                                            The physical plant shall be designed for persons with physical disabilities and/or mobility impairments and must comply with applicable federal, state, and local requirements. sec.90.68. Architectural Space Planning. (a) Large facilities. (1) Ancillary resident space. The minimum total ancillary resident-use space shall be not less than 35 square feet per bed. Ancillary space includes areas for living, dining, recreation, therapy, training, and other such program areas. It does not include bedrooms, passageways, offices, kitchens, laundries, etc. (more than 35 square feet per bed is usually needed in facilities with less than 60 beds). Facilities which have, or anticipate having, large proportions (approximately 65% or greater) of nonambulatory and/or bedfast residents shall provide at least 50 square feet of ancillary space per bed unless otherwise approved by DHS. Areas providing less space than called for in this paragraph cannot be approved except on an individual basis where clearly justified. (2) Resident bedrooms. (A) Bedrooms shall be arranged and equipped for adequate personal care and for comfort and privacy. Bedrooms shall have full height walls that extend from floor to ceiling with doors. (Partial partitions or furnishings are not a substitute.) An exception is that existing facilities constructed prior to October 3, 1988, that have partial partitions in lieu of full-height walls, need not install the full-height walls unless there are major renovations or conversions. (B) Bedrooms shall provide at least 80 square feet for a single occupancy (one bed) and 60 square feet per bed for multiple occupancy. (Note: room configuration and usability is taken into consideration and there may be instances where the minimum square footage will not be acceptable.) The minimum room dimension shall be at least eight feet for a single room and at least ten feet for a multiple-bed room, unless otherwise approved by the department. An exception is that multi-occupancy bedrooms for persons in wheelchairs shall have 70 square feet per wheelchair occupant bed. (C) No more than four beds shall be in any one bedroom. An exception is that the department may grant a variance from the limit of four residents per room only if a physician who is a member of the interdisciplinary team and who is a qualified mental retardation professional: (i) certifies that each resident to be placed in a bedroom housing 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 housing in a room of only four or fewer residents would not be medically feasible. (D) In the bedrooms and for each resident there shall 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 shall provide at least 24 inches of lineal hanging space per bed (in certain cases, such as for infants, exceptions may be made). Married couples may share a bed. (E) Each bedroom shall have at least one outside wall with an operable window giving outside exposure. Unless approved otherwise by the department, the window sill of the required window shall be no higher than 36 inches from the floor and shall be at or above outside grade level. Other window requirements shall be as called for in the National Fire Protection Association (NFPA) 101. The window area for bedrooms shall be equal to at least 10% 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 the resident(s) occupying the room. The window shall be no more than 36 inches (measured to the window sill) above the floor. (G) All resident bedrooms shall open onto an exit corridor, living area, or public area and shall be arranged for convenient resident access to dining, living, and bathing areas. (3) Social-diversional spaces. (A) Living rooms, day rooms, lounges, etc., must be provided on a sliding scale as follows (as part of the minimum required ancillary space):
                                                                                                                                                                                                                                                                                                                                                                                                              Figure 1: 40 TAC sec.90.68(a)(3)(A) (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 shall have at least one outside window. Normally, resident classrooms and training areas should also have an outside window unless otherwise approved by the department. (4) Dining space. Dining space shall provide at least 15 square feet per resident bed for single-shift feeding. If procedure is approved for feeding in two shifts, at least eight square feet per resident bed shall be provided. (5) Training spaces (academic, behavioral, occupational, physical, and speech therapy, etc.). 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, training rooms should provide at least 20 square feet per resident trainee within the room except that no training room should be less than 80 square feet. For purposes of calculation, space should 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-bed facility). (6) Kitchens (main/dietary). (A) Kitchens shall be evaluated on the basis of their performance in the sanitary and efficient preparation and serving of meals to residents. Consideration shall 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 shall contain a detailed kitchen layout prepared by, or under the direction of, a registered or licensed dietitian. (B) Kitchens shall be designed so that room temperature, at peak load, shall not exceed an average temperature of 85 degrees Fahrenheit measured over the room at the five-foot level. The amount of supply air should take into account the large quantities of air exhausted at the range hood and dishwashing area. (C) Kitchens shall be provided with operational equipment as planned and scheduled by the facility's consultants for preparing and serving meals and for refrigerating and freezing of perishable foods, as well as equipment in, and/or adjacent to, the kitchen or dining area for producing ice. (D) Kitchens shall 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 shall contain a compartmented sink large enough to immerse pots and pans. Separation of soiled and clean dish areas shall be maintained, including air flow. (i) A mechanical dishwasher must be used to sanitize dishes and utensils and must meet requirements specified under 25 TAC sec.229.166(a)(4) (relating to Cleaning, Sanitization, and Storage of Equipment and Utensils), or (ii) Dishes and utensils will be manually sanitized in accordance with 25 TAC sec.229.166(a)(3)(E) prior to placement in the dishwasher. (E) Kitchens shall be provided with a supply of hot and cold water. Hot water for sanitizing purposes shall 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. (F) Kitchens shall be provided with at least one hand-washing lavatory or hand-sanitizing device. Hand-washing lavatories shall be provided with hot and cold running water, soap, and individual towels, preferably paper towels; common use towels shall not be used. (G) In new construction, staff restroom facilities with a lavatory shall be accessible to kitchen staff without traversing resident use areas. The restroom door shall not open directly into the kitchen, e.g., provide a vestibule. (H) In new construction, janitorial facilities shall be provided exclusively for the kitchen and shall be located in and entered from the kitchen. (I) Nonabsorbent smooth finishes or surfaces shall be used on kitchen floors, walls, and ceilings. Such surfaces shall be capable of being sanitized to maintain a healthful environment. (J) All operable window openings shall be screened. Doors opening to the outside of the building shall have self-closing devices. (7) Food storage areas (main/kitchen). (A) In new construction, food storage areas shall be planned on the basis of the number and type of resident meals to be served. The size and layout of dry foods storage shall be prepared by or designed under the direction of a licensed or registered dietitian. (B) Food storage areas shall provide for storage of a four-day minimum supply of nonperishable foods at all times. (C) Shelves shall be movable metal or sealed lumber, and walls must be finished with a nonabsorbent finish to provide a cleanable surface. (D) Dry food storage shall have an approved venting system to provide for positive air circulation. (E) The maximum room temperature for food storage shall not exceed 85 degrees Fahrenheit at all times. The measurement shall be taken at the five-foot level. (F) 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 stores. (8) Food services areas. (A) Where service areas other than the kitchen are used to dispense foods, these shall be designated as food service areas and shall have equipment for maintaining required food temperatures while serving. (B) Separate food service areas shall have hand-washing facilities as a part of the food service area. An employee toilet shall be provided. (C) Finishes of all surfaces except ceilings shall be the same as those required for dietary kitchens. (9) Other spaces. (A) Bathing units (tubs or showers) shall be provided at a minimum ratio of one per 15 beds. Waterclosets and lavatories shall be provided at a minimum ratio of one per eight beds. Bathing and toilet facilities should be of a type appropriate to the resident's varying needs and disabilities, and designed for privacy within the bathroom. (B) Adequate storage space must be provided for equipment, carts, wheelchairs, etc., so as to eliminate the problem of such items being left or stored in corridors, or overcrowding bedroom space. (b) Small facilities. (1) Bedrooms. (A) Bedrooms shall be arranged and equipped for adequate personal care and for comfort and privacy. Bedrooms shall have full height walls that extend from floor to ceiling with doors. (Partial partitions or furnishings are not a substitute.) (B) Bedrooms shall provide at least 80 square feet for a single occupancy (one bed) and 60 square feet per bed for multiple occupancy. (Note: room configuration and usability is taken into consideration and there may be instances where the minimum square footage will not be acceptable.) The minimum room dimension shall be at least eight feet for a single room and at least ten feet for a multiple-bed room, unless otherwise approved by the department. An exception is that multi-occupancy bedrooms for persons in wheelchairs shall have 70 square feet per wheelchair occupant bed. (C) No more than four beds shall be in any one bedroom. An exception is that the department may grant a variance from the limit of four residents per room only if a physician who is a member of the interdisciplinary team and who is a qualified mental retardation professional: (i) certifies that each resident to be placed in a bedroom housing 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 housing in a room of only four or fewer residents would not be medically feasible. (D) In the bedrooms and for each resident there shall be a bed with a comfortable mattress and appropriate bedding, functional furniture appropriate to residents' needs, and closet space providing security for personal clothing and belongings. Closet space shall provide at least 24 inches of lineal hanging space per bed (in certain cases, such as for infants, exceptions may be made). Married couples may share a bed. (E) Unless there is a door in the bedroom leading directly outside to grade level or an outside stair, every bedroom shall have at least one outside window that can be readily opened from the inside and provides a clear opening of at least 5.7 square feet (minimum width of 20 inches; minimum height of 24 inches). The bottom of the opening shall be not more than 44 inches above the floor. Minimum dimensions for operable window section are 20 inches wide by 41.2 inches in height, or 24 inches in height by 34.2 inches wide to provide the minimum 5.7 feet of opening. (F) Bedroom doors shall be 20-minute fire rated or 1 3/4-inch solid bonded core wood. These doors shall have automatic closures and latch in their frames. Exceptions are as follows. (i) Doors need only be smoke resistant and do not need automatic closure if the building has an approved sprinkler system throughout. (ii) Doors need only be smoke resistant with automatic closures if the facility is classified "prompt" level of evacuation difficulty. (G) Each small facility shall have at least two remotely located means of escape that do not involve windows. The arrangement shall be such that there is a primary means of escape from each sleeping room that provides a path of travel to the outside without traversing any corridor or other space exposed to unprotected vertical openings or common living spaces, such as living rooms and kitchens. Exceptions are as follows: (i) A second means of escape or alternate protection is not required: (I) if the bedroom has a door leading directly to the outside of the building, at or to grade level; or (II) if the building is protected with an approved sprinkler system meeting National Fire Protection Association (NFPA) 13 Standard for Installation of Sprinkler Systems or NFPA 13D Standard for Installation of Sprinkler Systems in One- and Two-family Dwellings and Mobile Homes standards. (ii) Separated primary means of escape is not necessary if the building is single story; has 1 3/4-inch solid bonded core doors to bedrooms or smoke resistant doors with closures; 20-minute fire protection for the structure; Class A or B interior finish; bedroom windows of proper size; total smoke detection coverage of habitable spaces, including loft areas that are tied into the manual fire alarm system; and two remote means of escape. (2) Living room space. Living room space shall provide at least 15 square feet per resident (with a minimum of 120 square feet regardless of number of residents). Living space can include one or more rooms or areas provided that the first such area is at least 80 square feet each. (3) Dining space. Dining space must be large enough to accommodate all residents at one sitting, and shall provide at least 15 square feet per resident. Living and dining space may be in one room or area providing a combined total of 30 square feet per resident (15 square feet living plus 15 square feet dining per resident). (4) Bathrooms. Bathrooms shall provide for individual privacy. Water closets and lavatories shall be provided at a minimum ratio of one for each five residents. There shall be at least one tub or shower for each eight residents. At least one bathroom (with water closets, lavatory, and tub or shower) shall be provided on each sleeping floor accessible to the residents of that floor. (5) Kitchen. The facility shall have a kitchen to meet the general food service needs of the residents. It shall include provisions for the storage, refrigeration, preparation, and serving of food; for dish and utensil cleaning; and for refuse storage and removal. A mechanical dishwasher shall be provided. (6) Office. An office or other space shall be available for private individual counseling and for the safekeeping of files and records. (7) Stairs. Buildings of two or more stories require at least two separate approved exit stairs from the upper floors. Usable space under the stairs is not allowed unless fire separated or protected in accordance with NFPA 101 Life Safety Code. Open interior stairways which constitute an "unprotected vertical opening" to a required exit passageway on the upper floor must be provided with a barrier (wall and door) at either the lower or upper level to prevent the rapid rise of fire or smoke originating on the lower level from rendering the upstairs passageway to the second stair impassable. (8) Fire rating. Interior wall and ceiling surfaces shall have, as the finished surface or a substrate or sheathing, a fire resistance of not less than 20 minutes, similar to that provided by 3/8-inch gypsum board. sec.90.69. Storage Requirements (All Facilities). (a) Bulk storage of hazardous items such as janitor supplies and equipment shall be provided in closets or spaces separate from resident use areas. Closets or spaces shall be maintained in a safe and sanitary condition and ventilated in a manner commensurate with the use of the closet or space. (b) There shall be space for equipment for daily out-of-bed activity for all residents. (c) There shall be suitable storage space accessible to the resident for personal possessions such as toys, televisions, radios, prosthetic equipment, and clothing. (d) Attics, mechanical rooms, boiler rooms, and other similar areas shall not be used for storage purposes. sec.90.70. Electrical, Heating, Ventilating, and Air-conditioning Systems (HVAC)-All Facilities. (a) Cooling and heating shall be provided, as necessary, for resident comfort. Heating systems in resident use areas shall be capable of maintaining a minimum temperature of 68 degrees Fahrenheit, and cooling of 81 degrees Fahrenheit maximum, with humidity in the normal comfort range. (b) The facility shall be well ventilated through the use of windows, mechanical ventilation, or a combination of both. Rooms and areas which do not have outside windows and which are used by residents or personnel shall be provided with functioning mechanical ventilation to change the air on a basis commensurate with the room usage. (c) Air systems shall provide for the induction and mixing of at least 10% outside fresh air into the facility unless otherwise approved by DHS, that is, 100% continuous recirculation of interior air in most areas is not acceptable; or the system shall be designed to meet American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE). (d) Operable outside windows shall be provided with insect screens that prevent insect entry. (e) Rooms such as baths, toilets, soiled linen, trash or garbage rooms, soiled utilities, janitor's closets, and other such areas which produce odors, fumes, excessive moisture, etc., shall be provided with an exhaust system ducted to the exterior, meeting nationally recognized standards for capacity and function. (f) Electrical and mechanical systems shall be safe and in working order. The department may require the facility sponsor or licensee to submit evidence to this effect, consisting of a written report by the local fire marshal, city/county building official having jurisdiction, or a registered professional engineer. (g) Use of electrical appliances, devices, and lamps shall be such as not to overload circuits. (h) Portable heaters and open-flame heating devices are prohibited. All fuel burning devices shall be vented. Working fireplaces are acceptable if of safe design and construction, and if screened or otherwise suitably enclosed. sec.90.71. Plumbing (All Facilities). (a) The water supply must be of safe, sanitary quality, suitable for use, and adequate in quantity and pressure. The water must be obtained from a water supply system; the location, construction, and operation of which are approved by the Texas Natural Resources Conservation Commission (TNRCC). (b) Sewage must be discharged into a state-approved sewerage system or septic system; otherwise, the sewage must be collected, treated, and disposed of in a manner which is approved by TNRCC. sec.90.72. Maintenance (All Facilities). (a) Walls, doors, and ceilings shall be maintained free from holes, cracks, falling plaster or paint, and shall be cleaned and painted. (b) Paint or plaster inside the building that contains lead shall be removed or covered so that it is not accessible to the residents. (c) All abandoned utilities such as electrical wiring, ducts, and pipes shall be removed from the facility when no longer usable. sec.90.73. Environmental Services. (a) Pest control. (1) The facility shall be kept free of insects, rodents, and vermin. The least toxic and least flammable effective chemicals shall be used. Poisons shall not be stored with food products and shall be under lock. (2) Garbage and trash shall be stored in enclosed containers, protected against leakage, contact with disease vectors, and access to animals. It shall be stored in areas separate from those used for the preparation and storage of food and shall be removed from the premises in conformity with state and local practices. Garbage and trash containers shall be maintained free of accumulations and coatings of garbage. Garbage storage areas shall be kept clean and in good repair. (b) Storage. Storage items shall be neatly arranged and placed to minimize fire hazard. Gasoline, volatile materials, paint, and similar products, excluding personal items, shall not be stored in the building housing residents except as may be approved by the local fire marshal. Accumulations of extraneous material and refuse shall not be permitted. (c) Laundry. (1) There shall be clean linen available at all times, and in a quantity to meet the needs of the residents. (2) Clean linen shall be stored in a clean storage area, which is easily accessible to the personnel. (3) Soiled linen and clothing in large facilities shall be transported or stored in approved containers or bags. (A) Soiled laundry storage shall be in separate, well ventilated areas and shall not be permitted to accumulate in other areas of the facility. (B) Soiled bags or containers shall not be used to convey clean linens. (C) Soiled linens shall not be sorted, laundered, rinsed, or stored in bathrooms, resident rooms, corridors, kitchens, or food storage areas. sec.90.74. Safety Operations. (a) Disaster plan. The facility must have a written plan with procedures to be followed in an internal or external disaster and for the care of casualties. (1) The facility must maintain the plan and procedures within the facility in a location known and accessible to all staff. The facility must ensure that the plan and procedures are reviewed when changes in administration, construction, or emergency phone numbers are made. (2) The facility must include in the disaster plan evacuation routes and procedures to be followed in the event of fire, explosion, or other disaster. The plan must also include procedures for the prompt transfer of casualties, medical records, medications, and for the notification of appropriate persons. (3) All employees must be familiar with the disaster plan and must be instructed in the location and use of the facility's alarm systems, fire- fighting equipment, and procedures. (4) The facility must post emergency evacuation routes prominently throughout the facility. An exception is that in small one-story buildings where all exits are obvious, the department may not require the posting of evacuation routes. (5) The fire alarm and sprinkler systems shall be inspected and tested at least once every three months by a licensed agent. Each such quarterly inspection and test shall be of the complete system including smoke dampers, individual sprinkler heads, etc. A standard report form of the inspection shall be completed by the agent and kept on file by the facility. The report shall include the signature of the person making the inspection and the date of the inspection. The facility shall maintain a current contract on file for the services of the inspecting company. An exception is that small facilities are only required to have semiannual inspections in lieu of quarterly inspections. (6) All fires shall be reported to the department within 72 hours. However, any fire causing injury or death shall be reported immediately. A telephone report shall be followed by a written report on a form which is available from the department. (b) Fire and evacuation drills. (1) The facility must have a fire safety plan within the disaster plan. A comprehensive fire drill report form shall be completed for each rehearsal of the fire safety plan. (2) The facility must hold fire evacuation drills at least every quarter for each shift of personnel (12 per year) and under varied times and conditions. (3) Any direct care staff, including relief staff, must participate in the initial fire drill within ten days of their employment at the facility. An exception is that facilities meeting NFPA 101, Chapter 12 titled "New Health Care Occupancies" or Chapter 13 titled "Existing Care Occupancies," or meeting the impractical evacuation category of Chapter 21 titled "Residential Board and Care," are not required to conduct fire drills within ten days of employment. (4) The facility must: (A) actually evacuate residents during at least one evacuation drill each year on each shift; (B) make special provisions for the evacuation of the physically handicapped, such as fire chutes and mattress loops with poles; (C) write and file a report and evaluation of each drill and list details, date, time, who participated, and any problems that occurred; and (D) investigate all accidents and take corrective action to prevent similar accidents in the future. (5) Drills for other emergencies, such as severe weather, bomb-threats, etc., shall be covered in the facility's policies and disaster plan with drills held according to the policy. (c) Smoking regulations. Smoking policies shall be formulated and adopted by the facility. The policies shall comply with all applicable codes, regulations, and standards, including local ordinances. It is the responsibility of the facility to inform residents, staff, visitors, and other affected parties of smoking policies through distribution and/or posting. The facility is responsible for enforcement of smoking regulations. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601446 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter G. Abuse, Neglect, and Exploitation; Complaint and Incident Reports and Investigations 40 TAC sec.90.212 The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The amendment implements the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.90.212. Incidents of Abuse and Neglect Reportable by Facilities to the Texas Department of Human Services (DHS). (a)-(b) (No change.) (c) [Reports of abuse or neglect in nursing facilities are to be made to DHS's state office, Austin, Texas, at (512) 834-6778 during normal workday hours, and to 1-800-458-9858 on weekends and holidays.] Reports of abuse or neglect in facilities serving persons with mental retardation or a related condition are to be made to DHS's state office at (512) 834-6671 during normal workday hours, and to 1-800-292-2065 on weekends and holidays. The person reporting must make an oral report immediately on learning of the alleged abuse or neglect. A written investigation report must be sent no later than the fifth calendar day after the oral report. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601447 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter H. Enforcement 40 TAC sec.90.231 The new section is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The new section implements the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.90.231. Warning Letter.
                                                                                                                                                                                                                                                                                                                                                                                                                When Texas Department of Human Services (DHS) personnel determine that a facility is out of compliance with licensure rules to a degree that places the facility at risk of the imposition of licensing actions, DHS may send a warning letter to the facility. The warning letter notifies the facility that the violations of licensing rules must be corrected. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601448 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter L. Provisions Applicable to Facilities Generally 40 TAC sec.sec.90.323-90.325 (Editor's note: The text of the following sections proposed for repeal will not be published. The sections may be examined in the offices of the Texas Department of Human Services or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.) The repeals are proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The repeals implement the Human Resources Code, sec.sec.22.001-22.024 and sec.sec.32.001-32.042. sec.90.323. Procedures for Inspection of Public Records. sec.90.324. Time Periods for Processing Licenses for Long Term Care Facilities. sec.90.325. Operating a Part of a Facility Under the Standards of a Lesser Licensing Category. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601449 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 40 TAC sec.90.323, sec.90.327 The new section and amendment are proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The new section and amendment implement the Human Resources Code, sec.sec.22. 001-22.024 and sec.sec.32.001-32.042. sec.90.323. Procedures for Inspection of Public Records. (a) Procedures for inspection of public records will be in accordance with the Texas Government Code, Chapter 552, and as further described in this section. (b) The Long Term Care-Regulatory, Texas Department of Human Services (DHS), is responsible for the maintenance and release of records on licensed facilities, and other related records. (c) The application for inspection of public records is subject to the following criteria: (1) the application must be made to Long Term Care-Regulatory, Texas Department of Human Services, 8407 Wall Street, Austin, Texas 78754; (2) the requestor must identify himself; (3) the requestor must give reasonable prior notice of the time for inspection and/or copying of records; (4) the requestor must specify the records requested; (5) on written applications, if DHS unable to ascertain the records being requested, DHS may return the written application to the requestor for clarification; and (6) DHS will provide the requested records as soon as possible; however, if the records are in active use, or in storage, or time is needed for proper de- identification or preparation of the records for inspection, DHS will so advise the requestor and set an hour and date within a reasonable time when the records will be available. (d) Original records may be inspected or copied, but in no instance will original records be removed from DHS offices. (e) Records maintained by Long Term Care-Regulatory are open to the public, with the following exceptions: (1) incomplete reports, audits, evaluations, and investigations made of, for, or by DHS are confidential; (2) all reports, records, and working papers used or developed by DHS in an investigation of reports of abuse and neglect are confidential, and may be released to the public only as follows: (A) completed written investigation reports are open to the public, provided the report is de-identified. The process of de-identification means removing all names and other personally identifiable data, including any information from witnesses and others furnished to DHS as part of the investigation; and (B) the reporter and the facility will be notified of the results of DHS's investigation of a reported case of abuse or neglect, whether DHS concluded that abuse or neglect occurred or did not occur; (3) all names and related personal, medical, or other identifying information about a resident are confidential; (4) information about any identifiable person which is defamatory or an invasion of privacy is confidential; (5) information identifying complainants or informants is confidential; (6) itineraries of surveys and inspections are confidential; (7) other information that is excepted from release by the Government Code, Chapter 552, is not available to the public; and (8) to implement this subsection, DHS may not alter or de-identify original records. Instead, DHS will make available for public review or release only a properly de-identified copy of the original record. (f) Long Term Care-Regulatory will charge for copies of records upon request. (1) If the requestor wants to inspect records, the requestor will specify the records to be inspected. DHS will make no charge for this service, unless the director of Long Term Care-Regulatory determines a charge is appropriate based on the nature of the request. (2) If the requestor wants copies of a record, the requestor will specify in writing the records to be copied on an appropriate DHS form, and DHS will complete the form by specifying the charge for the records, which the requestor must pay in advance. Checks and other instruments of payment must be made payable to the Texas Department of Human Services. (3) Any expenses for standard-size copies incurred in the reproduction, preparation, or retrieval of records must be borne by the requestor on a cost basis in accordance with costs established by the State Purchasing and General Services Commission or DHS for office machine copies. (4) For documents that are mailed, DHS will charge for the postage at the time it charges for the production. All applicable sales taxes will be added to the cost of copying records. (5) When a request involves more than one long-term care facility, each facility will be considered a separate request. sec.90.327. Notice of Changes in Key Personnel. [(a) A nursing facility must notify the Texas Department of Human Services (department) no later than 30 days after the date of hire of the nursing home administrator, medical director, and director of nursing. [(b) A maternity facility or a] A
                                                                                                                                                                                                                                                                                                                                                                                                                  facility [serving persons with mental retardation or related conditions] must notify the department no later than 30 days after the date of hire of the administrator [or executive director]. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601450 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Chapter 92. Personal Care Facilities The Texas Department of Human Services (DHS) proposes the repeal of sec.92. 19, concerning fees for plan reviews, construction inspection services, and feasibility inspection services, and the repeal of sec.92.63, concerning plans, approvals, and construction procedures; amendment to sec.92.62, concerning general requirements; and new sec.92.63, concerning construction and initial survey of completed construction, in its personal care facilities chapter. The purpose of the repeals is to delete rules regarding functions DHS no longer performs. The purpose of the amendment is to update the rule regarding fire extinguishers. The purpose of the new section is to modify the new facility construction procedures. Burton F. Raiford, commissioner, has determined that for the first five-year period the sections are in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the proposal. Mr. Raiford also has determined that for each year of the first five years the sections are in effect the public benefit anticipated as a result of enforcing the proposal will be clear rules. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the proposal. Questions about the content of this proposal may be directed to Susan Syler at (512) 438-3111 in DHS's Long Term Care Policy Section. Written comments on the proposal may be submitted to Nancy Murphy, Media and Policy Services-313, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register. Subchapter B. Application Procedures 40 TAC sec.92.19 (Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Department of Human Services or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.) The repeal is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The repeal implements the Human Resources Code, sec.sec.22.001-22.024 and sec.sec.32.001-32.042. sec.92.19. Fees for Plan Reviews, Construction Inspection Services, and Feasibility Inspection Services. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601451 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter D. Facility Construction 40 TAC sec.92.62 The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The amendment implements the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.92.62. General Requirements. (a)-(h) (No change.) (i) Portable fire extinguishers. Portable fire extinguishers must be provided and maintained to comply with the provisions of the National Fire Protection Association (NFPA) 10. This includes such items as type of extinguishers (A, B, or C), location and spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent (with any necessary servicing), and hydrostatic testing as recommended by the manufacturer. (1) Extinguishers in resident corridors must be spaced so that travel distance is not more than 75 feet. The minimum size of extinguishers must be either 2 1/2 gallon for water type or five pound for ABC type. (2) Extinguishers must be installed on supplied hangers or brackets or be mounted in cabinets approved by the Texas Department of Human Services (DHS). (3) Extinguishers must be surface wall-mounted or recessed in cabinets where they are not subject to physical damage or dislodgement. [(1) At least one portable Underwriters Laboratory (U.L.) or factory mutual (F.M.)-approved five-pound Class B:C dry chemical fire extinguisher, rechargeable type, is required in each laundry, kitchen and walk-in mechanical room. ABC type extinguishers shall not be used in kitchens. An exception is that in small facilities, ABC type extinguishers will be acceptable for these spaces. [(2) Portable U.L. or F.M.-approved 2-1/2 gallon stored-pressure water-type fire extinguishers (Class A) must be provided in areas serving resident bedrooms. One such unit shall be located within 75 feet of any resident bedroom door. Acidic base (ABC) and dry chemical types are not acceptable. [(3) Extinguishers must be readily accessible. Units must be installed on hangers or brackets, mounted in special cabinets, or set on appropriate shelves. Operating instructions shall face outward. Mounting heights shall not exceed five feet above the floor for extinguishers weighing 40 pounds or more. Alternative locations and arrangements for fire extinguishers may be as approved by the department for small facilities, facilities consisting of separated small building units, or unusual building arrangements.] (4) Extinguishers having a gross weight not exceeding 40 pounds must be installed so that the top of the extinguisher is not more than five feet above the floor. Extinguishers with a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than 3 1/2 feet above the floor. The clearance between the bottom of the extinguisher and the floor must not be less than four inches. (5) Portable extinguishers provided in hazardous rooms must be located as close as possible to the exit door opening and on the latch (knob) side. (6) Staff must be appropriately trained in the use of each type of extinguisher in the facility. (7)
                                                                                                                                                                                                                                                                                                                                                                                                                    [(4)] Regular monthly inspections or "quick checks" must be made by facility representatives to assure that extinguishers are in the proper location, condition, and working order. Annual maintenance or "thorough checks" must be accomplished in accordance with National Fire Protection Association Standard Number 10A (NFPA 10A) by competent personnel licensed or certified to perform servicing by the State Fire Marshal. Unserviceable extinguishers must be replaced. (j)-(l) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601452 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 40 TAC sec.92.63 (Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Department of Human Services or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.) The repeal is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The repeal implements the Human Resources Code, sec.sec.22.001-22.024 and sec.sec.32.001-32.042. sec.92.63. Plans, Approvals, and Construction Procedures. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601453 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 The new section is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The new section implements the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.92.63. Construction and Initial Survey of Completed Construction. (a) Construction phase. (1) The Texas Department of Human Services (DHS), Architectural Section in Austin, Texas, must be notified in writing of construction start. (2) All construction shall be done in accordance minimum licensing requirements. It is the sponsor's responsibility to employ qualified personnel to prepare the contract documents for construction of a new facility or remodeling of an existing facility. Contract documents for additions and remodeling and for the construction of an entirely new facility must be prepared by an architect licensed by the Texas State Board of Architectural Examiners. Drawings must bear the seal of the architect. Certain parts of final plans, designs, and specifications must bear the seal of a registered professional engineer approved by the State Board of Registration for Professional Engineers to operate in Texas. These certain parts include sheets and sections covering structural, electrical, mechanical, and sanitary engineering. (A) Remodeling is the construction, removal, or relocation of walls and partitions; the construction of foundations, floors, or ceiling-roof assemblies; the expanding or altering of safety systems (including, but not limited to, sprinkler, fire alarm, and emergency systems); or the conversion of space in a facility to a different use. (B) General maintenance and repairs of existing material and equipment, repainting, applications of new floor, wall, or ceiling finishes, or similar projects are not included as remodeling, unless as a part of new construction. DHS must be provided flame spread documentation for new materials applied as finishes. (b) Contract documents. (1) Site plan documents must include grade contours; streets (with names); north arrow; fire hydrants; fire lanes; utilities, public or private; fences; unusual site conditions, such as ditches, low water levels, other buildings on- site; and indications of buildings five feet or less beyond site property lines. (2) Foundation plan documents must include general foundation design and details. (3) Floor plan documents must include room names, numbers, and usages; doors (numbered) including swing; windows; legend or clarification of wall types; dimensions; fixed equipment; plumbing fixtures; and kitchen basic layout; and identification of all smoke barrier walls (outside wall to outside wall) or fire walls. (4) For both new construction and additions or remodeling to existing buildings, an overall plan of the entire building must be drawn or reduced to fit on an 8 1/2 inch by 11 inch sheet; submit two reduced plans for file record. See subsection (d)(3) of this section. (5) Schedules must include door materials, widths, types; window materials, sizes, types; room finishes; and special hardware. (6) Elevations and roof plan must include exterior elevations, including material note indications and any roof top equipment; roof slopes, drains, and gas piping, and interior elevations where needed for special conditions. (7) Details must include wall sections as needed (especially for special conditions); cabinet and built-in work, basic design only; cross sections through buildings as needed; and miscellaneous details and enlargements as needed. (8) Building structure documents must include structural framing layout and details (primarily for column, beam, joist, and structural frame building); roof framing layout (when this cannot be adequately shown on cross section); cross sections in quantity and detail to show sufficient structural design and structural details as necessary to assure adequate structural design, also calculated design loads. (9) Electrical documents must include electrical layout, including lights, convenience outlets, equipment outlets, switches, and other electrical outlets and devices; service, circuiting, distribution, and panel diagrams; exit light system (exit signs and emergency egress lighting); emergency electrical provisions (such as generators and panels); fire alarm and similar systems (such as control panel, devices, and alarms); sizes and details sufficient to assure safe and properly operating systems; and a staff communication system. (10) Plumbing documents must include plumbing layout with pipe sizes and details sufficient to assure safe and properly operating systems, water systems, sanitary systems, gas systems, other systems normally considered under the scope of plumbing, fixtures, and provisions for combustion air supply. (11) Heating, ventilation, and air-conditioning (HVAC) documents must include sufficient details of HVAC systems and components to assure a safe and properly operating installation including, but not limited to, heating, ventilating, and air-conditioning layout, ducts, protection of duct inlets and outlets, combustion air, piping, exhausts, and duct smoke and/or fire dampers; and equipment types, sizes, and locations. (12) Sprinkler system documents must include plans and details of NFPA designed systems; plans and details of partial systems provided only for hazardous areas; electrical devices interconnected to the alarm system. (13) Other layouts, plans, or details as may be necessary for a clear understanding of the design and scope of the project; including plans covering private water or sewer systems must be reviewed by the local health or wastewater authority having jurisdiction. If no local authority, then the plans will be reviewed by DHS. (14) Specifications must include installation techniques, quality standards and/or manufacturers, references to specific codes and standards, design criteria, special equipment, hardware, painting, and any others as needed to amplify drawings and notes. (c) Initial survey of completed construction. (1) Upon completion of construction, including grounds and basic equipment and furnishings, a final construction inspection (initial survey) of the facility, including additions or remodeled areas, is required to be performed by the department (architectural section) prior to occupancy. A minimum of three weeks advance notice is needed. The completed construction shall have the written approval of the local authorities having jurisdiction, including the fire marshal, health department, and building inspector. (2) After the completed construction has been surveyed by a representative of the architectural section of the department and found acceptable, this information will be conveyed to the licensing officer of the department as part of the information needed to issue a license to the facility. In the case of additions or remodeling of existing facilities, a revision or modification to an existing license may be necessary. Note that the building, grades, drives, and parking must essentially be 100% complete at the time of this initial visit for occupancy approval and licensing, including basic furnishings and operational needs. A facility may accept up to three residents between the time it receives initial approval from the architectural section and the time the license is issued. (3) The following documents must be available to DHS's surveyor at the time of the survey of the completed building: (A) written approval of local authorities as called for in paragraph (1) of this subsection; (B) written certification of the fire alarm system by the installing agency (Form FML-009) of the Texas State Fire Marshal); (C) documentation of materials used in the building which are required to have a specific limited fire or flame spread rating including special wall finishes or floor coverings, flame retardant curtains (including cubicle curtains), rated ceilings, etc. This must include a signed letter from the installer, in the case of carpeting, etc., verifying that the carpeting installed is named in the laboratory test document; (D) approval of the completed sprinkler system installation by the designing engineer. A copy of the material list and test certification shall be available; (E) service contracts for maintenance and testing of alarm systems, sprinkler systems, etc.; (F) a copy of gas test results of the facility's gas lines from the meter; (G) a written statement from an architect/engineer stating that he certifies that the building was constructed to meet NFPA 101, Life Safety Code, and all locally applicable codes, and that the facility is in substantial conformance with minimum licensing requirements; and (H) the contract documents specified in subsection (b) of this section. (d) Nonapproval of new construction. (1) If, during the initial on-site survey of completed construction, the surveyor finds certain basic requirements not met, he may recommend to the department that the facility not yet be licensed and approved for occupancy. Such basic items may include the following: (A) construction which does not meet minimum code or licensure standards for basic requirements such as corridors being less than required width, ceilings installed at less than the minimum seven-foot six-inch height, resident bedroom dimensions less than required, and other such features which would disrupt or otherwise adversely affect the residents and staff if corrected after occupancy; (B) no written approval by local authorities; (C) fire protection systems not completely installed or not functioning properly, including, but not limited to, fire alarm systems, emergency power and lighting, and sprinkler systems; (D) required exits not all usable according to NFPA 101 requirements; (E) telephone not installed or not properly working; (F) sufficient basic furnishings, essential appliances, and equipment are not installed or not functioning; and (G) any other basic operational or safety feature which the surveyor, as the authority having jurisdiction, encounters which in his judgment would preclude safe and normal occupancy by residents on that day. (2) If the surveyor encounters only less basic (and less important) deficiencies, licensure may be recommended based on an approved written plan of correction from the facility's administrator. (3) Copies of reduced size floor plans on an 8 1/2 inch by 11 inch sheet shall be submitted in duplicate to the department for record/file use and for the facility's use and for facility's use for evacuation plan, fire alarm zone identification, etc. The plan shall contain basic legible information such as scale, room usage names, actual bedroom numbers, doors, windows, and any other pertinent information. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601454 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Chapter 94. Nurse Aides 40 TAC sec.94.11 The Texas Department of Human Services (DHS) proposes an amendment to sec.94.11, concerning registry; findings; inquiries, in its Nurse Aides chapter. The purpose of the amendment is to correct a reference. Burton F. Raiford, commissioner, has determined that for the first five-year period the section is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the section. Mr. Raiford also has determined that for each year of the first five years the section is in effect the public benefit anticipated as a result of enforcing the section will be clear rules. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the proposed section. Questions about the content of this proposal may be directed to Susan Syler at (512) 438-3111 in DHS's Long Term Care Policy Section. Written comments on the proposal may be submitted to Nancy Murphy, Media and Policy Services-313, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register. The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The amendment implements the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.94.11. Registry; Findings; Inquiries. (a)-(c) (No change.) (d) If an alleged act of abuse, neglect, or misappropriation of resident property by a nurse aide, who also is a permitted medication aide under Chapter 95 of this title (relating to Medication Aides), violates the rules in this chapter and Chapter 95 of this title, the department must comply with the formal hearing procedures under sec.sec.79.1601-79.1614
                                                                                                                                                                                                                                                                                                                                                                                                                      [79.1612] of this title (relating to Formal Appeals), the Administrative Procedures Act, Title 10 of the Texas Government Code, ssec.2001.051 et seq, and sec.sec.76. 101- 76.106
                                                                                                                                                                                                                                                                                                                                                                                                                        [sec.sec.76.101-76.108] of this title (relating to Criminal History Check of Employees in Facilities for Care of the Aged and Persons with Disabilities), if applicable. Through the formal hearing, determinations are made on both the certificate of nurse aide practice and the permit for medication aide practice. (e)-(i) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601455 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Chapter 96. Certification of Long Term Care Facilities The Texas Department of Human Services (DHS) proposes an amendment to sec.96.6, concerning Informal Administrative Review Process for Intermediate Care Facilities for the Mentally Retarded, and the repeal of sec.96.9, concerning standards for nursing facilities that participate in the Medical Assistance Program, in its Certification of Long Term Care Facilities chapter. The purpose of the amendment to 96.6 is to correct terminology. The purpose of the repeal is to delete rules which are no longer applicable. Burton F. Raiford, commissioner, has determined that for the first five-year period the sections are in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the proposal. Mr. Raiford also has determined that for each year of the first five years the sections are in effect the public benefit anticipated as a result of enforcing the proposal will be clear rules. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the proposal. Questions about the content of this proposal may be directed to Susan Syler at (512) 438-3111 in DHS's Long Term Care Policy Section. Written comments on the proposal may be submitted to Nancy Murphy, Media and Policy Services-313, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register. 40 TAC sec.96.6 The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The amendment implements the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.96.6. Informal Administrative Review Process for Intermediate Care Facilities for the Mentally Retarded. (a) (No change.) (b) Application. (1) (No change.) (2) Review process. (A)-(B) (No change.) (C) State agency central office review. If the conference with the public health regional administrator does not resolve the issue, a request may be made to the program director, ICFMR/RC
                                                                                                                                                                                                                                                                                                                                                                                                                          [MI/MR Services] Section, Long Term Care-Regulatory, Texas Department of Human Services, for an informal administrative review. If the conference with the program director, ICFMR/RC
                                                                                                                                                                                                                                                                                                                                                                                                                            [MI/MR Services] Section, does not resolve the issue, a request may then be made to the commissioner's designated representative
                                                                                                                                                                                                                                                                                                                                                                                                                              [Associateship, Special Health Services, Office of Quality Assurance, Texas Department of Health,] for an additional review and reconsideration. (c)-(d) (No change.) (e) Central office responsibility. Upon request by the facility or the public health region, the program director of the ICFMR/RC
                                                                                                                                                                                                                                                                                                                                                                                                                                [MI/MR Services] Section, will: (1)-(2) (No change.) (3) upon request by the facility or the program director, ICFMR/RC
                                                                                                                                                                                                                                                                                                                                                                                                                                  [MI/MR Services] Section, the commissioner's designated representative
                                                                                                                                                                                                                                                                                                                                                                                                                                    [department's Associateship for Special Health Services, Office of Quality Assurance,] will: (A) (No change.) (B) determine a resolution and present the resolution to the commissioner's designated representative
                                                                                                                                                                                                                                                                                                                                                                                                                                      [associate commissioner for Special Health Services] for concurrence; and (C) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601456 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 40 TAC sec.96.9 (Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Department of Human Services or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.) The repeal is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The repeal implements the Human Resources Code, sec.sec.22.001-22.024 and sec.sec.32.001-32.042. sec.96.9. Standards for Nursing Facilities That Participate in the Medical Assistance Program. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601457 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Chapter 98. Adult Day Care Facilities The Texas Department of Human Services (DHS) proposes the repeal of sec.98. 21, concerning fees for plan reviews, construction inspection services, and feasibility inspection services and the repeal of sec.98.61, concerning plans, approvals, and construction procedures; an amendment to sec.98.43, concerning safety; and new sec.98.61, concerning construction and initial survey of completed construction, in its Adult Day Care Facilities chapter. The purpose of the repeals is to delete rules regarding functions DHS no longer performs. The purpose of the amendments and new section is to modify new facility construction procedures. Burton F. Raiford, commissioner, has determined that for the first five-year period the sections are in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the proposal. Mr. Raiford also has determined that for each year of the first five years the sections are in effect the public benefit anticipated as a result of enforcing the proposal will be clear rules. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the proposal. Questions about the content of this proposal may be directed to Susan Syler at (512) 438-3111 in DHS's Long Term Care Policy Section. Written comments on the proposal may be submitted to Nancy Murphy, Media and Policy Services-313, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register. Subchapter B. Application Procedures 40 TAC sec.98.21 (Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Department of Human Services or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.) The repeal is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The repeal implements the Human Resources Code, sec.sec.22.001-22.024 and sec.sec.32.001-32.042. sec.98.21. Fees for Plan Reviews, Construction Inspection Services, and Feasibility Inspection Services. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601463 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter C. Standards for Adult Day Care and Adult Day Health Care Facilities 40 TAC sec.98.43 The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The amendment implements the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.98.43. Safety. (a)-(b) (No change.) (c) Personal safety. (1) Fire safety. (A)-(J) (No change.) (K) Portable fire extinguishers must be provided and maintained to comply with the provisions of the National Fire Protection Association (NFPA) 10. This includes such items as type of extinguishers (A, B, or C), location and spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent (with any necessary servicing), and hydrostatic testing as recommended by the manufacturer.
                                                                                                                                                                                                                                                                                                                                                                                                                                        [Provide 2 1/2 gallon pressurized water type portable fire extinguishers in client use areas. A portable Underwriters Laboratory or Factory Mutual approved five-pound Class B:C dry chemical fire extinguisher, rechargeable type, is required in each laundry, kitchen, and walk-in mechanical room. An ABC type extinguisher may be used in serving kitchens.] (L) (No change.) (2) (No change.) This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601464 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 Subchapter D. Facility Construction Procedures 40 TAC sec.98.61 (Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Department of Human Services or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.) The repeal is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The repeal implements the Human Resources Code, sec.sec.22.001-22.024 and sec.sec.32.001-32.042. sec.98.61. Plans, Approvals, and Construction Procedures. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601465 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765 The new section is proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs; and under Texas Civil Statutes, Article 4413(502), sec.16, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The new section implements the Human Resources Code, sec. s22.001-22.024 and sec.sec.32.001-32.042. sec.98.61. Construction and Initial Survey of Completed Construction. (a) Construction phase. (1) The Texas Department of Human Services (DHS), Architectural Section in Austin, Texas, must be notified in writing of construction start. (2) All construction shall be done in accordance with minimum licensing requirements. It is the sponsor's responsibility to employ qualified personnel to prepare the contract documents for construction of a new facility or remodeling of an existing facility. Contract documents for additions and remodeling and for the construction of an entirely new facility must be prepared by an architect licensed by the Texas State Board of Architectural Examiners. Drawings must bear the seal of the architect. Certain parts of final plans, designs, and specifications must bear the seal of a registered professional engineer approved by the State Board of Registration for Professional Engineers to operate in Texas. These certain parts include sheets and sections covering structural, electrical, mechanical, and sanitary engineering. (A) Remodeling is the construction, removal, or relocation of walls and partitions; the construction of foundations, floors, or ceiling-roof assemblies; the expanding or altering of safety systems (including, but not limited to, sprinkler, fire alarm, and emergency systems); or the conversion of space in a facility to a different use. (B) General maintenance and repairs of existing material and equipment, repainting, applications of new floor, wall, or ceiling finishes, or similar projects are not included as remodeling, unless as a part of new construction. DHS must be provided flame spread documentation for new materials applied as finishes. (b) Contract documents. (1) Site plan documents must include grade contours; streets with names; north arrow; fire hydrants; fire lanes; utilities, public or private; fences; unusual site conditions, such as ditches, low water levels, other buildings on-site; and indications of buildings five feet or less beyond site property lines. (2) Foundation plan documents must include general foundation design and details. (3) Floor plan documents must include room names, numbers, and usages; numbered doors including swing; windows; legend or clarification of wall types; dimensions; fixed equipment; plumbing fixtures; and kitchen basic layout; and identification of all smoke barrier walls (outside wall to outside wall) or fire walls. (4) For both new construction and additions or remodeling to existing buildings, an overall plan of the entire building must be drawn or reduced to fit on an 8 1/2 inch by 11 inch sheet; submit two reduced plans for file record. See subsection (d)(3) of this title (relating to Construction and Initial Survey of Completed Construction). (5) Schedules must include door materials, widths, types; window materials, sizes, types; room finishes; and special hardware. (6) Elevations and roof plan must include exterior elevations, including material note indications and any roof top equipment; roof slopes, drains, and gas piping, and interior elevations where needed for special conditions. (7) Details must include wall sections as needed (especially for special conditions); cabinet and built-in work, basic design only; cross sections through buildings as needed; and miscellaneous details and enlargements as needed. (8) Building structure documents must include structural framing layout and details (primarily for column, beam, joist, and structural frame building); roof framing layout (when this cannot be adequately shown on cross section); cross sections in quantity and detail to show sufficient structural design and structural details as necessary to assure adequate structural design, also calculated design loads. (9) Electrical documents must include electrical layout, including lights, convenience outlets, equipment outlets, switches, and other electrical outlets and devices; service, circuiting, distribution, and panel diagrams; exit light system (exit signs and emergency egress lighting); emergency electrical provisions (such as generators and panels); fire alarm and similar systems (such as control panel, devices, and alarms); sizes and details sufficient to assure safe and properly operating systems; and a staff communication system. (10) Plumbing documents must include plumbing layout with pipe sizes and details sufficient to assure safe and properly operating systems, water systems, sanitary systems, gas systems, other systems normally considered under the scope of plumbing, fixtures, and provisions for combustion air supply. (11) Heating, ventilation, and air-conditioning (HVAC) documents must include sufficient details of HVAC systems and components to assure a safe and properly operating installation including, but not limited to, heating, ventilating, and air-conditioning layout, ducts, protection of duct inlets and outlets, combustion air, piping, exhausts, and duct smoke and/or fire dampers; and equipment types, sizes, and locations. (12) Sprinkler system documents must include plans and details of NFPA designed systems; plans and details of partial systems provided only for hazardous areas; electrical devices interconnected to the alarm system. (13) Other layouts, plans, or details as may be necessary for a clear understanding of the design and scope of the project; including plans covering private water or sewer systems must be reviewed by the local health or waste water authority having jurisdiction. If no local authority, then the plans will be reviewed by DHS. (14) Specifications must include installation techniques, quality standards and/or manufacturers, references to specific codes and standards, design criteria, special equipment, hardware, painting, and any others as needed to amplify drawings and notes. (c) Initial survey of completed construction. (1) Upon completion of construction, including grounds and basic equipment and furnishings, a final construction inspection (initial survey) of the facility, including additions or remodeled areas, is required to be performed by the department (architectural section) prior to occupancy. A minimum of three weeks advance notice is needed. The completed construction shall have the written approval of the local authorities having jurisdiction, including the fire marshal, health department, and building inspector. (2) After the completed construction has been surveyed by a representative of the architectural section of DHS and found acceptable, this information will be conveyed to the licensing officer of DHS as part of the information needed to issue a license to the facility. In the case of additions or remodeling of existing facilities, a revision or modification to an existing license may be necessary. Note that the building, grades, drives, and parking must essentially be 100% complete at the time of this initial visit for occupancy approval and licensing, including basic furnishings and operational needs. A facility may accept up to three residents between the time it receives initial approval from the architectural section and the time the license is issued. (3) The following documents must be available to DHS's surveyor at the time of the survey of the completed building: (A) written approval of local authorities as called for in paragraph (1) of this subsection; (B) written certification of the fire alarm system by the installing agency (Form FML-009) of the Texas State Fire Marshal); (C) documentation of materials used in the building which are required to have a specific limited fire or flame spread rating including special wall finishes or floor coverings, flame retardant curtains (including cubicle curtains), rated ceilings, etc. This must include a signed letter from the installer, in the case of carpeting, etc. , verifying that the carpeting installed is named in the laboratory test document; (D) approval of the completed sprinkler system installation by the designing engineer. A copy of the material list and test certification shall be available; (E) service contracts for maintenance and testing of alarm systems, sprinkler systems, etc.; (F) a copy of gas test results of the facility's gas lines from the meter; (G) a written statement from an architect/engineer stating that he certifies that the building was constructed to meet NFPA 101, Life Safety Code, and all locally applicable codes, and that the facility is in substantial conformance with minimum licensing requirements; and (H) the contract documents specified in sec.92.63(b) of this title (relating to Construction and Initial Survey of Completed Construction). (d) Nonapproval of new construction. (1) If, during the initial on-site survey of completed construction, the surveyor finds certain basic requirements not met, he may recommend to DHS that the facility not yet be licensed and approved for occupancy. Such basic items may include the following: (A) construction which does not meet minimum code or licensure standards for basic requirements such as corridors being less than required width, ceilings installed at less than the minimum seven-foot six-inch height, resident bedroom dimensions less than required, and other such features which would disrupt or otherwise adversely affect the residents and staff if corrected after occupancy; (B) no written approval by local authorities; (C) fire protection systems not completely installed or not functioning properly, including, but not limited to, fire alarm systems, emergency power and lighting, and sprinkler systems; (D) required exits not all usable according to NFPA 101 requirements; (E) telephone not installed or not properly working; (F) sufficient basic furnishings, essential appliances, and equipment are not installed or not functioning; and (G) any other basic operational or safety feature which the surveyor, as the authority having jurisdiction, encounters which in his judgment would preclude safe and normal occupancy by residents on that day. (2) If the surveyor encounters only less basic and less important deficiencies, licensure may be recommended based on an approved written plan of correction from the facility's administrator. (3) Copies of reduced size floor plans on an 8 1/2 inch by 11 inch sheet shall be submitted in duplicate to DHS for record/file use and for the facility's use and for facility's use for evacuation plan, fire alarm zone identification, etc. The plan shall contain basic legible information such as scale, room usage names, actual bedroom numbers, doors, windows, and any other pertinent information. This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's authority to adopt. Issued in Austin, Texas, on February 1, 1996. TRD-9601466 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Earliest possible date of adoption: March 15, 1996 For further information, please call: (512) 438-3765