Form 2389 – Fill Out and Use This PDF

Form 2389

Page 2 of 5/01-2014

Facility ID No.

Inspection Exit Date

40 TAC

Assisted Living Facilities

Not

Chapter 92

Life Safety Code Checklist for Small Facilities – 40 TAC §92.62

Met

Subchapter D.

Facility Construction

§92.62

General Requirements

(f)

Fire alarm and sprinkler systems – continued

(f)(2)(A)

An existing small Type A facility housing 16 or fewer residents may have a system that meets NFPA 13, 13D or 13R requirements.

(f)(2)(B)

A new small Type A facility housing 16 or fewer residents must have a system that meets NFPA 13, 13D or 13R requirements, installed in

accordance with §32.2.3.5.2.

(f)(2)(C)

An existing small Type B facility housing 16 or fewer residents must be protected by a sprinkler system that meets the requirements of

NFPA 13, 13D or 13R, with additional requirements for coverage in all habitable areas and closets as specified by NFPA 101, §33.2.3.5.2.

(f)(2)(D)

A new small Type B facility housing 16 or fewer residents must be protected by a sprinkler system that meets the requirement of NFPA 13,

13R or 13D, with additional requirements for coverage in all habitable areas and closets as specified by NFPA 101, §32.2.3.5.2.

(f)(2)(E)

A new and an existing large Type B facility must have a complete sprinkler system that meets the requirements of the NFPA 13.

(f)(2)(F)

An existing large Type A facility may have an NFPA 13 system. In a building not more than four stories high, an NFPA 13R system may be permitted.

(f)(2)(G)

A new large Type A facility must have an NFPA 13 system; however, a building not more than four stories high may have an NFPA 13R

system.

(g)

Site and location

(g)(1)

Facility served by DADS-approved fire department, and adequate water supply is available.

(g)(2)

Facility must correct any site or building conditions that are a fire, health or physical hazard.

(g)(3)

The facility must provide or arrange for nearby parking spaces for private vehicles of residents and visitors.

(g)(4)

Ramps, walks and steps properly constructed. Guardrails, fences or handrails provided where required.

(g)(5)

All outside areas, grounds and adjacent buildings are maintained in good condition. Site grades provide for water

drainage away from the structure.

(h)

Sanitation and housekeeping

(h)(1)

Wastewater and sewage discharged in an approved manner.

(h)(2)

Water supply acceptable.

(h)(3)

Solid waste properly disposed.

(h)(4)

Operable windows are insect-screened.

(h)(5)

An ongoing pest control program is provided by facility staff or by contract with a licensed pest control company.

(h)(6)

All bathrooms, toilet rooms, and other odor-producing rooms or areas for soiled and unsanitary operations are

ventilated with operable windows or powered exhaust to the exterior.

(h)(7)

Kitchen and laundry procedures are utilized by facility staff to avoid cross-contamination between clean and soiled utensils and linens.

(h)(8)

Facility is free of accumulations of dirt, rubbish, dust and hazards. Floors are in good condition and cleaned regularly; walls and ceilings

structurally sound and in good repair. Storage areas and cellars kept in an organized manner. No storage in the attic spaces.

(h)(9)

The facility is adequately ventilated. Smoking areas have mechanical ventilation directed to the exterior to remove

smoke at the rate of 10 air changes per hour.

(h)(12)

Facility-provided linens are available in sufficient quantity and are sanitary. Clean linens must be stored in a clean area.

(i)

General safety features

(i)(1)

Local fire marshal inspection within last 12 months.

(i)(2)

The building must be kept in good repair; electrical, heating and cooling systems must be maintained in a safe manner.

(i)(3)

Existing furnace and water heater installations may be continued in service, subject to approval by DADS.

(i)(6)

Open-flame heating devices are prohibited. All fuel-burning heating devices must be vented. Working fireplaces are

acceptable if of safe design and construction and if screened or otherwise enclosed.

(i)(7)

Telephone available. Emergency phone numbers readily available.

(i)(8)

Gas pressure test performed as required. Gas-fired heating equipment inspected prior to heating season.

(i)(9)

Exterior and interior stairs must have handrails that are firmly secured to prevent falls.

(i)(10)

HVAC complies with NFPA 90A or NFPA 90B and maintains temperature within required range.

(i)(11)

Facility lighting is acceptable.

(i)(13)

Floor, ceiling and wall finish material must be complete and in place to provide a sanitary and structurally safe environment.

Form 2389

Page 3 of 5/01-2014

Facility ID No.

Inspection Exit Date

40 TAC

Assisted Living Facilities

Not

Chapter 92

Life Safety Code Checklist for Small Facilities – 40 TAC §92.62

Met

Subchapter D.

Facility Construction

§92.62

General Requirements

(j)

Portable fire extinguishers supplied in accordance with NFPA 10.

(j)(1)

Portable fire extinguishers are of the proper type and size and are located properly.

(j)(2)

Extinguishers are installed properly.

(j)(3)

Extinguishers are surface wall-mounted or recessed in cabinets and are not subject to physical damage or

dislodgment.

(j)(4)

Large portable fire extinguishers properly located.

(j)(5)

Portable extinguishers provided in hazardous rooms as required.

(j)(6)

Staff is trained in the use of each type of extinguisher in the facility.

(j)(7)

Monthly and yearly inspections of portable fire extinguishers made as required.

(k)

Waste and storage containers

(k)(1)

Metal wastebaskets of substantial gauge or any UL- or FM-approved containers must be provided in all

areas where smoking is permitted.

(k)(2)

Garbage, waste or trash containers provided for kitchens, janitor closets, laundries, mechanical or boiler

rooms, general storage, and similar places must be made of metal or any UL- or FM-approved material and

have a close-fitting cover.

(l)

The physical plant of all facilities housing residents with physical disabilities or mobility impairments

complies with applicable federal, state and local requirements for persons with disabilities.

(m)

Resident accommodations

(m)(1)

Resident bedrooms

(m)(1)(A)

Bedroom usable floor space meets the requirements for a Type A facility. Minimum dimension is at least 8

feet. Bedrooms for persons with physical disabilities or mobility impairments meet accessibility standards.

(m)(1)(B)

Bedroom usable floor space meets the requirements for a Type B facility. Minimum dimension is at least 10

feet. Bedrooms for persons with physical disabilities or mobility impairments meet accessibility standards.

(m)(1)(C)

Facility with living units consisting of separate living/dining spaces and bedrooms have at least 90% of the

required bedroom area.

(m)(1)(D)

No more than 50% of the beds are in rooms of three or more. No resident room has more than four beds.

(m)(1)(E)

Bedroom windows of proper size and location.

(m)(1)(E)(ii)

In existing buildings, if the window is not required for the secondary means of escape, the window size and

sill height requirements do not apply if the windows meet the local building code.

(m)(1)(F)

Furnishings provided by the facility are acceptable and maintained in good repair.

(m)(1)(G)

All resident rooms must open upon an exit, corridor, living area or public area and must be arranged for

convenient resident access to dining and recreation areas.

(m)(1)(H)

A staff or attendant area is provided on each floor or in each separate building. The area contains a desk or

writing surface and telephone. These areas have a communication system and fire alarm annunciation

indicating the units served.

(m)(1)(I)

Facilities that consist of two or more floors or separate buildings must have a communication system from

each resident living unit to a central staff location.

Form 2389

Page 4 of 5/01-2014

Facility ID No.

Inspection Exit Date

40 TAC

Assisted Living Facilities

Chapter 92

Life Safety Code Checklist for Small Facilities – 40 TAC §92.62

Not Met

Subchapter D.

Facility Construction

§92.62

General Requirements

(m)

Resident accommodations – continued

(m)(2)

Resident toilet and bathing facilities

(m)(2)(A)

All bedrooms are served by separate private, connecting or general toilet rooms for each sex if facility

houses both sexes. General toilet room or bathing room is accessible from a corridor or public space. A

lavatory is readily accessible to each water closet. At least one water closet, lavatory and bathing unit are

provided on each sleeping floor accessible to residents of that floor.

(m)(2)(B)

One water closet and one lavatory for each six occupants or fraction thereof are required. One tub or

shower for each 10 occupants or fraction thereof is required.

(m)(2)(C)

Privacy partitions or curtains must be provided at water closets and bathing units in rooms for multi-resident

use.

(m)(2)(D)

Tubs and showers must have non-slip bottoms or floor surfaces, either built-in or applied to the surface.

(m)(2)(E)

Resident-use hot water for lavatories and bathing units will be maintained between 100 degrees Fahrenheit

and 120 degrees Fahrenheit.

(m)(2)(F)

Towels, soap and toilet tissue must be available at all times for individual resident use.

(m)(3)

Resident living areas

(m)(3)(A)

At least 120 square feet of social-diversional area is provided. This space has exterior windows providing a

view of the outside.

(m)(3)(B)

The space provided for social-diversional areas complies with these standards.

(m)(3)(C)

DADS deducts a pathway equal to the corridor width when a corridor is required through a living or dining

area to access an exit. The pathways are clear of obstructions.

(m)(4)

Resident dining areas

(m)(4)(A)

A dining area is provided and appropriately furnished. A minimum of 120 square feet is provided in at least

one space. This space must have exterior windows providing a view of the outside.

(m)(4)(B)

Access to a dining area from the resident living units or bedrooms is covered.

(m)(4)(C)

Provided dining area is sufficient for the licensed capacity.

(m)(4)(D)

The total living and dining area may be a single or interconnecting space with a minimum of 240 square feet

of area.

(m)(5)

Facility provides sufficient storage.

(m)(6)

Kitchen

(m)(6)(A)

The facility must have a kitchen or dietary area to meet the general food-service needs of the residents. It

must include provisions for the storage, refrigeration, preparation and serving of food, dish and utensil

cleaning, and refuse storage and removal. Exception: Food may be prepared off-site or in a separate

building provided that the food is served at the proper temperature and transported in a sanitary manner.

(m)(6)(B)

Kitchens for facilities serving 16 or fewer non-employees per meal on a routine basis that have residential

ranges may have residential range hoods, if the range hoods meet the requirements of the local building code.

(m)(6)(E)

Auxiliary serving kitchens that are not contiguous to a food preparation or serving area must be designed as

follows:

(m)(6)(E)(i)

Where service areas other than the kitchen are used to dispense foods, these areas must be designated as

food-service areas and contain equipment for maintaining required food temperatures while serving.

(m)(6)(E)(ii)

Separate food-service areas must have hand-washing facilities as part of the food service area.

(m)(6)(E)(iii)

Finishes of all surfaces, except ceilings, must be the same as those required for dietary kitchens or

comparable areas.