Form 2389 "Assisted Living Facilities Life Safety Code Checklist for Small Facilities - 40 Tac Section 92.62" - Texas

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Download Form 2389 "Assisted Living Facilities Life Safety Code Checklist for Small Facilities - 40 Tac Section 92.62" - Texas

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Form 2389
January 2014-E
Assisted Living Facilities Life Safety Code
Checklist for Small Facilities – 40 TAC §92.62
Facility Name
Facility ID No.
Inspection Exit Date
Facility Address (Street, City, State and ZIP Code)
Telephone No. with Area Code
The items on the following checklist represent 40 Texas Administrative Code (TAC), Chapter 92, Licensing Standards for Assisted Living
Facilities. Violations of licensure standards are identified on the appropriate checklist by the requirements checked Not Met. When violations
are cited, a copy of the appropriate checklist is left with the facility at the exit conference. If additional violations are cited after the initial exit
conference, an additional exit conference will be conducted regarding the newly identified violations, with specific reference to the standard
violated. Other violations in areas not checked still may be pending from previous inspections and are not reflected on this current report.
NOTE: This checklist contains a brief description of the requirements. Refer to the licensure standards for a complete description of the
requirements.
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
(c)
Operational features
(c)(1)
Fire reports submitted as required.
(c)(2)
Fire drills conducted as required.
(c)(3)
Smoking regulations in-place and enforced.
(c)(4)
Required emergency evacuation plan posted.
(c)(5)
Emergency fire procedures available and acceptable.
(d)
Safety operations plan available and acceptable.
(e)
Construction
(e)(1)
Separation from other occupancies acceptable.
(e)(2)
Facility is fully sheathed and meets the construction requirements of NFPA 101.
(e)(3)
Wall covering meets flame spread requirements.
(e)(4)
Corridor doors of acceptable construction.
(e)(5)
Upper floors provided with at least two remote stairs of acceptable construction.
(e)(6)
All hazardous areas must be properly separated.
(f)
Fire alarm and sprinkler systems
(f)(1)
Facilities licensed for eight beds or less must provide a manual fire alarm system, with smoke detection that
complies with Household Fire Warning Equipment (NFPA 74), at a minimum. For all other facilities, an Underwriters
Laboratories (UL) listed manual fire alarm initiating system, with an interconnected automatic smoke detection and
alarm initiation system, must be provided in accordance with the NFPA 101, §9.6. The operation of any alarm-
initiating device must activate an audible or visual alarm at the site.
(f)(1)(A)
Smoke detectors installed in all required locations.
(f)(1)(B)
The fire alarm control panel properly located or staff carries monitoring device.
(f)(1)(C)
Fire alarm panel power source acceptable.
(f)(1)(D)
Emergency power source must be from approved storage batteries or on-site engine-driven generator set.
(f)(1)(E)
Fire alarm maintenance contract acceptable.
(f)(1)(F)
Smoke detector sensitivity checked as required.
(f)(2)
Sprinkler system properly installed. Acceptable maintenance contract is in force.
Form 2389
January 2014-E
Assisted Living Facilities Life Safety Code
Checklist for Small Facilities – 40 TAC §92.62
Facility Name
Facility ID No.
Inspection Exit Date
Facility Address (Street, City, State and ZIP Code)
Telephone No. with Area Code
The items on the following checklist represent 40 Texas Administrative Code (TAC), Chapter 92, Licensing Standards for Assisted Living
Facilities. Violations of licensure standards are identified on the appropriate checklist by the requirements checked Not Met. When violations
are cited, a copy of the appropriate checklist is left with the facility at the exit conference. If additional violations are cited after the initial exit
conference, an additional exit conference will be conducted regarding the newly identified violations, with specific reference to the standard
violated. Other violations in areas not checked still may be pending from previous inspections and are not reflected on this current report.
NOTE: This checklist contains a brief description of the requirements. Refer to the licensure standards for a complete description of the
requirements.
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
(c)
Operational features
(c)(1)
Fire reports submitted as required.
(c)(2)
Fire drills conducted as required.
(c)(3)
Smoking regulations in-place and enforced.
(c)(4)
Required emergency evacuation plan posted.
(c)(5)
Emergency fire procedures available and acceptable.
(d)
Safety operations plan available and acceptable.
(e)
Construction
(e)(1)
Separation from other occupancies acceptable.
(e)(2)
Facility is fully sheathed and meets the construction requirements of NFPA 101.
(e)(3)
Wall covering meets flame spread requirements.
(e)(4)
Corridor doors of acceptable construction.
(e)(5)
Upper floors provided with at least two remote stairs of acceptable construction.
(e)(6)
All hazardous areas must be properly separated.
(f)
Fire alarm and sprinkler systems
(f)(1)
Facilities licensed for eight beds or less must provide a manual fire alarm system, with smoke detection that
complies with Household Fire Warning Equipment (NFPA 74), at a minimum. For all other facilities, an Underwriters
Laboratories (UL) listed manual fire alarm initiating system, with an interconnected automatic smoke detection and
alarm initiation system, must be provided in accordance with the NFPA 101, §9.6. The operation of any alarm-
initiating device must activate an audible or visual alarm at the site.
(f)(1)(A)
Smoke detectors installed in all required locations.
(f)(1)(B)
The fire alarm control panel properly located or staff carries monitoring device.
(f)(1)(C)
Fire alarm panel power source acceptable.
(f)(1)(D)
Emergency power source must be from approved storage batteries or on-site engine-driven generator set.
(f)(1)(E)
Fire alarm maintenance contract acceptable.
(f)(1)(F)
Smoke detector sensitivity checked as required.
(f)(2)
Sprinkler system properly installed. Acceptable maintenance contract is in force.
Form 2389
Facility ID No.
Inspection Exit Date
Page 2 / 01-2014-E
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 HHS-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.
Kitchen and laundry procedures are utilized by facility staff to avoid cross-contamination between clean and soiled
(h)(7)
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.
Form 2389
Facility ID No.
Inspection Exit Date
Page 3 / 01-2014-E
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
(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 HHS.
(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.
(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.
Form 2389
Facility ID No.
Inspection Exit Date
Page 4 / 01-2014-E
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
(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.
(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.
Form 2389
Facility ID No.
Inspection Exit Date
Page 5 / 01-2014-E
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
(m)
Resident accommodations – continued
(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)
Resident 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.
Finishes of all surfaces, except ceilings, must be the same as those required for dietary kitchens or comparable
(m)(6)(E)(iii)
areas.
(m)(7)
Laundry and linen services
(m)(7)(C)
Resident-use laundry, if provided, must utilize residential-type washers and dryers. If more than three washers and
three dryers are located in one space, the area must be separated by a one-hour fire-rated barrier or have sprinkler
protection.
Signature of Inspection Team Member
Date