Form 2390 "Assisted Living Facilities Life Safety Code Checklist for Large Facilities - 26 Tac Section 553.62" - Texas

What Is Form 2390?

This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2019;
  • The latest edition provided by the Texas Health and Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 2390 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.

ADVERTISEMENT
ADVERTISEMENT

Download Form 2390 "Assisted Living Facilities Life Safety Code Checklist for Large Facilities - 26 Tac Section 553.62" - Texas

Download PDF

Fill PDF online

Rate (4.4 / 5) 11 votes
Form 2390
November 2019-E
Assisted Living Facilities
Life Safety Code Checklist for Large Facilities – 26 TAC §553.62
Facility Name
Facility ID No.
Inspection Exit Date
Street Address
City
State
ZIP Code
Area Code and Telephone No.
The items on the following checklist represent 26 Texas Administrative Code (TAC), Chapter 553, 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.
26 TAC
Assisted Living Facilities
Not Met
Chapter 553
Life Safety Code Checklist for Large Facilities – 26 TAC §553.62
Subchapter D. Facility Construction
§553.62
General Requirements
(c)
Operational features
(c)(1)
Fires reported 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)
Floor 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.
Exit signs, with emergency power, must be provided in all large facilities and installed in accordance with NFPA 101,
(e)(7)
§7.10.
Emergency lighting must be provided in all buildings with 25 or more rooms; in apartment buildings with 12 or more
(e)(8)
living units or that are three or more stories in height; and in all large facilities that are designed for Type B. The system
must be installed in accordance with NFPA 101, §7.9.
(f)
Fire alarm and sprinkler systems
Fire alarm and smoke detection system. Facility has an Underwriters Laboratories (UL) listed manual fire alarm initiating
(f)(1)
system, with an interconnected automatic smoke detection and alarm initiation system in accordance with the
requirements of NFPA 101, §9.6.
(f)(1)(A)
Smoke detectors installed in all required locations.
Facilities with apartment units may use listed smoke detectors with an alarm device and separate heat detector
contacts in the living area. The smoke detector must emit an audible signal within the apartment and annunciate at the
(f)(1)(A)(i)
main staff station or location. The heat detector contacts must be connected into the fire alarm system and provide a
general alarm when activated.
A facility constructed to meet NFPA 101, Chapter 18 or Chapter 19, need only meet §18.3.4.5.3/§19.3.4.5.1 for smoke
(f)(1)(A)(ii)-(iii)
detector locations.
Form 2390
November 2019-E
Assisted Living Facilities
Life Safety Code Checklist for Large Facilities – 26 TAC §553.62
Facility Name
Facility ID No.
Inspection Exit Date
Street Address
City
State
ZIP Code
Area Code and Telephone No.
The items on the following checklist represent 26 Texas Administrative Code (TAC), Chapter 553, 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.
26 TAC
Assisted Living Facilities
Not Met
Chapter 553
Life Safety Code Checklist for Large Facilities – 26 TAC §553.62
Subchapter D. Facility Construction
§553.62
General Requirements
(c)
Operational features
(c)(1)
Fires reported 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)
Floor 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.
Exit signs, with emergency power, must be provided in all large facilities and installed in accordance with NFPA 101,
(e)(7)
§7.10.
Emergency lighting must be provided in all buildings with 25 or more rooms; in apartment buildings with 12 or more
(e)(8)
living units or that are three or more stories in height; and in all large facilities that are designed for Type B. The system
must be installed in accordance with NFPA 101, §7.9.
(f)
Fire alarm and sprinkler systems
Fire alarm and smoke detection system. Facility has an Underwriters Laboratories (UL) listed manual fire alarm initiating
(f)(1)
system, with an interconnected automatic smoke detection and alarm initiation system in accordance with the
requirements of NFPA 101, §9.6.
(f)(1)(A)
Smoke detectors installed in all required locations.
Facilities with apartment units may use listed smoke detectors with an alarm device and separate heat detector
contacts in the living area. The smoke detector must emit an audible signal within the apartment and annunciate at the
(f)(1)(A)(i)
main staff station or location. The heat detector contacts must be connected into the fire alarm system and provide a
general alarm when activated.
A facility constructed to meet NFPA 101, Chapter 18 or Chapter 19, need only meet §18.3.4.5.3/§19.3.4.5.1 for smoke
(f)(1)(A)(ii)-(iii)
detector locations.
Form 2390
Page 2 / 11-2019-E
Facility ID No.
Inspection Exit Date
26 TAC
Assisted Living Facilities
Not Met
Chapter 553
Life Safety Code Checklist for Large Facilities – 26 TAC §553.62
Subchapter D. Facility Construction
§553.62
General Requirements
(f)
Fire alarm and sprinkler systems – continued
(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.
Smoke detector sensitivity checked as required.
(f)(1)(F)
In large facilities, the fire alarm panel must indicate as a separate zone, each floor and/or smoke compartment. Each
(f)(1)(G)
zone must have an alarm and trouble indication. Identification by zone is not required where all alarm initiating devices
are addressable and the status of each device is identified on the fire alarm panel.
In large Type B facilities the fire alarm must automatically notify the fire department in accordance with NFPA 101,
(f)(1)(H)
§9.6.4.
(f)(2)
Sprinkler system properly installed. Acceptable maintenance contract is in force.
A new and an existing large Type B facility must have a complete sprinkler system that meets the requirements of the
(f)(2)(E)
NFPA 13.
An existing large Type A facility may have an NFPA 13 system. In a building not more than four stories high, an NFPA
(f)(2)(F)
13R system may be permitted.
A new large Type A facility must have an NFPA 13 system; however, a building not more than four stories high may
(f)(2)(G)
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 are properly constructed. Guardrails, fences or handrails provided where required.
All outside areas, grounds and adjacent buildings are maintained in good condition. Site grades provide for water
(g)(5)
drainage away from the structure.
(h)
Sanitation and housekeeping
Wastewater and sewage must be discharged in an approved manner.
(h)(1)
(h)(2)
The water supply is acceptable.
(h)(3)
Solid waste is disposed of properly.
(h)(4)
Operable windows are insect-screened.
(h)(5)
An ongoing pest control program must be provided by facility staff or by contract with a licensed pest control company.
All bathrooms, toilet rooms, and odor-producing rooms or areas for soiled and unsanitary operations are ventilated with
(h)(6)
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.
Facility is free of accumulations of dirt, rubbish, dust and hazards. Floors are in good condition and cleaned regularly;
(h)(8)
walls and ceilings are structurally sound and maintained. Storage areas and cellars kept in an organized manner. No
storage in the attic spaces.
The facility is adequately ventilated. Smoking areas have mechanical ventilation directed to the exterior to remove
(h)(9)
smoke at the rate of 10 air changes per hour.
Janitor’s closets provided as required. Each janitor closet has a service sink and forced air ventilation ducted to the
(h)(10)
outside.
Form 2390
Page 3 / 11-2019-E
Facility ID No.
Inspection Exit Date
26 TAC
Assisted Living Facilities
Not Met
Chapter 553
Life Safety Code Checklist for Large Facilities – 26 TAC §553.62
Subchapter D. Facility Construction
§553.62
General Requirements
(h)
Sanitation and housekeeping – continued
A public/staff toilet, i.e., commode and lavatory, complying with accessibility standards is required for every large facility
(h)(11)
up to and including 60 beds. Facilities over 60 beds must have separate public and staff toilets in addition to the staff
toilets required for the dietary staff.
(h)(12)
Facility-supplied linens are available in sufficient quantity. 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 HHSC.
In large Type B facilities, all draperies and other window coverings in public or common areas, bedrooms, and living
(i)(4)
units must be flame resistant. In large Type A facilities, draperies must be flame resistant where smoking is permitted.
All newly installed carpet is Class I or II based on the "Critical Radiant Flux" ratings. Proper documentation was
(i)(5)
provided.
Open-flame heating devices are prohibited. All fuel-burning heating devices are properly vented. Working fireplace (if
(i)(6)
present) is acceptable.
(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)(12)
Passenger elevator provided if required.
Floor, ceiling and wall finish material must be complete and in place to provide a sanitary and structurally safe
(i)(13)
environment.
(j)
Portable fire extinguishers supplied in accordance with NFPA 10.
Portable fire extinguishers are of the proper type, and size and are located properly. At least one portable Underwriters
(j)(1)
Laboratories (UL) or Factory Mutual (FM)-approved 20-B:C dry chemical fire extinguisher, rechargeable type, is
provided in each laundry, kitchen and walk-in mechanical room.
(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.
Portable extinguishers provided in hazardous rooms are located as close as possible to the exit door opening and on
(j)(5)
the latch side.
(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
Metal wastebaskets of substantial gauge or any UL- or FM-approved containers must be provided in all areas where
(k)(1)
smoking is permitted.
Garbage, waste or trash containers provided for kitchens, janitor closets, laundries, mechanical or boiler rooms, general
(k)(2)
storage, and similar places must be made of metal or any UL- or FM-approved material and have a close-fitting cover.
Form 2390
Page 4 / 11-2019-E
Facility ID No.
Inspection Exit Date
26 TAC
Assisted Living Facilities
Not Met
Chapter 553
Life Safety Code Checklist for Large Facilities – 26 TAC §553.62
Subchapter D. Facility Construction
§553.62
General Requirements
(l)
The physical plant complies with applicable federal, state and local requirements for persons with disabilities.
(m)
Resident accommodations
(m)(1)
Resident bedrooms
Bedroom usable floor space meets the requirements for a Type A facility. Minimum dimension is at least 8 feet.
(m)(1)(A)
Bedrooms for persons with physical disabilities or mobility impairments must meet accessibility standards.
Bedroom usable floor space meets the requirements for a Type B facility. Minimum dimension is 10 feet. Bedrooms for
(m)(1)(B)
persons with physical disabilities or mobility impairments meet accessibility standards.
Facilities with living units consisting of separate living/dining spaces and bedrooms have at least 90% of the required
(m)(1)(C)
bedroom area.
A facility must have no more than 50% of its beds in bedrooms of three or more. A bedroom must have no more than
(m)(1)(D)
four beds.
(m)(1)(E)
Bedroom windows of proper size and location.
In Type B facilities and Type A facilities protected throughout by an approved automatic sprinkler system, the window
(m)(1)(E)(i)
opening size may be smaller than the minimum size listed, but must permit the venting of products of combustion. The
total window area in a bedroom must not be less than 8% of the required bedroom size.
In existing buildings, if the window is not required for the secondary means of escape, the window size and sill height
(m)(1)(E)(ii)
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.
All resident rooms must open upon an exit, corridor, living area or public area and must be arranged for convenient
(m)(1)(G)
resident access to dining and recreation areas.
A staff or attendant area is provided on each floor or in each separate building. The area has a desk or writing surface
(m)(1)(H)
and telephone. These areas have a communication system and fire alarm annunciation indicating the units served.
Facilities that consist of two or more floors or separate buildings must have a communication system from each resident
(m)(1)(I)
living unit to a central staff location.
(m)(2)
Resident toilet and bathing facilities
All bedrooms are served by separate private, connecting or general toilet rooms for each sex if facility houses both
sexes. General toilet rooms or bathing rooms are accessible from a corridor or public space. A lavatory is readily
(m)(2)(A)
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.
One water closet and one lavatory for each six occupants or fraction thereof are required. One tub or shower for each
(m)(2)(B)
10 occupants or fraction thereof is required.
(m)(2)(C)
Privacy partitions or curtains are provided at water closets and bathing units in rooms for multi-resident use.
(m)(2)(D)
Tubs and showers have non-slip bottoms or floor surfaces, either built-in or applied to the surface.
Resident-use hot water for lavatories and bathing units is maintained between 100 degrees Fahrenheit and 120
(m)(2)(E)
degrees Fahrenheit.
(m)(2)(F)
Towels, soap and toilet tissue are available at all times for individual resident use.
(m)(3)
Resident living areas
Social-diversional spaces, such as living rooms, day rooms, lounges, sunrooms, etc., must be provided and have
(m)(3)(A)
appropriate furniture. A minimum of 120 square feet must be provided in at least one space regardless of the number of
residents. This space must have exterior windows providing a view of the outside.
(m)(3)(B)
The space requirement for social-diversional areas complies with these standards.
Form 2390
Page 5 / 11-2019-E
Facility ID No.
Inspection Exit Date
26 TAC
Assisted Living Facilities
Not Met
Chapter 553
Life Safety Code Checklist for Large Facilities – 26 TAC §553.62
Subchapter D. Facility Construction
§553.62
General Requirements
(m)
Resident accommodations
(m)(3)
Resident living areas – continued
HHSC deducts a pathway equal to the corridor width when a corridor is required through a living or dining area to
(m)(3)(C)
access an exit. The pathways are clear of obstructions.
(m)(4)
Resident dining areas
A dining area must be provided and have appropriate furnishings. A minimum of 120 square feet must be provided in
(m)(4)(A)
at least one space, regardless of number of residents. 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 must be covered.
(m)(4)(C)
Dining area provided complies with these standards.
(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 provided sufficient storage.
(m)(6)
Kitchen
The facility must have a kitchen or dietary area to meet the general food-service needs of the residents. It must include
(m)(6)(A)
provisions for the storage, refrigeration, preparation and serving of food, dish and utensil cleaning, and refuse storage
and removal.
Kitchens for facilities serving 16 or fewer non-employees per meal on a routine basis that have residential ranges may
(m)(6)(B)
have residential range hoods, if the range hoods meet the requirements of the local building code.
(m)(6)(C)
Kitchens for facilities serving 17 or more non-employees per meal on a routine basis must be designed as follows:
Kitchens are evaluated on the basis of their performance in the sanitary and efficient preparation and serving of meals
(m)(6)(C)(i)
to residents and compliance with requirements for dietary service in §553.41(m)(18) of this chapter (relating to
Standards for Type A and Type B Assisted Living Facilities).
Kitchens must be designed so that room temperature, at peak load or in the summer, must not exceed 85 degrees
(m)(6)(C)(ii)
Fahrenheit measured over the room at the 5-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.
Facilities for washing and sanitizing dishes and cooking utensils are provided. The kitchen contains a multi-
(m)(6)(C)(iii)
compartment pot sink large enough to immerse pots and pans, and a mechanical dishwasher for washing and
sanitizing dishes. Separation of soiled and clean dish areas is maintained, including air flow.
(m)(6)(C)(iv)
A food preparation sink is provided. It is separate from the pot sinks.
A supply of hot and cold water is provided. Hot water for sanitizing purposes must be 180 degrees Fahrenheit or the
(m)(6)(C)(v)
manufacturer's suggested temperature for chemical sanitizers.
The kitchen is provided with a hand-washing lavatory in the food preparation area with hot and cold water, soap, towel
(m)(6)(C)(vi)
dispenser, and waste receptacle. The dish room area has ready access to a hand-washing lavatory.
Staff restroom facilities with lavatory are directly accessible to kitchen staff without traversing resident use areas. The
(m)(6)(C)(vii)
rest room does not open directly into the kitchen, but must open into a vestibule.
(m)(6)(C)(viii)
Janitorial facilities are provided exclusively for the kitchen and are located in the kitchen area.
Non-absorbent smooth finishes or surfaces are used on kitchen floors, walls and ceilings. Surfaces are capable of
(m)(6)(C)(ix)
being routinely cleaned and sanitized to maintain a healthful environment. Counter and cabinet surfaces, inside and
outside, have smooth, cleanable, non-porous finishes.
Doors between kitchen and dining or serving areas have ¼–inch fixed safety glass or a fire related glazing view panel
(m)(6)(C)(x)
mounted in a steel frame.
(m)(6)(C)(xi)
A garbage can or cart washing area with drain and hot water is provided either on the interior or exterior of the facility.
(m)(6)(C)(xii)
Floor drains must be provided in the kitchen and dishwashing areas.