TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 553. LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes in the Texas Administrative Code, Title 26, Chapter 553, concerning Licensing Standards for Assisted Living Facilities, amendments to §§553.3, 553.5, 553.7, 553.9, 553.17, 553.21, 553.23, 553.25, 553.27, 553.29, 553.31, 553.33, 553.35, 553.37, 553.39, 553.47, 553.100, 553.101, 553.103, 553.104, 553.107, 553.111 - 553.113, 553.115, 553.118, 553.119, 553.121, 553.122, 553.125, 553.128, 553.129, 553.131 - 553.133, 553.135, 553.137 - 553.139, 553.141 - 553.143, 553.145, 553.147 - 553.149, 553.211, 553.212, 553.215, 553.218, 553.219, 553.221, 553.222, 553.225, 553.228, 553.229, 553.231 - 553.233, 553.235, 553.237 - 553.239, 553.241 - 553.243, 553.245 - 553.249, 553.253, 553.254, 553.259, 553.301, 553.303, 553.305, 553.307, 553.309, 553.327, 553.331, 553.333, and 553.751; the repeal of §§553.43, 553.255, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271 - 553.273, 553.275, 553.311, 553.351, 553.353, 553.401, 553.403, 553.405, 553.407, 553.409, 553.411, 553.413, 553.415, 553.417, 553.419, 553.421, 553.423, 553.425, 553.427, 553.429, 553.431, 553.433, 553.435, 553.437, 553.439, 553.451, 553.453, 553.455, 553.457, 553.459, 553.461, 553.463, 553.465, 553.467, 553.469, 553.471, 553.473, 553.475, 553.477, 553.479, 553.481, 553.483, 553.501, 553.503, 553.551, 553.553, 553.555, 553.557, 553.559, 553.561, 553.563, 553.565, 553.567, 553.569, 553.571, 553.573, 553.575, 553.577, 553.579, 553.581, 553.583, 553.585, 553.587, 553.589, 553.591, 553.593, 553.595, 553.597, 553.601, 553.603, 553.651, 553.653, 553.655, 553.657, 553.659, 553.661, 553.701, 553.703, 553.705, 553.707, 553.709, and 553.711; and new §§553.45, 553.250, 553.261, 553.263, 553.265, 553.267, 553.269, 553.271, 553.273, 553.275, 553.277, 553.279, 553.281, 553.283, 553.285, 553.287, 553.289, 553.291 - 553.293, 553.295, 553.328, 553.351, 553.401, 553.451, 553.501, 553.551, 553.601, 553.651, and 553.701.

BACKGROUND AND PURPOSE

The purpose of the proposal is to update and reorganize certain rules in Chapter 553 to make key topics easier to find, add more clarity or specificity to certain rules, remove unnecessary or overly burdensome rules, improve overall readability, and update references throughout the chapter. Amendments throughout the chapter are to better reflect the current population served in assisted living facilities, which has changed greatly since the original rules were developed in 1991.

The proposal includes several important clarifications and enhancements. It clarifies that a resident in an assisted living facility must be at least 18 years old or an emancipated minor, strengthens rules relating to medication administration by requiring the documentation of doses administered instead of doses missed, clarifies that assisted living facilities must offer a planned activity to residents daily instead of at least once per week, adds guidance on the use of bedrails, clarifies that certain assistive devices and postural support devices are not to be construed as restraints, provides more guidance relating to respite admissions, specifies resident records must be retained for five years after services end, and reformats the rules in the enforcement section from question-and-answer format to standard rule format.

The proposal also updates a citation to the Texas Government Code as modified by House Bill (HB) 4611, 88th Legislature, Regular Session, 2023. HB 4611 made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature's ongoing statutory revision program. The updated citation became effective on April 1, 2025.

An earlier version of these rules was proposed in the December 22, 2023, issue of the Texas Register (48 TexReg 7759). The formal comment period on that proposal ended on January 22, 2024. Over 200 public comments were received. The main theme identified in the public comments was that some of the proposed regulations were too burdensome for providers. To effectively address the public comments, HHSC made the decision to withdraw that rule proposal. The notice providing that the proposed rules are withdrawn was published in the March 1, 2024, issue of the Texas Register. HHSC now proposes these amendments, repeals, and new rules in response to public and stakeholder comments.

SECTION-BY-SECTION SUMMARY

Edits are made throughout the rules to clarify language, correct punctuation and formatting for consistency, and improve overall readability. "Facility staff" is replaced with "staff" throughout since "staff" is defined as employees of an assisted living facility. Unnecessary or overly burdensome rules are removed. Reference citations are updated and rules are reorganized and renumbered where necessary.

Subchapter A, Introduction

The proposed amendment to §553.3, Definitions, amends the definitions for "abuse," "exploitation," and "neglect" to reference the definitions for these terms provided in Texas Health and Safety Code §260A.001. The proposed amendment also adds definitions that are used in the chapter. Definitions related to facility construction are relocated to proposed amended §553.101. The proposed amendment deletes definitions not used in the chapter. The proposed amendment also makes changes to certain definitions to add more clarity or update a reference.

The proposed amendment to §553.5, Types of Assisted Living Facilities, adds additional guidance related to the evacuation capability required of a resident in a Type A facility.

The proposed amendment to §553.7, Assisted Living Facility Services, updates references, adds a defined acronym, and adds clarity to the rule. The amendment also relocates language from §553.259(a)(1).

The proposed amendment to §553.9, General Characteristics of a Resident, adds the statement that a resident must be 18 years of age or older or an emancipated minor and updates guidance related to some general characteristics of a resident. Key updates to the list of general characteristics include statements providing that a resident may be incontinent without pressure sores in the genital or rectal areas or buttocks and use various assistive devices, as well as specifying that a resident may have a permanently placed percutaneous endoscopic gastrostomy tube which requires registered nurse (RN) delegation or RN designation as a health maintenance activity.

Subchapter B, Licensing

The proposed amendment to §553.17, Criteria for Licensing, adds more specific guidance related to whether an assisted living facility that has multiple buildings requires licensing as a small or large facility or requires multiple licenses. Edits are made to replace "on-site" with "onsite" and improve readability.

The proposed amendment to §553.21, Time Periods for Processing All Types of License Applications, adds clarity related to the payment of fees.

The proposed amendment to §553.23, Initial License Application Procedures and Requirements, adds clarity and standardizes capitalization and hyphenation.

The proposed amendment to §553.25, Initial License for a Type A or Type B Facility for an Applicant in Good Standing, updates references and standardizes capitalization and hyphenation.

The proposed amendment to §553.27, Certification of a Type B Facility or Unit for Persons with Alzheimer's Disease and Related Disorders, removes the requirement that HHSC cancel an assisted living facility's Alzheimer's certification if the facility undergoes a change of ownership; adds a statement that HHSC cancels Alzheimer's certification if a provider voluntarily surrenders it; and updates citations and references.

The proposed amendment to §553.29, Alzheimer's Certification of a Type B Facility for an Initial License Applicant in Good Standing, updates references and standardizes capitalization and hyphenation.

The proposed amendment to §553.31, Provisional License, adds clarity, corrects references and citations, deletes redundant language, and standardizes the hyphenation of a word.

The proposed amendment to §553.33, Renewal Procedures and Qualifications, deletes the requirement for an onsite health inspection by HHSC for renewal of a license, clarifies timeframes for presumed receipt when HHSC faxes or emails notices to license holders, adds clarity, and updates references.

The proposed amendment to §553.35, Changes of Ownership and Notice of Changes, updates a reference and standardizes capitalization and hyphenation.

The proposed amendment to §553.37, Relocation, adds clarity, updates capitalization, and standardizes the hyphenation of a word.

The proposed amendment to §553.39, Increase in Capacity, adds clarity and standardizes capitalization and hyphenation.

The proposed repeal of §553.43, Disclosure of Facility Identification Number, deletes the rule as no longer necessary because the information is added to proposed new §553.292.

Proposed new §553.45, Voluntary Closure, clarifies notification requirements for an assisted living facility that chooses to close the facility.

The proposed amendment to §553.47, License Fees, adds clarity, standardizes capitalization and hyphenation, and updates a reference.

Subchapter D, Facility Construction

The proposed amendment to §553.100, General Requirements, replaces a reference to NFPA 101, Life Safety Code, published by the National Fire Protection Association with the defined acronym "NFPA 101;" simplifies the statement of requirements based in NFPA 101 by deleting the listed examples of other NFPA 101 chapters that may apply to an assisted living facility without changing the intent of subsection (c); deletes references to the accessibility requirements of the Texas Department of Licensing and Regulation (TDLR) because those requirements are enforced by TDLR, not by HHSC; clarifies that an assisted living facility can only lock doors against egress or escape by means that are not permitted by NFPA 101, or if the facility is a Type B assisted living facility that is a certified Alzheimer's assisted living facility; and removes a reference to previously repealed §553.51 and adds references to §553.27, §553.29, and proposed new §553.250.

The proposed amendment to §553.101, Definitions, clarifies definitions that relate to certified Alzheimer's assisted living facilities to align with changes in usage in other sections in the chapter, defines new terms used in the subchapter related to certified Alzheimer's assisted living facilities, adds definitions specific to facility construction from §553.3, and deletes a defined term that is no longer used in this chapter.

The proposed amendment to §553.103, Site and Location for all Assisted Living Facilities, deletes the minimum number of parking spaces an assisted living facility must provide based on the facility's licensed capacity; deletes the requirement to provide a guardrail, fence, or handrail where a grade makes an abrupt change in level because the rule is subjective; and clarifies the limitation on licensing a new assisted living facility in a county of more than 3.3 million residents.

The proposed amendment to §553.104, Safety Operations, clarifies that an assisted living facility must maintain onsite documentation or written records for certain inspection, testing, and maintenance activities; reinstates the requirement for an assisted living facility to provide a reduced size floorplan upon request from HHSC, which was inadvertently repealed during a previous rule project; incorporates direct references to applicable requirements for certain assisted living facilities in National Fire Protection Association (NFPA 101), Life Safety Code, 2012 edition, as a convenience to assisted living facilities; clarifies references to portable fire extinguishers; clarifies that assisted living facilities must not allow an accumulation of waste in attics; makes changes in grammar that do not substantively change the requirements in the section; removes the requirement that an assisted living facility must have a "contract" with a service company to provide inspection, testing, and maintenance of fire safety systems; and removes the requirement that an assisted living facility must have a "program" to ensure inspection, testing, and maintenance of fire safety systems is performed. An assisted living facility must ensure inspection, testing, and maintenance activities are performed by a qualified individual. The Texas Department of Insurance requires certain activities to be performed by licensed individuals. An assisted living facility may obtain the required services on an as-needed basis. An assisted living facility is responsible for determining how to ensure the facility meets the requirements for inspection, testing, and maintenance of fire safety systems.

The proposed amendment to §553.107, Building Rehabilitation, removes the requirement for an assisted living facility to notify HHSC before the start of building rehabilitation; incorporates, as a convenience to assisted living facilities, direct references to applicable requirements for certain assisted living facilities, in NFPA 101, Life Safety Code, 2012 edition; adds lead-in phrases in paragraphs within subsection (c) to enhance readability; corrects references; and corrects the use of terms related to means of egress.

The proposed amendment to §553.111, Construction Requirements for an Existing Small Type A Assisted Living Facility, replaces "Texas Health and Human Services Commission" with the defined acronym "HHSC;" and incorporates, as a convenience to assisted living facilities, direct references to applicable requirements in NFPA 101, Life Safety Code, 2012 edition for certain assisted living facilities.

The proposed amendment to §553.112, Space Planning and Utilization Requirements for an Existing Small Type A Assisted Living Facility, replaces the term "social-diversional space" with "common living area," clarifies the requirements for common living areas and dining areas, clarifies the intent of provisions that allow floor area within the assisted living facility to be allocated between resident bedrooms and private or common living and dining areas; clarifies requirements related to bedroom windows, and relocates requirements related to the preparation of food and operation of the kitchen, which are not facility construction requirements, to §553.275.

The proposed amendment to §553.113, Means of Escape Requirements for an Existing Small Type A Assisted Living Facility, clarifies requirements for doors between resident bedrooms or living units and corridors when the assisted living facility does not have a fire sprinkler system.

The proposed amendment to §553.115, Fire Protection Systems Requirements for an Existing Small Type A Assisted Living Facility, clarifies the application of fire sprinkler system requirements in NFPA 101, extends the period for an existing assisted living facility with a fire sprinkler system to protect an attic by two years, to August 31, 2026, which is necessary because of the challenges assisted living facilities had obtaining the services to perform that work during the COVID-19 public health emergency, and standardizes the hyphenation of a word.

The proposed amendment to §553.118, Electrical Requirements for an Existing Small Type A Assisted Living Facility, clarifies minimum lighting requirements, updates communication system requirements at an assisted living facility to permit any technology that meets the communication system requirements, and clarifies the performance requirements for a communication system.

The proposed amendment to §553.119, Miscellaneous Requirements for an Existing Small Type A Assisted Living Facility, incorporates direct references related to furnishings, mattresses, and decorations, in NFPA 101, Life Safety Code, 2012 edition, as a convenience to assisted living facilities.

The proposed amendment to §553.121, Construction Requirements for an Existing Small Type B Assisted Living Facility, replaces "Texas Health and Human Services Commission" with the defined term "HHSC;" and incorporates, as a convenience to assisted living facilities, direct references to applicable requirements for certain assisted living facilities in NFPA 101, Life Safety Code, 2012 edition, as a convenience to assisted living facilities.

The proposed amendment to §553.122, Space Planning and Utilization Requirements for an Existing Small Type B Assisted Living Facility, replaces the term "social-diversional space" with "common living area;" clarifies the requirements for common living areas and dining areas; clarifies the intent of provisions that allow floor area within the assisted living facility to be allocated between resident bedrooms and private or common living and dining areas; clarifies requirements related to bedroom windows; and relocates requirements related to the preparation of food and operation of the kitchen, which are not facility construction requirements, to §553.275.

The proposed amendment to §553.125, Fire Protection Systems Requirements for an Existing Small Type B Assisted Living Facility, clarifies the statement of requirements for fire alarm system power supply sources; clarifies the application of fire sprinkler system requirements in NFPA 101; extends the period for an existing assisted living facility with a fire sprinkler system to protect an attic by two years, to August 31, 2026, which is necessary because of the challenges assisted living facilities had obtaining the services to perform that work during the COVID-19 public health emergency; and standardizes the hyphenation of a word.

The proposed amendment to §553.128, Electrical Requirements for an Existing Small Type B Assisted Living Facility, clarifies minimum lighting requirements, updates communication system requirements at an assisted living facility to permit any technology that meets the communication system requirements, and clarifies the performance requirements for a communication system.

The proposed amendment to §553.129, Miscellaneous Requirements for an Existing Small Type B Assisted Living Facility, incorporates, as a convenience to assisted living facilities, direct references to applicable requirements for certain assisted living facilities, in NFPA 101, Life Safety Code, 2012 edition.

The proposed amendment to §553.131, Construction Requirements for an Existing Large Type A Assisted Living Facility, incorporates direct references to applicable requirements for certain assisted living facilities, in NFPA 101, Life Safety Code, 2012 edition, as a convenience to assisted living facilities.

The proposed amendment to §553.132, Space Planning and Utilization Requirements for an Existing Large Type A Assisted Living Facility, replaces "Texas Health and Human Services Commission" with the defined acronym "HHSC;" replaces the term "social-diversional space" with "common living area;" clarifies the requirements for common living areas and dining areas; clarifies the intent of provisions that allow floor area within the assisted living facility to be allocated between resident bedrooms and private or common living and dining areas; clarifies requirements related to bedroom windows; relocates requirements related to the preparation of food and operation of the kitchen, which are not facility construction requirements, to §553.275; removes references to grease traps, which may be required by local jurisdictions but are not required by HHSC; relocates the figure from subsection (g)(1)(C) to (g)(1)(A) and the figure in subsection (g)(2)(D) to (g)(2)(A); and standardizes hyphenation.

The proposed amendment to §553.133, Means of Egress Requirements for an Existing Large Type A Assisted Living Facility, clarifies requirements related to inspection of doors in a means of egress already required of an assisted living facility.

The proposed amendment to §553.135, Fire Protection Systems Requirements for an Existing Large Type A Assisted Living Facility, allows the use of smoke alarms or smoke detectors in resident living units containing independent cooking equipment; clarifies the statement of requirements for fire alarm system power supply sources; extends the period for an assisted living facility with a fire sprinkler system to protect an attic by two years, to August 31, 2026, which is necessary because of the challenges assisted living facilities had obtaining the services to perform that work during the COVID-19 public health emergency; clarifies rule language; and standardizes the hyphenation of a word.

The proposed amendment to §553.137, Mechanical Requirements for an Existing Large Type A Assisted Living Facility, clarifies the minimum required number of water closets and lavatories.

The proposed amendment to §553.138, Electrical Requirements for an Existing Large Type A Assisted Living Facility, clarifies minimum lighting requirements, updates communication system requirements at an assisted living facility to permit any technology that meets the communication system requirements, and clarifies the performance requirements for a communication system.

The proposed amendment to §553.139, Miscellaneous Requirements for an Existing Large Type A Assisted Living Facility, incorporates, as a convenience to assisted living facilities, direct references to applicable requirements for certain assisted living facilities, in NFPA 101, Life Safety Code, 2012 edition.

The proposed amendment to §553.141, Construction Requirements for an Existing Large Type B Assisted Living Facility, replaces "Texas Health and Human Services Commission" with the defined term "HHSC;" incorporates, as a convenience to assisted living facilities, direct references to applicable requirements for certain assisted living facilities, in NFPA 101, Life Safety Code, 2012 edition; and clarifies requirements related to high-rise buildings already required of an assisted living facility.

The proposed amendment to §553.142, Space Planning and Utilization Requirements for an Existing Large Type B Assisted Living Facility, replaces "Texas Health and Human Services Commission" with the defined term "HHSC;" replaces the term "social-diversional space" with "common living area;" clarifies the requirements for common living areas and dining areas; clarifies the intent of provisions that allow floor area within the assisted living facility to be allocated between resident bedrooms and private or common living and dining areas; clarifies requirements related to bedroom windows; relocates requirements related to the preparation of food and operation of the kitchen, which are not facility construction requirements, to §553.275; relocates the figure from subsection (g)(1)(C) to (g)(1)(A) and the figure in subsection (g)(2)(D) to (g)(2)(A); and standardizes the hyphenation of a word.

The proposed amendment to §553.143, Means of Egress Requirements for an Existing Large Type B Assisted Living Facility, specifies that door-locking arrangements described in NFPA 101, Chapter 19, Existing Health Care Occupancies, 19.2.2.2.5, are not permitted and clarifies requirements related to maintenance of the means of egress already required of an assisted living facility.

The proposed amendment to §553.145, Fire Protection Systems Requirements for an Existing Large Type B Assisted Living Facility, allows the use of smoke alarms or smoke detectors in resident living units containing independent cooking equipment.

The proposed amendment to §553.147, Mechanical Requirements for an Existing Large Type B Assisted Living Facility, clarifies the minimum required number of water closets and lavatories, and clarifies requirements related to portable space-heating devices already required of an assisted living facility.

The proposed amendment to §553.148, Electrical Requirements for an Existing Large Type B Assisted Living Facility, clarifies minimum lightening requirements, updates communication system requirements at an assisted living facility to permit any technology that meets the communication system requirements and clarifies the performance requirements for a communication system.

The proposed amendment to §553.149, Miscellaneous Requirements for an Existing Large Type B Assisted Living Facility, incorporates, as a convenience to assisted living facilities, direct references to applicable requirements for certain assisted living facilities, in NFPA 101, Life Safety Code, 2012 edition.

The proposed amendment to §553.211, Construction Requirements for a New Small Type A Assisted Living Facility, incorporates, as a convenience to assisted living facilities, direct references to applicable requirements for certain assisted living facilities, in NFPA 101, Life Safety Code, 2012 edition.

The proposed amendment to §553.212, Space Planning and Utilization Requirements for a New Small Type A Assisted Living Facility, replaces "Texas Health and Human Services Commission" with the defined term "HHSC;" replaces the term "social-diversional space" with "common living area;" clarifies the requirements for common living areas and dining areas; clarifies the intent of provisions that allow floor area within the assisted living facility to be allocated between resident bedrooms and private or common living and dining areas; clarifies requirements related to bedroom windows; and relocates requirements related to the preparation of food and operation of the kitchen, which are not facility construction requirements, to §553.275.

The proposed amendment to §553.215, Fire Protection Systems Requirements for a New Small Type A Assisted Living Facility, adds clarity to a requirement related to electronic supervision of a fire sprinkler system.

The proposed amendment to §553.218, Electrical Requirements for a New Small Type A Assisted Living Facility, clarifies minimum lighting requirements, updates communication system requirements at an assisted living facility to permit any technology that meets the communication system requirements, and clarifies the performance requirements for a communication system.

The proposed amendment to §553.219, Miscellaneous Requirements for a New Small Type A Assisted Living Facility, incorporates, as a convenience to assisted living facilities, direct references to applicable requirements for certain assisted living facilities, in NFPA 101, Life Safety Code, 2012 edition.

The proposed amendment to §553.221, Construction Requirements for a New Small Type B Assisted Living Facility, incorporates, as a convenience to assisted living facilities, direct references to applicable requirements for certain assisted living facilities, in NFPA 101, Life Safety Code, 2012 edition.

The proposed amendment to §553.222, Space Planning and Utilization Requirements for a New Small Type B Assisted Living Facility, replaces "Texas Health and Human Services Commission" with the defined term "HHSC;" replaces the term "social-diversional space" with "common living area;" clarifies the requirements for common living areas and dining areas; clarifies the intent of provisions that allow floor area within the assisted living facility to be allocated between resident bedrooms and private or common living and dining areas; clarifies requirements related to bedroom windows; and relocates requirements related to the preparation of food and operation of the kitchen, which are not facility construction requirements, to §553.275.

The proposed amendment to §553.225, Fire Protection Systems Requirements for a New Small Type B Assisted Living Facility, adds clarity to a requirement related to electronic supervision of a fire sprinkler system.

The proposed amendment to §553.228, Electrical Requirements for a New Small Type B Assisted Living Facility, clarifies minimum lighting requirements, updates communication system requirements at an assisted living facility to permit any technology that meets the communication system requirements, and clarifies the performance requirements for a communication system.

The proposed amendment to §553.229, Miscellaneous Requirements for a New Small Type B Assisted Living Facility, incorporates, as a convenience to assisted living facilities, direct references to applicable requirements for certain assisted living facilities, in NFPA 101, Life Safety Code, 2012 edition.

The proposed amendment to §553.231, Construction Requirements for a New Large Type A Assisted Living Facility, clarifies the application of requirements for interior finish materials.

The proposed amendment to §553.232, Space Planning and Utilization Requirements for a New Large Type A Assisted Living Facility, replaces the term "social-diversional space" with "common living area;" clarifies the requirements for common living areas and dining areas; clarifies the intent of provisions that allow floor area within the assisted living facility to be allocated between resident bedrooms and private or common living and dining areas; clarifies requirements related to bedroom windows and relocates requirements related to the preparation of food and operation of the kitchen, which are not facility construction requirements, to §553.275; relocates the figure from subsection (g)(1)(C) to (g)(1)(A) and the figure in subsection (g)(2)(D) to (g)(2)(A); and standardizes hyphenation.

The proposed amendment to §553.233, Means of Egress Requirements for a New Large Type A Assisted Living Facility, clarifies requirements related to inspection of doors in a means of egress already required of an assisted living facility.

The proposed amendment to §553.235, Fire Protection Systems Requirements for a New Large Type A Assisted Living Facility, corrects NFPA 101 references, clarifies rule language, and standardizes a hyphenation.

The proposed amendment to §553.237, Mechanical Requirements for a New Large Type A Assisted Living Facility, corrects a typographical error and a hyphenation.

The proposed amendment to §553.238, Electrical Requirements for a New Large Type A Assisted Living Facility, clarifies minimum lighting requirements, updates communication system requirements at an assisted living facility to permit any technology that meets the communication system requirements, and clarifies the performance requirements for a communication system.

The proposed amendment to §553.239, Miscellaneous Requirements for a New Large Type A Assisted Living Facility, incorporates, as a convenience to assisted living facilities, direct references to applicable requirements for certain assisted living facilities, in NFPA 101, Life Safety Code, 2012 edition.

The proposed amendment to §553.241, Construction Requirements for a New Large Type B Assisted Living Facility, clarifies occupancy separation requirements in new large Type B assisted living facilities.

The proposed amendment to §553.242, Space Planning and Utilization Requirements for a New Large Type B Assisted Living Facility, replaces the term "social-diversional space" with "common living area;" clarifies the requirements for common living areas and dining areas; clarifies the intent of provisions that allow floor area within the assisted living facility to be allocated between resident bedrooms and private or common living and dining areas; clarifies requirements related to bedroom windows; standardizes a hyphenation; relocates the figure from subsection (g)(1)(C) to (g)(1)(A) and the figure in subsection (g)(2)(D) to (g)(2)(A); and relocates requirements related to the preparation of food and operation of the kitchen, which are not facility construction requirements, to §553.275.

The proposed amendment to §553.243, Means of Egress Requirements for a New Large Type B Assisted Living Facility, specifies that door-locking arrangements described in NFPA 101, Chapter 18, New Health Care Occupancies, 18.2.2.2.5, are not permitted and clarifies requirements related to maintenance of the means of egress already required of an assisted living facility.

The proposed amendment to §553.245, Fire Protection Systems Requirements for a New Large Type B Assisted Living Facility, corrects an error to a reference and allows the use of smoke alarms or smoke detectors in resident living units containing independent cooking equipment.

The proposed amendment to §242.246, Hazardous Area Requirements for a New Large Type B Assisted Living Facility, corrects references.

The proposed amendment to §553.247, Mechanical Requirements for a New Large Type B Assisted Living Facility, incorporates, as a convenience to assisted living facilities, direct references to applicable requirements for certain assisted living facilities, in NFPA 101, Life Safety Code, 2012 edition, and standardizes hyphenation.

The proposed amendment to §553.248, Electrical Requirements for a New Large Type B Assisted Living Facility, clarifies minimum lighting requirements, updates communication system requirements at an assisted living facility to permit any technology that meets the communication system requirements, and clarifies the performance requirements for a communication system.

The proposed amendment to §553.249, Miscellaneous Requirements for a New Large Type B Assisted Living Facility, incorporates, as a convenience to assisted living facilities, direct references to applicable requirements for certain assisted living facilities, in NFPA 101, Life Safety Code, 2012 edition.

New Division 12 is added in Subchapter D, titled "Specialized Assisted Living Facilities."

Proposed new §553.250, Construction Requirements for a Certified Alzheimer's Assisted Living Facility, has construction requirements from repealed §553.311 so that these requirements are located with the other facility construction requirements in Subchapter D and are easier to find. The proposed new rule organizes requirements for Alzheimer's certification based on whether an assisted living facility is small or large and whether it is fully locked or contains one or more certified Alzheimer's assisted living units.

Subchapter E, Standards For Licensure

The proposed amendment to §553.253, Employee Qualifications and Training, reorganizes manager and staff training requirements to add clarity. To be exempt from the 24-hour training course requirement, the amendment increases the time period an assisted living manager can have a break in employment as an assisted living manager from 30 days to 90 days and clarifies that subject matter dealing with internal affairs of an organization does not qualify for credit toward the 24-hour manager training course. The amendment to the section specifies that an attendant can have certification of equivalence of graduation and that a facility must have dedicated staff on duty for each shift and not share on-duty attendants with another facility or provider type. It also adds details to the required posting of the facility's 24-hour staffing pattern, contains a statement that a facility must not use a companion care provider or solicit or involve family members to provide care to residents to mitigate staffing shortages, adds infection prevention and control principles to the list of required staff training and continued education, and removes the word "certified" from training requirements for medication aides, as medication aides are not certified.

The proposed amendment to §553.254, Training Requirements for Staff Providing Personal Care Services to a Resident With Alzheimer's Disease or a Related Disorder in a Facility that is Not an Alzheimer's Certified Facility, incorporates the training policy requirement from repealed §553.255 so all training required for employees providing services to residents with Alzheimer's and related disorders is grouped into one section and there is no redundant information. The word "With" in the title of this section is changed to "with."

The proposed repeal of §553.255, All Staff Policy for Residents with Alzheimer's Disease or a Related Disorder, removes redundant requirements that are located in other sections relating to training policy requirements for employees of facilities with residents who have Alzheimer's disease and related disorders.

The proposed amendment to §553.259, Admission Policies and Procedures, adds that a facility must not admit a resident under the age of 18 years unless the person is an emancipated minor. The amendment adds the requirement for a facility to share the facility's disclosure statement and resident service plans with outside resources and obtain resident service (or care) plans from outside resources, adds a requirement that an assisted living facility that allows pets must have a pet policy, and specifies the information the pet policy must include. It also adds a requirement for a facility to address the use of service animals in accordance with the Americans with Disabilities Act, changes the term "resident assessment" to "resident evaluation," states the resident evaluation must be completed annually and upon a significant change in condition, and updates references. The amendment also relocates the statement that a facility is responsible for all care provided by the facility to §553.7, Assisted Living Facility Services, and information regarding inappropriate placement in Type A or Type B facilities to new §553.261 and adds a provision related to advance directives that facilities that employ a nurse must address nurse interventions during a life-threatening emergency.

The proposed repeal of §553.261, Coordination of Care, deletes the rule. New rules are proposed in Subchapter E based on the topic of each subsection of §553.261. These topics include: Medications; Accident, Injury or Acute Illness; Health Care Professional; Activities Program; Dietary Services; Infection Prevention and Control; and Restraints and Seclusion; which includes Wheelchair Self-Release Seat Belts.

The proposed repeal of §553.263, Health maintenance activities; §553.265, Resident Records and Retention; §553.267, Rights; §553.269, Access to Residents and Records by the State Long-Term Care Ombudsman Program; §553.271, Postings; §553.272, Advertisements, Solicitations, and Promotional Material; §553.273, Abuse, Neglect, or Exploitation Reportable to HHSC by Facilities; and §553.275, Emergency Preparedness and Response, deletes the rules. New rules are proposed with the same topics in Subchapter E. Repealing these rules, makes the section numbers available for new rules with the provisions from repealed §553.261. This keeps related key topics grouped together within the subchapter.

Proposed new §553.261, Inappropriate Placement in a Type A or Type B Facility, relocates content from §553.259 regarding inappropriate placement in Type A or Type B facilities and does not include the requirement for annual completion of HHSC training on aging in place and retaliation, as the requirement was removed from Texas Health and Safety Code §247.066 by House Bill 2358, 89th Legislature, Regular Session, 2025.

Proposed new §553.263, Resident Transfer and Discharge, requires the facility to establish a policy relating to resident transfer and discharge. It outlines residents' rights pertaining to being transferred or discharged. The information is from repealed §553.267.

Proposed new §553.265, Respite Admissions, provides requirements concerning residents admitted for respite care.

Proposed new §553.267, Medications, has requirements from repealed §553.261. The proposed new rule adds requirements for assisted living facilities to have written medication policies and procedures and maintain a medication profile record and a medication administration record for each resident who receives medication administration or supervision. Staff must record all medication doses administered and missed in the medication administration record. Previously, the rule only required staff to record missed doses.

The proposed new rule also adds guidance for assisted living facilities that administer medications with parameters and requires an assisted living facility that charges a fee for residents who choose not to use the facility's preferred pharmacy to disclose how the facility determines the amount of the fee. The requirement for monthly medication counseling for residents who self-administer medications is amended to require additional medication counseling whenever a resident has a significant change in condition that might affect the ability to self-administer medications. The option to include a medication take-back program is added to the requirement that drug disposal be carried out by a licensed pharmacist.

Proposed new §553.269, Accident, Injury, or Acute Illness, has requirements from repealed §553.261, with updated references. This new rule also provides a requirement for facilities to notify any outside resources that provide care to a resident who has been injured or had an accident or acute illness, within 48 hours. A facility must also provide a brief description of the accident, injury, or acute illness, the resident's location at the time of notification, and an estimated return date to the facility, if applicable, in order to coordinate continued care and services.

Proposed new §553.271, Health Care Professional, relocates requirements from repealed §553.261. This section describes that a health care professional may provide services to a resident within the health care professional's scope of practice. A resident may contract with a home and community support services agency licensed under Chapter 558 of this title, or with an independent health professional to have health care services delivered to the resident at the facility.

Proposed new §553.273, Activities Program, has requirements from repealed §553.261. This new rule changes the requirement from offering residents an activity at least once a week to offering residents a daily activity.

Proposed new §553.275, Dietary Services, has requirements from repealed §553.261. This rule contains requirements for food preparation and kitchen area from other amended rules in Subchapter D, Facility Construction, as the guidance is relevant in this rule. It also adds a requirement that staff who work with or handle unpackaged food must complete an accredited food handler training course and clarifies that the three daily meals or the equivalent must include all five basic food groups.

Proposed new §553.277, Infection Prevention and Control, has requirements from repealed §553.261. The new rule adds that during a declared public health emergency or disaster, the facility must also follow the requirements in Chapter 570, Subchapter B. The new rule also provides additional guidance for employee tuberculosis (TB) screening and decreases the requirement for employee TB education from annually to at least once every 24 months.

Proposed new §553.279, Restraints and Seclusion, has requirements from repealed §553.261. This section describes the circumstances under which restraints can be used and contains the requirements pertaining to wheelchair self-release seat belts. It also adds specific guidance pertaining to the use of bed rails.

Proposed new §553.281, Health Maintenance Activities, has requirements from repealed §553.263. This section describes the requirements for providing health maintenance activities. It also removes the provisions relating to RN delegation because RN delegation is separate from health maintenance activities and has different requirements. The provisions relating to RN delegation are proposed in new §553.283.

Proposed new §553.283, RN Delegation of Care Tasks, has requirements from repealed §553.263. The new rule clarifies that RN delegation is distinct from health maintenance activities. The proposed new rule clarifies that an RN providing RN delegation to staff of the assisted living facility must be an employee or a contractor of the assisted living facility.

Proposed new §553.285, Resident Records and Retention, has requirements from repealed §553.265. The new rule also adds a requirement to retain resident records for at least five years after services end and provides guidance pertaining to electronic records and destruction of records.

Proposed new §553.287, Rights, has requirements from repealed §553.267. The new rule specifies that an assisted living facility must provide a copy of the Residents' Bill of Rights to each resident or resident's legally authorized representative in the resident's primary language and adds specificity and clarity to rules pertaining to residents' rights to privacy and retaining personal property. The rule also adds a requirement for an assisted living facility to allow residents to form and participate in resident councils. The provisions regarding residents' rights pertaining to being transferred or discharged are relocated to new §553.263.

Proposed new §553.289, Access to Residents and Records by the State Long-Term Care Ombudsman Program, has requirements from repealed §553.269. It adds the requirement that a facility must not require complaints to be made to the assisted living facility before making a complaint to the Ombudsman Program.

Proposed new §553.291, Postings, has requirements from repealed §553.271. It also adds requirements to post the facility's evacuation floor plan, unless the facility is one-story or is licensed for fewer than 17 residents, the facility's meal menu for the current week, resident daily activities scheduled for the current month, emergency telephone numbers, and notices about electronic monitoring.

Proposed new §553.292, Advertisements, Solicitations, and Promotional Material, has requirements from repealed §553.272. This section describes the requirement for assisted living facilities to include the state-issued identification number in all advertisements and promotional material and adds forms of advertisement to include social media accounts and websites.

Proposed new §553.293, Abuse, Neglect, or Exploitation and Incidents Reportable to HHSC by Facilities, has requirements from repealed §553.273. This section describes the requirements and procedures for reporting abuse, neglect, and exploitation, and specifies which incidents must be reported to HHSC and law enforcement.

Proposed new §553.295, Emergency Preparedness and Response, has requirements from repealed §553.275. This section describes the requirement for assisted living facilities to have policies and procedures in place, and follow them, in the event of an emergency or disaster. It also adds the clarification that having an evacuation summary is a requirement, and not optional.

Subchapter F, Additional Licensing Standards For Certified Alzheimer's Assisted Living Facilities

The proposed amendment to §553.301, Manager Qualifications and Training, adds "Alzheimer's Certified Facility or Unit" and other clarifications to the title. The update aims to clearly differentiate between rules addressing Alzheimer's certified facilities and those that do not. Edits are made to add references and correct grammar.

The proposed amendment to §553.303, Staff Training, adds "Alzheimer's Certified Facility or Unit" and other clarifications to the title. The update aims to clearly differentiate between rules addressing Alzheimer's certified facilities and those that do not. The amendments also clarify certain guidance to make information easier to find and understand.

The proposed amendment to §553.305, Staffing, adds "Alzheimer's Certified Facility or Unit" and other clarifications to the title. The update aims to clearly differentiate between rules addressing Alzheimer's certified facilities and those that do not. The amendments also clarify certain guidance.

The proposed amendment to §553.307, Admission Procedures, Assessment, and Service Plan, adds "Alzheimer's Certified Facility or Unit" and other clarifications to the title. The update aims to clearly differentiate between rules addressing Alzheimer's certified facilities and those that do not. The amendments also clarify certain guidance.

The proposed amendment to §553.309, Activities Program, add "Alzheimer's Certified Facility or Unit" and other clarifications to the title. The update aims to clearly differentiate between rules addressing Alzheimer's certified facilities and those that do not. The amendments also reorganize some rules and clarify certain guidance to make information easier to find and understand.

The proposed repeal of §553.311, Physical Plant Requirements for Alzheimer's Units, deletes the rule. The information from the rule is relocated to new proposed §553.250.

Subchapter G, Inspections, Investigations, and Informal Dispute Resolution

The proposed amendment to §553.327, Inspections, Investigations, and Other Visits, adds a requirement that an assisted living facility that maintains electronic records must have a mechanism for printing all documentation if a surveyor or investigator requests a printed copy. The amendment also corrects grammatical error.

Proposed new §553.328, Plan of Removal, specifies procedures for a facility to submit a plan of removal if HHSC has found a violation that creates an immediate threat to health and safety of a resident.

The proposed amendment to §553.331, Determinations and Actions (Investigation Findings), adds a form name and standardizes hyphenation.

The proposed amendment to §553.333, Informal Dispute Resolution, adds specificity to how HHSC redacts or excludes information on documents related to an informal dispute resolution and updates references.

Subchapter H, Enforcement

The proposed repeal of the following rules in Subchapter H deletes the rules as the provisions from these rules are proposed in new rules, rewritten in standard format rather than the question-and-answer style. The repealed sections are §§553.351 and 553.353 in Division 1; 553.401, 553.403, 553.405, 553.407, 553.409, 553.411, 553.413, 553.415, 553.417, 553.419, 553.421, 553.423, 553.425, 553.427, 553.429, 553.431, 553.433, 553.435, 553.437, and 553.439 in Division 2; 553.451, 553.453, 553.455, 553.457, 553.459, 553.461, 553.463, 553.465, 553.467, 553.469, 553.471, 553.473, 553.475, 553.477, 553.479, 553.481, and 553.483 in Division 3; 553.501 and 553.503 in Division 4; 553.551, 553.553, 553.555, 553.557, 553.559, 553.561, 553.563, 553.565, 553.567, 553.569, 553.571, 553.573, 553.575, 553.577, 553.579, 553.581, 553.583, 553.585, 553.587, 553.589, 553.591, 553.593, 553.595, and 553.597 in Division 5; 553.601 and 553.603 in Division 6; 553.651, 553.653, 553.655, 553.657, 553.659, and 553.661 in Division 7; 553.701, 553.703, 553.705, 553.707, 553.709, and 553.711 in Division 8.

Proposed new §553.351, Enforcement General Information, has requirements from the repealed sections of Subchapter H, Division 1. The proposed new rule rewrites the rules in standard format rather than the question-and-answer style. The rule provides when HHSC may take enforcement actions and the type of enforcement actions that may be taken.

Proposed new §553.401, Suspension Actions Against a License, has requirements from the repealed sections of Subchapter H, Division 2. The proposed new rule is written in standard format rather than the question-and-answer style. The rule provides when HHSC may suspend a facility's license and describes the process for suspension as well as the opportunity to show compliance and the right to appeal.

Proposed new §553.451, Revocation Actions Against a License, has requirements from repealed Subchapter H, Division 3. The proposed new rule is written in standard format rather than the question-and-answer style. The rule provides when HHSC may revoke a facility's license and describes the process for revocation as well as the opportunity to show compliance and the right to appeal.

Proposed new §553.501, Temporary Restraining Order and Injunctions Against a License, has requirements from repealed Subchapter H, Division 4. The proposed new rule is written in standard format rather than the question-and-answer style. The rule provides when HHSC will refer a facility to the Office of Attorney General and where HHSC will refer a facility that is operating without a license.

Proposed new §553.551, Emergency License Suspension and Closing Order Actions Against a License, has requirements from repealed Subchapter H, Division 5. The proposed new rule is written in standard format rather than the question-and-answer style. The rule provides when HHSC can suspend a license or order an immediate closing of all or part of a facility and the actions the facility must take when a facility is closed partly or fully.

Proposed new §553.601, Civil Penalties, has requirements from repealed Subchapter H, Division 6. The proposed new rule is written in standard format rather than the question-and-answer style. The rule provides when HHSC may refer a facility to the Office of the Attorney General and when civil penalties can be assessed.

Proposed new §553.651, Involuntary Appointment of a Trustee, has requirements from repealed Subchapter H, Division 7. The proposed new rule is written in standard format rather than the question-and-answer style. The rule provides when HHSC may petition a court for involuntary appointment of a trustee to operate a facility and when HHSC may provide emergency assistance funds.

Proposed new §553.701, Appointment of a Trustee by Agreement, has requirements from repealed Subchapter H, Division 8. The proposed new rule is written in standard format rather than the question-and-answer style. The rule provides what happens when a facility requests the appointment of a trustee.

The proposed amendment to §553.751, Administrative Penalties, changes the term "opportunity to correct" to "right to correct," makes edits for formatting and consistency, and updates references.

FISCAL NOTE

Victoria Grady, Deputy Chief, Finance, has determined that for each year of the first five years that the rules will be in effect, enforcing or administering the rules do not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the rules will be in effect:

(1) the proposed rules will not create or eliminate a government program;

(2) implementation of the proposed rules will not affect the number of HHSC employee positions;

(3) implementation of the proposed rules will result in no assumed change in future legislative appropriations;

(4) the proposed rules will not affect fees paid to HHSC;

(5) the proposed rules will create new regulations;

(6) the proposed rules will expand and repeal existing regulations;

(7) the proposed rules will not change the number of individuals subject to the rules; and

(8) the proposed rules will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Victoria Grady has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities. The rules do not impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply with the rules.

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to these rules because the rules are necessary to protect the health, safety, and welfare of the residents of Texas; the rules do not impose a cost on regulated persons; and the rules are amended to reduce the burden or responsibilities imposed on regulated persons by the rules.

PUBLIC BENEFIT AND COSTS

David Kostroun, Chief Regulatory Services Officer, has determined that for each year of the first five years the rules are in effect, the public will benefit from increased clarity in the rules and more specific guidance concerning staff training requirements, general characteristics of residents in assisted living facilities, and residents' rights. The rules clarify provider responsibilities which will benefit assisted living facility providers, staff, and the public. The rules will also make the survey process more consistent throughout the state and better protect the health and safety of the residents served.

Victoria Grady has also determined that for the first five years the rules are in effect, there are no anticipated economic costs for persons required to comply with the proposed rules because there are no requirements to alter current business practices and there are no new fees or costs imposed on those required to comply.

TAKINGS IMPACT ASSESSMENT

HHSC has determined that the proposal does not restrict or limit an owner's right to the owner's property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.

PUBLIC COMMENT

Written comments on the proposal, including information related to the cost, benefit, or effect of the proposed rule, as well as any applicable data, research, or analysis, may be submitted to Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 4601 West Guadalupe Street, Austin, Texas 78751; or emailed to HHSRulesCoordinationOffice@hhs.texas.gov.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period, (2) hand-delivered before 5:00 p.m. on the last working day of the comment period, or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 25R031" in the subject line.

SUBCHAPTER A. INTRODUCTION

26 TAC §§553.3, 553.5, 553.7, 553.9

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §524.0005, which provides that the executive commissioner of HHSC shall adopt rules to implement the executive commissioner's authority under Texas Government Code Chapter 524 with respect to the health and human services system, and §524.0151, which provides that the executive commissioner of HHSC shall adopt rules necessary to carry out the commission's duties under Texas Government Code Chapter 531 and adopt rules and policies for the operation and provision of services by the health and human services agencies; and Texas Health and Safety Code §247.025 and §247.026, which provide that the executive commissioner of HHSC shall adopt rules necessary to implement Texas Health and Safety Code Chapter 247 and to ensure the quality of care and protection of assisted living facility residents' health and safety, respectively.

The amendments implement Texas Government Code §524.0005 and §524.0151 and Texas Health and Safety Code §247.025 and §247.026.

§553.3. Definitions.

The following [ ~~words and~~ ] terms[ , ] when used in this chapter[ , ] have the following meanings [ ~~meaning~~ ], unless the context clearly indicates otherwise.

(1) Abuse-- Has the meaning provided in Texas Health and Safety Code §260A.001.

[(A) For a person under 18 years of age who is not and has not been married or who has not had the disabilities of minority removed for general purposes, the term has the meaning in Texas Family Code §261.001(1), which is an intentional, knowing, or reckless act or omission by an employee, volunteer, or other individual working under the auspices of a facility or program that causes or may cause emotional harm or physical injury to, or the death of, a child served by the facility or program, as further described by rule or policy; and]

[(B) For a person other than one described in subparagraph (A) of this paragraph, the term has the meaning in Texas Health and Safety Code §260A.001(1), which is:]

[(i) the negligent or willful infliction of injury, unreasonable confinement, intimidation, or cruel punishment with resulting physical or emotional harm or pain to a resident by the resident's caregiver, family member, or other individual who has an ongoing relationship with the resident; or]

[(ii) sexual abuse of a resident, including any involuntary or nonconsensual sexual conduct that would constitute an offense under Texas Penal Code §21.08 (relating to Indecent Exposure), or Texas Penal Code, Chapter 22 (relating to Assaultive Offenses), committed by the resident's caregiver, family member, or other individual who has an ongoing relationship with the resident.]

(2) Accreditation commission--Has the meaning provided [ ~~given~~ ] in Texas Health and Safety Code §247.032.

(3) Activities of daily living--Activities routinely performed in the normal course of the day, including bathing, oral care, dressing, grooming, routine hair care, routine skin and nail care, meal preparation, feeding, exercising, toileting, transfer or ambulation, positioning, and assistance with self-administered medications. The term does not include HMAs and tasks performed under RN delegation, which must be assessed in accordance with applicable Texas Board of Nursing rules in 22 TAC Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions).

(4) [ ~~(3)~~ ] Actual harm--A negative outcome that compromises a resident's physical, mental, or emotional well-being.

(5) [ ~~(4)~~ ] Advance directive--Has the meaning provided [ ~~given~~ ] in Texas Health and Safety Code §166.002.

(6) [ ~~(5)~~ ] Affiliate--With respect to:

(A) a corporation: [ ~~a partnership, each partner thereof;~~ ]

(i) each officer and director;

(ii) each stockholder with a disclosable interest; and

(iii) any subsidiary or parent company of the corporation;

(B) a limited liability company: [ ~~a corporation, each officer, director, principal stockholder, subsidiary, or person with a disclosable interest, as the term is defined in this section; and~~ ]

(i) each officer;

(ii) each member;

(iii) each manager; or

(iv) parent company;

(i) the individual's spouse, if the individual is a sole proprietor; [ ~~said person's spouse;~~ ]

(ii) each partnership and each partner thereof of which the individual or any affiliate of the individual is a partner; and [ ~~each partnership and each partner thereof, of which said person or any affiliate of said person is a partner; and~~ ]

(iii) each corporation in which the individual is an officer, director, or a stockholder with a disclosable interest in the corporation; [ ~~each corporation in which said person is an officer, director, principal stockholder, or person with a disclosable interest.~~ ]

(D) a partnership:

(i) each partner in the partnership, including general and limited partners (regardless of the percentage of direct or indirect ownership or controlling authority); and

(ii) any parent company of the partnership;

(E) a trust, each trustee of the trust; and

(F) a group of co-owners under any other business arrangement:

(i) each officer;

(ii) each director, or the equivalent under the specific business arrangement; and

(iii) any parent company of the business.

(7) [ ~~(6)~~ ] Alzheimer's Assisted Living Disclosure Statement form--The HHSC-prescribed form a facility uses to describe the nature of care or treatment of residents with Alzheimer's disease and related disorders.

(8) [ ~~(7)~~ ] Alzheimer's disease and related disorders--Alzheimer's disease and any other irreversible dementia described by the Centers for Disease Control and Prevention (CDC), or in the most current edition of the Diagnostic and Statistical Manual of Mental Disorders.

(9) [ ~~(8)~~ ] Alzheimer's facility--A Type B facility that is certified to provide specialized services to residents with Alzheimer's disease or a related condition.

(10) [ ~~(9)~~ ] Applicant--A person applying for a license to operate an assisted living facility under Texas Health and Safety Code[ , ] Chapter 247.

(11) [ ~~(10)~~ ] Assisted Living Facility Memory Care Disclosure Statement form--The HHSC-prescribed form that a facility uses when the facility advertises, markets, or otherwise promotes that it provides memory care services to residents with Alzheimer's disease and related disorders.

(12) Assistive devices--Products or tools for residents designed to help residents be more independent and improve quality of life. Assistive devices help residents complete activities of daily living and make walking and moving from place to place easier and safer, whether it is with or without staff assistance.

(13) [ ~~(11)~~ ] Attendant--A facility employee who provides personal care services to residents and performs other duties in the facility as needed. [ ~~direct care to residents. This employee may serve other functions, including cook, janitor, porter, maid, laundry worker, security personnel, bookkeeper, activity director, and manager.~~ ]

(14) [ ~~(12)~~ ] Authorized electronic monitoring (AEM)--The placement and use of an electronic monitoring device to record audio, video, or both, after meeting the requirements to allow electronic monitoring. [ ~~of an electronic monitoring device in a resident's room and using the device to make tapes or recordings after making a request to the facility to allow electronic monitoring.~~ ]

(15) [ ~~(13)~~ ] Behavioral emergency--Has the meaning provided [ ~~given~~ ] in §553.279 of this chapter (relating to Restraints and Seclusion). [ ~~§553.261(g)(2) of this chapter (relating to Coordination of Care).~~ ]

(16) Capacity--The number of residents for which a facility is licensed to provide services, regardless of census.

(17) [ ~~(14)~~ ] Certified ombudsman--Has the meaning provided [ ~~given~~ ] in §88.2 of this title (relating to Definitions).

(18) [ ~~(15)~~ ] CFR--Code of Federal Regulations.

(19) [ ~~(16)~~ ] Change of ownership--An event that results in a change to the federal taxpayer identification number of the license holder of a facility. The substitution of a personal representative for a deceased license holder is not a change of ownership.

~~[(17) Commingles--The laundering of apparel or linens of two or more individuals together.]~~

(20) [ ~~(18)~~ ] Controlling person--[ A person with the ability, acting alone or with others, to directly or indirectly influence, direct, or cause the direction of the management, expenditure of money, or policies of a facility or other person. A controlling person includes: ]

(A) A person acting alone or with others, who can directly or indirectly influence, direct, or cause the direction of the management, expenditure of money, or policies of an assisted living facility or other person. [ ~~a management company, landlord, or other business entity that operates or contracts with others for the operation of a facility;~~ ]

(B) For purposes of this chapter, "controlling person" includes: [ ~~any person who is a controlling person of a management company or other business entity that operates a facility or that contracts with another person for the operation of an assisted living facility;~~ ]

(i) a management company, landlord, or other business entity that operates or contracts with others for the operation of an assisted living facility;

(ii) a person who is a controlling person of a management company or other business entity that operates an assisted living facility or that contracts with another person for the operation of an assisted living facility; and

(iii) any other individual who, because of a personal, familial, or other relationship with the owner, manager, landlord, tenant, or provider of an assisted living facility, is in a position of actual control or authority with respect to the facility, without regard to whether the individual is formally named as an owner, manager, director, officer, provider, consultant, contractor, or employee of the facility.

(C) Notwithstanding any other provision of this section, for purposes of this chapter, a controlling person of an assisted living facility or of a management company or other business entity described in subparagraph (B)(i) of this paragraph that is a publicly traded corporation or is controlled by a publicly traded corporation means an officer or director of the corporation. The term does not include a shareholder or lender of the publicly traded corporation. [ an officer or director of a publicly traded corporation that is, or that controls, a facility, management company, or other business entity described in subparagraph (A) of this paragraph but does not include a shareholder or lender of the publicly traded corporation; and ]

(D) A controlling person described by subparagraph (B)(iii) of this paragraph does not include an employee, lender, secured creditor, landlord, or other person who does not exercise formal or actual influence or control over the operation of an assisted living facility. [ any other individual who, because of a personal, familial, or other relationship with the owner, manager, landlord, tenant, or provider of a facility, is in a position of actual control or authority with respect to the facility, without regard to whether the individual is formally named as an owner, manager, director, officer, provider, consultant, contractor, or employee of the facility, except an employee, lender, secured creditor, landlord, or other person who does not exercise formal or actual influence or control over the operation of a facility. ]

(21) [ ~~(19)~~ ] Covert electronic monitoring--The placement and use of an electronic monitoring device that is not open and obvious, and about which the facility and HHSC have not been informed by the resident, by the person who placed the device in the room, or by a person who uses the device.

(22) [ ~~(20)~~ ] Delegation-- Written authorization by a registered nurse (RN), acting for the assisted living facility, for an attendant to perform a specific nursing care task in a selected situation. Delegation is allowed when the criteria for the task are met, following Texas Board of Nursing rules in 22 TAC Chapter 225. [ In the assisted living facility context, written authorization by a registered nurse (RN) acting on behalf of the facility for personal care staff to perform tasks of nursing care in selected situations, where delegation criteria are met for the task. The delegation process includes nursing assessment of a resident in a specific situation, evaluation of the ability of the personal care staff, teaching the task to the personal care staff, ensuring supervision of the personal care staff in performing a delegated task, and re-evaluating the task at regular intervals. ]

(23) [ ~~(21)~~ ] Dietitian--A person who currently holds a license or provisional license issued by the Texas Department of Licensing and Regulation.

(24) [ ~~(22)~~ ] Direct ownership interest--Ownership of equity in the capital, stock, or profits of, or a membership interest in, an applicant or license holder.

(25) [ ~~(23)~~ ] Disclosable interest--Five percent or more direct or indirect ownership interest in an applicant or license holder.

(26) [ ~~(24)~~ ] Disclosure statement--An HHSC form for prospective residents or the residents' [ ~~their~~ ] legally authorized representatives that a facility must complete. The form contains information regarding the facility's preadmission, admission, and discharge processes [ ~~process~~ ]; resident evaluation [ ~~assessment~~ ] and service plans; staffing patterns; the physical environment of the facility; resident activities; and facility services.

(27) Durable medical equipment--Items that are ordered by a health care provider for everyday or extended use during treatment and recovery from an injury or illness or due to age-related problems.

(28) [ ~~(25)~~ ] Electronic monitoring device-- A video camera or audio device placed in a resident's room to watch or listen to the resident. Devices used to monitor phone calls or electronic messages without informed consent from the resident or responsible party are not included in this definition. [ Video surveillance cameras and audio devices installed in a resident's room, designed to acquire communications or other sounds that occur in the room. An electronic, mechanical, or other device used specifically for the nonconsensual interception of wire or electronic communication is excluded from this definition. ]

(29) [ ~~(26)~~ ] Exploitation-- Has the meaning provided in Texas Health and Safety Code §260A.001.

[(A) For a person under 18 years of age who is not and has not been married or who has not had the disabilities of minority removed for general purposes, the term has the meaning in Texas Family Code §261.001(3), which is the illegal or improper use of a child or of the resources of a child for monetary or personal benefit, profit, or gain by an employee, volunteer, or other individual working under the auspices of a facility or program as further described by rule or policy; and]

[(B) For a person other than one described in subparagraph (A) of this paragraph, the term has the meaning in Texas Health and Safety Code §260A.001(4), which is the illegal or improper act or process of a caregiver, family member, or other individual who has an ongoing relationship with the resident using the resources of a resident for monetary or personal benefit, profit, or gain without the informed consent of the resident.]

(30) [ ~~(27)~~ ] Facility--An entity required to be licensed under the Assisted Living Facility Licensing Act, Texas Health and Safety Code[ , ] Chapter 247.

(31) [ ~~(28)~~ ] Fire suppression authority--The paid or volunteer fire-fighting organization or tactical unit that is responsible for fire suppression operations and related duties once a fire incident occurs within its jurisdiction.

[(29) Flame spread--The rate of fire travel along the surface of a material. This is different than other requirements for time-rated "burn through" resistance ratings, such as one-hour rated. Flame spread ratings are Class A (0-25), Class B (26-75), and Class C (76-200).]

(32) [ ~~(30)~~ ] Functional disability--A mental, cognitive, or physical disability that precludes the physical performance of self-care tasks, including HMAs [ ~~health maintenance activities~~ ] and personal care.

(33) [ ~~(31)~~ ] Governmental unit--The state or any county, municipality, or other political subdivision, or any department, division, board, or other agency of any of the foregoing.

(34) [ ~~(32)~~ ] Health care professional--An individual who holds a current license or certification [ ~~licensed, certified,~~ ] or is otherwise legally authorized to administer health care, for profit or otherwise, in the ordinary course of business or professional practice. [ ~~The term includes a physician, registered nurse, licensed vocational nurse, licensed dietitian, physical therapist, and occupational therapist.~~ ]

(A) The term includes individuals such as physicians, registered nurses, licensed vocational nurses, licensed dietitians, physical therapists, and occupational therapists.

(B) A health care professional may be employed by the facility, employed by or contracted with an outside entity such as a home and community support services agency, or an independent contractor.

(35) [ ~~(33)~~ ] HMA-- Health maintenance activity . [ ~~(HMA)--~~ ] A [ ~~Consistent with 22 TAC §225.4 (relating to Definitions), a~~ ] task that:

(A) meets the definition of HMA in 22 TAC §225.4 (relating to Definitions) and requires a higher level of skill to perform than assistance with activities of daily living; [ ~~may be exempt from delegation based on an RN's assessment in accordance with §553.263(c) of this chapter (relating to Health Maintenance Activities); and~~ ]

(B) is exempt from delegation based on an RN's assessment in accordance with 22 TAC Chapter 225; and [ ~~requires a higher level of skill to perform than personal care services and, in the context of an ALF, excludes the following tasks:~~ ]

(i) intermittent catheterization; and

(ii) subcutaneous, nasal, or insulin pump administration of insulin or other injectable medications prescribed in the treatment of diabetes mellitus.

(36) [ ~~(34)~~ ] HHSC--The Texas Health and Human Services Commission.

(37) [ ~~(35)~~ ] Immediate threat to the health or safety of a resident--A situation that causes, or is likely to cause, serious injury, harm, or impairment to or the death of a resident.

(38) [ ~~(36)~~ ] Immediately available-- A situation in which staff are able to respond right away to an emergency after receiving a notice from a communication or alarm system. To be immediately available, staff must be inside the facility while on duty and located within 600 feet of the resident who is farthest away. [ The capacity of facility staff to immediately respond to an emergency after being notified through a communication or alarm system. The staff are to be no more than 600 feet from the farthest resident and in the facility while on duty. ]

(39) [ ~~(37)~~ ] Indirect ownership interest--Any ownership or membership interest in a person that has a direct ownership interest in an applicant or license holder.

(40) [ ~~(38)~~ ] Isolated--A situation in which a very limited number of residents are affected[ , ] and a very limited number of staff are involved, or a [ ~~the~~ ] situation that has occurred only occasionally.

(41) [ ~~(39)~~ ] Key infectious agents--Bacteria, viruses, and other microorganisms that [ ~~which~~ ] cause the most common infections and infectious diseases in long-term care facilities, and that can be mitigated by establishing, implementing, maintaining, and enforcing proper infection[ , ] prevention[ , ] and control policies and procedures.

(42) [ ~~(40)~~ ] Large facility--A facility licensed for 17 or more residents.

(43) [ ~~(41)~~ ] Legally authorized representative--A person authorized by law to act on behalf of a person with regard to a matter described in this chapter, which [ ~~and~~ ] may include a parent, guardian, spouse, sibling, [ ~~or managing conservator of a minor,~~ ] or a resident's legal [ ~~the~~ ] guardian or agent under a power of attorney [ ~~of an adult~~ ].

(44) [ ~~(42)~~ ] License holder--A person that holds a license to operate a facility.

[(43) Listed--Equipment, materials, or services included in a list published by an organization concerned with evaluation of products or services, that maintains periodic inspection of production of listed equipment or materials or periodic evaluation of services, and whose listing states that either the equipment, material, or service meets appropriate designated standards or has been tested and found suitable for a specified purpose. The listing organization must be acceptable to the authority having jurisdiction, including HHSC or any other state, federal, or local authority.]

~~[(44) Local code--A model building code adopted by the local building authority where the facility is constructed or located.]~~

(45) Management services--Services provided under contract between the owner of a facility and a person to provide for the operation of the [ a ] facility, including administration, staffing, maintenance, or delivery of resident services. Management services do not include contracts solely for maintenance, laundry, transportation, or food services.

(46) Manager--The individual in charge of the day-to-day operation of the facility.

(47) Managing local ombudsman--Has the meaning provided [ ~~given~~ ] in §88.2 of this title.

(48) Medication--

(A) Medication is any substance:

(i) recognized as a drug in the official United States Pharmacopoeia, Official Homeopathic Pharmacopoeia of the United States, Texas Drug Code Index or official National Formulary, or any supplement to any of these official documents;

(ii) intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease;

(iii) other than food intended to affect the structure or any function of the body; and

(iv) intended for use as a component of any substance specified in this definition.

(B) Medication includes both prescription and over-the-counter medication, unless otherwise specified.

(49) Medication administration--The direct application of a medication or drug to the body of a resident by an individual legally allowed to administer medication in the state of Texas.

(50) Medication assistance or supervision--The assistance or supervision of a resident's [ ~~the~~ ] medication regimen by [ ~~facility~~ ] staff. Refer to §553.267(c) [ ~~§553.261(a)~~ ] of this chapter (relating to Medications) .

(51) Medication self-administration--A resident taking [ ~~(self- or self-administration of)--The capability of a resident to administer~~ ] the resident's own medication or treatments without help [ ~~assistance~~ ] from [ ~~the facility~~ ] staff.

(52) Memory care services-- Enhanced services provided by a facility without Alzheimer's certification that support the social and safety needs of residents with Alzheimer's disease and related disorders and that help maintain resident dignity and independence. [ ~~Services provided by an assisted living facility to meet the needs of residents with a diagnosis of Alzheimer's disease or related disorders or a diagnosis of dementia.~~ ]

(53) Multidrug-resistant organisms--Bacteria and other microorganisms that have developed resistance to multiple types of medicine used to act against the microorganism.

(54) Neglect-- Has the meaning provided in Texas Health and Safety Code §260A.001.

[(A) For a person under 18 years of age who is not and has not been married or who has not had the disabilities of minority removed for general purposes, the term has the meaning in Texas Family Code §261.001(4), which is a negligent act or omission by an employee, volunteer, or other individual working under the auspices of a facility or program, including failure to comply with an individual treatment plan, plan of care, or individualized service plan, that causes or may cause substantial emotional harm or physical injury to, or the death of, a child served by the facility or program as further described by rule or policy; and]

[(B) For a person other than one described in subparagraph (A) of this paragraph, the term has the meaning in Texas Health and Safety Code §260A.001(6), which is the failure to provide for oneself the goods or services, including medical services, which are necessary to avoid physical or emotional harm or pain or the failure of a caregiver to provide such goods or services.]

~~[(55) NFPA 101--The 2012 publication titled NFPA 101 Life Safety Code published by the National Fire Protection Association, Inc., 1 Batterymarch Park, Quincy, Massachusetts 02169.]~~

(55) [ ~~(56)~~ ] Ombudsman intern--Has the meaning provided [ ~~given~~ ] in §88.2 of this title.

(56) [ ~~(57)~~ ] Ombudsman program--Has the meaning provided [ ~~given~~ ] in §88.2 of this title.

(57) [ ~~(58)~~ ] Online portal--A secure portal provided on the HHSC website for licensure activities, including for an assisted living facility applicant to submit licensure applications and information.

(58) Outside resources--Services and support that a facility does not provide or that a resident chooses not to receive from the facility, but that are needed for a resident to keep the highest possible level of independence and quality of life. Outside resource service providers include:

(A) an employee of a home and community support services agency in accordance with Texas Health and Safety Code Chapter 142;

(B) a health care professional, as defined in this section;

(D) companion services.

(59) Pattern of violation--Repeated, but not widespread in scope, failures of a facility to comply with this chapter or a rule, standard, or order adopted under Texas Health and Safety Code[ , ] Chapter 247 that:

(A) result in a violation; and

(B) are found throughout the services provided by the facility or that affect or involve the same residents or facility employees.

(60) Person--Any individual, firm, partnership, corporation, association, or joint stock association, and the legal successor thereof.

(61) Personal care services--Assistance with activities of daily living, as defined in this section, or general supervision or oversight of the physical and mental well-being of residents in the facility. [ feeding, dressing, moving, bathing, or other personal needs or maintenance; or general supervision or oversight of the physical and mental well-being of a person who needs assistance to maintain a private and independent residence in the facility or who needs assistance to manage his or her personal life, regardless of whether a guardian has been appointed for the person. ]

~~[(62) Personal care staff--An attendant whose primary employment function is to provide personal care services.]~~

(62) [ ~~(63)~~ ] Physician--A practitioner licensed by the Texas Medical Board.

(63) Plan of correction--A plan that identifies all actions an assisted living facility will take to correct violations and specifies the date by which those violations will be corrected.

(64) Plan of removal--A plan that identifies all actions an assisted living facility will take to immediately address noncompliance that has caused or is likely to cause serious injury, serious harm, serious impairment, or death by detailing how the facility will keep residents safe and free from serious harm or death caused by the noncompliance.

(65) [ ~~(64)~~ ] Potential for minimal harm--A violation that has the potential for causing no more than a minor negative impact on a resident.

(66) [ ~~(65)~~ ] Practitioner--An individual who is currently licensed in a state in which the individual practices as a physician, dentist, podiatrist, or a physician assistant; or an RN registered with [ ~~a registered nurse approved by~~ ] the Texas Board of Nursing [ ~~to practice~~ ] as an advanced practice registered nurse.

(67) [ ~~(66)~~ ] Private and unimpeded access--Access to enter a facility or communicate with a resident outside of the hearing and view of others, without interference or obstruction from staff, [ ~~facility employees,~~ ] volunteers, or contractors.

[(67) Qualified medical personnel--An individual who is licensed, certified, or otherwise authorized to administer health care. The term includes a physician, registered nurse, and licensed vocational nurse.]

(68) Rapid influenza diagnostic test--A test administered to a person with flu-like symptoms that can detect the influenza viral nucleoprotein antigen.

(69) Resident--An individual accepted for care in a facility , including for respite care .

(70) Resident evaluation--Assessment of a resident to determine what care is needed, as required by Texas Health and Safety Code §247.002.

(71) [ ~~(70)~~ ] Respite--The provision by a facility of room, board, and care at the level ordinarily provided for permanent residents of the facility to a person for not more than 60 days for each stay in the facility.

(72) Responsible party--An individual authorized by the resident to act for the resident as an official delegate or agent. A responsible party is usually a family member or relative but may be a legal guardian or other individual. The resident may authorize a responsible party in writing or verbally.

(73) [ ~~(71)~~ ] Restraint hold--

(A) A manual method, except for physical guidance or prompting of brief duration, used to restrict:

(i) free movement or normal functioning of all or a portion of a resident's body; or

(ii) normal access by a resident to a portion of the resident's body.

(B) Physical guidance or prompting of brief duration becomes a restraint if the resident resists the guidance or prompting.

(74) [ ~~(72)~~ ] Restraints--

(A) Chemical restraints are psychoactive drugs administered for the purposes of discipline or convenience and [ ~~are~~ ] not required to treat the resident's medical symptoms.

(B) Physical restraints are tools or manual methods used to stop or limit a resident from moving freely. [ ~~any manual method, or physical or mechanical device, material, or equipment attached or adjacent to the resident that restricts freedom of movement.~~ ] Physical restraints include restraint holds. This definition does not apply to wheelchairs, seating systems, or secondary supports when used to provide postural support, stability, pressure distribution, and pressure relief.

(75) [ ~~(73)~~ ] RN --Registered nurse. [ ~~(registered nurse)--~~ ] A person who holds a current and active license from the Texas Board of Nursing to practice professional nursing, as defined in Texas Occupations Code §301.002(2).

[(74) Safety--Protection from injury or loss of life due to such conditions as fire, electrical hazard, unsafe building or site conditions, and the hazardous presence of toxic fumes and materials.]

(76) [ ~~(75)~~ ] Seclusion--The involuntary confinement of a resident alone in a room or area that the resident is physically prevented from leaving. [ ~~separation of a resident from other residents and the placement of the resident alone in an area from which the resident is prevented from leaving.~~ ]

(77) [ ~~(76)~~ ] Service plan--A written description of the medical care, supervision, or non-medical [ ~~nonmedical~~ ] care needed by a resident.

~~[(77) Short-term acute episode--An illness of less than 30 days' duration.]~~

(78) Significant change--A sudden or major improvement or decline in the physical, cognitive, or behavioral status of a resident that is inconsistent with the resident's condition when admitted or last evaluated or assessed. Ordinary day-to-day fluctuations in a resident's functioning and behavior, short-term illnesses such as colds, or gradual deterioration in a resident's ability to conduct activities of daily living that accompanies the aging process are not considered significant changes.

(79) Skilled nursing--Medically ordered care that can only be provided by or under the supervision or delegation of a licensed nurse.

(80) [ ~~(78)~~ ] Small facility--A facility licensed for 16 or fewer residents.

(81) [ ~~(79)~~ ] Stable and predictable--A phrase describing the clinical and behavioral status of a resident that is non-fluctuating and consistent and does not require the regular presence of a registered or licensed vocational nurse.

[(A) The phrase does not include within its meaning a description of the clinical and behavioral status of a resident that is expected to change rapidly or needs continuous or continual nursing assessment and evaluation.]

~~[(B) The phrase does include within its meaning a description of the condition of a resident receiving hospice care within a facility where deterioration is predictable.]~~

(82) [ ~~(80)~~ ] Staff--Employees of an assisted living facility.

(83) [ ~~(81)~~ ] Standards--The minimum conditions, requirements, and criteria established in this chapter with which a facility must comply to be licensed under this chapter.

(84) [ ~~(82)~~ ] State Ombudsman--Has the meaning provided [ ~~given~~ ] in §88.2 of this title.

(85) [ ~~(83)~~ ] Terminal condition--A medical diagnosis, certified by a physician, of an illness that is expected to [ ~~will~~ ] result in death in six months or less.

(86) [ ~~(84)~~ ] Universal precautions--An approach to infection control in which blood, any body fluids visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids are treated as if known to be infectious for HIV, hepatitis B, and other blood-borne pathogens.

(87) [ ~~(85)~~ ] Vaccine Preventable Diseases--The diseases included in the most current recommendations of the Advisory Committee on Immunization Practices of the CDC.

(88) [ ~~(86)~~ ] Widespread in scope--A violation of Texas Health and Safety Code[ , ] Chapter 247 , or a rule, standard, or order adopted under Chapter 247 that:

(A) is pervasive throughout the services provided by the facility; or

(B) represents a systemic failure by the facility that affects or has the potential to affect a large portion of or all of the residents of the facility.

(89) [ ~~(87)~~ ] Willfully interfere--To act or not act to intentionally prevent, interfere with, or impede [ ~~impeded,~~ ] or to attempt to intentionally prevent, interfere with, or impede.

(90) [ ~~(88)~~ ] Working day--Any 24-hour period, Monday through Friday, excluding state and federal holidays.

§ 553.5. Types of Assisted Living Facilities.

(a) Basis for licensure type. A facility must be licensed as a Type A or Type B facility. A facility's licensure type is based on the capability of the residents to evacuate the facility, as described in this section.

(b) Type A. In a Type A facility, a resident:

(1) must be physically and mentally capable of evacuating the facility without help [ ~~physical assistance~~ ] from staff . This includes a resident who uses a wheelchair or electric cart, as long as the resident can leave the building without help from staff during an emergency; [ , which may include an individual who is mobile, although non-ambulatory, such as an individual who uses a wheelchair or an electric cart, and has the capacity to transfer and evacuate himself or herself in an emergency; ]

(2) does not require routine attendance during nighttime sleeping hours;

(3) must be capable of following directions under emergency conditions; and

(4) must be able to demonstrate [ ~~to HHSC~~ ] that the resident [ ~~they~~ ] can travel from the resident's own living unit to a centralized space, such as a lobby, living room, or dining room on the level of discharge, within a 13-minute period without continuous staff assistance and without using an elevator. [ ~~meet the evacuation requirements described in Subchapter D of this chapter (relating to Facility Construction).~~ ]

(1) require staff assistance to evacuate;

(2) require attendance during nighttime sleeping hours;

(3) be incapable of following directions under emergency conditions; and

(4) require assistance in transferring to and from a wheelchair; but

(5) must not be permanently bedfast.

(d) Type C.

(1) A Type C facility is a four-bed facility that was originally licensed by HHSC to provide adult foster care services as described in Chapter 278, Subchapter B of this title (relating to Minimum Standards For Adult Foster Care) [ ~~40 TAC Chapter 48, Subchapter K (relating to Minimum Standards for Adult Foster Care)~~ ].

(2) HHSC no longer issues Type C licenses and Type C licensure is no longer a requirement to contract with HHSC to provide adult foster care services. In accordance with Chapter 278, Subchapter B of this title, [ ~~40 TAC Chapter 48, Subchapter K, in order~~ ] to contract with HHSC as a provider of adult foster care services, an applicant must have a current license for a Type A or Type B assisted living facility.

§ 553.7. Assisted Living Facility Services.

(a) An assisted living facility is an entity that [ ~~must~~ ]:

(1) provides, [ ~~furnish,~~ ] in one or more facilities, food and shelter for [ to ] four or more persons who are unrelated to the proprietor [ ~~of the establishment~~ ]; and

(2) provides [ ~~provide~~ ]:

(A) personal care services; or

(B) medication administration by a person licensed or otherwise authorized in this state to administer the medication.

(b) An assisted living facility [ ~~establishment~~ ] may provide:

(1) assistance with or supervision of medication administration;

(2) HMAs [ ~~health maintenance activities~~ ] in accordance with §553.281 [ ~~§553.263~~ ] of this chapter (relating to Health Maintenance Activities); and

(3) skilled nursing services for the following limited purposes:

(A) coordination of [ ~~coordinate~~ ] resident care with an outside home and community support services agency or other health care professional;

(B) provision or delegation of personal care services and medication administration, as described in this chapter;

(D) temporary [ ~~delivery, for a period not to exceed 30 days, of temporary~~ ] skilled nursing services for a minor illness, injury, or emergency for up to 30 days .

(c) As part of the facility's general supervision and oversight of the physical and mental well-being of its residents, the facility remains responsible for all care provided by the facility.

§ 553.9. General Characteristics of a Resident.

(a) A resident must be 18 years of age or older or an emancipated minor.

(b) [ ~~This section describes some general characteristics of a resident in a facility.~~ ] A resident may:

(1) exhibit symptoms of cognitive [ ~~mental~~ ] or emotional distress, provided the resident [ ~~disturbance, but~~ ] is not considered to be at risk of imminent harm to self or others;

(2) need help with activities of daily living as defined in §553.3 of this subchapter (relating to Definitions) [ ~~assistance with movement~~ ];

(3) be incontinent without pressure sores in the genital or rectal area or buttocks; [ ~~require assistance with bathing, dressing, and grooming;~~ ]

(4) need toileting assistance, or reminders, to encourage routine toileting to prevent incontinence; [ ~~require assistance with routine skin care, such as application of lotions or treatment of minor cuts and burns;~~ ]

(5) have healthcare conditions and diagnoses that could require additional care from outside resources, as defined in §553.3 of this subchapter; [ ~~need reminders to encourage toilet routine and prevent incontinence;~~ ]

(6) manage the resident's own medication regimen and storage, may need assistance with a medication regimen, or may need medication administration or medication storage by staff; [ ~~require temporary services by professional personnel;~~ ]

(7) need encouragement to join in activities like eating, hygiene, socializing, and going to appointments; [ ~~assistance with medication, supervision of self-medication, or medication administration;~~ ]

(8) need monitoring due to feelings of sadness, depression, or apathy; [ ~~require encouragement to eat, or monitoring due to social or psychological reasons of temporary illness;~~ ]

(9) be hearing , speech, or vision impaired ; [ ~~or speech impaired;~~ ]

(10) require an established therapeutic diet; [ ~~be incontinent without pressure sores;~~ ]

(11) use various assistive devices, as defined in §553.3 of this subchapter, that increase independence; [ ~~require an established therapeutic diet;~~ ]

(12) need assistance with meals, which may include feeding; and [ ~~require self-help devices; and~~ ]

(13) have a permanently placed percutaneous endoscopic gastrostomy (PEG) tube for feeding and medication administration that requires RN delegation or RN designation as an HMA, as described in this chapter. [ ~~need assistance with meals, which may include feeding.~~ ]

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 18, 2026.

TRD-202603589

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 4, 2026

For further information, please call: (512) 438-3161

SUBCHAPTER B. LICENSING

26 TAC §§553.17, 553.21, 553.23, 553.25, 553.27, 553.29, 553.31, 553.33, 553.35, 553.37, 553.39, 553.45, 553.47

STATUTORY AUTHORITY

The amendments and new section are authorized by Texas Government Code §524.0005, which provides that the executive commissioner of HHSC shall adopt rules to implement the executive commissioner's authority under Texas Government Code Chapter 524 with respect to the health and human services system, and §524.0151, which provides that the executive commissioner of HHSC shall adopt rules necessary to carry out the commission's duties under Texas Government Code Chapter 531 and adopt rules and policies for the operation and provision of services by the health and human services agencies; and Texas Health and Safety Code §247.025 and §247.026, which provide that the executive commissioner of HHSC shall adopt rules necessary to implement Texas Health and Safety Code Chapter 247 and to ensure the quality of care and protection of assisted living facility residents' health and safety, respectively.

The amendments and new section implement Texas Government Code §524.0005 and §524.0151 and Texas Health and Safety Code §247.025 and §247.026.

§ 553.17. Criteria for Licensing.

(a) A person must be licensed by HHSC to establish or operate an assisted living facility in Texas.

(1) HHSC considers one or more facilities to be part of the same establishment and, therefore, subject to licensure as an assisted living facility, based on the following factors:

(A) common ownership;

(B) physical proximity;

(D) any public appearance of joint operations or of a relationship between the facilities.

(2) The presence or absence of any one factor in paragraph (1) of this subsection is not conclusive.

(3) Licensed capacity means the total number of residents allowed in the entire assisted living establishment under one license. If more than one license is obtained, licensed capacity is set for each license separately.

(b) To obtain a license, a person must follow the application requirements in this subchapter and meet the criteria for a license.

(1) the applicant, license holder, controlling person, and any person required to submit background and qualification information meet the criteria and eligibility for licensing[ , ] in accordance with this section; and

(2) [ ~~(1)~~ ] the building in which the facility is housed:

(A) meets local fire ordinances;

(B) is approved by the local fire authority;

(C) meets HHSC licensing standards in accordance with Subchapter D of this chapter (relating to Facility Construction) based on an onsite [ ~~on-site~~ ] inspection by HHSC or the standards for accreditation based on an onsite [ ~~on-site~~ ] accreditation survey by an accreditation commission; and

(D) if located in a county of more than 3.3 million residents , for initial license applications submitted or issued on or after December 6, 2022, is not located in a 100-year floodplain; and

(3) [ ~~(2)~~ ] operation of the facility meets HHSC licensing standards based on an onsite [ ~~on-site~~ ] health inspection by HHSC, which must include observation of the care of a resident; or

(4) [ ~~(3)~~ ] the facility meets the standards for accreditation based on an onsite [ ~~on-site~~ ] accreditation survey by the accreditation commission.

(d) An applicant who chooses the option authorized in subsection (c)(4) [ ~~(c)(3)~~ ] of this section must contact HHSC to determine which accreditation commissions are available to meet the requirements of that subsection. If a license holder uses an onsite [ ~~on-site~~ ] accreditation survey by an accreditation commission, as provided in this subsection and §553.33(h) [ ~~§553.33(i)~~ ] of this subchapter (relating to Renewal Procedures and Qualifications), the license holder must:

(1) provide written notification to HHSC by submitting an updated application in the licensing system within five working days after the license holder receives [ a ] notice of change in accreditation status from the accreditation commission; and

(2) include a copy of the notice of change with the license holder's [ ~~its~~ ] written notification to HHSC.

(e) HHSC issues a license to a facility meeting all requirements of this chapter. The facility must not exceed the maximum allowable number of residents specified on the license.

(f) HHSC denies an application for an initial license or a renewal of a license if:

(1) the applicant, license holder, controlling person, or any person required to be disclosed on the application for licensure has been debarred or excluded from the Medicare or Medicaid programs by the federal government or a state;

(2) a court has issued an injunction prohibiting the applicant, license holder, controlling person, or any person required to be disclosed on the application for licensure from operating a facility; or

(3) during the five years preceding the date of the application, a license to operate a health care facility, long-term care facility, assisted living facility, or similar facility in any state held by the applicant, license holder, controlling person, or any person required to be disclosed on the application for licensure has been revoked.

(g) A license holder or controlling person who operates a nursing facility or an assisted living facility for which a trustee was appointed and for which emergency assistance funds, other than funds to pay the expenses of the trustee, were used is subject to exclusion from eligibility for:

(1) the issuance of an initial license for a facility for which the person has not previously held a license; and

(2) the renewal of the license of the facility for which the trustee was appointed.

(h) HHSC may deny an application for an initial license or refuse to renew a license if an applicant, license holder, controlling person, or any person required to be disclosed on the application for licensure:

(1) violates Texas Health and Safety Code[ , ] Chapter 247; a section, standard, or order adopted under Chapter 247; or a license issued under Chapter 247 in either a repeated or substantial manner;

(2) commits an act described in §553.751(a)(2) - (9) of this chapter (relating to Administrative Penalties);

(3) aids, abets, or permits a substantial violation described in paragraph (1) or (2) of this subsection about which the person had or should have had knowledge;

(4) fails to provide the required information, facts, or references;

(5) engages in the following:

(A) knowingly submits false or intentionally misleading statements to HHSC;

(B) provides false information [ ~~uses subterfuge~~ ] or uses other evasive means of filing an application for licensure;

(C) provides false information [ ~~engages in subterfuge~~ ] or uses other evasive means of filing on behalf of another who is unqualified for licensure;

(D) knowingly conceals a material fact related to licensure; or

(E) is responsible for fraud;

(6) fails to pay the following fees, taxes, and assessments when due:

(A) license fees, as described in §553.47 of this subchapter (relating to License Fees); or

(B) franchise taxes, if applicable;

(7) during the five years preceding the date of the application, has a history in any state or other jurisdiction of any of the following:

(A) operation of a facility that has been decertified or has had its contract canceled under the Medicare or Medicaid program;

(B) federal or state long-term care facility, assisted living facility, or similar facility sanctions or penalties, including monetary penalties, involuntary downgrading of the status of a facility license, proposals to decertify, directed plans of correction, or the denial of payment for new Medicaid admissions;

(C) unsatisfied final judgments, excluding judgments wholly unrelated to the provision of care rendered in long-term care facilities;

(D) eviction involving any property or space used as a facility; or

(E) suspension of a license to operate a health care facility, long-term care facility, assisted living facility, or a similar facility;

(8) violates Texas Health and Safety Code §247.021 by operating a facility without a license; [ or ]

(9) is subject to denial or refusal of a license as described in Chapter 560 of this title (relating to Denial or Refusal of License) during the time frames described in that chapter ; or [ . ]

(10) chooses to surrender the license in lieu of enforcement action.

(i) Without limitation, HHSC reviews all information provided by an applicant, a license holder, a person required to be disclosed on the application for licensure, or a manager when considering grounds for denial of an initial license application or a renewal application in accordance with subsection (h) of this section. HHSC may grant a license if HHSC finds the applicant, license holder, person required to be disclosed on the application for licensure, affiliate, or manager is able to comply with the rules in this chapter.

(j) HHSC reviews final actions when considering the grounds for denial of an initial license application or renewal application in accordance with subsections (f) and (h) of this section. An action is final when routine administrative and judicial remedies are exhausted. An applicant must disclose all actions, whether pending or final.

(k) If an applicant owns multiple facilities, HHSC examines the overall record of compliance in all of the applicant's facilities. An overall record poor enough to deny issuance of a new license does not preclude the renewal of a license of a facility with a satisfactory record.

§ 553.21. Time Periods for Processing All Types of License Applications.

(a) HHSC reviews an application for a license within 30 days after the date HHSC Licensing and Credentialing Section, Long-term Care Regulation, receives the application and the payment of associated fees and notifies the applicant if additional information is needed to complete the application.

(b) HHSC denies an application that remains incomplete 120 days after the date that HHSC Licensing and Credentialing Section, Long-term Care Regulation receives the application and the payment of associated fees .

(c) HHSC issues a license within 30 days after HHSC determines that the applicant and the facility have met all licensure requirements referenced in §553.23 of this subchapter (relating to Initial License Application Procedures and Requirements) or §553.33 of this subchapter (relating to Renewal Procedures and Qualifications), as applicable.

(d) If HHSC does not process an application in the time period stated, the applicant has a right to make a request to the program director for reimbursement of the license fees paid with the application.

(1) If the program director does not agree that the established time period has been violated or finds that good cause existed for exceeding the established time period, the program director denies the request.

(2) Good cause for exceeding the established time period exists if:

(A) the number of applications to be processed exceeds by 15 percent or more the number processed in the same calendar quarter of the preceding year;

(B) HHSC must rely on another public or private entity to process all or a part of the application received by HHSC, and the delay is caused by that entity; or

(3) If the request for reimbursement is denied, the applicant may appeal to the HHSC Executive Commissioner for resolution of the dispute. The applicant must send a written statement to the HHSC Executive Commissioner describing the request for reimbursement and the reason for the request. The HHSC Executive Commissioner will make a timely decision concerning the appeal and notify the applicant in writing of the decision.

§ 553.23. Initial License Application Procedures and Requirements.

(a) An applicant must complete the HHSC pre-licensure training course before submitting an application for an initial license. An applicant that is currently licensed under Texas Health and Safety Code[ , ] Chapter 247 is exempt from this requirement.

(b) An applicant for an initial license must submit an application in accordance with §553.19 of this subchapter (relating to General Application Requirements) and include full payment of the fees required in §553.47 of this subchapter (relating to License Fees).

(c) HHSC reviews an application for an initial license within 30 days after the date HHSC Licensing and Credentialing Section, Long-term Care Regulation receives the application and associated fees and notifies the applicant if additional information is needed to complete the application.

[(d) The applicant must notify HHSC via the online portal indicating that the facility is ready for a Life Safety Code (LSC) inspection. The notice must be submitted with the application or within 120 days after the HHSC Licensing and Credentialing Section, Long-term Care Regulation receives the application. After the applicant has satisfied the application submission requirements in §553.17 of this subchapter (relating to Criteria for Licensing) and §553.19 of this subchapter, HHSC staff conduct an on-site LSC inspection of the facility to determine if the facility meets the applicable NFPA 101 and other physical plant requirements in Subchapter D of this chapter (relating to Facility Construction).]

(d) [ ~~(e)~~ ] If the facility fails to meet the licensure requirements within 120 days after the initial life safety code (LSC) [ ~~LSC~~ ] inspection, HHSC denies the application for a license.

(e) [ ~~(f)~~ ] After a facility has met the licensure requirements in Subchapter D of this chapter (relating to Facility Construction) and has admitted at least one but no more than three residents, the applicant must notify HHSC via the online portal that the facility is ready for a health inspection.

(1) HHSC staff conduct an onsite [ ~~on-site~~ ] health inspection to determine if the facility meets the licensure requirements for standards of operation and resident care in Subchapter E of this chapter (relating to Standards for Licensure).

(2) If the facility fails to meet the licensure requirements for standards of operation and resident care within 120 days after the initial health inspection, HHSC denies the application for a license.

(f) [ ~~(g)~~ ] HHSC issues a license within 30 days after HHSC determines that the applicant and the facility have met the licensure requirements of this section. The issuance of a license constitutes HHSC's official written notice to the facility of the approval of the application.

(g) [ ~~(h)~~ ] HHSC may deny an application for an initial license if the applicant, controlling person, or any person required to submit background and qualification information fails to meet the criteria for a license established in §553.17 of this subchapter (relating to Criteria for Licensing) .

(h) [ ~~(i)~~ ] If HHSC denies an application for an initial license, HHSC sends the applicant a written notice of the denial and informs the applicant of the applicant's right to request an administrative hearing to appeal the denial. The administrative hearing is held in accordance with Texas Health and Human Services Commission rules at 1 TAC Chapter 357 [ ~~Texas Administrative Code, Title 1, Part 15, Chapter 357,~~ ] Subchapter I (relating to Hearings Under the Administrative Procedure Act).

§ 553.25. Initial License for a Type A or Type B Facility for an Applicant in Good Standing.

(a) An applicant may request that HHSC issue, before conducting an onsite [ ~~on-site~~ ] health inspection, an initial license for a Type A or Type B facility. The applicant must request the license by completing [ ~~submitting~~ ] a form prescribed by HHSC and submitting the form to HHSC via the online portal.

(b) If an applicant makes a request in accordance with subsection (a) of this section, HHSC determines the applicant is in good standing, and the applicant complies with subsection (d) of this section, the applicant is not required to admit a resident to the facility or have the onsite [ ~~on-site~~ ] health inspection described in §553.23(e) [ ~~§553.23(f)~~ ] of this subchapter (relating to Initial License Application Procedures and Requirements) before HHSC issues an initial license.

(1) one of the following conditions is met:

(A) the applicant has operated or been a controlling person of a licensed Type A or Type B facility in Texas for at least six consecutive years; or

(B) the applicant has not held a license for a Type A or Type B facility, but a controlling person of the applicant has operated or been a controlling person of a licensed Type A or Type B facility in Texas for at least six consecutive years; and

(2) each licensed facility operated by the applicant or the controlling person described in paragraph (1)[ ~~(A) or (B)~~ ] of this subsection:

(A) has not had a violation of a licensing rule:

(i) that:

(I) resulted in actual harm to a resident, which is defined as a negative outcome that compromises the resident's physical, mental , or emotional well-being; or

(II) posed an immediate threat of harm causing or likely to cause serious injury, impairment, or death to a resident; and

(ii) that:

(I) the facility did not challenge;

(II) was affirmed; or

(III) is pending a final determination; and

(B) has not had a sanction imposed by HHSC against the facility during the six years before the date an application is submitted that resulted in:

(i) a civil penalty;

(ii) an administrative penalty;

(iii) an injunction;

(iv) the denial, suspension, or revocation of a license; or

(v) an emergency closure.

(d) An applicant that makes a request in accordance with subsection (a) of this section must:

(1) submit the following to HHSC for approval via the online portal:

(A) the applicant's policies and procedures;

(B) proof that the applicant has followed the requirements in §553.257 of this chapter (relating to Personnel); and [ ~~evidence that the applicant has complied with §553.257(b) of this chapter (relating to Human Resources); and~~ ]

(C) documentation that the applicant's employees have the credentials described in §553.253 of this chapter (relating to Employee Qualifications and Training); and

(2) comply with [ ~~§553.23(d) of this subchapter and~~ ] §553.17 of this subchapter (relating to Criteria for Licensing).

(e) HHSC issues an initial license to an applicant that makes a request in accordance with subsection (a) of this section if HHSC determines that an applicant:

(1) is in good standing;

(2) has submitted information in accordance with subsection (d)(1) of this section that complies with this chapter; and

(3) is in compliance with applicable [ ~~NFPA 101 and other physical plant~~ ] requirements of Subchapter D of this chapter (relating to Facility Construction), including meeting the requirements of a life safety code [ ~~Life Safety Code~~ ] (LSC) inspection within 120 days after the date HHSC staff conduct the initial LSC inspection.

(f) HHSC staff conduct an onsite [ ~~on-site~~ ] health inspection within 90 days after the date HHSC issues a license in accordance with subsection (e) of this section. The onsite [ ~~on-site~~ ] health inspection includes HHSC observation of the facility's provision of care to at least one resident.

(g) Until a facility that is issued an initial license under this section meets the requirements of the onsite [ ~~on-site~~ ] health inspection described in subsection (f) of this section, the facility must attach a written addendum to the disclosure statement required by §553.259(d) [ ~~§553.259(c)(1)~~ ] of this chapter (relating to Admission Policies and Procedures) as notice to a resident or a prospective resident that the facility has not met the requirements of the onsite [ ~~on-site~~ ] health inspection. At a minimum, the addendum must state that:

(1) the facility has not met the requirements of an initial onsite [ ~~on-site~~ ] health inspection for a license; and

(2) HHSC staff conduct an onsite [ ~~on-site~~ ] health inspection for licensure within 90 days after the date the license is issued.

§ 553.27. Certification of a Type B Facility or Unit for Persons with Alzheimer's Disease and Related Disorders.

(a) A facility that advertises, markets, or otherwise promotes that the facility or a distinct unit of the facility provides specialized care for persons with Alzheimer's disease or related disorders must be certified or have the unit certified under subsection (d) of this section or §553.29 of this subchapter (relating to Alzheimer's Certification of a Type B Facility for an Initial License Applicant in Good Standing). Certification under this section is not required for a facility to use advertising terms such as "medication reminders or assistance," "meal and activity reminders," "escort service," or "short-term memory loss, confusion, or forgetfulness."

(b) To be certified under subsection (d) of this section, a facility must be licensed as a Type B facility.

(c) A license holder must request certification of a facility or unit under subsection (d) of this section by submitting the forms prescribed by HHSC via the online portal and include full payment of applicable fees described in §553.47(c) of this subchapter (relating to License Fees).

(d) After HHSC receives a request for certification in accordance with subsection (c) of this section, HHSC certifies a licensed Type B facility as a certified Alzheimer's facility or a unit of a licensed Type B facility as a certified Alzheimer's unit, if HHSC determines that :

(1) [ ~~that~~ ] the facility or unit is in compliance with §553.250 [ ~~§553.311~~ ] of this chapter (relating to Construction Requirements for a Certified Alzheimer's Assisted Living Facility [ ~~(relating to Physical Plant Requirements for Alzheimer's Units)~~ ] and other applicable requirements of Subchapter D of this chapter (relating to Facility Construction)[ ~~, including meeting the requirements of a Life Safety Code (LSC) inspection~~ ] within 120 days after the date HHSC staff conduct an initial life safety code [ ~~LSC~~ ] inspection; and

(2) [ ~~that~~ ] the facility or unit meets the requirements of Subchapter F of this chapter (relating to Additional Licensing Standards for Certified Alzheimer's Assisted Living Facilities) based on an onsite [ ~~on-site~~ ] health inspection, during which HHSC observes the facility's or unit's provision of care to at least one resident who has been admitted to the Alzheimer's facility or unit.

(e) A facility or unit may not exceed the maximum number of residents specified on the Alzheimer's certificate issued to the facility by HHSC.

(f) A facility must post the facility's or unit's Alzheimer's certificate in a prominent location for public view.

(g) An Alzheimer's certificate is valid for three years from the effective date of approval by HHSC.

(h) HHSC cancels an Alzheimer's certificate if:

~~[(1) a certified facility, or the facility in which a certified unit is located, undergoes a change of ownership; or]~~

(1) [ ~~(2)~~ ] HHSC determines that a certified facility or unit is not in compliance with applicable laws and rules ; or [ . ]

(2) the legal entity or individual for which the certification is issued voluntarily surrenders the certification.

(i) A facility must remove a cancelled certificate from display and advertising and surrender the certificate to HHSC.

§ 553.29. Alzheimer's Certification of a Type B Facility for an Initial License Applicant in Good Standing.

(a) An applicant may request that HHSC [ ~~, before conducting an on-site health inspection,~~ ] issue an initial license for a Type B facility and an Alzheimer's certification for the facility or a distinct unit of the facility before HHSC conducts an onsite health inspection . The applicant must meet the requirements of §553.25 of this subchapter (relating to Initial License for a Type A or Type B Facility for an Applicant in Good Standing) for the initial license and the requirements of this section for certification of the facility or unit.

(b) An applicant must request certification by submitting forms prescribed by HHSC via the online portal and include full payment of applicable fees described in §553.47 of this subchapter (relating to License Fees).

(c) An applicant that makes a request under [ ~~in accordance with~~ ] subsection (a) of this section is not required to admit a resident to the facility or unit or have the onsite [ ~~on-site~~ ] health inspection described in §553.23(e) [ ~~§553.23(f)~~ ] of this subchapter (relating to Initial License Application Procedures and Requirements) before HHSC certifies the facility or unit if HHSC determines that the applicant is in good standing:

(1) for the issuance of an initial license of the facility in accordance with §553.25(c) of this subchapter; and

(2) for certification of the facility or unit in accordance with subsection (d) of this section.

(d) An applicant is in good standing to obtain certification of a facility or unit if:

(1) for at least six consecutive years before applying for certification:

(A) the applicant has been:

(i) the license holder for an Alzheimer's certified facility in Texas or a facility in Texas that has an Alzheimer's certified unit; or

(ii) a controlling person of the license holder for an Alzheimer's certified facility in Texas or a facility in Texas that has an Alzheimer's certified unit; or

(B) a controlling person of the applicant has been:

(i) the license holder for an Alzheimer's certified facility in Texas or a facility in Texas that has an Alzheimer's certified unit; or

(ii) a controlling person of the license holder for an Alzheimer's certified facility in Texas or a facility in Texas that has an Alzheimer's certified unit;

(2) each licensed facility operated by the applicant or the controlling person has not had a violation or sanction described in §553.25(c)(2) of this subchapter; and

(3) each licensed facility operated by the applicant or the controlling person has had no more than two violations listed in §553.287(a) [ ~~§553.267(a)~~ ] of this chapter (relating to Rights) during the six-year period immediately before the applicant applied for certification.

(e) For purposes of subsection (d)(3) of this section, a facility has a violation if:

(1) the applicant or controlling person operating the facility did not challenge the violation;

(2) a final determination on the violation is pending; or

(3) the violation was upheld.

(f) An applicant that makes a request in accordance with subsection (a) of this section must submit to HHSC for approval via the online portal:

(1) the applicant's policies and procedures required by Subchapter F of this chapter (relating to Additional Licensing Standards for Certified Alzheimer's Assisted Living Facilities); and

(2) documentation demonstrating that the applicant is complying with Subchapter F of this chapter and §553.257 [ ~~§553.257(b)~~ ] of this chapter (relating to Personnel [ ~~Human Resources~~ ]).

(g) HHSC certifies a facility or unit after an applicant makes a request in accordance with subsection (a) of this section if HHSC determines that the applicant:

(1) meets the good standing requirements described in §553.25(c) of this subchapter and subsection (d) of this section;

(2) has submitted information in accordance with subsection (f) of this section; and

(3) is in compliance with:

(A) §553.27 of this subchapter (relating to Certification of a Type B Facility or Unit for Persons with Alzheimer's Disease and Related Disorders); and

(B) §553.250 [ ~~§553.311~~ ] of this chapter (relating to Construction Requirements for a Certified Alzheimer's Assisted Living Facility) [ ~~(relating to Physical Plant Requirements for Alzheimer's Units)~~ ].

(h) HHSC conducts an onsite [ ~~on-site~~ ] health inspection to determine if the facility or unit meets the requirements of Subchapter F of this chapter within 90 days after the date HHSC certifies a facility or unit in accordance with subsection (g) of this section. During each onsite [ ~~on-site~~ ] health inspection, HHSC observes the provision of care to at least one resident who has been admitted to the facility or unit.

(i) Until a facility or unit that is issued a certification under this section meets the requirements of the onsite [ ~~on-site~~ ] health inspection described in subsection (h) of this section, the facility must attach a written addendum to the disclosure statement required by §553.307(a) of this chapter (relating to Admission Procedures, Evaluation, and Service Plan for Residents in an Alzheimer's Certified Facility or Unit) [ ~~(relating to Admission Procedures, Assessment, and Service Plan)~~ ] to notify a resident or a prospective resident that the facility or unit has not met the requirements of the onsite [ ~~on-site~~ ] health inspection. At a minimum, the addendum must state that:

(1) the facility or unit has not met the requirements of an initial onsite [ ~~on-site~~ ] health inspection for Alzheimer's certification; and

(2) HHSC conducts an onsite [ ~~on-site~~ ] health inspection for Alzheimer's certification within 90 days after the date of certification.

(j) To obtain certification of a unit in a Type B facility that is already licensed, a license holder must comply with §553.27 of this subchapter.

§ 553.31. Provisional License.

~~[(a) HHSC may issue a six-month provisional license in the case of a corporate change of ownership.]~~

(a) [ ~~(b)~~ ] HHSC may issue [ ~~issues~~ ] a six-month provisional license for a newly constructed facility without conducting a life safety code [ ~~an NFPA 101 and physical plant~~ ] inspection to verify that the facility is in compliance with the applicable requirements of [ ~~under~~ ] Subchapter D of this chapter (relating to Facility Construction), [ ~~and, as applicable §553.311, of this chapter (relating to Physical Plant Requirements for Alzheimer's Units),~~ ] if:

(1) an applicant makes a written request for [ ~~requests in writing~~ ] a provisional license by submitting the required application in the online portal ;

(2) the applicant submits working drawings and specifications to HHSC for review in accordance with applicable procedures for plan review, approval, and construction in Subchapter D of this chapter, before facility construction begins;

(3) the applicant obtains all approvals, including a certificate of occupancy in a jurisdiction that requires one, from local authorities having jurisdiction in the area in which the facility is located, such as the fire marshal, health department, and building inspector;

(4) the applicant submits a complete license application within 30 days after receipt of all local approvals described in paragraph (3) of this subsection;

(5) the applicant pays in full the license fees required by §553.47 of this subchapter (relating to License Fees);

(6) the applicant, or a person who is a controlling person and an owner of the applicant, has constructed another facility in this state that complies with applicable [ ~~NFPA 101 and physical plant~~ ] requirements in Subchapter D of this chapter[ ~~, and, as applicable, §553.311 of this chapter~~ ]; and

(7) the applicant is in compliance with resident-care standards for licensure required by Subchapter E of this chapter (relating to Standards for Licensure) based on an onsite [ ~~on-site~~ ] inspection conducted in accordance with §553.327 of this chapter (relating to Inspections, Investigations, and Other Visits).

(b) [ ~~(c)~~ ] HHSC considers the date facility construction begins to be the date the building construction permit for the facility was approved by local authorities.

(1) the 180th day after the effective date of the provisional license or the end of any extension period granted by HHSC; or

(2) the date a three-year license is issued to the provisional license holder.

(d) [ ~~(e)~~ ] HHSC conducts a life safety code [ ~~an NFPA 101 and physical plant~~ ] inspection of a facility as soon as reasonably possible after HHSC issues a provisional license to the facility.

(e) [ ~~(f)~~ ] After conducting a life safety code [ ~~an NFPA 101 and physical plant~~ ] inspection, HHSC issues a license in accordance with Texas Health and Safety Code §247.023 to the provisional license holder if the facility passes the inspection and the applicant meets all requirements for a license.

§ 553.33. Renewal Procedures and Qualifications.

(a) The facility is responsible for submitting an application for license renewal via the online portal before the expiration date printed on the license. A license issued under this chapter:

(1) expires three years after the date issued;

(2) must be renewed before the license expiration date; and

(3) is not automatically renewed.

(b) An application for renewal must comply with the requirements of §553.19 of this subchapter (relating to General Application Requirements), and, as applicable, §553.21 of this subchapter (relating to Time Periods for Processing All Types of License Applications). The submission of a license fee alone does not constitute an application for renewal.

(c) To renew a license, a license holder must submit an application for renewal with HHSC via the online portal before the expiration date of the license. For purposes of Texas Government Code §2001.054, HHSC considers a license holder to have submitted a timely and sufficient application for the renewal of a license, which continues the license in effect and permits the facility to continue operations while HHSC is processing the renewal application, if the license holder submits to HHSC the basic fee described in §553.47(a) [ ~~§553.47(a)(1) or (2)~~ ] of this subchapter (relating to License Fees); and:

(1) a complete application for renewal no later than 45 days before the expiration of the current license;

(2) an incomplete application for renewal, with a letter explaining the circumstances that prevented the inclusion of the missing information no later than 45 days before the expiration of the current license; or

(3) a complete application or an incomplete application, with a letter explaining the circumstances that prevented the inclusion of the missing information, and the late fee described in §553.47(b) of this chapter during the 45-day period ending on the date the current license expires.

(d) HHSC may propose to deny, in accordance with subsection (l) [ ~~(m)~~ ] of this section, a timely and sufficient, but incomplete, renewal application submitted in accordance with subsection (c) of this section if the license holder fails to complete the application by paying in full all fees due beyond the basic fee and late fee paid in accordance with §553.47(b) of this chapter, and by submitting all information and documentation required to complete the license holder's renewal application before the date that the current license expires. HHSC does not grant a license unless a renewal application is complete. It is the license holder's responsibility to ensure that the application is submitted timely [ ~~submitted~~ ] to HHSC.

(e) A license expires if the license holder fails to submit a timely and sufficient application in accordance with subsection (c) of this section before the expiration date of the license.

(f) A person whose license has expired may not operate a facility without obtaining a license in accordance with the application requirements for an initial license in §553.23 of this subchapter (relating to Initial License Application Procedures and Requirements). Operating a facility without a license is subject to civil and administrative penalties and other authorized civil remedies.

(g) HHSC reviews an application for a renewal license within 30 days after the date HHSC Licensing and Credentialing Section, Long-term Care Regulation receives the application and notifies the applicant if additional information is needed to complete the application.

[(h) A license holder applying for a renewal license must show that the facility meets HHSC licensing standards based on an on-site inspection by HHSC. The on-site inspection must include an observation of the care of a resident.]

(h) [ ~~(i)~~ ] If an applicant is relying on meeting standards for accreditation in accordance with §553.17(c)(3) [ ~~§553.17(c)(2)~~ ] of this subchapter (relating to Criteria for Licensing) to show that it meets the requirements for licensure, the application for a renewal license must include a copy of the license holder's accreditation report from the accreditation commission with its application for renewal.

(i) [ ~~(j)~~ ] HHSC may hold [ ~~pend~~ ] action on an application for the renewal of a license for up to six months if the facility does not meet licensure requirements during an onsite [ ~~on-site~~ ] inspection.

(j) [ ~~(k)~~ ] The issuance of a license constitutes official written notice from HHSC to the facility that its application is approved.

(k) [ ~~(l)~~ ] HHSC may deny an application for the renewal of a license if the applicant, controlling person, or any person required to submit background and qualification information fails to meet the criteria for a license established in §553.17 of this subchapter.

(l) [ ~~(m)~~ ] Before denying an application for renewal of a license, HHSC provides [ ~~gives~~ ] the license holder[ : ]

[(1)] notice by [ ~~registered or certified~~ ] mail , by fax, in person, or by email of the facts or conduct alleged to warrant the proposed action[ ; ] and

[(2)] an opportunity to show compliance with all requirements of law for the retention of the license.

(1) If a document was sent by mail, HHSC will presume that it was received no later than three days after mailing.

(2) If a document was sent by fax or email before 5:00 p.m. on a business day, HHSC will presume that the document was received on the same day; otherwise, HHSC will presume that the document was received on the next business day.

(m) [ ~~(n)~~ ] To request an opportunity to show compliance, the license holder must send its written request to the Associate Commissioner of Long-term Care Regulation. The request must:

(1) be postmarked no later than 10 days after the date of HHSC notice and be received in the office of the Associate Commissioner of Long-term Care Regulation no later than 10 days after the date of the postmark; and

(2) contain specific documentation refuting HHSC allegations.

(n) [ ~~(o)~~ ] The opportunity to show compliance is limited to a review of documentation submitted by the license holder and information HHSC used as the basis for its proposed action and is not conducted as an adversary hearing. HHSC provides [ ~~gives~~ ] the license holder a written affirmation or reversal of the proposed action.

(o) [ ~~(p)~~ ] If HHSC denies an application for the renewal of a license, the applicant may request:

(1) an informal reconsideration by HHSC; and

(2) an administrative hearing or binding arbitration to appeal the denial, as described in §553.801 of this chapter (relating to Arbitration).

§ 553.35. Changes of Ownership and Notice of Changes.

(a) For purposes of this section, a temporary change of ownership license is a temporary license issued to an applicant who proposes to become the new operator of a facility that exists on the date the application is submitted.

(b) A license holder may not transfer its license. The applicant (new license holder) must obtain a temporary change of ownership license followed by an initial three-year license in accordance with this section. When HHSC [ ~~the Texas Health and Human Services Commission (HHSC)~~ ] approves the change of ownership by issuing a temporary change of ownership license to the new license holder, the current license holder's license becomes invalid as of the effective date of the change of ownership indicated in the change of ownership application. Between the effective date of the change of ownership and the issuance of the temporary change of ownership license, the current license holder remains responsible under its license; however, the applicant may operate a facility on behalf of a current license holder during such period of time.

(1) a complete HHSC application for a license in accordance with HHSC instructions and §553.23 of this subchapter (relating to Initial Application Procedures and Requirements) or an incomplete application with a letter explaining the circumstances that prevented the inclusion of the missing information;

(2) full payment of the fees required in §553.47 of this subchapter (relating to License Fees); and

(3) a signed and notarized Change of Ownership Transfer Affidavit HHSC Form 1092 from the applicant and the facility's current license holder of intent to transfer operation of the facility from the current license holder to the applicant, beginning on the change of ownership effective date specified on the change of ownership application.

(d) To avoid a facility operating while unlicensed, an applicant must submit all items required by subsection (c) of this section at least 30 days before the anticipated date of the change of ownership, unless the 30-day notice requirement is waived in accordance with subsection (e) of this section.

(e) HHSC may waive the 30-day notice required by subsection (d) of this section if HHSC determines that the applicant presents evidence showing that circumstances prevented the submission of the items specified in subsection (c) of this section and that not waiving the notice would create a threat to resident welfare or health and safety.

(f) Upon HHSC approval of the items specified in subsection (c) of this section, HHSC issues a temporary change of ownership license to the applicant if HHSC finds that the applicant, all controlling persons, and all persons disclosed in the application satisfy the requirements in §553.17 of this subchapter (relating to Criteria for Licensing), except for §553.17(c) and (d).

(1) The issuance of a temporary change of ownership license constitutes HHSC's official written notice to the facility of the approval of the application for a change of ownership.

(2) The effective date of the temporary change of ownership license is the date requested in the application and cannot precede the date the application is received by HHSC through the online portal.

(g) A temporary change of ownership license expires on the earlier of:

(1) 90 days after its effective date or the last day of any extension HHSC provides in accordance with subsection (h) of this section; or

(2) the date HHSC issues a three-year license in accordance with subsection (k) of this section.

(h) HHSC, in its sole discretion, may extend a temporary change of ownership license for a term of 90 days at a time based upon extenuating circumstances.

(i) HHSC staff conduct an onsite [ ~~on-site~~ ] health inspection to verify compliance with the licensure requirements after issuing a temporary change of ownership license. HHSC may conduct a desk review instead of an onsite [ ~~on-site~~ ] health inspection after issuing a temporary change of ownership if:

(1) less than 50 percent of the direct or indirect ownership interest in the former license holder differs from that of the new license holder; or

(2) every owner with a disclosable interest in the new license holder has a disclosable interest in the former license holder.

(j) HHSC, in its sole discretion, may conduct an onsite life safety code [ ~~on-site Life Safety Code~~ ] inspection of the facility after issuing a temporary change of ownership license.

(k) If the applicant, all controlling persons, and all persons disclosed in the application satisfy the requirements of §553.17 of this subchapter, except for §553.17(c)(2)(A)- (C), [ ~~§553.17(c)(1)(A) - (C),~~ ] for a license, and the facility passes the change of ownership health inspection as described in subsection (i) of this section, HHSC issues a three-year license within 30 days after HHSC determines that the applicant and the facility have met the licensure requirements of this section. The effective date of the three-year license is the same date as the effective date of the change of ownership and cannot precede the date the application was received by HHSC through the online portal.

(l) HHSC may deny an application for a change of ownership if the applicant, controlling person, or any person disclosed in the application fails to meet the criteria for a license established in §553.17 of this subchapter.

(m) If HHSC denies an application for a temporary change of ownership license or a three-year license, HHSC sends the applicant a written notice of the denial and informs the applicant of the applicant's right to request an administrative hearing to appeal the denial. The administrative hearing is held in accordance with HHSC rules at 1 TAC Chapter 357, Subchapter I (relating to Hearings Under the Administrative Procedure Act).

(n) If a license holder that is not a publicly traded company adds an owner with a disclosable interest, but the license holder does not undergo a change of ownership, the license holder must notify HHSC no later than 30 days after the addition of the owner by submitting an application through the online portal.

(o) If a license holder changes its name but does not undergo a change of ownership, the license holder must notify HHSC and submit documentation evidencing a legal name change by submitting an application through the online portal. On receipt of the notice and documentation, HHSC reissues the current license in the license holder's new name.

§ 553.37. Relocation.

(a) Relocation is the closing of a facility and the movement of its residents to another location for which the license holder does not hold a current license. This section does not apply to relocations conducted as part of a facility's emergency response activities under §553.295 of this chapter (relating to Emergency Preparedness and Response).

(b) A license holder must not relocate a facility without a license from HHSC for the facility at the new location.

(c) To apply for relocation, the license holder for the current location must submit an application via the online portal for an initial license for the new location in accordance with §553.23 of this subchapter (relating to Initial Application Procedures and Requirements) and full payment of the fees required in §553.47 of this subchapter (relating to License Fees). The applicant must enter the proposed date of relocation on the application, subject to issuance of a license.

(d) Residents must not be relocated until HHSC inspects the new building and approves the [ ~~new~~ ] building [ ~~has been inspected and approved~~ ] as meeting the life safety code (LSC) [ ~~Life Safety Code~~ ] licensure requirements in Subchapter D of this chapter (relating to Facility Construction).

(e) Following LSC [ ~~Life Safety Code~~ ] approval by HHSC, the license holder must notify HHSC via the online portal of the date the residents will be relocated.

(f) After a facility has met standards of operations in subsection (d) of this section, HHSC staff conduct an onsite [ ~~on-site~~ ] health inspection if one was not conducted within the last survey [ ~~licensure~~ ] period, to determine if the facility meets the licensure requirements for standards of operation and resident care in Subchapter E of this chapter (relating to Standards for Licensure).

(g) HHSC issues a license for the new facility if the new facility meets the standards of operations in subsections (d) and (e) of this section.

(h) The license holder must continue to maintain the license at the current location and must continue to meet all requirements for operation of the facility until HHSC has approved the relocation. The issuance of a license constitutes HHSC approval of the relocation. The license for the current location becomes invalid upon issuance of the new license for the new location. The license from the other location must be returned to HHSC.

§ 553.39. Increase in Capacity.

(a) A license holder must not increase a facility's licensed capacity without approval from HHSC.

(b) The license holder must submit an application for an increase in capacity in accordance with §553.19 of this subchapter (relating to General Application Requirements) and the fee required in §553.47 of this subchapter (relating to License Fees).

(c) The license holder must arrange for an inspection of the facility by the local fire marshal and provide the signed fire marshal approval to HHSC.

(d) After HHSC's review of an application and after the applicant notifies HHSC via the online portal that the facility is ready for a life safety code [ ~~Life Safety Code~~ ] (LSC) inspection, HHSC staff conduct an onsite [ ~~on-site~~ ] LSC inspection of the facility to determine if the facility meets the [ ~~LSC~~ ] licensure requirements in Subchapter D of this chapter (relating to Facility Construction).

(e) If the facility fails to meet the LSC licensure requirements within 120 days after the LSC inspection, HHSC denies the application for an increase in capacity.

(f) After a facility has met LSC licensure requirements, HHSC staff conduct an onsite [ ~~on-site~~ ] health inspection, if one was not conducted within the last survey [ ~~licensure~~ ] period, to determine if the facility meets the licensure requirements for standards of operation and resident care in Subchapter E of this chapter (relating to Standards for Licensure).

(g) HHSC issues a new license with an increased capacity within 30 days after HHSC determines that all licensure requirements have been met. HHSC may grant approval to occupy the increased capacity once HHSC determines that all licensure requirements have been met.

(h) In order to meet the residents' health and safety needs in the event of a fire, natural disaster, or catastrophic event, HHSC may grant approval to temporarily exceed a facility's licensed capacity provided the health and safety of residents are not compromised and the facility can meet the required health care service needs of all residents. A facility may exceed its licensed capacity under this circumstance, monitored by HHSC Survey Operations , until residents can be transferred to a permanent location. HHSC issues authorization for the temporary increase in the facility's licensed capacity. The authorization to temporarily increase the capacity ends when the facility receives written notice from HHSC ending the authorization.

§ 553.45. Voluntary Closure.

(a) If a license holder decides to voluntarily close an assisted living facility, the license holder must send a written notice at least 30 days before the facility closes. This notice must include the planned closing date and be sent to:

(1) HHSC Licensing;

(2) the facility's designated regional office;

(3) the State Ombudsman; and

(4) the residents of the facility and the residents' legally authorized representatives.

(b) The facility must assist a resident to find placement at another facility upon request to the extent practicable.

§ 553.47. License Fees.

(a) Basic fees.

(1) Type A and Type B. The license fee is $300, plus $15 for each bed for which a license is sought, with a maximum of $2,250 for a three-year license. The fee must be paid with an initial application, change of ownership application, or renewal application.

(2) Increase in capacity. An approved increase in capacity is subject to an additional fee of $15 for each bed. HHSC does not assess the fee for temporary capacity increases in response to an emergency.

(b) Late renewal fee. An applicant that submits an application for license renewal later than the 45th day before the expiration date of the license must pay a late fee of an amount equal to one-half of the basic fee required in accordance with subsection (a) [ ~~(a)(1) and (2)~~ ] of this section.

(c) Alzheimer's certification. In addition to the basic license fee described in subsection (a) of this section, a facility that applies for certification as an Alzheimer's facility under Subchapter E of this chapter (relating to Standards for Licensure) must pay an additional license fee. For a three-year license issued in accordance with subsection (a)(1) of this section or §553.33(a)(1) of this subchapter (relating to Renewal Procedures and Qualifications) , the additional fee is $300.

(d) Trust fund fee.

(1) If the amount in the facility trust fund, established under Texas Health and Safety Code[ , ] Chapter 242, Subchapter D, and [ ~~Chapter 247~~ ] §247.003(b), is less than $500,000, HHSC collects an annual fee from each facility. The fee is based on a monetary amount specified for each licensed unit of capacity or bed space and is in an amount sufficient to provide not more than $500,000 in the trust fund. When the trust fund fee is collected, HHSC sends written notice to each facility stating the amount of the fee and the date the fee is due. A facility must pay the amount of the fee within 90 days after the date the fee is due.

(2) HHSC may charge and collect a trust fund fee more than once a year if necessary to ensure that the amount in the facility trust fund is sufficient to make the disbursements required under Texas Health and Safety Code §242.0965. When this subsequent trust fund fee is collected, HHSC sends written notice to each facility stating the amount of the fee and the date the fee is due. A facility must pay the amount of the fee within 90 days after the date the fee is due.

(3) Failure to pay the trust fund fee within 90 days after the date the fee is due as stated on the written notice described in paragraphs (1) and (2) of this subsection may result in an assessment of an administrative penalty under the administrative penalties described in §553.751 [ ~~Subchapter H, Division 9~~ ] of this chapter (relating to Administrative Penalties).

(e) Plan review fee. An applicant may submit building plans for a new building, an addition, the conversion of a building not licensed, or for the remodeling of an existing licensed facility for review by HHSC architectural staff. If the applicant chooses to submit building plans for review, the applicant must pay a fee for the plan review according to the following schedule:

Figure: 26 TAC §553.47(e) (No change.)

(f) Payment of fees. A facility or applicant must pay fees in a method allowed by [ ~~check, cashier's check, money order, or credit card, made payable to~~ ] HHSC. All fees are nonrefundable, except as provided in Texas Government Code[ , ] Chapter 2005, and in §553.21(d) of this chapter (relating to Time Periods for Processing All Types of License Applications).

(g) Optional expedited inspection and associated fee.

(1) An applicant for an assisted living facility license may obtain an expedited inspection described in subparagraph (A) or (B) of this paragraph if the applicant meets the requirements in both clauses of the applicable subparagraph.

(A) A life safety code [ ~~Life Safety Code~~ ] (LSC) inspection conducted no later than the 15th calendar day after the date HHSC receives a request for an expedited inspection, if the applicant:

(i) indicates that the facility is ready for a LSC inspection [ ~~meets the application requirements under this subchapter for the applicable license~~ ]; and

(ii) submits the applicable expedited LSC inspection fee in accordance with the fee schedule in paragraph (2) of this subsection; or

(B) an onsite [ ~~on-site~~ ] health inspection conducted no later than the 21st calendar day after the date HHSC receives a request for an expedited inspection, if the applicant:

(i) indicates that it is ready for a health inspection and meets the application requirements under this subchapter for the applicable license; and

(ii) submits the applicable expedited onsite [ ~~on-site~~ ] health inspection fee in accordance with the fee schedule in paragraph (2) of this subsection.

(2) An applicant requesting an expedited inspection must include the applicable fee from the following fee schedule with a request for an expedited inspection submitted in accordance with paragraph (1) of this subsection.

Figure: 26 TAC §553.47(g)(2) (No change.)

(h) If, after HHSC conducts two life safety code [ ~~LSC~~ ] inspections for a given application, the applicant requests an additional inspection, then the applicant must pay a fee of $25 per bed, with a minimum payment of $1,000 for the third and each subsequent inspection pertaining to the same application.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 18, 2026.

TRD-202603591

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 4, 2026

For further information, please call: (512) 438-3161

26 TAC §553.43

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §524.0005, which provides that the executive commissioner of HHSC shall adopt rules to implement the executive commissioner's authority under Texas Government Code Chapter 524 with respect to the health and human services system, and §524.0151, which provides that the executive commissioner of HHSC shall adopt rules necessary to carry out the commission's duties under Texas Government Code Chapter 531 and adopt rules and policies for the operation and provision of services by the health and human services agencies; and Texas Health and Safety Code §247.025 and §247.026, which provide that the executive commissioner of HHSC shall adopt rules necessary to implement Texas Health and Safety Code Chapter 247 and to ensure the quality of care and protection of assisted living facility residents' health and safety, respectively.

The repeal implements Texas Government Code §524.0005 and §524.0151 and Texas Health and Safety Code §247.025 and §247.026.

§ 553.43. Disclosure of Facility Identification Number.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 18, 2026.

TRD-202603590

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 4, 2026

For further information, please call: (512) 438-3161

SUBCHAPTER D. FACILITY CONSTRUCTION

DIVISION 1. GENERAL PROVISIONS

26 TAC §553.100, §553.101

STATUTORY AUTHORITY

The amendments implement Texas Government Code §524.0005 and §524.0151 and Texas Health and Safety Code §247.025 and §247.026.

§ 553.100. General Requirements.

(a) A building or structure used as a licensed assisted living facility, whether new or existing, must comply with these standards.

(b) All assisted living facilities must meet the requirements of NFPA 101 [ ~~comply with National Fire Protection Association Life Safety Code (NFPA 101)~~ ] and any applicable Tentative Interim Amendment (TIA) issued by NFPA (National Fire Protection Association), unless stated [ ~~NFPA, except as~~ ] otherwise [ ~~stated~~ ] in these standards.

(c) All assisted living facilities must meet the requirements of [ ~~comply with~~ ] other chapters, sections, subsections, and paragraphs of NFPA 101, as those chapters, sections, subsections, and paragraphs [ ~~they~~ ] relate to[ : ] Chapter 18, New Health Care Occupancies; Chapter 19, Existing Health Care Occupancies; Chapter 32, New Residential Board and Care Occupancies; and Chapter 33, Existing Residential Board and Care Occupancies . [ ~~, including:~~ ]

~~[(1) Chapter 1, Administration;]~~

~~[(2) Chapter 2, Referenced Publications;]~~

~~[(3) Chapter 3, Definitions;]~~

~~[(4) Chapter 4, General;]~~

~~[(5) Chapter 5, Performance-Based Option;]~~

~~[(6) Chapter 6, Classification of Occupancy and Hazard of Contents;]~~

~~[(7) Chapter 7, Means of Egress;]~~

~~[(8) Chapter 8, Features of Fire Protection;]~~

~~[(9) Chapter 9, Building Service and Fire Protection Equipment;]~~

~~[(10) Chapter 10, Interior Finish, Contents, and Furnishings;]~~

~~[(11) Chapter 11, Special Structures and High-Rise Buildings; and]~~

~~[(12) Chapter 43, Building Rehabilitation.]~~

(d) An assisted living facility that wishes to be reclassified from a small facility to a large facility, from a Type A facility to a Type B facility, or both, must meet the requirements for a new facility of the type and size specified in this subchapter to be reclassified.

(e) This [ ~~The requirements of this~~ ] subchapter applies [ ~~apply~~ ] to an assisted living facility as follows . [ : ]

(1) All assisted living facilities must meet the requirements of [ ~~comply with~~ ] Division 1 of this subchapter (relating to General Provisions) and Division 2 of this subchapter (relating to Provisions Applicable to All Facilities).

(2) An existing assisted living facility is one that received its first license before August 31, 2021, and has kept its license in effect since then. The rules in this subchapter apply to an existing assisted living facility, as follows. [ An assisted living facility initially licensed before August 31, 2021, and continually operated under an assisted living license without interruption since then, is considered an existing assisted living facility and must comply with the following, as applicable: ]

(A) An existing small Type A assisted living facility must meet the requirements of [ ~~comply with~~ ] Division 4 of this subchapter (relating to Existing Small Type A Assisted Living Facilities).

(B) An existing small Type B assisted living facility must meet the requirements of [ ~~comply with~~ ] Division 5 of this subchapter (relating to Existing Small Type B Assisted Living Facilities).

(C) An existing large Type A assisted living facility must meet the requirements of [ ~~comply with~~ ] Division 6 of this subchapter (relating to Existing Large Type A Assisted Living Facilities).

(D) An existing large Type B assisted living facility must meet the requirements of [ ~~comply with~~ ] Division 7 of this subchapter (relating to Existing Large Type B Assisted Living Facilities).

(3) A new [ An ] assisted living facility is one that applies for a new license [ ~~initially licensed~~ ] on or after August 31, 2021. Any [ ~~2021, or any~~ ] new building or building addition at a licensed assisted facility that is completed [ ~~to a currently licensed assisted living facility constructed~~ ] on or after August 31, 2021, is also considered a new assisted living facility . The rules in this subchapter apply to a new assisted living facility, as follows. [ ~~and must comply with the following:~~ ]

(A) A new small Type A assisted living facility must meet the requirements of [ ~~comply with~~ ] Division 8 of this subchapter (relating to New Small Type A Assisted Living Facilities).

(B) A new small Type B assisted living facility must meet the requirements of [ ~~comply with~~ ] Division 9 of this subchapter (relating to New Small Type B Assisted Living Facilities).

(C) A new large Type A assisted living facility must meet the requirements of [ ~~comply with~~ ] Division 10 of this subchapter (relating to New Large Type A Assisted Living Facilities).

(D) A new large Type B assisted living facility must meet the requirements of [ ~~comply with~~ ] Division 11 of this subchapter (relating to New Large Type B Assisted Living Facilities).

(f) An assisted living facility must comply with local codes and ordinances as follows . [ : ]

(1) Where there is [ ~~An assisted living facility located within the jurisdiction of~~ ] a local AHJ, an assisted living facility [ organization, office, or individual responsible for enforcing the requirements of a code or standard, or for approving equipment, materials, an installation, or a procedure that adopts codes or ordinances governing building construction or fire safety (Authority Having Jurisdiction or AHJ) ] must comply with the [ ~~applicable~~ ] local codes and ordinances . The local AHJ decides how local codes and ordinances are interpreted and enforced. [ ~~adopted by the AHJ, as interpreted and enforced by the AHJ. The description of the occupancy may vary with local codes.~~ ]

(2) Where [ ~~An assisted living facility located where~~ ] there is no local AHJ an assisted living facility must be designed and constructed to meet a nationally recognized [ ~~nationally-recognized~~ ] building code and its related [ ~~referenced~~ ] codes.

(3) If a building was already being used [ ~~An existing building, either occupied~~ ] as an assisted living facility when HHSC inspected it for the first time, or the building changed use to become an assisted living facility before that first inspection by HHSC, [ ~~at the time of initial inspection by HHSC or converted to occupancy as an assisted living facility prior to the initial inspection by HHSC,~~ ] the building must meet all local requirements for that building use. The local AHJ decides how local codes and ordinances are interpreted and enforced. [ ~~pertaining to that building for that occupancy as administered by the local AHJ for the adopted code or ordinance.~~ ]

(4) An assisted living facility must keep records showing compliance with all local requirements. [ ~~submit documentation from the local AHJ that local requirements are satisfied.~~ ]

(g) When local laws, codes, or ordinances are different from the standards for assisted living facilities set forth in this subchapter [ ~~Subchapter D~~ ], an assisted living facility must comply with both local and HHSC requirements.

(h) An assisted living facility must ensure building rehabilitation on existing buildings is classified according to NFPA 101 and that any rehabilitation complies with NFPA 101 and §553.107 of this subchapter (relating to Building Rehabilitation).

(i) An assisted living facility must ensure buildings, or portions of buildings, are not occupied during construction, repair, alterations, or additions, except when required means of egress, required means of escape, and required fire protection features are in place and continuously maintained for the portion occupied. Alternative life safety measures may be put in place if prior approval is obtained from HHSC.

(j) An assisted living facility must ensure no existing life safety feature is removed or reduced when the feature is a requirement for a new facility. Life safety features, and equipment not required by NFPA 101, that have been installed in existing buildings must continue to be maintained or be completely removed, if prior approval is obtained from HHSC.

(k) An assisted living facility must not lock doors against egress or escape unless it is allowed by NFPA 101 or the facility is a certified Alzheimer's assisted living facility that meets the requirements of §553.250 of this chapter (relating to Construction Requirements for a Certified Alzheimer's Assisted Living Facility). A certified Alzheimer's assisted living facility is an assisted living facility certified according to §553.27 of this chapter (relating to Certification of a Type B Facility or Unit for Persons with Alzheimer's Disease and Related Disorders) or §553.29 of this chapter (relating to Alzheimer's Certification of Type B Facility for an Initial License Applicant in Good Standing). [ comply with the plan review and inspection requirements of the Texas Accessibility Standards (TAS) adopted by the Texas Department of Licensing and Regulation (TDLR) rules in Texas Administrative Code, Title 16, Chapter 68, and must provide documentation demonstrating it has registered the facility with TDLR and obtained a plan review from a Registered Accessibility Specialist, if TDLR requires the facility to be registered and reviewed. ]

[(l) An assisted living facility must not segregate any area housing residents from other parts of the assisted living facility housing residents, except as permitted by §553.51 of this chapter (relating to Certification of a Facility or Unit for Persons with Alzheimer's Disease and Related Disorders).]

§ 553.101. Definitions.

The following [ ~~words and~~ ] terms[ ~~, when used~~ ] in this subchapter[ , ] have the following meanings, unless the context clearly indicates otherwise. The definitions in §553.3 of this chapter (relating to Definitions) also apply to this subchapter.

(1) Approved--Acceptable to HHSC [ ~~the Texas Health and Human Services Commission~~ ].

(2) AHJ-- Authority having jurisdiction . [ ~~(AHJ)--~~ ] An organization, office, or individual responsible for enforcing the requirements of a code or standard, or for approving equipment, materials, an installation, or a procedure.

(3) Auxiliary serving kitchen--An area that is not contiguous to a food preparation or serving area and that is for serving food but is not used for cooking or meal preparation.

(4) Bedroom usable floor space--The floor area of a resident bedroom that may be considered toward meeting minimum requirements for a resident bedroom floor area.

(5) Building rehabilitation--Any construction activity involving repair, modernization, reconfiguration, renovation, changes in occupancy or use, or installation of new fixed equipment, including:

(A) the replacement of finishes, such as new flooring or wall finishes or the painting of walls and ceilings;

(B) the construction, removal, or relocation of walls, partitions, floors, ceilings, doors, or windows;

(D) changes to the appearance of the exterior of a building, including new finish materials;

(E) the installation, repair, replacement, or extension of fire protection systems, including fire sprinkler systems, fire alarm system, and fire suppression systems, at cooking operations;

(F) the replacement of door hardware, plumbing fixtures, handrails in corridors, or grab rails in bathrooms and restrooms;

(G) the repair, replacement, or extension of required communication systems;

(H) the repair or replacement of emergency electrical system equipment and components, including generator sets, transfer switches, distribution panel boards, receptacles, switches, and light fixtures;

(I) the change of a wing or area to a certified [ ~~Certified~~ ] Alzheimer's assisted living facility or certified Alzheimer's assisted living unit; [ ~~Disease Assisted Living Facility or unit;~~ ]

(J) the change of a certified [ ~~Certified~~ ] Alzheimer's assisted living facility or certified Alzheimer's assisted living unit to ordinary resident use; [ ~~Disease Assisted Living Facility or unit to ordinary resident-use;~~ ]

(K) a change in the use of space, including the change of resident bedrooms to other uses, such as offices, storage, or living or dining spaces; and

(L) changes in locking arrangements, such as the installation of access control systems or the installation or removal of electronic locking devices, including electromagnetic locks, and other delayed-egress locking devices.

(6) Co-mingles--The laundering of apparel or linens of two or more individuals together.

(7) Control door--A door between two certified Alzheimer's assisted living units or a certified Alzheimer's assisted living unit and other resident-use or public areas of an assisted living facility. A control door is intended for separating residents living in a certified Alzheimer's assisted living unit from residents living in another certified Alzheimer's assisted living unit or from residents living in a part of an assisted living facility that is not a certified Alzheimer's assisted living unit for the safety of the Alzheimer's assisted living unit resident.

(8) [ ~~(7)~~ ] Conversion--Change of occupancy from an existing residential or health care occupancy to a residential board and care occupancy, including an assisted living facility located in a building that had been used as a residence or a health care facility such as a hospital or a nursing home.

[(8) Direct telephone--A telephone that automatically dials and connects to a fixed location when the caller takes the handset off-hook without requiring the caller to input a receiving telephone number. A direct telephone must ring at a location staffed 24-hours a day and may not be answered by an answering machine or voicemail system. A direct telephone may also function as a regular telephone when a receiving telephone number is entered.]

~~[(9) Factory Mutual (FM)--An organization that certifies products and services for compliance with loss prevention standards. Also known as FM Approvals.]~~

(9) [ ~~(10)~~ ] Finished ground level--The level of the finished ground (earth or other surface on ground).

(10) Flame spread--A measure of how fire spreads along the surface of a material. This is different than the fire resistance rating of a material. Flame spread is described as Class A, Class B, or Class C.

(11) FM--Factory Mutual. An organization that certifies products and services for compliance with loss prevention standards. Also known as FM Approvals.

(12) [ ~~(11)~~ ] Fuel-fired heating device--Any equipment, device, or apparatus, or any part thereof, which is installed for the purpose of combustion of fuel, including natural gas, liquid petroleum gas (propane), or solid fuel, to produce heat or energy used as a component of a heating system providing heat for any interior space or water source. Freestanding solid fuel- or pellet-fuel burning appliances such as freestanding wood-burning or pellet-burning stoves do not meet this definition.

(13) [ ~~(12)~~ ] Independent cooking equipment--An electric or gas stove or range with one or more burners, with or without an oven.

(14) Listed--Equipment, materials, or services included in a list published by an organization concerned with evaluation of products or services that maintains periodic inspection of production of listed equipment or materials or periodic evaluation of services, and whose listing states that either the equipment, material, or service meets appropriate designated standards or has been tested and found suitable for a specified purpose. The listing organization must be acceptable to the authority having jurisdiction, including HHSC or any other state, federal, or local authority.

(15) [ ~~(13)~~ ] Living unit--A portion of a facility arranged as a separate unit providing one or more bedrooms, toilet and bathing facilities, and living or dining spaces, with or without facilities for cooking, exclusively for the use of the residents residing in the bedrooms.

(16) Local code--A set of rules for building safety or fire safety that the local government or fire marshal has officially adopted for the area where the building is located.

(17) [ ~~(14)~~ ] Neighborhood or household--A portion of a large facility arranged as a unit providing bedrooms, toilet and bathing facilities, resident living areas, and kitchen facilities serving up to 16 residents.

(18) [ ~~(15)~~ ] NFPA--National Fire Protection Association.

(19) [ ~~(16)~~ ] NFPA 10--Standard for Portable Fire Extinguishers, 2010 edition.

(20) [ ~~(17)~~ ] NFPA 13--Standard for the Installation of Sprinkler Systems, 2010 edition.

(21) [ ~~(18)~~ ] NFPA 13D--Standard for the Installation of Sprinkler Systems in One-and Two-Family Dwellings and Manufactured Homes, 2010 edition.

(22) [ ~~(19)~~ ] NFPA 13R--Standard for the Installation of Sprinkler Systems in Residential Occupancies Up to and Including Four Stories in Height, 2010 edition.

(23) [ ~~(20)~~ ] NFPA 25--Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems, 2011 edition.

(24) [ ~~(21)~~ ] NFPA 54--National Fuel Gas Code, 2012 edition.

(25) [ ~~(22)~~ ] NFPA 70--National Electrical Code, 2011 edition.

(26) [ ~~(23)~~ ] NFPA 72--National Fire Alarm and Signaling Code, 2010 edition.

(27) [ ~~(24)~~ ] NFPA 96--Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations, 2011 edition.

(28) NFPA 101--Life Safety Code, 2012 edition.

(29) [ ~~(25)~~ ] NFPA 110--Standard for Emergency and Standby Power Systems, 2010 edition.

(30) [ ~~(26)~~ ] NFPA 211--Standard for Chimneys, Fireplaces, Vents, and Solid Fuel-Burning Appliances, 2010 edition.

(31) [ ~~(27)~~ ] NFPA 720--Standard for Installation of Carbon Monoxide (CO) Detection and Warning Equipment, 2012 edition.

(32) [ ~~(28)~~ ] Special Waste from Health Care-Related Facilities--Special waste from health care-related facilities as defined in Texas Administrative Code, Title 25, Part 1, Chapter 1, Subchapter K (relating to Definition, Treatment, and Disposition of Special Waste from Health Care-Related Facilities).

(33) [ ~~(29)~~ ] TCEQ--Texas Commission on Environmental Quality.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 18, 2026.

TRD-202603592

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 4, 2026

For further information, please call: (512) 438-3161

DIVISION 2. PROVISIONS APPLICABLE TO ALL FACILITIES

26 TAC §553.103, §553.104

STATUTORY AUTHORITY

The amendments implement Texas Government Code §524.0005 and §524.0151 and Texas Health and Safety Code §247.025 and §247.026.

§ 553.103. Site and Location for all Assisted Living Facilities.

(a) Firefighting unit. An assisted living facility must be served by a professional or volunteer firefighting unit and must have a water supply that meets the firefighting unit's requirements and approval.

(b) Correction of hazards. An assisted living facility must correct a site or building condition that HHSC staff identifies to be a fire, health, or physical hazard.

[(1)] An assisted living facility must provide or arrange for nearby parking spaces for the private vehicles of residents and visitors.

[(2) An assisted living facility must provide a minimum of one parking space for every four residents in its licensed capacity, and for any fraction thereof, or per local requirements, whichever is more stringent.]

(d) Ramps.

(1) An assisted living facility must ensure a ramp, walk, or step is of slip-resistive texture and is uniform, without irregularities.

(2) An assisted living facility must ensure a ramp does not exceed a slope of one foot in 12 feet.

(3) An assisted living facility must ensure any new ramp has a clear width of at least 36 inches. A new ramp is one that was installed or constructed on or after August 31, 2021.

~~[(e) Site conditions. An assisted living facility must provide a guardrail, fence, or handrail where a grade makes an abrupt change in level.]~~

(e) [ ~~(f)~~ ] Outside grounds. An assisted living facility must ensure that each outside area, grounds, and any adjacent buildings are maintained in good condition and kept free of rubbish, garbage, and untended growth that may constitute a fire or health hazard.

(f) [ ~~(g)~~ ] Drainage. An assisted living facility must ensure site grades provide for water drainage away from structures to prevent ponding or standing water at or near a building, unless the ponding or standing water is part of an approved drainage system intended to hold water for a period of time.

(g) [ ~~(h)~~ ] 100-year Floodplain. An assisted living facility in a county with more than 3.3 million residents that applies for a new [ ~~an initial~~ ] license or that was first [ ~~is initially~~ ] licensed on or after December 6, 2022, must not be located in a 100-year floodplain . [ ~~, if the facility is located in a county of more than 3.3 million residents.~~ ]

§ 553.104. Safety Operations.

(a) Local fire marshal inspection.

(1) An assisted living facility must obtain an inspection at least once every 12 months[ , ] by the local fire marshal, or the Texas State Fire Marshal's Office in locations where there is no local fire marshal, and must correct any items cited by the local fire marshal, or the Texas State Fire Marshal's Office, to the satisfaction of those authorities.

(2) An assisted living facility must maintain documentation at the facility reflecting the outcome of the most recent annual inspection.

(b) Emergency evacuation floor plan. An assisted living facility, other than a one-story small Type A or a one-story small Type B assisted living facility, must post an emergency evacuation floor plan in a location visible to residents.

(c) Fire safety plan. An assisted living facility must establish a fire safety plan for the protection of all persons in the facility in the event of fire.

(1) The [ An ] assisted living facility must follow [ ~~ensure~~ ] the fire safety plan [ ~~is in effect~~ ] at all times.

(2) The [ An ] assisted living facility must provide [ ~~make~~ ] written copies of the fire safety plan [ ~~are available~~ ] to all supervisory personnel.

(3) The [ An ] assisted living facility fire safety plan must cover [ ~~ensure the fire safety plan addresses~~ ]:

(A) evacuation to an area of refuge;

(B) evacuation from the building when necessary; and

(4) If the facility is a large Type B assisted living facility , the following provisions also apply. [ : ]

(A) An existing large Type B assisted living facility must ensure the fire safety plan includes the provisions described in 19.7.2, Procedure in Case of Fire, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(B) A new large Type B assisted living facility must ensure the fire safety plan includes the provisions described in 18.7.2, Procedure in Case of Fire, in NFPA 101, Chapter 18, New Health Care Occupancies.

(5) The [ An ] assisted living facility must review [ ~~ensure~~ ] the fire safety plan [ ~~is reviewed~~ ] at least once a year or when there are changes in the needs of residents. The facility must keep a written record showing when the fire safety plan was reviewed or changed. [ ~~annually and revised, as needed, to address the changing needs of residents.~~ ]

(6) The [ An ] assisted living facility must train [ ~~instruct and inform~~ ] all employees on what to do in case of a fire and what the employees' roles are in [ ~~of their duties and responsibilities under~~ ] the fire safety plan . The facility must conduct this training at least once every year and whenever the plan is updated. The facility must keep a written record showing when each employee was trained on the employee's duties and responsibilities under the fire safety plan. [ ~~at least annually, and when the fire safety plan is revised.~~ ]

(7) The [ An ] assisted living facility must keep a copy of the fire safety plan where it is easy to access. [ ~~readily available at all times within the facility.~~ ]

(8) The [ An ] assisted living facility must ensure the fire safety plan is based on residents' physical and cognitive abilities. [ ~~reflects the current evacuation capabilities of the residents.~~ ]

(d) Fire drills. An assisted living facility must conduct a fire drill on each work shift at least once during each calendar quarter [ ~~one quarterly fire drill on each shift~~ ] with at least one drill each month. Each drill must meet the following [ ~~these~~ ] requirements . [ : ]

(1) The [ An ] assisted living facility must ensure staff take part in fire drills according to the assisted living facility's fire safety plan.

(2) The [ An ] assisted living facility must ensure [ ~~inform~~ ] residents know the [ of ] evacuation procedures and where all [ ~~locations of~~ ] exits are .

(3) The [ An ] assisted living facility must keep a written record of [ ~~document~~ ] every fire drill . The facility must use [ ~~using~~ ] the most current version of the HHSC [ ~~required Texas Health and Human Services (HHSC) form titled~~ ] "Fire Drill Report" available on the HHSC website or a form that includes at least the same information as the HHSC form .

(4) If the assisted living facility is a [ A ] large Type B assisted living facility , the facility must activate the fire alarm signal during a fire drill held [ ~~conducted~~ ] between 6:00 a.m. and 9:00 p.m.

(5) An assisted living facility may announce when a fire drill will happen. [ ~~to residents in advance.~~ ]

(e) Reporting fires.

(1) An assisted living facility must [ ~~immediately~~ ] report a fire immediately if the fire causes an [ ~~causing~~ ] injury to a resident or the death of [ to ] a resident.

(2) An assisted living facility must report a fire [ ~~causing damage to the facility or facility equipment~~ ] to HHSC within 72 hours after the fire is extinguished if the fire causes damage to the facility or to facility equipment .

(3) After reporting the fire [ ~~making a report~~ ] by telephone or email, an assisted living facility must file a written report using the most current version of the required HHSC form titled "Fire Report for Long Term Care Facilities" available on the HHSC website.

(f) Smoking policies. An assisted living facility must establish and enforce policies regarding smoking, even if the policy is that smoking will not be permitted. The policy must also address the use of e-cigarettes and vaping devices. If smoking will be permitted, the smoking policies must:

(1) designate smoking areas for residents and staff; and

(2) provide ashtrays of noncombustible material and safe design in smoking areas.

(g) An assisted living facility must comply with the requirements of 4.6.12, Maintenance, Inspection, and Testing, in NFPA 101, Chapter 4, General.

(h) [ ~~(g)~~ ] Fire alarm system. [ An assisted living facility must establish a program to inspect, test, and maintain the fire alarm system according to the requirements of NFPA 72, and according to the requirements of NFPA 720 where carbon monoxide detection is provided, and must execute the program at least once every six months. ]

(1) An assisted living facility must ensure the facility's fire alarm system is inspected, tested, and maintained according to NFPA 72.

(2) Where required carbon monoxide detection is provided, an assisted living facility must ensure carbon monoxide detection is inspected, tested, and maintained according to NFPA 720.

(3) [ ~~(1)~~ ] An assisted living facility must hire [ ~~contract with~~ ] a company that holds an Alarm Certificate of Registration from the State Fire Marshal's Office to provide the inspection, testing, and maintenance services. [ ~~execute the program.~~ ]

(4) [ ~~(2)~~ ] An assisted living facility must ensure a company performing any [ ~~that performs a~~ ] service [ ~~under the contract~~ ] required by [ ~~under paragraph (1) of~~ ] this subsection completes, signs, and dates an inspection form . The inspection form must state the services the company performed. The form must be substantially similar to [ ~~like~~ ] the inspection and testing form in NFPA 72 . [ ~~for a service provided under the contract.~~ ]

[(3) If a task required by NFPA 72 or NFPA 720 must occur at intervals other than during the contracted visits in this subsection, an assisted living facility must ensure the task is performed and documented by a knowledgeable individual.]

(5) [ ~~(4)~~ ] An assisted living facility must ensure:

(A) a fire alarm system component that requires visual inspection is visually inspected according to [ ~~in accordance with~~ ] NFPA 72;

(B) a fire alarm system component that requires testing is tested according to [ ~~in accordance with~~ ] NFPA 72; and

(C) a fire alarm system component that requires maintenance is maintained according to [ ~~in accordance with~~ ] NFPA 72.

(6) [ ~~(5)~~ ] An assisted living facility that provides carbon monoxide detection must ensure:

(A) a carbon monoxide detection component that requires visual inspection is visually inspected according to [ ~~in accordance with~~ ] NFPA 720;

(B) a carbon monoxide detection component that requires testing is tested according to [ ~~in accordance with~~ ] NFPA 720; and

(C) a carbon monoxide detection component that requires maintenance is maintained according to [ ~~in accordance with~~ ] NFPA 720 . [ ~~; and~~ ]

[(D) a facility with a carbon monoxide detection component installed before August 31, 2021, must perform visual inspection, testing, and maintenance of that component beginning no later than August 31, 2022.]

(7) [ ~~(6)~~ ] A large assisted living facility containing smoke compartments must ensure each required smoke damper is inspected and tested according to [ ~~in accordance with~~ ] NFPA 101.

(8) [ ~~(7)~~ ] An assisted living facility must ensure smoke detector sensitivity is checked within one year after installation and every two years thereafter using any of the [ ~~in accordance~~ ] with test methods in NFPA 72.

(9) [ ~~(8)~~ ] An assisted living facility must maintain onsite documentation of compliance with this subsection and must maintain record copies of documents regarding the installation of a fire alarm system, including as-built installation drawings, operation and maintenance manuals, the installation certificate for the system, and written sequences for its operation.

(10) [ ~~(9)~~ ] An assisted living facility must make documentation described in paragraph (9) [ ~~(8)~~ ] of this subsection available to HHSC on request.

(i) [ ~~(h)~~ ] Fire sprinkler system. An assisted living facility with [ ~~that is equipped with~~ ] a fire sprinkler system, including a fire sprinkler system meeting NFPA 13D, must ensure the facility's fire sprinkler system is inspected, tested, and maintained [ ~~establish a program to inspect, test, and maintain the fire sprinkler system~~ ] according to [ ~~the requirements of~~ ] NFPA 25 . [ ~~, and must execute the program at least once every six months.~~ ]

(1) The [ An ] assisted living facility must hire [ ~~contract with~~ ] a company that holds an appropriate Sprinkler Certificate of Registration from the State Fire Marshal's Office to provide the inspection, testing, and maintenance services. [ ~~execute the program.~~ ]

(2) The [ An ] assisted living facility must ensure a company performing any [ ~~that performs a~~ ] service [ ~~under the contract~~ ] required by [ ~~under paragraph (1) of~~ ] this subsection completes, signs, and dates an inspection form . The inspection form must clearly state the services the company performed. The form must be substantially similar to [ ~~like~~ ] the inspection and testing form in NFPA 25 . [ ~~for a service provided under the contract.~~ ]

[(3) If a task required by NFPA 25 must occur at intervals other than during the contracted visits in this subsection, an assisted living facility must ensure the task is performed and documented by knowledgeable individuals.]

(3) [ ~~(4)~~ ] The [ An ] assisted living facility must ensure :

(A) [ ~~that~~ ] a sprinkler system component that requires visual inspection is visually inspected according to [ ~~in accordance with~~ ] NFPA 25 ; [ . ]

(B) [ ~~(5) An assisted living facility must ensure that~~ ] a sprinkler system component that requires testing is tested according to [ ~~in accordance with~~ ] NFPA 25 ; [ . ]

(C) [ ~~(6) An assisted living facility must ensure that~~ ] a sprinkler system component that requires maintenance is maintained according to [ ~~in accordance with~~ ] NFPA 25 ; and [ . ]

(D) [ ~~(7) An assisted living facility must ensure that~~ ] an individual sprinkler head is inspected and maintained according to [ ~~in accordance with~~ ] NFPA 25.

(4) [ ~~(8)~~ ] The [ An ] assisted living facility must maintain onsite documentation of compliance with this subsection and must maintain record copies of documents regarding the installation of a fire sprinkler system, including as-built installation drawings, hydraulic calculations, proof of adequate fire sprinkler water supply, and installation certificates for the system.

(5) [ ~~(9)~~ ] The [ An ] assisted living facility must make documentation described in paragraph (4) [ ~~(8)~~ ] of this subsection available to HHSC on request.

(j) [ ~~(i)~~ ] Portable fire extinguishers.

(1) An assisted living facility must ensure staff are taught how to correctly [ ~~appropriately trained in the~~ ] use every [ ~~of each~~ ] type of portable fire extinguisher used in the facility.

(2) An assisted living facility must inspect and maintain portable fire extinguishers and:

(A) ensure that its staff perform regular monthly inspections [ ~~or "quick checks"~~ ] to ensure extinguishers are located in the designated place, extinguisher locations are not obstructed to access or visibility, and the pressure gauge reading or indicator on the extinguisher is in the operable range or position;

(B) ensure annual maintenance and inspection [ ~~or "thorough checks"~~ ] are performed according to NFPA 10 by an individual employed by a company holding an appropriate Extinguisher Certificate of Registration from the State Fire Marshal's Office to perform inspection, testing, and maintenance of portable fire extinguishers;

(D) replace unserviceable fire extinguishers.

(k) [ ~~(j)~~ ] General facility condition and safety features.

(1) An assisted living facility must ensure staff utilize procedures to avoid cross-contamination between clean and soiled processes, including the handling of linens and cooking utensils.

(2) An assisted living facility must keep all buildings in good repair.

(A) An assisted living facility must ensure that the [ ~~maintain~~ ] electrical, heating, and cooling systems in the facility are working safely. [ ~~so these systems operate in a safe manner. As evidence that these systems operate in a safe manner,~~ ] HHSC may require the facility to provide [ ~~submit~~ ] a report on the safety of these systems. This report must be written [ ~~prepared~~ ] by one of the following:

(i) the fire marshal;

(ii) the city or county building official having jurisdiction over the location of the facility;

(iii) a licensed electrician; or

(iv) a registered professional engineer.

(B) The [ An ] assisted living facility must ensure electrical appliances, devices, and lamps do not overload the electrical circuits . [ ~~or use extension cords of excessive length.~~ ]

(3) An assisted living facility must keep all buildings free of accumulations of dirt, rubbish, dust, and hazards.

(4) An assisted living facility must maintain floors in good condition and clean floors regularly.

(5) An assisted living facility must [ ~~structurally~~ ] maintain walls and ceilings and must repair, repaint, or clean walls and ceilings whenever needed.

(6) An assisted living facility must keep storage areas and cellars organized and free from obstructions.

(7) An assisted living facility must not store any items or allow the accumulation of waste in attic spaces.

(8) An assisted living facility must ensure all equipment requiring periodic maintenance, testing, and servicing is accessible.

(A) The [ An ] assisted living facility must ensure equipment that is necessary to conduct maintenance, testing, and services, including ladders, specific tools, and keys, is readily available to staff or maintenance personnel on site.

(B) The [ An ] assisted living facility must provide access panels, at least 20 inches wide by 20 inches long, for building maintenance and must ensure access panels are located for reasonable access to equipment and fire or smoke barrier walls installed in the attic or other concealed spaces.

(l) [ ~~(k)~~ ] Waste and storage containers.

(1) An assisted living facility must provide metal waste baskets of substantial gauge or any UL- or FM-approved container in each area where smoking is permitted, if applicable, in accordance with the facility's smoking policies required in subsection (f) of this section.

(2) An assisted living facility must provide one or more garbage, waste, or trash containers with close-fitting covers, made of metal or of any UL- or FM-approved material, for use in :

(A) kitchens ; [ , ]

(B) janitor closets ; [ , ]

(D) mechanical rooms; [ or ]

(E) boiler rooms ; and [ , ]

(F) rooms used for [ ~~general~~ ] storage . [ ~~rooms, and similar places.~~ ]

(3) A facility may use disposable plastic liners in [ ~~the~~ ] containers for sanitation.

(4) [ ~~(3)~~ ] An assisted living facility must ensure all trash, garbage, and waste, including waste classified as Special Waste from Health Care-Related Facilities, is removed [ ~~trash, and garbage are disposed of~~ ] from the building regularly, [ ~~premises at regular intervals~~ ] according to state and local requirements. [ ~~The facility may not permit or allow an accumulation of waste on the facility premises, either inside or outside of facility buildings.~~ ]

(m) [ ~~(l)~~ ] Pest control.

(1) An assisted living facility must have an ongoing and effective pest control program executed by [ ~~facility~~ ] staff or by contract with a licensed pest control company.

(2) An assisted living facility must ensure [ ~~the~~ ] chemicals used to control pests are labeled correctly and stored securely. [ ~~the least toxic and least flammable chemicals that are effective.~~ ]

(3) An assisted living facility must ensure each operable window has [ ~~is provided with~~ ] an insect screen.

(n) [ ~~(m)~~ ] Flammable or combustible liquids. An assisted living facility must not store flammable or combustible liquids, such as gasoline, oil-based paint, charcoal lighter fluid, or similar liquids, [ ~~products~~ ] in any [ a ] building where [ ~~that houses~~ ] residents live .

(o) [ ~~(n)~~ ] Storage of oxygen. An assisted living facility must ensure sanitary use and storage of oxygen for the safety of all residents.

(1) An assisted living facility must ensure oxygen cylinders in the possession and under the control of the facility are:

(A) identified by attached labels or stencils naming the contents;

(B) not stored with flammable or combustible materials;

(C) protected from abnormal mechanical shock that [ ~~, which~~ ] is liable to damage the cylinder, valve, or safety device;

(D) protected from tamper by unauthorized individuals;

(E) if not supported in a proper cart or stand, properly chained or supported;

(F) stored so the cylinders can be used in the order received from the supplier;

(G) if empty and full cylinders are stored in the same enclosure or room, stored so that empty cylinders are separated from full cylinders; and

(H) if empty, marked to avoid confusion and delay if a full cylinder is needed in a rapid manner.

(2) An assisted living facility must adopt, implement, and enforce procedures for resident use, storage, and handling of oxygen cylinders and liquid oxygen containers in the possession and under the control of residents, to ensure the safety of all residents.

(p) [ ~~(o)~~ ] Gas pressure test.

(1) An assisted living facility must obtain an initial pressure test of facility gas lines from the gas meter or propane storage tank to all gas-fired appliances and equipment.

(2) An assisted living facility must obtain an additional gas pressure test when the facility performs major renovations or additions to the gas piping or gas-fired equipment that interrupt gas service or replace gas-fired equipment.

(q) [ ~~(p)~~ ] Annual gas heating check.

(1) An assisted living facility must ensure all gas heating systems are checked at least once per year[ , ] before [ ~~prior to~~ ] the heating season for proper operation and safety by persons who are licensed or approved by the State of Texas to inspect the equipment.

(2) An assisted living facility must maintain records [ ~~of the testing~~ ] of the annual gas heating check [ ~~system~~ ].

(3) An assisted living facility must correct [ ~~unsatisfactory~~ ] conditions that prevent gas heating equipment from operating safely and must ensure gas heating equipment will operate as intended .

(r) [ ~~(q)~~ ] Emergency generator. A large assisted living facility that uses an emergency generator to provide power to emergency lighting systems must ensure the generator is tested and maintained according to Chapter 8, Routine Maintenance and Operational Testing, in NFPA 110. Routine maintenance and operational testing required by NFPA 110 includes the following procedures:

(1) a readily available record of inspections, test, exercising, operation, and repairs;

(2) monthly testing of cranking batteries;

(3) weekly inspection of the generator set and other components that make up the emergency power system;

(4) monthly exercise of the generator under load;

(5) monthly test of transfer switches; and

(6) a continuous operational test for at least 1-1/2 hours every three years.

(s) Reduced-size floor plan. An assisted living facility must make a floor plan of each floor and each building of a facility available to HHSC on request. The floor plan should include the facility's room designations and all walls, doors, and windows.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 18, 2026.

TRD-202603593

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 4, 2026

For further information, please call: (512) 438-3161

DIVISION 3. BUILDING REHABILITATION

26 TAC §553.107

STATUTORY AUTHORITY

The amendment is authorized by Texas Government Code §524.0005, which provides that the executive commissioner of HHSC shall adopt rules to implement the executive commissioner's authority under Texas Government Code Chapter 524 with respect to the health and human services system, and §524.0151, which provides that the executive commissioner of HHSC shall adopt rules necessary to carry out the commission's duties under Texas Government Code Chapter 531 and adopt rules and policies for the operation and provision of services by the health and human services agencies; and Texas Health and Safety Code §247.025 and §247.026, which provide that the executive commissioner of HHSC shall adopt rules necessary to implement Texas Health and Safety Code Chapter 247 and to ensure the quality of care and protection of assisted living facility residents' health and safety, respectively.

The amendment implements Texas Government Code §524.0005 and §524.0151 and Texas Health and Safety Code §247.025 and §247.026.

§ 553.107. Building Rehabilitation.

[(a) Prior to the start of building rehabilitation, other than that classified as repair in subsection (b) of this section, a facility must notify the Texas Health and Human Services commission (HHSC) in Austin, Texas, in writing.]

(a) [ ~~(b)~~ ] Upon completion of building rehabilitation, other than that classified as repair or renovation in this section and NFPA 101, Chapter 43, Building Rehabilitation , a final construction inspection of the facility must be performed by HHSC before [ ~~prior to~~ ] occupancy of the rehabilitated area . The facility is responsible for being aware of requirements for approval of the completed construction by [ ~~must have the written approval of~~ ] the local AHJ. [ ~~authority having jurisdiction, including the fire marshal and building official.~~ ] When construction or building rehabilitation does not alter the licensed capacity of a facility, based on submitted documentation and the scope of the performed building rehabilitation, HHSC may :

(1) permit a facility to use the rehabilitated portion of a facility before completing [ ~~pending~~ ] a final construction inspection ; or

(2) [ ~~may~~ ] determine a final construction inspection is not required.

(b) An assisted living facility undergoing rehabilitation must meet the requirements of NFPA 101, Chapter 43, Building Rehabilitation, unless this subchapter states otherwise. In addition to the requirements of this subchapter and NFPA 101, Chapter 43, a large Type B assisted living facility must meet the following requirements.

(1) An existing large Type B assisted living facility must meet the requirements of 19.1.1.4.3, Rehabilitation, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(2) A new large Type B assisted living facility must meet the requirements of 18.1.1.4.3, Rehabilitation, in NFPA 101, Chapter 18, New Health Care Occupancies.

(3) A large Type B assisted living facility containing a smoke compartment that is not protected by a fire sprinkler system must meet the requirements of 18.4.3, Nonsprinklered Existing Smoke Compartment Rehabilitation, in NFPA 101, Chapter 18, New Health Care Occupancies.

(1) Repair. An assisted living facility must ensure the patching, restoration, or painting of materials, elements, equipment, or fixtures for maintaining such materials, elements, equipment, or fixtures in good or sound condition is classified as repair and must ensure the repair:

(A) meets the [ ~~applicable~~ ] requirements of §553.100(e) of this subchapter (relating to General Requirements) , as applicable ;

(B) uses like materials, unless such materials are prohibited by NFPA 101, as modified by this subchapter; and

(C) does not make a building less conforming with NFPA 101, as modified by this subchapter, with the applicable sections of this subchapter, or with any alternative arrangements previously approved by HHSC, than it was before the repair was undertaken.

(2) Renovation. An assisted living facility must ensure the replacement in kind, strengthening, or upgrading of building elements, materials, equipment, or fixtures that does not result in a reconfiguration of the building spaces within is classified as renovation and must ensure:

(A) any new work that is part of a renovation meets the [ ~~applicable~~ ] requirements of §553.100(e) of this subchapter , as applicable ;

(B) any new interior or exterior finishes meet the [ ~~applicable~~ ] requirements of §553.100(e)(3) of this subchapter , as applicable ; and

(3) Modification. An assisted living facility must ensure the reconfiguration of any space; addition, relocation, or elimination of any door or window; addition or elimination of load-bearing elements; reconfiguration or extension of any system; installation of any additional equipment; or changes in locking arrangements as defined in §553.101(5)(L) [ ~~§553.101(6)(L)~~ ] of this subchapter (relating to Definitions), is classified as modification and must ensure:

(A) a newly constructed element, component, or system meets the [ ~~applicable~~ ] requirements of §553.100(e)(3) of this subchapter , as applicable ;

(B) all other work in a modification meets, at a minimum, the requirements for a renovation according to paragraph (2) of this subsection; and

(C) where the total rehabilitation work area classified as modification exceeds 50 percent of the total building area, the work is classified as reconstruction subject to paragraph (4) of this subsection.

(4) Reconstruction. An assisted living facility must ensure the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress or fire protection systems are not in place or continuously maintained, is classified as reconstruction and must ensure:

(A) reconstruction of components of the means of egress meets the [ ~~applicable~~ ] requirements of §553.100(e) of this subchapter, as applicable, except for the following components, which must meet the specific requirements of §553.100(e)(3) of this subchapter:

(i) illumination of means of egress;

(ii) emergency lighting of means of egress; and

(iii) marking of means of egress, including exit signs;

(B) if the total rehabilitation work area classified as reconstruction on any one floor exceeds 50 percent of the total area of the floor, all means of egress components identified in subparagraph (A) of this paragraph [ ~~(4)(A)(i) - (iii) of this subsection~~ ] and located on that floor meet the specific requirements of §553.100(e)(3) of this subchapter;

(C) if the total rehabilitation work area classified as reconstruction exceeds 50 percent of the total building area, all means of egress components identified in subparagraph (A) of this paragraph [ ~~(4)(A)(i) - (iii) of this subsection~~ ] and located in the building meet the specific requirements of §553.100(e)(3) of this subchapter; and

(D) all other work classified as reconstruction meets, at a minimum, the requirements for modification according to paragraph (3) of this subsection and renovation according to paragraph (2) of this subsection.

(5) Change of use or level of activity. An assisted living facility must ensure a change in the purpose or level of activity within a facility that involves a change in application of the requirements of this subchapter is classified as a change of use. [ ~~, including~~ ]

(A) A [ a ] change of a wing or area to a certified Alzheimer's assisted living facility [ ~~Certified Alzheimer's Disease Assisted Living Facility~~ ] or certified Alzheimer's assisted living unit is a change of use. [ ~~, or~~ ]

(B) A [ a ] change of a certified Alzheimer's assisted living facility or certified Alzheimer's assisted living unit to ordinary resident use is a change of use. [ ~~Certified Alzheimer's Disease Assisted Living Facility or unit to ordinary resident-use, is classified as a change of use and meets the specific requirements of §553.100(e)(3) of this subchapter.~~ ]

(C) If the change of use does not create a hazardous area, the assisted living facility must ensure the rehabilitation work area meets the requirements of §553.100(e) of this subchapter, as applicable.

(D) If the change of use creates a hazardous area, the assisted living facility must ensure the rehabilitation work area meets the requirements of §553.100(e)(3) of this subchapter, as applicable.

(6) Change of occupancy. An assisted living facility must ensure a change in the use of a structure or portion of a structure is classified as a change of occupancy and meets the specific requirements of §553.100(e)(3) of this subchapter.

(7) Addition. An assisted living facility must ensure an increase in the building area, aggregate floor area, building height, or number of stories of a structure is classified as an addition and meets the specific requirements of §553.100(e)(3) of this subchapter.

(A) An addition to an existing large Type B assisted living facility must be separated from any existing structure if required by 19.1.1.4.1, Additions, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(B) An addition to a new large Type B assisted living facility must be separated from any existing structure if required by 18.1.1.4.1, Additions, in NFPA 101, Chapter 18, New Health Care Occupancies.

(d) An assisted living facility, or portion of an assisted living facility, undergoing construction, repair, or improvement operations must meet the requirements of 4.6.10, Construction, Repair, and Improvement Operations, in NFPA 101, Chapter 4, General. [ An assisted living facility undergoing rehabilitation must comply with the requirements of NFPA 101, as modified by this subchapter in accordance with the requirements of NFPA 101, Chapter 43, Building Rehabilitation. ]

(1) [ ~~(e)~~ ] An assisted living facility undergoing rehabilitation to an occupied building that involves means of escape, means of egress, or exits must ensure [ ~~exit-ways, or exit doors must be accomplished without compromising~~ ] the means of escape, means of egress, or exits are not compromised, and that [ ~~or creating~~ ] a dead-end situation is not created at any time.

(2) HHSC may approve temporary exits , or the facility must relocate residents until construction blocking exits is completed. [ ~~the exit is completed.~~ ]

(3) The facility must maintain other basic safety features, including fire alarm systems and fire sprinkler systems, in compliance with the [ ~~their~~ ] relevant standards and must maintain required emergency power at all times during construction.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 18, 2026.

TRD-202603594

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 4, 2026

For further information, please call: (512) 438-3161

DIVISION 4. EXISTING SMALL TYPE A ASSISTED LIVING FACILITIES

26 TAC §§553.111 - 553.113, 553.115, 553.118, 553.119

STATUTORY AUTHORITY

The amendments implement Texas Government Code §524.0005 and §524.0151 and Texas Health and Safety Code §247.025 and §247.026.

§ 553.111. Construction Requirements for an Existing Small Type A Assisted Living Facility.

(a) Structurally sound. An existing small Type A assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads in accordance with applicable building codes.

(b) Separation of occupancies. An existing small Type A assisted living facility must be separated from other occupancies by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards, unless otherwise permitted by paragraph (2) of this subsection.

(1) An existing small Type A assisted living facility must be separated from other assisted living facilities, hospitals, or nursing facilities. Beginning August 31, 2021, an existing small Type A assisted living facility must be separated from any new occupancy or new use subject to HHSC licensing. [ ~~the Texas Health and Human Services commission (HHSC) licensing.~~ ]

(2) An existing small Type A assisted living facility is not required to be separated from another occupancy not subject to HHSC licensing standards if the two occupancies are so intermingled that construction of a fire barrier having a 2-hour fire resistance rating is impractical and the following conditions are met.

(A) The means of escape, construction, protection, and other safeguards for the entire building must comply with the NFPA 101 requirements for an existing small Type A assisted living facility.

(B) HHSC must be provided [ ~~given~~ ] unrestricted and unannounced access at any reasonable time to inspect the other occupancy type for compliance with the NFPA 101 requirements for an existing small Type A assisted living facility.

(1) Except as provided in paragraph (3) of this subsection, an existing small Type A assisted living facility must ensure all buildings used by residents are sheathed with materials providing a fire resistance rating and ensure:

(A) interior wall and ceiling surfaces have finished surfaces, substrates, or sheathing with a fire resistance rating of not less than 20 minutes; and

(B) columns, beams, girders, or trusses that are not enclosed within walls or ceilings are encased in materials having a fire resistance rating of not less than 20 minutes.

(2) A sprinkler system does not substitute for the minimum sheathing requirements under paragraph (1) of this subsection.

(3) A building constructed to meet the minimum building construction type requirements of 19.1.6, Minimum Construction Requirements, in NFPA 101, Chapter 19, Existing Health Care Occupancies, is not also required to be sheathed.

(d) Interior finish. An existing small Type A assisted living facility must ensure interior wall , [ ~~and~~ ] ceiling , and floor finish materials meet the requirements of 33.2.3.3, Interior Finish, [ ~~33.2.3.3.2, Interior Wall and Ceiling Finish,~~ ] in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(e) Vertical openings. An existing small Type A assisted living facility must ensure vertical openings are protected according to the requirements of 33.2.3.1, Protection of Vertical Openings, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

§ 553.112. Space Planning and Utilization Requirements for an Existing Small Type A Assisted Living Facility.

(a) Resident bedrooms.

(1) An existing small Type A assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below finished ground level.

(2) An existing small Type A assisted living facility must ensure bedroom-usable floor space is not less than 80 square feet for a bedroom housing one resident and not less than 60 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted by paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than eight feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by HHSC.

(3) An existing small Type A assisted living facility with individual living units that have both a bedroom and other living space may reduce the required bedroom usable floor space for a bedroom for more than one resident by up to 10 percent. The bedroom must continue to meet the minimum dimension requirements in paragraph (2) of this subsection. This reduction cannot be used together with the provision for reducing common living areas or common dining areas as described in subsection (g) of this section. [ An existing small Type A assisted living facility containing individual living units that include living space for the residents in addition to their bedrooms may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. An existing small Type A assisted living facility may not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in subsection (g)(5) of this section. ]

(4) An existing small Type A assisted living facility may house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. An existing small Type A assisted living facility must ensure each bedroom has at least one operable window with outside exposure and meeting the following requirements.

(1) The windowsill [ ~~window sill~~ ] must be no higher than 44 inches above the floor.

(2) The window must be easy for [ ~~operable by~~ ] all residents occupying the bedroom to open and close from the inside without using [ ~~, from the inside, without the use of~~ ] tools or special devices to unlatch or unlock the window .

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space required by subsection (a)(2) of this section.

(4) An existing bedroom window not meeting these requirements may be continued in service with approval from HHSC. [ ~~subject to approval by HHSC.~~ ]

(5) An existing small Type A assisted living facility that is not equipped with a fire sprinkler system meeting the requirements of §553.115 of this division (relating to Fire Protection Systems Requirements for an Existing Small Type A Assisted Living Facility) must provide at least one window in each bedroom in the facility that, in addition to meeting the requirements of paragraphs (1) - (4) of this subsection, meets the following requirements . [ : ]

(A) The bedroom window must meet the requirements of §553.113 of this division (relating to Means of Escape Requirements for an Existing Small Type A Assisted Living Facility) for use as a secondary means of escape from a resident sleeping room.

(B) The bedroom window must not be blocked by bars, shrubs, or any obstacle that could impede evacuation.

(C) The bedroom window must provide an operable section with a clear opening of not less than 5.7 square feet with a minimum width of 20 inches and a minimum height of 24 inches.

(6) An existing small Type A assisted living facility that is protected by an automatic sprinkler system meeting the requirements of §553.115 of this division must provide an operable window in a bedroom. The window opening size may be smaller than the minimum size stated [ ~~listed~~ ] in paragraph (5) of this subsection but must be operable according to the requirements of paragraph (2) of this subsection.

(c) Bedroom furnishings. When a resident does not provide [ ~~their own~~ ] furnishings, an existing small Type A assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed, including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) private clothes storage space, which must have closable doors, and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) An existing small Type A assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) An existing small Type A assisted living facility must ensure all resident rooms are arranged for convenient resident access to dining and recreation areas.

(e) Staff area. An existing small Type A assisted living facility must provide a staff area on each floor of an existing small Type A assisted living facility and in each separate building containing resident sleeping rooms, except as permitted under paragraph (1) of this subsection.

(1) An existing small Type A assisted living facility that is not more than two-stories in height and is composed of separate buildings grouped together and connected by covered walks, is not required to provide a staff area on each floor or in each building, provided that a staff area is located not more than 200 feet walking distance from the farthest resident living unit.

(2) An existing small Type A assisted living facility must provide the following at each staff area:

(A) a desk or writing surface;

(B) a telephone; and

(C) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.115 of this division . [ ~~(relating to Fire Protection Systems Requirements for an Existing Small Type A Assisted Living Facility).~~ ]

(f) Resident toilet and bathing facilities. An existing small Type A assisted living facility must ensure each resident bedroom is served by a separate, private toilet room, a connecting toilet room, or a general toilet room.

(1) An existing small Type A assisted living facility that houses individuals of more than one sex [ ~~gender~~ ] must provide toilet rooms for each sex, [ ~~gender,~~ ] or individual single-occupant toilet rooms for use by either sex [ ~~any gender~~ ].

(2) An existing small Type A assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) An existing small Type A assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.117 of this division (relating to Mechanical Requirements for an Existing Small Type A Assisted Living Facility).

(g) Common living areas and dining areas. [ ~~Resident living areas.~~ ]

(1) Common living areas. [ An existing small Type A assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms. ]

(A) An existing small Type A assisted living facility must provide at least 15 square feet of common living areas for each resident based on the licensed capacity of the facility. [ a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space. ]

(i) At least one common living area must be at least 120 square feet in area regardless of the number of residents based on the facility's licensed capacity or other provisions of this section that allow a reduction in the total minimum common living area.

(ii) A common living area that is smaller than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) An existing small Type A assisted living facility with individual living units that have both a bedroom and other living space may reduce the minimum square footage for the total common living area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common living area. The bedroom must continue to meet the minimum dimension requirements in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. This reduction cannot be used together with the provision for reducing required bedroom usable floor space as described in subsection (a)(3) of this section.

(B) Each common living area used to meet the requirements of this subsection must have appropriate furniture. [ ~~An existing small Type A assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.~~ ]

(C) A common living area counted toward meeting the requirements of this subsection must have at least one exterior window with a view of the outside. [ An existing small Type A assisted living facility must ensure the total space for social-diversional area provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement. ]

(D) A common living area that is not required to meet the requirements of this subsection is not required to have windows with a view of the outside.

(E) Any path used as an escape route through any common living area must always be free of obstructions.

(2) Common dining areas. [ ~~An existing small Type A assisted living facility must provide a dining area with appropriate furniture.~~ ]

(A) An existing small Type A assisted living facility must provide at least 15 square feet of dining area for each resident based on the licensed capacity of the facility. [ a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum dining space. ]

(i) At least one dining area must be at least 120 square feet in area regardless of the number of residents based on the facility's licensed capacity or other provisions in this section that allow a reduction in the total minimum common dining area.

(ii) A dining area that is smaller than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) An existing small Type A assisted living facility with individual living units that have both a bedroom and other living space may reduce the minimum square footage for total common dining area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common dining area. The bedroom must continue to meet the minimum dimension requirements in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. This reduction cannot be used together with the provision for reducing required bedroom usable floor space as described in subsection (a)(3) of this section.

(B) There must be a covered path from all resident living units or bedrooms to a common dining area. [ ~~An existing small Type A assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.~~ ]

(C) A dining area used to meet the requirements of this subsection must have furniture suitable for dining use. [ ~~An existing small Type A assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.~~ ]

(D) A dining area counted toward meeting the requirements of this subsection must have at least one exterior window with a view of the outside. [ An existing small Type A assisted living facility must ensure the total space for dining areas provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement. ]

(E) A dining area that is not required to be counted toward meeting the requirements of this subsection is not required to have windows with a view of the outside.

(F) Any path used as an escape route through a dining area must always be free of obstructions.

(3) Combining common living areas and dining areas. [ An existing small Type A assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet. ]

(A) An existing small Type A assisted living facility may have the living area and dining area together in one space as long as the combined space is at least 240 square feet.

(B) Each area within a combined common living area and dining area must have appropriate furniture for the use of the space or area.

(4) Limitations on minimum area reduction. [ ~~An existing small Type A assisted living facility must ensure an escape route through a resident living or dining area is kept clear of obstructions.~~ ]

(A) A resident individual living unit area contributed toward total common living area or total common dining area cannot be counted more than once per living unit. The individual living unit area may be divided between common living area and dining area calculations.

(B) An existing small Type A assisted living facility cannot use both the reduction in space for common living or dining areas allowed by this subsection and the reduction in space for bedrooms allowed by subsection (a)(3) of this section at the same time.

[(5) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, an existing small Type A assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.]

[(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.]

[(B) An existing small Type A assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.]

(h) Storage areas. An existing small Type A assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies, including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnishes linen;

(7) soiled linen, if the facility furnishes linen; and

(8) lawn and maintenance equipment.

(i) Kitchen.

[(1) An existing small Type A assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.]

[(2) An existing small Type A assisted living facility that prepares food on-site must provide a kitchen or dietary area meeting the general food service needs of the residents and must ensure that the kitchen:]

[(A) is equipped to store, refrigerate, prepare, and serve food;]

[(B) is equipped to clean and sterilize;]

[(C) provides for refuse storage and removal; and]

[(D) meets the requirements of the local fire, building, and health codes.]

[(3)] An existing small Type A assisted living facility must ensure a kitchen uses only residential cooking equipment or, if the kitchen uses commercial cooking equipment, that the facility protects the kitchen's cooking operations as required in §553.116 of this division (relating to Hazardous Area Requirements for an Existing Small Type A Assisted Living Facility).

§ 553.113. Means of Escape Requirements for an Existing Small Type A Assisted Living Facility.

(a) The provisions of NFPA 101, Chapter 7, Means of Egress, do not apply to an existing small Type A assisted living facility unless explicitly referenced by this section or by NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(b) An existing small Type A assisted living facility must meet the requirements of 33.2.2, Means of Escape, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, except as described in this section.

(c) An existing small Type A assisted living facility must ensure doors meet the requirements of 33.2.2.5, Doors, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, and the additional requirements of this section.

(1) If [ ~~A resident room door in~~ ] an existing small Type A assisted living facility does not have [ ~~not protected throughout by~~ ] an approved automatic fire sprinkler system complying with the requirements of §553.115 of this division (relating to Fire Protection Systems Requirements for an Existing Small Type A Assisted Living Facility) , the door to a resident room must meet the requirements of this paragraph, as applicable. [ ~~must meet one of the following options.~~ ] A resident room door is not otherwise required to meet the requirements for doors in 33.2.3.6, Construction of Corridor Walls, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies. The door must:

(A) [ ~~The door must~~ ] be a solid core wood door at least 1-3/4 inches thick or have a 20-minute opening protection rating and must latch in its frame to resist the passage of smoke; or

(B) [ ~~The door must~~ ] be self-closing or automatic-closing and must latch in its frame to resist the passage of smoke.

(2) A resident room door in an existing small Type A assisted living facility protected throughout by an approved automatic fire sprinkler system complying with the requirements of §553.115 of this division must latch in its frame to resist the passage of smoke.

(3) In an existing small Type A assisted living facility comprised of buildings that contain living units with independent cooking equipment within the living unit, a door between the living unit and a corridor or hallway must:

(A) be self-closing or automatic-closing; and

(B) latch in its frame to resist the passage of smoke.

(4) A resident room door or living unit door must not be arranged to prevent the occupant from closing the door.

(d) An existing small Type A assisted living facility providing a bedroom window used as a secondary means of escape must ensure the window meets the requirements for a bedroom window used as a secondary means of escape in §553.112 of this division (relating to Space Planning and Utilization Requirements for an Existing Small Type A Assisted Living Facility).

(e) An existing small Type A assisted living facility providing spaces for use by residents on floors other than the ground floor must provide at least two separate approved stairs.

(1) An existing stair may be continued in service with approval from HHSC. [ ~~, subject to approval by HHSC.~~ ]

(2) A stair used as means of escape must meet the requirements of 33.2.2.6, Stairs, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(3) Each stair must be arranged and located so that it is not necessary to go through another room, including a bedroom or bathroom, to reach the stair.

(4) Each stair must be provided with handrails.

(5) Each stair must be provided with normal lighting according to the requirements of §553.118 of this division (relating to Electrical Requirements for an Existing Small Type A Assisted Living Facility).

(6) A stair in an existing building that became an assisted living through conversion must meet the dimensional criteria for existing stairs in 7.2.2.2, Dimensional Criteria, in NFPA 101, Chapter 7, Means of Egress.

(7) An existing stair, previously approved by HHSC, may be rebuilt to the same dimensions but must meet all other requirements for stairs in NFPA 101.

§ 553.115. Fire Protection Systems Requirements for an Existing Small Type A Assisted Living Facility.

(a) Fire alarm and smoke detection system. An existing small Type A assisted living facility must provide a manual fire alarm system meeting the requirements of [ ~~section~~ ] 9.6, Fire Detection, Alarm, and Communication Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment, as modified by this section.

(1) General. An existing small Type A assisted living facility must ensure the operation of any alarm initiating device automatically activates an audible or a visual alarm at the site.

(2) Smoke detectors.

(A) An existing small Type A assisted living facility must install smoke detectors in resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens, laundries, attached garages used for car parking, and public or common areas, except as permitted in subparagraphs (B) and (C) of this paragraph.

(B) An existing small Type A assisted living facility may install heat detectors in lieu of smoke detectors in kitchens, laundries, and attached garages used for car parking.

(C) An existing small Type A assisted living facility located in a building constructed to meet the requirements of NFPA 101, Chapter 19, Existing Health Care Occupancies, may install a smoke detection system meeting the requirements of 19.3.4.5.1, Corridors, in NFPA 101, Chapter 19, Existing Health Care Occupancies, in lieu of the requirements in subparagraph (A) of this paragraph.

(3) Alarm control panel.

(A) An existing small Type A assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) An existing small Type A assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(4) Fire alarm power source.

[(A)] An existing small Type A assisted living facility must ensure the power supply source for a fire alarm system is in accordance with NFPA 72. [ ~~powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.~~ ]

~~[(B) An existing small Type A assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.]~~

(b) Fire sprinkler system. In accordance with the requirements of 33.2.3.5, Extinguishment Requirements, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, an existing small Type A assisted living facility may provide:

[(1) An existing small Type A assisted living facility may provide one of the following fire sprinkler systems according to the requirements of 33.2.3.5, Extinguishment Requirements, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.]

(1) [ ~~(A)~~ ] a [ A ] fire sprinkler system meeting the requirements of NFPA 13 in accordance with 33.2.3.5.3.3 , in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies ;

(2) [ ~~(B)~~ ] a [ A ] fire sprinkler system meeting the requirements of NFPA 13R in accordance with 33.2.3.5.3.4 , in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies ; or

(3) [ ~~(C)~~ ] a [ A ] fire sprinkler system meeting the requirements of NFPA 13D in accordance with 33.2.3.5.3.2 , in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies .

[(2) An existing small Type A assisted living facility must provide supervision of any fire sprinkler system where required by 33.2.3.5, Extinguishment Requirements, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.]

(c) Protection of attics. An existing small Type A assisted living facility that has [ ~~equipped with~~ ] a fire sprinkler system must ensure an attic is protected according to the requirements of 33.2.3.5.7, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, not later than August 31, 2026 [ ~~August 31, 2024~~ ].

(d) Portable fire extinguishers. An existing small Type A assisted living facility must provide and maintain portable fire extinguishers according to the requirements of NFPA 10.

(1) An existing small Type A assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) An existing small Type A assisted living facility must ensure portable fire extinguishers are located so the travel distance from any point in the facility to an extinguisher is no more than 75 feet.

(3) An existing small Type A assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10.

(B) All other portable fire extinguishers must have a rating of at least 2-A:5-B:C according to NFPA 10.

(4) An existing small Type A assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or mounted in an approved cabinet.

(5) An existing small Type A assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) An existing small Type A assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the door leading from the room and on the latch or knob side of the door.

§ 553.118. Electrical Requirements for an Existing Small Type A Assisted Living Facility.

(a) Electrical system. An existing small Type A assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. An existing small Type A assisted living facility must provide illumination throughout the building. Minimum lighting levels must not be lower than the following. [ : ]

(1) In [ ~~10 footcandles in~~ ] resident rooms illumination must be at least 10 footcandles during the day when [ ~~during the day--illumination requirements for these areas apply to lighting throughout the space, as~~ ] measured anywhere in the space at 30 inches above the floor . [ ~~anywhere in the room;~~ ]

(2) In [ ~~20 footcandles in~~ ] each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator , illumination must be at least 20 footcandles during the day when [ ~~during the day--illumination requirements for these areas apply to lighting throughout the space as~~ ] measured anywhere in the space at 30 inches above the floor . [ ~~anywhere in the room; and~~ ]

(3) For [ ~~50 footcandles for~~ ] each medication preparation or storage area, kitchen, and desk within a staff station , illumination must be at least 50 footcandles when [ ~~. Illumination requirements apply when the area is in use for a task it supports, as~~ ] measured where the task is being performed , when the area is in use for the task it supports .

(c) Telephone. An existing small Type A assisted living facility must provide at least one telephone in the facility that is available to both staff and residents. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. An existing small Type A assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must include at least :

~~[(A) be a direct telephone, emergency call system, or intercom;]~~

~~[(B) if it is an existing communication system, be approved by HHSC to be continued in service; and]~~

~~[(C) include at least:]~~

(A) [ ~~(i)~~ ] one central notification station accessible to staff at all times [ ~~at a fixed location~~ ] that receives all calls processed through the system; and

(B) [ ~~(ii)~~ ] one call station or device accessible to residents at all times in each resident's living unit. [ ~~permanently fixed call station or device in every resident living unit.~~ ]

(2) An existing small Type A assisted living facility may provide:

(A) additional or portable notification stations or devices in addition to the central notification station; or

(B) additional call stations or devices in private or common resident areas.

(3) An existing small Type A assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands , but these devices must not replace a call station in a resident living unit . [ ~~However, a device may not be a substitute for a fixed call station in a resident living unit.~~ ]

§ 553.119. Miscellaneous Requirements for an Existing Small Type A Assisted Living Facility.

(a) An existing small Type A assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located.

(b) An existing small Type A assisted living facility must ensure furnishings, mattresses, and decorations meet the requirements of 33.7.5, Furnishings, Mattresses, and Decorations, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 18, 2026.

TRD-202603595

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 4, 2026

For further information, please call: (512) 438-3161

DIVISION 5. EXISTING SMALL TYPE B ASSISTED LIVING FACILITIES

26 TAC §§553.121, 553.122, 553.125, 553.128, 553.129

STATUTORY AUTHORITY

The amendments implement Texas Government Code §524.0005 and §524.0151 and Texas Health and Safety Code §247.025 and §247.026.

§ 553.121. Construction Requirements for an Existing Small Type B Assisted Living Facility.

(a) Structurally sound. An existing small Type B assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads in accordance with applicable building codes.

(b) Separation of occupancies. An existing small Type B assisted living facility must be separated from other occupancies by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards, unless otherwise permitted by paragraph (2) of this subsection.

(1) An existing small Type B assisted living facility must be separated from other assisted living facilities, hospitals, or nursing facilities. Beginning August 31, 2021, an existing small Type A assisted living facility must be separated from any new occupancy or new use subject to HHSC licensing.

(2) An existing small Type B assisted living facility is not required to be separated from another occupancy not subject to HHSC [ ~~Texas Health and Human Services Commission (HHSC)~~ ] licensing standards if the two occupancies are so intermingled that construction of a fire barrier having a 2-hour fire resistance rating is impractical and the following conditions are met.

(A) The means of escape, construction, protection, and other safeguards for the entire building must comply with the NFPA 101 requirements for an existing small Type B assisted living facility.

(1) Except as provided in paragraph (3) of this subsection, an existing small Type B assisted living facility must ensure all buildings used by residents are sheathed with materials providing a fire resistance rating.

(A) Interior wall and ceiling surfaces must have finished surfaces, substrates, or sheathing with a fire resistance rating of not less than 20 minutes.

(B) Columns, beams, girders, or trusses that are not enclosed within walls or ceilings must be encased in materials having a fire resistance rating of not less than 20 minutes.

(2) A sprinkler system does not substitute for the minimum sheathing requirements under paragraph (1) of this subsection.

(d) Interior finish. An existing small Type B assisted living facility must ensure interior wall , [ ~~and~~ ] ceiling , and floor finish materials meet the requirements of 33.2.3.3, Interior Finish, [ ~~33.2.3.3.2, Interior Wall and Ceiling Finish,~~ ] in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(e) Vertical openings. An existing small Type B assisted living facility must ensure vertical openings are protected according to the requirements of 33.2.3.1, Protection of Vertical Openings, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

§ 553.122. Space Planning and Utilization Requirements for an Existing Small Type B Assisted Living Facility.

(a) Resident bedrooms.

(1) An existing small Type B assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below finished ground level.

(2) An existing small Type B assisted living facility must ensure bedroom-usable floor space is not less than 100 square feet for a bedroom housing one resident and not less than 80 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted by paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than 10 feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by HHSC [ ~~the Texas Health and Human Services Commission (HHSC)~~ ].

(3) An existing small Type B assisted living facility with individual living units that have both a bedroom and other living space may reduce the required bedroom usable floor space for a bedroom for more than one resident by up to 10 percent. The bedroom must continue to meet the minimum dimension requirements in paragraph (2) of this subsection. This reduction cannot be used together with the provision for reducing common living areas or common dining areas as described in subsection (g) of this section. [ An existing small Type B assisted living facility containing individual living units that include living space for the residents, in addition to their bedroom, may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. An existing small Type B assisted living facility must not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in subsection (g)(5) of this section. ]

(4) An existing small Type B assisted living facility must house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. An existing small Type B assisted living facility must ensure each bedroom has at least one operable window with outside exposure and meeting the following requirements.

(1) The windowsill [ ~~window sill~~ ] must be no higher than 44 inches above the floor.

(2) The window must be easy for all residents [ ~~operable by all residents~~ ] occupying the bedroom to open and close from the inside without using any [ ~~, from the inside, without the use of~~ ] tools or special devices to unlatch or unlock the window .

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space required by subsection (a)(2) of this section.

(4) An existing bedroom window not meeting these requirements may be continued in service with approval from HHSC. [ ~~subject to approval by HHSC.~~ ]

(c) Bedroom furnishings. When a resident does not provide [ ~~their own~~ ] furnishings, an existing small Type B assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed, including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) private clothes storage space, which must include closable door, and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) An existing small Type B assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) An existing small Type B assisted living facility must ensure all resident rooms are arranged for convenient resident access to dining and recreation areas.

(e) Staff area. An existing small Type B assisted living facility must provide a staff area on each floor of an existing small Type B assisted living facility and in each separate building containing resident sleeping rooms. An existing small Type B assisted living facility must provide the following at each staff area:

(1) a desk or writing surface;

(2) a telephone; and

(3) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.125 of this division (relating to Fire Protection Systems Requirements for an Existing Small Type B Assisted Living Facility).

(f) Resident toilet and bathing facilities. An existing small Type B assisted living facility must ensure each resident bedroom is served by a separate, private toilet room, a connecting toilet room, or a general toilet room.

(1) An existing small Type B assisted living facility that houses individuals of more than one sex [ ~~gender~~ ] must provide toilet rooms for each sex, [ ~~gender,~~ ] or individual single-occupant toilet rooms for use by either sex [ ~~any gender~~ ].

(2) An existing small Type B assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) An existing small Type B assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.127 of this division (relating to Mechanical Requirements for an Existing Small Type B Assisted Living Facility).

(g) Common living areas and dining areas. [ ~~Resident living areas.~~ ]

(1) Common living areas. [ An existing small Type B assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms. ]

(A) An existing small Type B assisted living facility must provide at least 15 square feet for common living areas for each resident in the licensed capacity of the facility. [ a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space. ]

(i) At least one common living area must be at least 120 square feet in area regardless of the number of residents based on the facility's licensed capacity or other provisions in this section that allow a reduction in the total minimum common living area.

(ii) A common living area that is smaller than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) An existing small Type B assisted living facility with individual living units that have both a bedroom and other living space may reduce the minimum square footage for the total common living area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common living area. The bedroom must continue to meet the minimum dimension requirements in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. This reduction cannot be used together with the provision for reducing required bedroom usable floor space as described in subsection (a)(3) of this section.

(B) Each common living area used to meet the requirements of this subsection must have appropriate furniture. [ ~~An existing small Type B assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.~~ ]

(C) A common living area counted toward meeting the requirements of this subsection must have at least one exterior window with a view of the outside. [ An existing small Type B assisted living facility must ensure the total space for social-diversional area provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement. ]

(D) A common living area that is not required to be counted toward meeting the requirements of this subsection is not required to have windows with a view of the outside.

(E) Any path used as an escape route through any common living area must always be free of obstructions.

(2) Common dining areas. [ ~~An existing small Type B assisted living facility must provide a dining area with appropriate furniture.~~ ]

(A) An existing small Type B assisted living facility must provide at least 15 square feet of dining area for each resident in the licensed capacity of the facility. [ a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum dining space. ]

(ii) A dining area that is smaller than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) An existing small Type B assisted living facility with individual living units that have both a bedroom and other living space may reduce the minimum square footage for total common dining area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common dining area. The bedroom must continue to meet the minimum dimension requirements in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. This reduction cannot be used together with the provision for reducing required bedroom usable floor space as described in subsection (a)(3) of this section.

(B) There must be a covered path from all resident living units or bedrooms to a common dining area. [ ~~An existing small Type B assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.~~ ]

(C) A dining area used to meet the requirements of this subsection must have furniture suitable for dining use. [ ~~An existing small Type B assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.~~ ]

(D) A dining area counted toward meeting the requirements of this subsection must have at least one exterior window with a view of the outside. [ An existing small Type B assisted living facility must ensure the total space for dining areas provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement. ]

(E) A dining area that is not required to be counted toward meeting the requirements of this subsection is not required to have windows with a view of the outside.

(F) Any path used as an escape route through a dining area must always be free of obstructions.

(3) Combining common living areas and dining areas. [ An existing small Type B assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet. ]

(A) An existing small Type B assisted living facility may have the living area and dining area together in one space as long as the combined space is at least 240 square feet.

(B) Each area within a combined common living area and dining area must have appropriate furniture for the use of the space or area.

(4) Limitations on minimum area reduction. [ ~~An existing small Type B assisted living facility must ensure an escape route through a resident living or dining area is kept clear of obstructions.~~ ]

(A) A resident individual living unit area contributed toward total common living area or total common dining area cannot be counted more than once for each living unit. The individual living unit area may be divided between common living area and dining area calculations.

(B) An existing small Type B assisted living facility cannot use both the reduction in space for common living or dining areas allowed by this subsection and the reduction in space for bedrooms allowed by subsection (a)(3) of this section at the same time.

[(5) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, an existing small Type B assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.]

[(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.]

[(B) An existing small Type B assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.]

(h) Storage areas. An existing small Type B assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies, including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnishes linen;

(7) soiled linen, if the facility furnishes linen; and

(8) lawn and maintenance equipment.

(i) Kitchen.

[(1) An existing small Type B assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.]

[(2) An existing small Type B assisted living facility that prepares food on-site must provide a kitchen or dietary area meeting the general food service needs of the residents and must ensure that the kitchen:]

[(A) is equipped to store, refrigerate, prepare, and serve food;]

[(B) is equipped to clean and sterilize;]

[(C) provides for refuse storage and removal; and]

[(D) meets the requirements of the local fire, building, and health codes.]

[(3)] An existing small Type B assisted living facility must ensure a kitchen uses only residential cooking equipment or, if the kitchen uses commercial cooking equipment, that the facility protects the kitchen's cooking operations as required in §553.126 of this division (relating to Hazardous Area Requirements for an Existing Small Type B Assisted Living Facility).

§ 553.125. Fire Protection Systems Requirements for an Existing Small Type B Assisted Living Facility.

(a) Fire alarm and smoke detection system. An existing small Type B assisted living facility must provide a manual fire alarm system meeting the requirements of [ ~~section~~ ] 9.6, Fire Detection, Alarm, and Communication Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment, as modified by this section.

(1) General. An existing small Type B assisted living facility must ensure the operation of any alarm initiating device automatically activates an audible or a visual alarm at the site.

(2) Smoke detectors.

(A) An existing small Type B assisted living facility must install smoke detectors in resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens, laundries, attached garages used for car parking, and public or common areas, except as permitted in subparagraphs (B) and (C) of this paragraph.

(B) An existing small Type B assisted living facility may install heat detectors in lieu of smoke detectors in kitchens, laundries, and attached garages used for car parking.

(C) An existing small Type B assisted living facility located in a building constructed to meet the requirements of NFPA 101, Chapter 19, Existing Health Care Occupancies, may install a smoke detection system meeting the requirements of 19.3.4.5.1, Corridors, in NFPA 101, Chapter 19, Existing Health Care Occupancies, in lieu of the requirements in subparagraph (A) of this paragraph.

(3) Alarm control panel.

(A) An existing small Type B assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) An existing small Type B assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(4) Fire alarm power source.

[(A)] An existing small Type B assisted living facility must ensure the power supply source for a fire alarm system is in accordance with NFPA 72. [ ~~powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.~~ ]

~~[(B) An existing small Type B assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.]~~

(b) Fire sprinkler system.

(1) In accordance with requirements of 33.2.3.5, Extinguishment Requirements, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, an existing small Type B assisted living facility must provide: [ An existing small Type B assisted living facility must provide one of the following fire sprinkler systems according to the requirements of 33.2.3.5, Extinguishment Requirements, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies. ]

(A) a [ A ] fire sprinkler system meeting the requirements of NFPA 13 in accordance with 33.2.3.5.3, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies; [ ~~33.2.3.5.3.3;~~ ]

(B) a [ A ] fire sprinkler system meeting the requirements of NFPA 13R in accordance with 33.2.3.5.3.5, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies; or [ ~~33.2.3.5.3.4; or~~ ]

(C) a [ A ] fire sprinkler system meeting the requirements of NFPA 13D in accordance with 33.2.3.5.3.2 , in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies .

(2) An existing small Type B assisted living facility must ensure a fire sprinkler system is supervised according to 9.7.2, Supervision, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(c) Protection of attics. An existing small Type B assisted living facility that has [ ~~equipped with~~ ] a fire sprinkler system must ensure an attic is protected according to the requirements of 33.2.3.5.7, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, not later than August 31, 2026 [ ~~August 31, 2024~~ ].

(d) Portable fire extinguishers. An existing small Type B assisted living facility must provide and maintain portable fire extinguishers according to the requirements of NFPA 10.

(1) An existing small Type B assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) An existing small Type B assisted living facility must ensure portable fire extinguishers are located so the travel distance from any point in the facility to an extinguisher is no more than 75 feet.

(3) An existing small Type B assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10; or

(B) Other portable fire extinguishers must have a rating of at least 2-A:5-B:C according to NFPA 10.

(4) An existing small Type B assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or mounted in an approved cabinet.

(5) An existing small Type B assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) An existing small Type B assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the door leading from the room and on the latch or knob side of the door.

§ 553.128. Electrical Requirements for an Existing Small Type B Assisted Living Facility.

(a) Electrical system. An existing small Type B assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. An existing small Type B assisted living facility must provide illumination throughout the building. Minimum lighting levels must not be lower than the following. [ : ]

(2) In [ ~~20 footcandles in~~ ] each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator , illumination must be at least 20 footcandles during the day when [ ~~during the day--illumination requirements for these areas apply to lighting throughout the space, as~~ ] measured anywhere in the space at 30 inches above the floor . [ ~~anywhere in the room; and~~ ]

(c) Telephone. An existing small Type B assisted living facility must provide at least one telephone in the facility that is available to both staff and residents. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. An existing small Type B assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must include at least :

~~[(A) be a direct telephone, emergency call system or intercom;]~~

~~[(B) if it is an existing communication system, be approved by the Texas Health and Human Services Commission to be continued in service;]~~

~~[(C) include at least:]~~

(A) [ ~~(i)~~ ] one central notification station accessible to staff at all times [ ~~at a fixed location~~ ] that receives all calls processed through the system; and

(B) [ ~~(ii)~~ ] one [ ~~permanently fixed~~ ] call station or device accessible to residents at all times in each resident's living unit. [ ~~in every resident living unit.~~ ]

(2) An existing small Type B assisted living facility may provide:

(A) additional or portable notification stations or devices in addition to the central notification station; or

(B) additional call stations or devices in private or common resident areas.

(3) An existing small Type B assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands , but these devices must not replace a call station in a resident living unit . [ ~~However, a device may not be a substitute for a fixed call station in a resident living unit.~~ ]

§ 553.129. Miscellaneous Requirements for an Existing Small Type B Assisted Living Facility.

(a) An existing small Type B assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located.

(b) An existing small Type B assisted living facility must ensure furnishings, mattresses, and decorations meet the requirements of 33.7.5, Furnishings, Mattresses, and Decorations, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 18, 2026.

TRD-202603596

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 4, 2026

For further information, please call: (512) 438-3161

DIVISION 6. EXISTING LARGE TYPE A ASSISTED LIVING FACILITIES

26 TAC §§553.131 - 553.133, 553.135, 553.137 - 553.139

STATUTORY AUTHORITY

The amendments implement Texas Government Code §524.0005 and §524.0151 and Texas Health and Safety Code §247.025 and §247.026.

§ 553.131. Construction Requirements for an Existing Large Type A Assisted Living Facility.

(a) Structurally sound. An existing large Type A assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads in accordance with applicable building codes.

(b) Separation of occupancies. An existing large Type A assisted living facility must be separated from other occupancies by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards, unless otherwise permitted by paragraph [ ~~paragraphs~~ ] (1) or (2) of this subsection.

(1) An existing large Type A assisted living facility must be separated from other assisted living facilities, hospitals or nursing facilities. Beginning August 31, 2021, an existing large Type A assisted living facility must be separated from any new occupancy or new use subject to HHSC licensing.

(2) An existing large Type A assisted living facility is not required to be separated from another occupancy not subject to HHSC licensing standards if the two occupancies are so intermingled that construction of a fire barrier having a 2-hour fire resistance rating is impractical and the following conditions are met.

(A) The means of egress, construction, protection, and other safeguards for the entire building must comply with the NFPA 101 requirements for an existing large Type A assisted living facility.

(1) Except as provided in paragraph (3) of this subsection, an existing large Type A assisted living facility must ensure all buildings used by residents are sheathed with materials providing the following fire resistance ratings.

(A) Interior wall and ceiling surfaces must have finished surfaces, substrates, or sheathing with a fire resistance rating of not less than 20 minutes.

(B) Columns, beams, girders, or trusses that are not enclosed within walls or ceilings must be encased in materials having a fire resistance rating of not less than 20 minutes.

(2) A sprinkler system does not substitute for this minimum sheathing requirement under paragraph (1) of this subsection.

(d) Interior finish. An existing large Type A assisted living facility must ensure interior wall , [ ~~and~~ ] ceiling , and floor finish materials meet the requirements of 33.3.3.3, Interior Finish, [ ~~33.3.3.3.2, Interior Wall and Ceiling Finish,~~ ] in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(e) Vertical openings. An existing large Type A assisted living facility must ensure vertical openings are protected according to the requirements of 33.3.3.1, Protection of Vertical Openings, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

§ 553.132. Space Planning and Utilization Requirements for an Existing Large Type A Assisted Living Facility.

(a) Resident bedrooms.

(1) An existing large Type A assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below finished ground level.

(2) An existing large Type A assisted living facility must ensure bedroom usable floor space is not less than 80 square feet for a bedroom housing one resident and not less than 60 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted by paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than eight feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by HHSC. [ ~~the Texas Health and Human Services Commission (HHSC).~~ ]

(3) An existing large Type A assisted living facility with individual living units that have both a bedroom and other living space may reduce the required bedroom usable floor space for a bedroom for more than one resident by up to 10 percent. The bedroom must continue to meet the minimum dimension requirements in paragraph (2) of this subsection. This reduction cannot be used together with the provision for reducing common living areas or common dining areas as described in subsection (g) of this section. [ An existing large Type A assisted living facility containing individual living units that include living space for the residents, in addition to their bedroom, may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. An existing large Type A assisted living facility must not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in subsection (g)(6) of this section. ]

(4) An existing large Type A assisted living facility must house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. An existing large Type A assisted living facility must ensure each bedroom has at least one operable window with outside exposure [ ~~and~~ ] meeting the following requirements.

(1) The windowsill [ ~~window sill~~ ] must be no higher than 44 inches above the floor.

(2) The window must be easy for all residents [ ~~operable by a resident~~ ] occupying the bedroom to open and close from the inside without using any [ ~~, from the inside, without the use of~~ ] tools or special devices to unlatch or unlock the window .

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space according to the requirements of subsection (a)(2) of this section.

(4) An existing bedroom window not meeting these requirements may be continued in service with approval from HHSC. [ ~~, subject to approval by HHSC.~~ ]

(c) Bedroom furnishings. When a resident does not provide [ ~~their own~~ ] furnishings, an existing large Type A assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed, including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) private clothes storage space, which must have closable doors, and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) An existing large Type A assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) An existing large Type A assisted living facility must ensure a resident room is arranged for convenient resident access to dining and recreation areas.

(e) Staff area. An existing large Type A assisted living facility must provide a staff area on each floor of an existing large Type A assisted living facility and in each separate building containing resident sleeping rooms, except as permitted under paragraph (1) of this subsection.

(1) An existing large Type A assisted living facility that is not more than two stories in height and is composed of separate buildings grouped together and connected by covered walks, is not required to provide a staff area on each floor or in each building, provided that a staff area is located not more than 200 feet walking distance from the farthest resident living unit.

(2) An existing large Type A assisted living facility must provide the following at each staff area:

(A) a desk or writing surface;

(B) a telephone; and

(C) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.135 of this division (relating to Fire Protection Systems Requirements for an Existing Large Type A Assisted Living Facility).

(f) Resident toilet and bathing facilities. An existing large Type A assisted living facility must ensure each resident bedroom is served by a separate private toilet room, a connecting toilet room, or a general toilet room.

(1) An existing large Type A assisted living facility that houses individuals of more than one sex [ ~~gender~~ ] must provide toilet rooms for each sex, [ ~~gender,~~ ] or individual single-occupant toilet rooms for use by either sex [ ~~any gender~~ ].

(2) An existing large Type A assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) An existing large Type A assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.137 of this division (relating to Mechanical Requirements for an Existing Large Type A Assisted Living Facility).

(g) Common living areas and dining areas. [ ~~Resident living areas.~~ ]

(1) Common living areas. [ An existing large Type A assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms. ]

(A) An existing large Type A assisted living facility must ensure the total space for common living areas is provided on a sliding scale according to the following table. [ provide a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space. ]

Figure: 26 TAC §553.132(g)(1)(A) (.pdf)

(ii) A common living area that is smaller than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) An existing large Type A assisted living facility with individual living units that have both a bedroom and other living space may reduce the minimum square footage for the total common living area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common living area. The bedroom must continue to meet the minimum dimension requirements in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. This reduction cannot be used together with the provision for reducing required bedroom usable floor space as described in subsection (a)(3) of this section.

(B) Each common living area used to meet the requirements of this subsection must have appropriate furniture. [ ~~An existing large Type A assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.~~ ]

(C) A common living area counted toward meeting the requirements of this subsection must have at least one exterior window with a view of the outside. [ An existing large Type A assisted living facility must ensure the total space for social-diversional areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement. ]

[ ~~Figure: 26 TAC §553.132(g)(1)(C)~~ ]

(D) A common living area that is not required to be counted toward meeting the requirements of this subsection is not required to have windows with a view of the outside.

(E) If a means of egress passes through a common living area, the facility must subtract the space required for that means of egress, based on the minimum required width for a corridor according to §553.133 of this division (relating to Means of Egress Requirements for an Existing Large Type A Assisted Living Facility), from the total size of the room when determining the size of the common living area.

(2) Common dining areas. [ ~~An existing large Type A assisted living facility must provide a dining area with appropriate furniture.~~

(A) An existing large Type A assisted living facility must ensure the total space for dining areas is provided on a sliding scale according to the following table. [ provide a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum dining space. ]

Figure: 26 TAC §553.132(g)(2)(A) (.pdf)

(ii) A dining area that is smaller than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) An existing large Type A assisted living facility with individual living units that have both a bedroom and other living space may reduce the minimum square footage for total common dining area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common dining area. The bedroom must continue to meet the minimum dimension requirements in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. This reduction cannot be used together with the provision for reducing required bedroom usable floor space as described in subsection (a)(3) of this section.

(B) There must be a covered path from all resident living units or bedrooms to a common dining area. [ ~~An existing large Type A assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.~~ ]

(C) A dining area used to meet the requirements of this subsection must have furniture suitable for dining use. [ ~~An existing large Type A assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.~~ ]

(D) A dining area counted toward meeting the requirements of this subsection must have at least one exterior window with a view of the outside. [ An existing large Type A assisted living facility must ensure the total space for dining areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement. ]

[ ~~Figure: 26 TAC §553.132(g)(2)(D)~~ ]

(E) A dining area that is not required to be counted toward meeting the requirements of this subsection is not required to have windows with a view of the outside.

(F) If a means of egress passes through a common dining area, the facility must subtract the space required for that means of egress, based on the minimum required width for a corridor according to §553.133 of this division, from the total size of the room when determining the size of the common dining area.

(3) Combining common living areas and dining areas. [ An existing large Type A assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet. ]

(A) An existing large Type A assisted living facility may have the living area and dining area together in one space as long as the combined space is at least 240 square feet.

(B) Each area within a combined common living area and dining area must have appropriate furniture for the use of the space or area.

(4) Limitations on minimum area reduction. [ For calculation purposes, where a means of egress passes through a living or dining area, an existing large Type A assisted living facility must deduct a pathway, equal to the minimum corridor width, according to §553.133 of this division (relating to Means of Egress Requirements for an Existing Large Type A Assisted Living Facility), from the measured area of the space. ]

(B) An existing large Type A assisted living facility cannot use both the reduction in space for common living or dining areas allowed by this subsection and the reduction in space for bedrooms allowed by subsection (a)(3) of this section at the same time.

~~[(5) An existing large Type A assisted living facility must ensure a means of egress through a resident living or dining area is kept clear of obstructions, except as permitted by NFPA 101.]~~

[(6) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, an existing large Type A assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social-diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.]

[(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.]

[(B) An existing large Type A assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.]

(h) Storage areas. An existing large Type A assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies, including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnishes linen;

(7) soiled linen, if the facility furnishes linen; and

(8) lawn and maintenance equipment.

(i) General kitchen.

[(1) An existing large Type A assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.]

~~[(2) An existing large Type A assisted living facility must ensure a kitchen meets the requirements of the local fire, building, and health codes.]~~

(1) [ ~~(3)~~ ] An existing large Type A assisted living facility that prepares food onsite [ ~~on-site~~ ] must provide a kitchen or dietary area that includes [ ~~to meet the general food service needs of the residents and must include~~ ] space for:

(A) storage, refrigeration, preparation, and serving food;

(B) dish and utensil cleaning, which includes:

(i) a three-compartment sink large enough to immerse pots and pans; and

(ii) a mechanical dishwasher for washing and sanitizing dishes;

(D) a handwashing station in every food preparation area with a supply of hot and cold water, soap, a towel dispenser and a waste receptacle;

(E) a handwashing lavatory that is readily accessible to every dish room area;

(F) refuse storage and removal; and

(G) floor drains in the kitchen and dishwashing areas, unless the facility was licensed before January 6, 2014, and the facility can keep the floor clean . [ ~~; and~~

~~[(H) a grease trap, if required by local authorities.]~~

(2) [ ~~(4)~~ ] An existing large Type A assisted living facility must ensure a kitchen is designed so that room temperature, at peak load or in the summer, does not exceed 85 degrees Fahrenheit measured throughout the room at five feet above the floor.

(3) [ ~~(5)~~ ] An existing large Type A assisted living facility must ensure the volume of supply air provided takes into account the large quantities of air that may be exhausted at the range hood and dishwashing area.

(4) [ ~~(6)~~ ] An existing large Type A assisted living facility must provide a supply of hot and cold water.

(A) Hot water for sanitizing purposes must be 180 degrees Fahrenheit.

(B) When chemical sanitizers are used, hot water must meet the manufacturer's suggested temperature.

(5) [ ~~(7)~~ ] An existing large Type A assisted living facility must maintain a separation between soiled and clean dish areas.

(6) [ ~~(8)~~ ] An existing large Type A assisted living facility must maintain a separation of air flow between soiled and clean dish areas.

(j) Kitchen restrooms.

(1) An existing large Type A assisted living facility must provide a restroom facility for kitchen staff, including a lavatory, except as described in paragraph (2) of this subsection.

(A) The restroom facility must be directly accessible to kitchen staff without traversing resident-use areas.

(B) The restroom must open into a service corridor or vestibule and not open directly into the kitchen.

(2) An existing large Type A assisted living facility licensed before January 6, 2014, may provide a staff restroom that may be located outside the kitchen area.

(k) Kitchen janitorial facility.

(1) An existing large Type A assisted living facility must provide janitorial facilities exclusively for the kitchen and located in the kitchen area, except as described in paragraph (2) of this subsection.

(2) An existing large Type A assisted living facility licensed before January 6, 2014, must provide a janitorial facility for the kitchen. The janitorial facility may be located outside the kitchen if sanitary procedures are used to reduce the possibility of cross-contamination.

(3) An existing large Type A assisted living facility must provide a garbage can or cart washing area with a floor drain and a supply of hot water. The garbage can or cart washing area may be in the interior or on the exterior of the facility.

(4) An existing large Type A assisted living facility must provide floor drains in the kitchen and dishwashing areas unless the facility was licensed before January 6, 2014, and the facility can keep the floors clean.

~~[(5) If required by local authorities, an existing large Type A assisted living facility must provide a grease trap.]~~

(l) Finishes.

(1) An existing large Type A assisted living facility must provide non-absorbent, smooth finishes or surfaces on all kitchen floors, walls and ceilings.

(2) An existing large Type A assisted living facility must provide non-absorbent, smooth, cleanable finishes on counter surfaces and all cabinet surfaces.

(3) An existing large Type A assisted living facility must ensure surfaces are capable of being routinely cleaned and sanitized to maintain a healthful environment.

(m) Vision panels in communicating doors.

(1) An existing large Type A assisted living facility must ensure a door between a kitchen and a dining area, serving area, or resident-use area, is provided with a vision panel with fixed safety glass. Where the door is a required fire door or is located in a fire barrier or other fire resistance-rated enclosure, the vision panel, including the glazing and the frame, must meet the requirements of NFPA 101.

(2) Existing doors between kitchens and adjacent spaces that are not provided with vision panels may be continued in service with approval from HHSC. [ ~~, subject to approval by HHSC.~~ ]

(n) Auxiliary serving kitchens.

(1) An existing large Type A assisted living facility must ensure an auxiliary serving kitchen is equipped to maintain required food temperatures.

(2) An existing large Type A assisted living facility must ensure an auxiliary serving kitchen is equipped with a handwashing lavatory meeting the requirements of this section.

(3) An existing large Type A assisted living facility must ensure all surfaces in an auxiliary serving kitchen meet the requirements for finishes in this section.

(o) Protection of cooking operations.

(1) An existing large Type A assisted living facility must protect cooking facilities using commercial or residential cooking equipment for meal preparation as commercial cooking operations, according to the requirements for commercial cooking equipment in §553.136 of this division (relating to Hazardous Area Requirements for an Existing Large Type A Assisted Living Facility).

(2) The following commercial or residential cooking equipment used only for reheating, and not for meal preparation, is not required to comply with the requirements of §553.136 of this division:

(A) microwave ovens;

(B) hot plates; or

(p) Food storage areas.

(1) An existing large Type A assisted living facility must provide a food storage area large enough to consistently maintain a four-day minimum supply of non-perishable food. A food storage area may be located away from the food preparation area as long as there is space adjacent to the kitchen for necessary daily usage.

(2) An existing large Type A assisted living facility must provide dollies, racks, pallets, wheeled containers, or shelving, so that food is not stored on the floor.

(A) An existing large Type A assisted living facility must ensure shelves are adjustable wire type shelving.

(B) An existing large Type A assisted living facility licensed before January 6, 2014, may use wood shelves provided the shelves are sealed and clean.

(3) An existing large Type A assisted living facility must provide non-absorbent finishes or surfaces on all floors and walls in food storage areas.

(4) An existing large Type A assisted living facility must provide effective ventilation in dry food storage areas to ensure positive air circulation.

(5) An existing large Type A assisted living facility must ensure the maximum room temperature in a food storage area does not exceed 85 degrees Fahrenheit at any time, when measured at the highest food storage level, but not less than five feet above the floor.

(q) Laundry and linen services.

(1) An existing large Type A assisted living facility that co-mingles and processes laundry onsite [ ~~on-site~~ ] in a central location, regardless of the type of laundry equipment used, must ensure a laundry area:

(A) is separated from the assisted living building by a fire barrier having a one-hour fire resistance rating, and this separation must extend from the floor to the floor or roof above;

(B) is protected throughout by a fire sprinkler system;

(C) has access doors that open to the exterior or to an interior non-resident use area, such as a vestibule or service corridor; and

(D) is provided with:

(i) a soiled linen receiving, holding, and sorting room with a floor drain and forced exhaust to the exterior that;

(I) must always operate when soiled linen is held in this area; and

(II) may be combined with the washer section;

(ii) a general laundry work area that is separated by partitioning a washer section and a dryer section;

(iii) a storage area for laundry supplies;

(iv) a folding area;

(v) an adequate air supply and ventilation for staff comfort without having to rely on opening a door that is part of the fire barrier separation required by subparagraph (A) of this paragraph; [ ~~subparagraph (1)(A) of this subsection;~~ ] and

(vi) provisions to exhaust heat from dryers and to separate dryer make-up air from the habitable work areas of the laundry.

(2) If linen is processed off site, the facility must provide:

(A) a soiled linen holding room with adequate forced exhaust ducted to the exterior; and

(B) a clean linen receiving, holding, inspection, sorting or folding, and storage room.

(3) An existing large Type A assisted living facility must ensure a laundry area for resident use [ ~~resident-use~~ ] meets the following requirements.

(A) An existing large Type A assisted living facility must ensure only residential type washers and dryers are provided in a laundry area for resident use [ ~~resident-use~~ ].

(B) When more than three washers and three dryers are provided in one laundry area for resident use, the area must be:

(i) protected throughout by a fire sprinkler system; or

(ii) separated from the facility by a fire barrier having a one-hour fire resistance rating.

§ 553.133. Means of Egress Requirements for an Existing Large Type A Assisted Living Facility.

(a) An existing large Type A assisted living facility must meet the requirements of 33.3.2, Means of Egress, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, except as described in this section.

(b) The provisions of 33.3.2.11.2, Lockups, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, are not permitted.

(c) An existing large Type A assisted living facility must ensure doors meet the requirements of 33.3.2.2.2, Doors, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, and the additional requirements of this section.

(1) A resident room door in an existing large Type A assisted living facility must latch in its frame to resist the passage of smoke.

(2) In an existing large Type A assisted living facility comprised of buildings that contain living units with independent cooking equipment within the living unit, a door between the living unit and a corridor or hallway must:

(A) be self-closing or automatic-closing; and

(B) latch in its frame to resist the passage of smoke.

(3) A resident room door or living unit door must not be arranged to prevent the occupant from closing the door.

(4) An existing large Type A assisted living facility must ensure doors in a means of egress that are required to swing in the direction of egress travel, according to NFPA 101, are inspected and tested according to 33.7.7, Inspection of Door Openings, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(d) An existing large Type A assisted living facility providing spaces for use by residents on floors other than the ground floor must provide at least two separate approved stairs and must ensure stairs used as a means of egress meet the requirements of 33.3.2.2.3, Stairs, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(e) An existing large Type A assisted living facility must ensure means of egress are marked according to the requirements of 33.3.2.10, Marking of Means of Egress, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(f) An existing large Type A assisted living facility containing more than 25 sleeping rooms must provide emergency lighting, according to the requirements of 33.3.2.9, Emergency Lighting, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, unless each sleeping room has a direct exit to the outside at the finished ground level.

§ 553.135. Fire Protection Systems Requirements for an Existing Large Type A Assisted Living Facility.

(a) Fire alarm and smoke detection system. An existing large Type A assisted living facility must provide a manual fire alarm system meeting the requirements of 9.6, Fire Detection, Alarm, and Communication Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment, as modified by this section.

(1) General. An existing large Type A assisted living facility must ensure the operation of any alarm initiating device automatically activates an audible or a visual alarm at the site.

(2) Smoke detectors.

(A) An existing large Type A assisted living facility must install smoke detectors in resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens, laundries, attached garages used for car parking, and public or common areas, except as permitted in subparagraphs (B) - (D) of this paragraph.

(B) An existing large Type A assisted living facility may install heat detectors in lieu of smoke detectors in kitchens, laundries, and attached garages used for car parking.

(C) An existing large Type A assisted living facility located in a building constructed to meet the requirements of NFPA 101, Chapter 19, Existing Health Care Occupancies, may install a smoke detection system meeting the requirements of 19.3.4.5.1, Corridors, in NFPA 101, Chapter 19, Existing Health Care Occupancies, in lieu of the requirements found in subparagraphs (A) and (B) of this paragraph.

(D) An existing large Type A assisted living facility comprised of buildings containing living units with independent cooking equipment must additionally have:

(i) a smoke alarm or smoke detector installed in all [ in ] resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens and laundries within the living unit, that sounds an alarm only within the living unit; and

(ii) a heat detector installed in the kitchen within the living unit that activates the general alarm.

(3) Alarm control panel.

(A) An existing large Type A assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) An existing large Type A assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(C) An existing large Type A assisted living facility must ensure a fire alarm panel indicates each floor and smoke compartment, as applicable, as a separate zone. Each zone must provide an alarm and trouble indication. When all alarm initiating devices are addressable and the status of each device is identified on the fire alarm panel, zone indication is not required.

(4) Fire alarm power source.

[(A)] An existing large Type A assisted living facility must ensure the power supply source for a fire alarm system is in accordance with NFPA 72. [ ~~a fire alarm system is powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.~~ ]

~~[(B) An existing large Type A assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.]~~

(5) Emergency forces notification. An existing large Type A assisted living facility not equipped with a fire alarm system that automatically notifies emergency forces must immediately notify the fire department by telephone or other means.

(b) Fire sprinkler system.

(1) An existing large Type A assisted living facility may provide a fire sprinkler system meeting the requirements of NFPA 13 in accordance with 33.3.3.5.1, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(2) An existing large Type A assisted living facility located in a building that is four or fewer stories in height may provide a fire sprinkler system meeting the requirements of NFPA 13R in accordance with 33.3.3.5.1.1, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(3) An existing large Type A assisted living facility located in a high-rise building must be protected throughout by an approved, supervised automatic fire sprinkler system meeting the requirements of NFPA 13 according to 33.3.3.5.3, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(c) Protection of attics. An existing large Type A assisted living facility that has [ ~~equipped with~~ ] a fire sprinkler system must ensure an attic is protected according to the requirements of 33.3.3.5.4, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies, not later than August 31, 2026 [ ~~2024~~ ].

(d) Portable fire extinguishers. An existing large Type A assisted living facility must provide and maintain portable fire extinguishers according to the requirements of NFPA 10.

(1) An existing large Type A assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) An existing large Type A assisted living facility must ensure portable fire extinguishers are located in resident corridors so the travel distance from any point in the facility to an extinguisher is no more than 75 feet.

(3) An existing large Type A assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10.

(B) All other portable fire extinguishers must have a rating of at least 2-A:5-B:C according to NFPA 10.

(C) A facility must provide at least one approved 20-B:C portable fire extinguisher in each laundry, kitchen and walk-in mechanical room.

(4) An existing large Type A assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or mounted in an approved cabinet.

(5) An existing large Type A assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) An existing large Type A assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the exit access door leading from the room and on the latch or knob side of the door.

§ 553.137. Mechanical Requirements for an Existing Large Type A Assisted Living Facility.

(a) Wastewater and water supply.

(1) Wastewater. An existing large Type A assisted living facility must ensure wastewater and sewage are discharged into a sewerage system or an onsite sewerage facility approved by the Water Quality Division of the Texas Commission on Environmental Quality (TCEQ), or to a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Quality Division of TCEQ.

(2) Water supply. An existing large Type A assisted living facility must ensure the water supply is of safe, sanitary quality, suitable for use, adequate in quantity and pressure, and obtained from a public or private water supply system or a private well.

(b) Resident-use plumbing fixtures.

(1) Water closets and lavatories.

(A) An existing large Type A assisted living facility must provide at least one water closet and one lavatory for every six residents and for any fraction thereof [ ~~each additional resident fewer than six~~ ]. Multiple toilets in a single space must comply with paragraph (2)(B) of this subsection.

(B) An existing large Type A assisted living facility must ensure a lavatory is readily accessible to each water closet.

(C) An existing large Type A assisted living facility must provide at least one water closet, lavatory, and bathing unit, that are accessible to residents, on each floor containing resident sleeping rooms.

(2) Bathing units.

(A) An existing large Type A assisted living facility must provide one tub or shower for every 10 residents, and for any fraction thereof.

(B) Where multiple water closets or bathing units are provided in a single space, an existing large Type A assisted living facility must provide partitions or curtains to separate plumbing fixtures for resident privacy.

(C) An existing large Type A assisted living facility must ensure tubs and showers have non-slip bottoms or floor surfaces, either built-in or applied to the surfaces.

(3) Hot water supply. An existing large Type A assisted living facility must provide a supply of hot water for resident-use. Hot water for lavatories and bathing units accessible to residents must be maintained between 100 and 120 degrees Fahrenheit.

(4) Supplies. An existing large Type A assisted living facility must supply towels, soap, and toilet tissue for individual resident use.

(c) Public and staff-use plumbing fixtures. In addition to the staff toilets required for the dietary staff according to §553.132(j) of this division (relating to Space Planning and Utilization Requirements for an Existing Large Type A Assisted Living Facility), an existing large Type A assisted living facility must provide toilets, including water closets and lavatories, for use by the public and by [ ~~facility~~ ] staff as follows:

(1) if licensed for 60 or fewer residents, a toilet for use by the public and by [ ~~facility~~ ] staff; or

(2) if licensed for more than 60 residents, a toilet for use by the public and a separate toilet for use by [ ~~facility~~ ] staff.

(d) Gas. An existing large Type A assisted living facility must ensure equipment using natural gas or propane and related gas piping meets the requirements of 9.1.1, Gas, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(e) Heating, ventilation, and air-conditioning (HVAC) and exhaust systems.

(1) General requirements. An existing large Type A assisted living facility must ensure HVAC equipment meets the requirements of 33.3.6.2, Heating, Ventilating, and Air-Conditioning, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(2) Heating and cooling. An existing large Type A assisted living facility must provide heating and cooling for resident comfort.

(A) An existing large Type A assisted living facility must ensure air conditioning systems can maintain and do maintain the comfort range of 68 to 82 degrees Fahrenheit in resident-use areas.

(B) An existing large Type A assisted living facility constructed or licensed after August 1, 2004, must have a central air-conditioning system, or a substantially similar air conditioning system, that can maintain and does maintain a temperature range required under subparagraph (A) of this paragraph within areas used by residents.

(C) An existing large Type A assisted living facility may not use an open flame heating device in the facility, except as permitted by subparagraphs (D) - (E) of this section.

(D) An existing large Type A assisted living facility must ensure a fuel-fired heating device, other than a working fireplace, meets the following requirements.

(i) A fuel-fired heating device must be connected to a chimney or vent.

(ii) A fuel-fired heating device must take air for combustion directly from outside.

(iii) A fuel-fired heating device must be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area.

(iv) A fuel-fired heating device must have safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

(v) A fuel-fired heating device not meeting the requirements of clauses (i) - (iv) of this subparagraph may be continued in service, subject to approval by HHSC.

(E) An existing large Type A assisted living facility must ensure a working fireplace meets the following requirements.

(i) A building containing a working fireplace must be protected by an approved, supervised automatic sprinkler system with listed quick response or listed residential sprinklers.

(ii) A new working fireplace must be installed, maintained and used according to NFPA 54 and NFPA 211.

(iii) A working fireplace may not be located in a resident sleeping room.

(iv) The room where a working fireplace is located must be provided with electrically supervised carbon monoxide detection connected to the fire alarm system according to NFPA 720.

(v) A direct-vent gas fireplace, as defined in NFPA 54, must meet the following requirements.

(I) A direct-vent gas fireplace must include a sealed glass front with a wire mesh panel or screen.

(II) The controls for a direct-vent gas fireplace must be locked or located in a restricted location.

(vi) A solid-fuel burning fireplace must be equipped with:

(I) a raised hearth at least four inches above the surrounding finished floor; and ,

(II) a fireplace enclosure that is guaranteed against breakage up to a temperature of 650 degrees Fahrenheit and constructed of heat-tempered glass or other approved material ;

(vii) An existing working fireplace not meeting the requirements of clauses (i) - (vi) of this subparagraph may be continued in service, subject to approval by HHSC.

(3) Ventilation.

(A) An existing large Type A assisted living facility must be ventilated using windows, mechanical ventilation, or a combination of both.

(B) An existing large Type A assisted living facility with interior areas designated for smoking within the building must provide mechanical ventilation directed to the exterior to remove smoke at the rate of 10 air changes per hour.

(4) Exhaust. An existing large Type A assisted living facility must ensure bathrooms, toilet rooms, janitorial facilities, and other odor-producing rooms or areas for soiled or unsanitary operations are exhausted with operable windows or powered exhaust vented to the exterior for odor control.

§ 553.138. Electrical Requirements for an Existing Large Type A Assisted Living Facility.

(a) Electrical system. An existing large Type A assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. An existing large Type A assisted living facility must provide illumination throughout the building. Minimum lighting levels must not be lower than the following. [ : ]

(2) In [ ~~20 footcandles in~~ ] each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator , illumination must be at least 20 footcandles during the day when [ ~~during the day--illumination requirements for these areas apply to lighting throughout the space, as~~ ] measured anywhere in the space at 30 inches above the floor . [ ~~anywhere in the room; and~~ ]

(c) Telephone. An existing large Type A assisted living facility must provide at least one telephone in the facility that is available to both staff and residents. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. An existing large Type A assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must include at least :

~~[(A) be a direct telephone, emergency call system or intercom;]~~

~~[(B) if it is an existing communication system, be approved by HHSC to be continued in service;]~~

~~[(C) include at least:]~~

(A) [ ~~(i)~~ ] one central notification station accessible to staff at all times [ ~~at a fixed location~~ ] that receives all calls processed through the system; and

(B) [ ~~(ii)~~ ] one [ ~~permanently fixed~~ ] call station or device accessible to residents at all times in each resident's living unit. [ ~~in every resident living unit.~~ ]

(2) An existing large Type A assisted living facility may provide:

(A) additional or portable notification stations or devices in addition to the central notification station; or

(B) additional call stations or devices in private or common resident areas.

(3) An existing large Type A assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands , but these devices must not replace a call station in a resident living unit . [ ~~However, a device may not be a substitute for a fixed call station in a resident living unit~~ ].

§ 553.139. Miscellaneous Requirements for an Existing Large Type A Assisted Living Facility.

(a) An existing large Type A assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located.

(b) An existing large Type A assisted living facility must ensure an elevator, dumbwaiter, or vertical conveyor meets the requirements of 33.3.6.3, Elevators, Dumbwaiters, and Vertical Conveyors, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(c) An existing large Type A assisted living facility must ensure a rubbish chute, incinerator, or laundry chute meets the requirements of 33.3.6.4, Rubbish Chutes, Incinerators, and Laundry Chutes, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

(d) An existing large Type A assisted living facility must ensure furnishings, mattresses, and decorations meet the requirements of 33.7.5, Furnishings, Mattresses, and Decorations, in NFPA 101, Chapter 33, Existing Residential Board and Care Occupancies.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 18, 2026.

TRD-202603597

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 4, 2026

For further information, please call: (512) 438-3161

DIVISION 7. EXISTING LARGE TYPE B ASSISTED LIVING FACILITIES

26 TAC §§553.141 - 553.143, 553.145, 553.147 - 553.149

STATUTORY AUTHORITY

The amendments implement Texas Government Code §524.0005 and §524.0151 and Texas Health and Safety Code §247.025 and §247.026.

§ 553.141. Construction Requirements for an Existing Large Type B Assisted Living Facility.

(a) Structurally sound. An existing large Type B assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads according to applicable building codes.

(b) Separation of occupancies. An existing large Type B assisted living facility must be separated from other occupancies by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards, unless otherwise permitted by paragraph [ ~~paragraphs~~ ] (1) or (2) of this subsection.

(1) An existing large Type B assisted living facility is not required to be separated from a hospital or nursing facility unless the separation is required by NFPA 101 or the standards for licensing the hospital or nursing facility. Beginning August 31, 2021, an existing large Type B assisted living facility must be separated from any new occupancy or new use subject to HHSC. [ ~~the Texas Health and Human Services Commission (HHSC) licensing.~~ ]

(2) An existing large Type B assisted living facility is not required to be separated from another occupancy not subject to HHSC licensing standards if the two occupancies are so intermingled that construction of a fire barrier having a 2-hour fire resistance rating is impractical and the following conditions are met.

(A) The means of egress, construction, protection, and other safeguards for the entire building must comply with the NFPA 101 requirements for an existing large Type B assisted living facility.

(c) Construction type. An existing large Type B assisted living facility must ensure a building housing the facility meets the requirements of 19.1.6, Minimum Construction Requirements, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(d) Interior finish. An existing Large Type B assisted living facility must ensure interior wall, ceiling , and floor finish materials meet the requirements of 19.3.3, Interior Finish, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(e) Vertical openings. An existing large Type B assisted living facility must ensure vertical openings are protected according to the requirements of 19.3.1, Protection of Vertical Openings, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(f) An existing large Type B assisted living facility that meets the definition of a high-rise building in NFPA 101, must meet the requirements of 19.4.2, High-Rise Buildings, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

§ 553.142. Space Planning and Utilization Requirements for an Existing Large Type B Assisted Living Facility.

(a) Resident bedrooms.

(1) An existing large Type B assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below finished ground level.

(2) An existing large Type B assisted living facility must ensure bedroom usable floor space is not less than 100 square feet for a bedroom housing one resident and not less than 80 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted by paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than 10 feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by HHSC. [ ~~the Texas Health and Human Services Commission (HHSC).~~ ]

(3) If an existing large Type B assisted living facility has individual living units that include both a bedroom and other living space, the facility may make a bedroom for more than one resident up to 10 percent smaller than the required bedroom usable floor space. A bedroom must still meet the minimum dimensional criteria in paragraph (2) of this subsection. A facility must not use this provision at the same time as the provision allowing the reduction of common living areas or common dining areas found in subsection (g) of this section. [ An existing large Type B assisted living facility containing individual living units that include living space for the residents, in addition to their bedroom, may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. An existing large Type B assisted living facility must not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in subsection (g)(6) of this section. ]

(4) An existing large Type B assisted living facility must house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. An existing large Type B assisted living facility must ensure each bedroom has at least one operable window, with outside exposure meeting [ ~~, that meets~~ ] the following requirements.

(1) The windowsill [ ~~window sill~~ ] must be no higher than 44 inches above the floor.

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space required by subsection (a)(2) of this section.

(4) An existing bedroom window that does not meet these requirements may be continued in service with approval from HHSC. [ ~~, subject to approval by HHSC.~~ ]

(c) Bedroom furnishings. When a resident does not provide [ ~~their own~~ ] furnishings, an existing large Type B assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed, including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) private clothes storage space, which must have closable doors, and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) An existing large Type B assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) An existing large Type B assisted living facility must ensure all resident rooms are arranged for convenient resident access to dining and recreation areas.

(e) Staff area. An existing large Type B assisted living facility must provide a staff area on each floor of an existing large Type B assisted living facility and in each separate building containing resident sleeping rooms. An existing large Type B assisted living facility must provide the following at each staff area:

(1) a desk or writing surface;

(2) a telephone; and

(3) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.145 of this division (relating to Fire Protection Systems Requirements for an Existing Large Type B Assisted Living Facility).

(f) Resident toilet and bathing facilities. An existing large Type B assisted living facility must ensure each resident bedroom is served by a separate private toilet room, a connecting toilet room, or a general toilet room.

(1) An existing large Type B assisted living facility that houses individuals of more than one sex [ ~~gender~~ ] must provide toilet rooms for each sex, [ ~~gender,~~ ] or individual single-occupant toilet rooms for use by either sex [ ~~any gender~~ ].

(2) An existing large Type B assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) An existing large Type B assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.147 of this division (relating to Mechanical Requirements for an Existing Large Type B Assisted Living Facility).

(g) Common living areas and dining areas. [ ~~Resident living areas.~~ ]

(1) Common living areas. [ An existing large Type B assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms. ]

(A) An existing large Type B assisted living facility must ensure the total space for common living areas is provided on a sliding scale according to the following table. [ provide a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space. ]

Figure: 26 TAC §553.142(g)(1)(A) (.pdf)

(ii) A common living area less than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) An existing large Type B assisted living facility with individual living units that have both a bedroom and other living space may reduce the minimum square footage for the total common living area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common living area. The bedroom must continue to meet the minimum dimension requirements in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. This reduction cannot be used together with the provision for reducing required bedroom usable floor space as described in subsection (a)(3) of this section.

(B) Each common living area used to meet the requirements of this subsection must have appropriate furniture. [ ~~An existing large Type B assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.~~ ]

(C) A common living area counted toward meeting the requirements of this subsection must have at least one exterior window with a view of the outside. [ An existing large Type B assisted living facility must ensure the total space for social-diversional areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement. ]

[ ~~Figure: 26 TAC §553.142(g)(1)(C)~~ ]

(D) A common living area that is not required to be counted toward meeting the requirements of this subsection is not required to have windows with a view of the outside.

(E) If a means of egress passes through a common living area, the facility must subtract the space required for that means of egress, based on the minimum required width for a corridor according to §553.143 of this division (relating to Means of Egress Requirements for an Existing Large Type B Assisted Living Facility), from the total size of the room when determining the size of the common living area.

(2) Common dining areas. [ ~~An existing large Type B assisted living facility must provide a dining area with appropriate furniture.~~ ]

(A) An existing large Type B assisted living facility must ensure the total space for dining areas is provided on a sliding scale according to the following table. [ provide a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum dining space. ]

Figure: 26 TAC §553.142(g)(2)(A) (.pdf)

(i) At least one dining area must be at least 120 square feet in area regardless of the number of residents based on the facility's licensed capacity or other provisions of this section allowing a reduction in the total minimum common dining area.

(ii) A dining area less than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) An existing large Type B assisted living facility with individual living units that have both a bedroom and other living space may reduce the minimum square footage for total common dining area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common dining area. The bedroom must continue to meet the minimum dimension requirements in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. This reduction cannot be used together with the provision for reducing required bedroom usable floor space as described in subsection (a)(3) of this section.

(B) There must be a covered path from all resident living units or bedrooms to a common dining area. [ ~~An existing large Type B assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.~~ ]

(C) A dining area used to meet the requirements of this subsection must have furniture suitable for dining use. [ ~~An existing large Type B assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.~~ ]

(D) A dining area counted toward meeting the requirements of this subsection must have at least one exterior window with a view of the outside. [ An existing large Type B assisted living facility must ensure the total space for dining areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement.

[ ~~Figure: 26 TAC §553.142(g)(2)(D)~~ ]

(E) A dining area that is not required to be counted toward meeting the requirements of this subsection is not required to have windows with a view of the outside.

(F) If a means of egress passes through a common dining area, the facility must subtract the space required for that means of egress, based on the minimum required width for a corridor according to §553.143 of this division, from the total size of the room when determining the size of the common dining area.

(3) Combining common living areas and dining areas. [ An existing large Type B assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet. ]

(A) An existing large Type B assisted living facility may have the living area and dining area together in one space as long as the combined space is at least 240 square feet.

(B) Each area within a combined common living area and dining area must have appropriate furniture for the use of the space or area.

(4) Limitations on minimum area reduction. [ For calculation purposes, where a means of egress passes through a living or dining area, an existing large Type B assisted living facility must deduct a pathway, equal to the minimum corridor width, according to §553.143 of this division (relating to Means of Egress Requirements for an Existing Large Type B Assisted Living Facility), from the measured area of the space. ]

(B) An existing large Type B assisted living facility cannot use both the reduction in space for common living or dining areas allowed by this subsection and the reduction in space for bedrooms allowed by subsection (a)(3) of this section at the same time.

~~[(5) An existing large Type B assisted living facility must ensure a means of egress through a resident living or dining area is kept clear of obstructions, except as permitted by NFPA 101.]~~

[(6) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, an existing large Type B assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social-diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.]

[(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.]

[(B) An existing large Type B assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.]

(h) Storage areas. An existing large Type B assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies, including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnishes linen;

(7) soiled linen, if the facility furnishes linen; and

(8) lawn and maintenance equipment.

(i) General kitchen.

[(1) An existing large Type B assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.]

~~[(2) An existing large Type B assisted living facility must ensure a kitchen meets the requirements of the local fire, building, and health codes.]~~

(1) [ ~~(3)~~ ] An existing large Type B assisted living facility that prepares food onsite [ ~~on-site~~ ] must provide a kitchen or dietary area that includes [ ~~to meet the general food service needs of the residents and must include~~ ] space for:

(A) storage, refrigeration, preparation, and serving of food;

(B) dish and utensil cleaning, which includes:

(i) a three compartment sink large enough to immerse pots and pans; and

(ii) a mechanical dishwasher for washing and sanitizing dishes;

(D) a handwashing station in every food preparation area with a supply of hot and cold water, soap, a towel dispenser, and a waste receptacle;

(E) a handwashing lavatory that is readily accessible to every dish room area;

(F) refuse storage and removal; and

(G) floor drains in the kitchen and dishwashing areas, unless the facility was licensed before January 6, 2014, and the facility can keep the floor clean . [ ~~; and~~

~~[(H) a grease trap, if required by local authorities.]~~

(2) [ ~~(4)~~ ] An existing large Type B assisted living facility must ensure a kitchen is designed so that room temperature, at peak load or in the summer, does not exceed 85 degrees Fahrenheit, measured throughout the room at five feet above the floor.

(3) [ ~~(5)~~ ] An existing large Type B assisted living facility must ensure the volume of supply air provided takes into account the large quantities of air that may be exhausted at the range hood and dishwashing area.

(4) [ ~~(6)~~ ] An existing large Type B assisted living facility must provide a supply of hot and cold water.

(A) Hot water for sanitizing purposes must be 180 degrees Fahrenheit.

(B) When chemical sanitizers are used, hot water must meet the manufacturer's suggested temperature.

(5) [ ~~(7)~~ ] An existing large Type B assisted living facility must maintain a separation between soiled and clean dish areas.

(6) [ ~~(8)~~ ] An existing large Type B assisted living facility must maintain a separation of air flow between soiled and clean dish areas.

(j) Kitchen restrooms.

(1) An existing large Type B assisted living facility must provide a restroom facility for kitchen staff, including a lavatory, except as described in paragraphs (2) and (3) of this subsection.

(A) The restroom facility must be directly accessible to kitchen staff without traversing resident-use areas.

(B) The restroom must open into a service corridor or vestibule and not open directly into the kitchen.

(2) An existing large Type B assisted living facility licensed before January 6, 2014, may provide a staff restroom located outside the kitchen area.

(3) An existing large Type B assisted living facility must ensure a kitchen serving a neighborhood or household provides a restroom accessible to kitchen staff that is in close proximity to the kitchen.

(k) Kitchen janitorial facility.

(1) An existing large Type B assisted living facility must provide janitorial facilities exclusively for the kitchen and located in the kitchen area, except as described in paragraphs (2) and (3) of this subsection.

(2) An existing large Type B assisted living facility licensed before January 6, 2014, must provide a janitorial facility for the kitchen. The janitorial facility may be located outside the kitchen if sanitary procedures are used to reduce the possibility of cross-contamination.

(3) An existing large Type B assisted living facility must ensure a kitchen serving a neighborhood or household provides a janitorial facility exclusively for the kitchen that is close to the kitchen.

(4) An existing large Type B assisted living facility must provide a garbage can or cart washing area with a floor drain and a supply of hot water. The garbage can or cart washing area may be in the interior or on the exterior of the facility.

(5) An existing large Type B assisted living facility must provide floor drains in the kitchen and dishwashing areas, unless the facility was licensed before January 6, 2014, and the facility can keep the floors clean.

~~[(6) If required by local authorities, an existing large Type B assisted living facility must provide a grease trap.]~~

(l) Finishes.

(1) An existing large Type B assisted living facility must provide non-absorbent, smooth finishes or surfaces on all kitchen floors, walls, and ceilings.

(2) An existing large Type B assisted living facility must provide non-absorbent, smooth, cleanable finishes on counter surfaces and all cabinet surfaces.

(3) An existing large Type B assisted living facility must ensure surfaces are capable of being routinely cleaned and sanitized to maintain a healthful environment.

(m) Vision panels in communicating doors.

(1) An existing large Type B assisted living facility must ensure a door between a kitchen and a dining, serving, or resident-use area is provided with a vision panel with fixed safety glass. Where the door is a required fire door or is in a fire barrier or other fire resistance-rated enclosure, the vision panel, including the glazing and the frame, must meet the requirements of NFPA 101.

(2) Existing doors between kitchens and adjacent spaces that are not provided with vision panels may be continued in service with approval from HHSC. [ ~~subject to approval by HHSC.~~ ]

(n) Auxiliary serving kitchens.

(1) An existing large Type B assisted living facility must ensure an auxiliary serving kitchen is equipped to maintain required food temperatures.

(2) An existing large Type B assisted living facility must ensure an auxiliary serving kitchen is equipped with a handwashing lavatory meeting the requirements of this section.

(3) An existing large Type B assisted living facility must ensure all surfaces in an auxiliary serving kitchen meet the requirements for finishes in this section.

(o) Protection of cooking operations.

(1) An existing large Type B assisted living facility must protect cooking facilities according to the requirements in §553.146 of this division (relating to Hazardous Area Requirements for an Existing Large Type B Assisted Living Facility) except as provided for in paragraph (3) of this subsection.

(2) The following commercial or residential cooking equipment used only for reheating, and not for meal preparation, is not required to comply with the requirements of §553.146 of this division:

(A) microwave ovens;

(B) hot plates; or

(3) A facility providing a kitchen serving a neighborhood or household may continue to operate the kitchen without modification subject to approval by HHSC.

(p) Food storage areas.

(1) An existing large Type B assisted living facility must provide a food storage area large enough to consistently maintain a four-day minimum supply of non-perishable food. A food storage area may be located away from the food preparation area as long as there is space adjacent to the kitchen for necessary daily usage.

(2) An existing large Type B assisted living facility must provide dollies, racks, pallets, wheeled containers, or shelving so that food is not stored on the floor.

(A) An existing large Type B assisted living facility must ensure shelves are adjustable wire type shelving.

(B) An existing large Type B assisted living facility licensed before January 6, 2014, may use wood shelves provided the shelves are sealed and clean.

(3) An existing large Type B assisted living facility must provide non-absorbent finishes or surfaces on all floors and walls in food storage areas.

(4) An existing large Type B assisted living facility must provide effective ventilation in dry food storage areas to ensure positive air circulation.

(5) An existing large Type B assisted living facility must ensure the maximum room temperature in a food storage area does not exceed 85 degrees Fahrenheit at any time when measured at the highest food storage level, but not less than five feet above the floor.

(q) Laundry and linen services.

(1) An existing large Type B assisted living facility that co-mingles and processes laundry onsite [ ~~on-site~~ ] in a central location, regardless of the type of laundry equipment used, must ensure a laundry area:

(A) is separated from the assisted living building by a fire barrier having a one-hour fire resistance rating, which must extend from the floor to the floor or roof above:

(B) is protected throughout by a fire sprinkler system;

(C) has access doors that open to the exterior or to an interior non-resident use area, such as a vestibule or service corridor; and

(D) is provided with:

(i) a soiled linen receiving, holding, and sorting room with a floor drain and forced exhaust to the exterior which;

(I) must always operate when soiled linen is held in this area; and

(II) may be combined with the washer section;

(ii) a general laundry work area that is separated by partitioning a washer section and a dryer section [ ~~with~~ ];

(iii) a storage area for laundry supplies;

(iv) a folding area;

(v) an adequate air supply and ventilation for staff comfort without having to rely on opening a door that is part of the fire barrier separation required by subparagraph (A) of this paragraph; and [ ~~paragraph (1)(A) of this subsection; and~~ ]

(vi) provisions to exhaust heat from dryers and to separate dryer make-up air from the habitable work areas of the laundry.

(2) If linen is processed off site, the facility must provide:

(A) a soiled linen holding room with adequate forced exhaust ducted to the exterior; and

(B) a clean linen receiving, holding, inspection, sorting or folding, and storage room.

(3) An existing large Type B assisted living facility must ensure a laundry area for resident use [ ~~resident-use~~ ] meets the following requirements.

(A) An existing large Type B assisted living facility must ensure only residential type washers and dryers are provided in a laundry area for resident use [ ~~resident-use~~ ].

(B) When more than three washers and three dryers are provided in one laundry area for resident use [ ~~resident-use~~ ], the area must be:

(i) protected throughout by a fire sprinkler system; or

(ii) separated from the facility by a fire barrier having a one-hour fire resistance rating.

§ 553.143. Means of Egress Requirements for an Existing Large Type B Assisted Living Facility.

(a) An existing large Type B assisted living facility must meet the requirements of 19.2, Means of Egress, in NFPA 101, Chapter 19, Existing Health Care Occupancies, except as described in this section.

(b) An existing large Type B assisted living facility must ensure doors meet the requirements of 19.2.2.2, Doors, in NFPA 101, Chapter 19, Existing Health Care Occupancies, and the additional requirements of this section.

(1) A resident room door in an existing large Type B assisted living facility must latch in its frame to resist the passage of smoke.

(2) In an existing large Type B assisted living facility comprised of buildings containing living units, with independent cooking equipment within the living unit, a door between the living unit and a corridor or hallway must:

(A) be self-closing or automatic-closing; and

(B) latch in its frame to resist the passage of smoke.

(3) A resident room door or living unit door must not be arranged to prevent the occupant from closing the door.

(4) An existing large Type B assisted living facility must not use the door-locking arrangements described in 19.2.2.2.5 in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(c) An existing large Type B assisted living facility providing spaces for use by residents on floors other than the ground floor must provide at least two separate approved stairs and must ensure stairs used as a means of egress meet the requirements of 19.2.2.3, Stairs, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(d) An existing large Type B assisted living facility must ensure means of egress are marked according to the requirements of 19.2.10, Marking of Means of Egress, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(e) An existing large Type B assisted living facility must provide emergency lighting according to the requirements of 19.2.9, Emergency Lighting, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(f) An existing large Type B assisted living facility must maintain means of egress according to the requirements of 19.7.3, Maintenance of Means of Egress, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

§ 553.145. Fire Protection Systems Requirements for an Existing Large Type B Assisted Living Facility.

(a) Fire alarm and smoke detection system. An existing large Type B assisted living facility must provide a fire alarm system meeting the requirements of 19.3.4, Detection, Alarm, and Communications Systems, in NFPA 101, Chapter 19, Existing Health Care Occupancies, as modified by this section.

(1) General. An existing large Type B assisted living facility must ensure the operation of any alarm initiating device automatically activates an audible or a visual alarm at the site.

(2) Smoke detectors.

(A) An existing large Type B assisted living facility must install smoke detectors meeting the requirements of 19.3.4.5.1, Corridors, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(B) An existing large Type B assisted living facility comprised of buildings containing living units with independent cooking equipment must additionally have:

(i) a smoke alarm or smoke detector installed in all resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens, and laundries within the living unit that sounds an alarm only within the living unit; and

(ii) a heat detector installed in the kitchen within the living unit that activates the general alarm.

(3) Alarm control panel.

(A) An existing large Type B assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) An existing large Type B assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(C) An existing large Type B assisted living facility must ensure a fire alarm panel indicates each floor and smoke compartment, as applicable, as a separate zone. Each zone must provide an alarm and trouble indication. When all alarm initiating devices are addressable and the status of each device is identified on the fire alarm panel, zone indication is not required.

(4) Fire alarm power source.

[(A)] An existing large Type B assisted living facility must ensure the power supply source for a fire alarm system is in accordance with NFPA 72. [ ~~a fire alarm system is powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.~~ ]

~~[(B) An existing large Type B assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.]~~

(5) Emergency forces notification. An existing large Type B assisted living facility must ensure a fire alarm system automatically notifies emergency forces according to the requirements of 19.3.4.3.2, Emergency Forces Notification, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(b) Fire sprinkler system. An existing large Type B assisted living facility must provide a fire sprinkler system meeting the requirements of NFPA 13 in accordance with 19.3.5.3, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(c) Portable Fire Extinguishers. An existing large Type B assisted living facility must provide and maintain portable fire extinguishers according to the requirements of NFPA 10.

(1) An existing large Type B assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) An existing large Type B assisted living facility must ensure portable fire extinguishers are located in resident corridors so the travel distance from any point in the facility to an extinguisher is no more than 75 feet.

(3) An existing large Type B assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10.

(B) All other portable fire extinguishers must have a rating of at least 2-A:5-B:C according to NFPA 10.

(C) A facility must provide at least one approved 20-B:C portable fire extinguisher in each laundry, kitchen, and walk-in mechanical room.

(4) An existing large Type B assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or mounted in an approved cabinet.

(5) An existing large Type B assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) An existing large Type B assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the exit access door leading from the room and on the latch or knob side of the door.

§ 553.147. Mechanical Requirements for an Existing Large Type B Assisted Living Facility.

(a) Wastewater and water supply.

(1) Wastewater. An existing large Type B assisted living facility must ensure wastewater and sewage are discharged into a sewerage system or an onsite sewerage facility approved by the Water Quality Division of TCEQ, [ ~~the Texas Commission on Environmental Quality (TCEQ),~~ ] or to a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Quality Division of TCEQ.

(2) Water supply. An existing large Type B assisted living facility must ensure the water supply is of safe, sanitary quality, suitable for use, adequate in quantity and pressure, and obtained from a public or private water supply system or a private well.

(b) Resident-use plumbing fixtures.

(1) Water closets and lavatories.

(A) An existing large Type B assisted living facility must provide at least one water closet and one lavatory for every [ ~~each~~ ] six residents , and for any fraction thereof. [ ~~and for each additional resident fewer than six.~~ ] Multiple toilets in a single space must comply with paragraph (2)(B) of this subsection.

(B) An existing large Type B assisted living facility must ensure a lavatory is readily accessible to each water closet.

(C) An existing large Type B assisted living facility must provide at least one water closet, lavatory, and bathing unit, that are accessible to residents, on each floor containing resident sleeping rooms.

(2) Bathing units.

(A) An existing large Type B assisted living facility must provide one tub or shower for every 10 residents, and for any fraction thereof.

(B) Where multiple water closets or bathing units are provided in a single space, an existing large Type B assisted living facility must provide partitions or curtains to separate plumbing fixtures for resident privacy.

(C) An existing large Type B assisted living facility must ensure tubs and showers have non-slip bottoms or floor surfaces, either built-in or applied to the surfaces.

(3) Hot water supply. An existing large Type B assisted living facility must provide a supply of hot water for resident use [ ~~resident-use~~ ]. Hot water for lavatories and bathing units accessible to residents must be maintained between 100 and 120 degrees Fahrenheit.

(4) Supplies. An existing large Type B assisted living facility must supply towels, soap, and toilet tissue for individual resident use.

(c) Public and staff-use plumbing fixtures. In addition to the staff toilets required for the dietary staff according to §553.142(j) of this division (relating to Space Planning and Utilization Requirements for an Existing Large Type B Assisted Living Facility), a new large Type B assisted living facility must provide toilets, including water closets and lavatories, for use by the public and by [ ~~facility~~ ] staff, as follows:

(1) if licensed for 60 or fewer residents, a toilet for use by the public and by [ ~~facility~~ ] staff; or

(2) if licensed for more than 60 residents, a toilet for use by the public and a separate toilet for use by [ ~~facility~~ ] staff.

(d) Gas. An existing large Type B assisted living facility must ensure equipment using natural gas or propane and related gas piping meets the requirements of 9.1.1, Gas, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(e) Heating, ventilation, and air-conditioning (HVAC) and exhaust systems.

(1) General requirements. An existing large Type B assisted living facility must ensure HVAC equipment meets the requirements of 19.5.2, Heating, Ventilating and Air-Conditioning, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(2) Heating and cooling. An existing large Type B assisted living facility must provide heating and cooling for resident comfort.

(A) An existing large Type B assisted living facility must ensure air conditioning systems can maintain and do maintain the comfort range of 68 to 82 degrees Fahrenheit in resident-use areas.

(B) An existing large Type B assisted living facility constructed or licensed after August 1, 2004, must have a central air conditioning system, or a substantially similar air conditioning system, that can maintain and does maintain a temperature range required under subparagraph (A) of this paragraph within areas used by residents.

(C) An existing large Type B assisted living facility may not use an open flame heating device in the facility, except as permitted by subparagraphs (D) and [ - ] (E) of this paragraph.

(D) An existing large Type B assisted living facility must ensure a fuel-fired heating device, other than a working fireplace, meets the following requirements.

(i) A fuel-fired heating device must be connected to a chimney or vent.

(ii) A fuel-fired heating device must take air for combustion directly from outside.

(iii) A fuel-fired heating device must be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area.

(iv) A fuel-fired heating device must have safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

(v) A fuel-fired heating device not meeting the requirements of clauses (i) - (iv) of this subparagraph may be continued in service with approval from HHSC. [ ~~, subject to approval by HHSC.~~ ]

(E) An existing large Type B assisted living facility must ensure a working fireplace meets the following requirements.

(i) A building containing a working fireplace must be protected by an approved, supervised automatic sprinkler system with listed quick response or listed residential sprinklers.

(ii) A new working fireplace must be installed, maintained and used according to NFPA 54 and NFPA 211.

(iii) A working fireplace may not be located in a resident sleeping room.

(iv) The room where a working fireplace is located must be provided with electrically supervised carbon monoxide detection connected to the fire alarm system according to NFPA 720.

(v) A direct-vent gas fireplace, as defined in NFPA 54, must meet the following requirements.

(I) A direct-vent gas fireplace must include a sealed glass front with a wire mesh panel or screen.

(II) The controls for a direct-vent gas fireplace must be locked or located in a restricted location.

(vi) A solid-fuel burning fireplace must be equipped with:

(I) a raised hearth at least four inches above the surrounding finished floor; and

(II) a fireplace enclosure that is guaranteed against breakage up to a temperature of 650 degrees Fahrenheit and constructed of heat-tempered glass or other approved material.

(vii) An existing working fireplace not meeting the requirements of clauses (i) - (vi) of this subparagraph may be continued in service, subject to approval by HHSC.

(F) An existing large Type B assisted living facility must ensure a suspended unit heater meets the requirements of 19.5.2.3(1), in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(G) An existing large Type B assisted living facility must ensure portable space-heating devices, including electric space heaters, meet the requirements of 19.7.8, Portable Space-Heating Devices, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(3) Ventilation.

(A) An existing large Type B assisted living facility must be ventilated using windows or mechanical ventilation, or a combination of both.

(B) An existing large Type B assisted living facility with interior areas designated for smoking within the building must provide mechanical ventilation directed to the exterior to remove smoke at the rate of 10 air changes per hour.

(4) Exhaust. An existing large Type B assisted living facility must ensure bathrooms, toilet rooms, janitorial facilities, and other odor-producing rooms or areas for soiled or unsanitary operations are exhausted with operable windows or powered exhaust vented to the exterior for odor control.

§ 553.148. Electrical Requirements for an Existing Large Type B Assisted Living Facility.

(a) Electrical system. An existing large Type B assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. An existing large Type B assisted living facility must provide illumination throughout the building. Minimum lighting levels must not be lower than the following. [ : ]

(2) In [ ~~20 footcandles in~~ ] each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator , illumination must be at least 20 footcandles during the day when [ ~~during the day--illumination requirements for these areas apply to lighting throughout the space, as~~ ] measured anywhere in the space at 30 inches above the floor . [ ~~anywhere in the room; and~~ ]

(c) Telephone. An existing large Type B assisted living facility must provide at least one telephone in the facility that is available to both staff and residents. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. An existing large Type B assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must include at least :

~~[(A) be a direct telephone, emergency call system, or intercom;]~~

~~[(B) if it is an existing communication system, be approved by the Texas Health and Human Services Commission to be continued in service; and]~~

~~[(C) include at least:]~~

(A) [ ~~(i)~~ ] one central notification station accessible to staff at all times [ ~~at a fixed location~~ ] that receives all calls processed through the system; and

(B) [ ~~(ii)~~ ] one [ ~~permanently fixed~~ ] call station or device accessible to residents at all times in each resident's living unit. [ ~~in every resident living unit.~~ ]

(2) An existing large Type B assisted living facility may provide:

(A) additional or portable notification stations or devices in addition to the central notification station; or

(B) additional call stations or devices in private or common resident areas.

(3) An existing large Type B assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands , but these devices must not replace a call station in a resident living unit . [ ~~However, a device may not be a substitute for a fixed call station in a resident living unit.~~ ]

§ 553.149. Miscellaneous Requirements for an Existing Large Type B Assisted Living Facility.

(a) An existing large Type B assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located.

(b) An existing large Type B assisted living facility must ensure an elevator, escalator, or conveyor meets the requirements of 19.5.3, Elevators, Escalators, and Conveyors, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(c) An existing large Type B assisted living facility must ensure a rubbish chute, incinerator, or laundry chute meets the requirements of 19.5.4, Rubbish Chutes, Incinerators, and Laundry Chutes, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

(d) An existing large Type B assisted living facility must ensure furnishings, mattresses, and decorations meet the requirements of 19.7.5, Furnishings, Mattresses, and Decorations, in NFPA 101, Chapter 19, Existing Health Care Occupancies.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 18, 2026.

TRD-202603598

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 4, 2026

For further information, please call: (512) 438-3161

DIVISION 8. NEW SMALL TYPE A ASSISTED LIVING FACILITIES

26 TAC §§553.211, 553.212, 553.215, 553.218, 553.219

STATUTORY AUTHORITY

The amendments implement Texas Government Code §524.0005 and §524.0151 and Texas Health and Safety Code §247.025 and §247.026.

§ 553.211. Construction Requirements for a New Small Type A Assisted Living Facility.

(a) Structurally sound. A new small Type A assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads according to applicable building codes.

(b) Separation of occupancies. A new small Type A assisted living facility must be separated from other occupancies including other assisted living facilities, hospitals, or nursing facilities, by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards.

(1) Except as provided in paragraph (3) of this subsection , a new small Type A assisted living facility must ensure all buildings used by residents are sheathed with materials providing a fire resistance rating as follows.

(A) Interior wall and ceiling surfaces must have finished surfaces, substrates, or sheathing with a fire resistance rating of not less than 20 minutes.

(B) Columns, beams, girders, or trusses that are not enclosed within walls or ceilings must be encased in materials having a fire resistance rating of not less than 20 minutes.

(2) A sprinkler system does not substitute for the minimum sheathing requirements under paragraph (1) of this subsection.

(3) A building constructed to meet the minimum building construction type requirements of 18.1.6, Minimum Construction Requirements, in NFPA 101, Chapter 18, New Health Care Occupancies, is not also required to be sheathed.

(d) Interior finish. A new small Type A assisted living facility must ensure interior wall , [ ~~and~~ ] ceiling , and floor finish materials meet the requirements of 32.2.3.3, Interior Finish, [ ~~32.2.3.3.2, Interior Wall and Ceiling Finish,~~ ] in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(e) Vertical openings. A new small Type A assisted living facility must ensure vertical openings are protected according to the requirements of 32.2.3.1, Protection of Vertical Openings, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

§ 553.212. Space Planning and Utilization Requirements for a New Small Type A Assisted Living Facility.

(a) Resident bedrooms.

(1) A new small Type A assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below finished ground level.

(2) A new small Type A assisted living facility must ensure bedroom usable floor space is not less than 80 square feet for a bedroom housing one resident and not less than 60 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted by paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than eight feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by HHSC. [ ~~the Texas Health and Human Services Commission.~~ ]

(3) A new small Type A assisted living facility with individual living units that have both a bedroom and other living space may reduce the required bedroom usable floor space for a bedroom for more than one resident by up to 10 percent. The bedroom must continue to meet the minimum dimension requirements in paragraph (2) of this subsection. This reduction cannot be used together with the provision for reducing common living areas or common dining areas as described in subsection (g) of this section. [ A new small Type A assisted living facility containing individual living units that include living space for the residents in addition to their bedrooms may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. A new small Type A assisted living facility may not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in subsection (g)(5) of this section. ]

(4) A new small Type A assisted living facility must house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. A new small Type A assisted living facility must ensure each bedroom has at least one operable window with outside exposure and meeting the following requirements.

(1) The windowsill [ ~~window sill~~ ] must be no higher than 44 inches above the floor.

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space required by [ in ] subsection (a)(2) of this section. [ ~~(a)(3) of this section.~~ ]

(c) Bedroom furnishings. When a resident does not provide their own furnishings, a new small Type A assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed, including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) private clothes storage space, which must include closable doors, and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) A new small Type A assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) A new small Type A assisted living facility must ensure all resident rooms are arranged for convenient resident access to dining and recreation areas.

(e) Staff area. A new small Type A assisted living facility must provide a staff area on each floor of a new small Type A assisted living facility and in each separate building containing resident sleeping rooms, except as permitted under paragraph (1) of this subsection.

(1) A new small Type A assisted living facility that is not more than two stories in height and is composed of separate buildings grouped together and connected by covered walks, is not required to provide a staff area on each floor or in each building, provided that a staff area is located not more than 200 feet walking distance from the farthest resident living unit.

(2) A new small Type A assisted living facility must provide the following at each staff area:

(A) a desk or writing surface;

(B) a telephone; and

(C) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.215 of this division (relating to Fire Protection Systems Requirements for a New Small Type A Assisted Living Facility).

(f) Resident toilet and bathing facilities. A new small Type A assisted living facility must ensure each resident bedroom is served by a separate private toilet room, a connecting toilet room, or a general toilet room.

(1) A new small Type A assisted living facility that houses individuals of more than one sex [ ~~gender~~ ] must provide toilet rooms for each sex, [ ~~gender,~~ ] or individual single-occupant toilet rooms for use by either sex [ ~~any gender~~ ].

(2) A new small Type A assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) A new small Type A assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.217 of this division (relating to Mechanical Requirements for a New Small Type A Assisted Living Facility).

(g) Common living areas and dining areas. [ ~~Resident living areas.~~ ]

(1) Common living areas. [ A new small Type A assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms. ]

(A) A new small Type A assisted living facility must provide at least 15 square feet for common living areas for each resident in the licensed capacity of the facility. [ a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space. ]

(ii) A common living area less than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) A new small Type A assisted living facility with individual living units that have both a bedroom and other living space may reduce the minimum square footage for the total common living area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common living area. The bedroom must continue to meet the minimum dimension requirements in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. This reduction cannot be used together with the provision for reducing required bedroom usable floor space as described in subsection (a)(3) of this section.

(B) A common living area used to meet the requirements of this subsection must have appropriate furniture. [ ~~A new small Type A assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.~~ ]

(C) A common living area counted toward meeting the requirements of this subsection must have at least one exterior window with a view of the outside. [ A new small Type A assisted living facility must ensure the total space for social-diversional area provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement. ]

(D) A common living area that is not required to meet the requirements of this subsection is not required to have windows with a view of the outside.

(E) Any path used as an escape route through any common living area must always be free of obstructions.

(2) Common dining areas. [ ~~A new small Type A assisted living facility must provide a dining area with appropriate furniture.~~ ]

(A) A new small Type A assisted living facility must provide at least 15 square feet of dining area for each resident in the licensed capacity of the facility. [ a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum dining space. ]

(i) At least one dining area must be at least 120 square feet in area regardless of the number of residents based on the facility's licensed capacity or other provisions of this section that allow a reduction in the total minimum common dining area.

(ii) A dining area less than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) A new small Type A assisted living facility with individual living units that have both a bedroom and other living space may reduce the minimum square footage for total common dining area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common dining area. The bedroom must continue to meet the minimum dimension requirements in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. This reduction cannot be used together with the provision for reducing required bedroom usable floor space as described in subsection (a)(3) of this section.

(B) There must be a covered path from all resident living units or bedrooms to a common dining area. [ ~~A new small Type A assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.~~ ]

(C) A dining area used to meet the requirements of this subsection must have furniture suitable for dining use. [ ~~A new small Type A assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.~~ ]

(D) A dining area counted toward meeting the requirements of this subsection must have at least one exterior window with a view of the outside. [ A new small Type A assisted living facility must ensure the total space for dining areas provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement. ]

(E) A dining area that is not required to be counted toward meeting the requirements of this subsection is not required to have windows with a view of the outside.

(F) Any path used as an escape route through a dining area must always be free of obstructions.

(3) Combining common living areas and dining areas. [ A new small Type A assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet. ]

(A) A new small Type A assisted living facility may have the living area and dining area together in one space as long as the combined space is at least 240 square feet.

(B) Each area within a combined common living area and dining area must have appropriate furniture for the use of the space or area.

(4) Limitations on minimum area reduction. [ ~~A new small Type A assisted living facility must ensure an escape route through a resident living or dining area is kept clear of obstructions.~~ ]

(B) A new small Type A assisted living facility cannot use both the reduction in space for common living or dining areas allowed by this subsection and the reduction in space for bedrooms allowed by subsection (a)(3) of this section at the same time.

[(5) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, a new small Type A assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.]

[(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.]

[(B) A new small Type A assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.]

(h) Storage areas. A new small Type A assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies, including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnishes linen;

(7) soiled linen, if the facility furnishes linen; and

(8) lawn and maintenance equipment.

(i) Kitchen.

~~[(1) A new small Type A assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.]~~

[(2) A new small Type A assisted living facility that prepares food on-site must provide a kitchen or dietary area meeting the general food service needs of the residents and must ensure that the kitchen:]

[(A) is equipped to store, refrigerate, prepare and serve food;]

[(B) is equipped to clean and sterilize;]

[(C) provides for refuse storage and removal; and]

[(D) meets the requirements of the local fire, building, and health codes.]

[(3)] A new small Type A assisted living facility must ensure a kitchen uses only residential cooking equipment or, if the kitchen uses commercial cooking equipment, that the facility protects the kitchen's cooking operations as required in §553.216 of this division (relating to Hazardous Area Requirements for a New Small Type A Assisted Living Facility).

§ 553.215. Fire Protection Systems Requirements for a New Small Type A Assisted Living Facility.

(a) Fire alarm and smoke detection system. A new small Type A assisted living facility must provide a manual fire alarm system meeting the requirements of 9.6, Fire Detection, Alarm, and Communication Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment, as modified by this section.

(1) General. A new small Type A assisted living facility must ensure the operation of any alarm initiating device automatically activates the manual fire alarm system evacuation alarm for the entire building.

(2) Smoke detectors.

(A) A new small Type A assisted living facility must install smoke detectors in resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens, laundries, attached garages used for car parking, and public or common areas, except as permitted in subparagraphs (B) and (C) of this paragraph.

(B) A new small Type A assisted living facility may install heat detectors in lieu of smoke detectors in kitchens, laundries, and attached garages used for car parking.

(C) A new small Type A assisted living facility located in a building constructed to meet the requirements of NFPA 101, Chapter 18, New Health Care Occupancies, may install a smoke detection system meeting the requirements of 18.3.4.5.3, Nursing Homes, in NFPA 101, Chapter 18, New Health Care Occupancies, in lieu of the requirements found in subparagraph (A) of this paragraph.

(3) Alarm control panel.

(A) A new small Type A assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) A new small Type A assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(4) Fire alarm power source.

[(A)] A new small Type A assisted living facility must ensure the power supply source for a fire alarm system is in accordance with NFPA 72. [ ~~powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.~~ ]

~~[(B) A new small Type A assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.]~~

(b) Fire sprinkler system.

(1) In accordance with requirements in 32.2.3.5, Extinguishment Requirements in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, a new small Type A assisted living facility must provide: [ A new small Type A assisted living facility must provide one of the following fire sprinkler systems according to the requirements of 32.2.3.5, Extinguishment Requirements, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies. ]

(A) a [ A ] fire sprinkler system meeting the requirements of NFPA 13 in accordance with 32.2.3.5.3 , in NFPA 101, Chapter 32, New Residential Board and Care Occupancies ;

(B) a [ A ] fire sprinkler system meeting the requirements of NFPA 13R in accordance with 32.2.3.5.3.1 , in NFPA 101, Chapter 32, New Residential Board and Care Occupancies ; or

(C) a [ A ] fire sprinkler system meeting the requirements of NFPA 13D in accordance with 32.2.3.5.3.2 , in NFPA 101, Chapter 32, New Residential Board and Care Occupancies .

(2) A new small Type A assisted living facility must ensure a fire sprinkler system is supervised according to 9.7.2, Supervision, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment. [ ~~provide electrical supervision of any fire sprinkler system according to the requirements of 32.2.3.5.4, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.~~ ]

(c) Protection of attics. A new small Type A assisted living facility must ensure an attic is protected according to the requirements of 32.2.3.5.7, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(d) Portable fire extinguishers. A new small Type A assisted living facility must provide and maintain portable fire extinguishers according to the requirements of NFPA 10.

(1) A new small Type A assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) A new small Type A assisted living facility must ensure portable fire extinguishers are located so the travel distance from any point in the facility to an extinguisher is no more than 75 feet.

(3) A new small Type A assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10.

(B) All other portable fire extinguishers must have a rating of at least 2-A:10-B:C according to NFPA 10.

(4) A new small Type A assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or mounted in an approved cabinet.

(5) A new small Type A assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) A new small Type A assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the door leading from the room and on the latch or knob side of the door.

§ 553.218. Electrical Requirements for a New Small Type A Assisted Living Facility.

(a) Electrical system. A new small Type A assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. A new small Type A assisted living facility must provide illumination throughout the building. Minimum lighting levels must not be lower than the following. [ : ]

(2) In [ ~~20 footcandles in~~ ] each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator , illumination must be at least 20 footcandles during the day when [ ~~during the day--illumination requirements for these areas apply to lighting throughout the space, as~~ ] measured anywhere in the space at 30 inches above the floor . [ ~~anywhere in the room; and~~ ]

(c) Telephone. A new small Type A assisted living facility must provide at least one telephone in the facility that is available to both staff and residents. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. A new small Type A assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must include at least :

~~[(A) be a direct telephone, emergency call system or intercom;]~~

~~[(B) include at least:]~~

(A) [ ~~(i)~~ ] one central notification station accessible to staff at all times [ ~~at a fixed location~~ ] that receives all calls processed through the system; and

(B) [ ~~(ii)~~ ] one call station or device accessible to residents at all times in each resident's living unit. [ ~~permanently fixed call station or device in every resident living unit.~~ ]

(2) A new small Type A assisted living facility may provide:

(A) additional or portable notification stations or devices in addition to the central notification station; or

(B) additional call stations or devices in private or common resident areas.

(3) A new small Type A assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands , but these devices must not replace a call station in a resident living unit . [ ~~However, a device may not be a substitute for a fixed call station in a resident living unit.~~ ]

§ 553.219. Miscellaneous Requirements for a New Small Type A Assisted Living Facility.

(a) A new small Type A assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located.

(b) A new small Type A assisted living facility must ensure an [ ~~any new~~ ] elevator, escalator, or conveyor meets the requirements of 32.2.5.3, Elevators, Escalators, and Conveyors, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(c) A new small Type A assisted living facility must ensure furnishings, mattresses, and decorations meet the requirements of 32.7.5, Furnishings, Mattresses, and Decorations, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 18, 2026.

TRD-202603599

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 4, 2026

For further information, please call: (512) 438-3161

DIVISION 9. NEW SMALL TYPE B ASSISTED LIVING FACILITIES

26 TAC §§553.221, 553.222, 553.225, 553.228, 553.229

STATUTORY AUTHORITY

The amendments implement Texas Government Code §524.0005 and §524.0151 and Texas Health and Safety Code §247.025 and §247.026.

§ 553.221. Construction Requirements for a New Small Type B Assisted Living Facility.

(a) Structurally sound. A new small Type B assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads according to applicable building codes.

(b) Separation of occupancies. A new small Type B assisted living facility must be separated from other occupancies, including other assisted living facilities, hospitals or nursing facilities, by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards.

(1) Except as provided in paragraph (3) of this subsection, a new small Type B assisted living facility must ensure all buildings used by residents are sheathed with materials providing a fire resistance rating as follows.

(A) Interior wall and ceiling surfaces must have finished surfaces, substrates, or sheathing with a fire resistance rating of not less than 20 minutes.

(B) Columns, beams, girders, or trusses that are not enclosed within walls or ceilings must be encased in materials having a fire resistance rating of not less than 20 minutes.

(2) A sprinkler system does not substitute for the minimum sheathing requirements under paragraph (1) of this subsection.

(d) Interior finish. A new small Type B assisted living facility must ensure interior wall , [ ~~and~~ ] ceiling , and floor finish materials meet the requirements of 32.2.3.3, Interior Finish, [ ~~32.2.3.3.2, Interior Wall and Ceiling Finish,~~ ] in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(e) Vertical openings. A new small Type B assisted living facility must ensure vertical openings are protected according to the requirements of 32.2.3, Protection of Vertical Openings, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

§ 553.222. Space Planning and Utilization Requirements for a New Small Type B Assisted Living Facility.

(a) Resident bedrooms.

(1) A new small Type B assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below finished ground level.

(2) A new small Type B assisted living facility must ensure bedroom usable floor space is not less than 100 square feet for a bedroom housing one resident and not less than 80 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted by paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than 10 feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by HHSC. [ ~~the Texas Health and Human Services Commission.~~ ]

(3) A new small Type B assisted living facility with individual living units that have both a bedroom and other living space may reduce the required bedroom usable floor space for a bedroom for more than one resident by up to 10 percent. The bedroom must continue to meet the minimum dimension requirements in paragraph (2) of this subsection. This reduction cannot be used together with the provision for reducing common living areas or common dining areas as described in subsection (g) of this section. [ A new small Type B assisted living facility containing individual living units that include living space for the residents, in addition to their bedroom, may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. A new small Type B assisted living facility must not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in subsection (g)(5) of this section. ]

(4) A new small Type B assisted living facility must house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. A new small Type B assisted living facility must ensure each bedroom has at least one operable window with outside exposure [ ~~and~~ ] meeting the following requirements.

(1) The windowsill [ ~~window sill~~ ] must be no higher than 44 inches above the floor.

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space required by subsection (a)(3) of this section.

(c) Bedroom furnishings. When a resident does not provide their own furnishings, a new small Type B assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed, including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) private clothes storage space, which must have closable doors, and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) A new small Type B assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) A new small Type B assisted living facility must ensure all resident rooms are arranged for convenient resident access to dining and recreation areas.

(e) Staff area. A new small Type B assisted living facility must provide a staff area on each floor of a new small Type B assisted living facility and in each separate building containing resident sleeping rooms. A new small Type B assisted living facility must provide the following at each staff area:

(1) a desk or writing surface;

(2) a telephone; and

(3) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.225 of this division (relating to Fire Protection Systems Requirements for a New Small Type B Assisted Living Facility).

(f) Resident toilet and bathing facilities. A new small Type B assisted living facility must ensure each resident bedroom is served by a separate private toilet room, a connecting toilet room, or a general toilet room.

(1) A new small Type B assisted living facility that houses individuals of more than one sex [ ~~gender~~ ] must provide toilet rooms for each sex, [ ~~gender,~~ ] or individual single-occupant toilet rooms for use by either sex [ ~~any gender~~ ].

(2) A new small Type B assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) A new small Type B assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.227 of this division (relating to Mechanical Requirements for a New Small Type B Assisted Living Facility).

(g) Common living areas and dining areas. [ ~~Resident living areas.~~ ]

(1) Common living areas. [ A new small Type B assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms. ]

(A) A new small Type B assisted living facility must provide at least 15 square feet for common living areas for each resident in the licensed capacity of the facility. [ a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space. ]

(ii) A common living area less than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) A new small Type B assisted living facility with individual living units that have both a bedroom and other living space may reduce the minimum square footage for the total common living area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common living area. The bedroom must continue to meet the minimum dimension requirements in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. This reduction cannot be used together with the provision for reducing required bedroom usable floor space as described in subsection (a)(3) of this section.

(B) A common living area used to meet the requirements of this subsection must have appropriate furniture. [ ~~A new small Type B assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.~~ ]

(C) A common living area counted toward meeting the requirements of this subsection must have at least one exterior window with a view of the outside. [ A new small Type B assisted living facility must ensure the total space for social-diversional area provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement. ]

(D) A common living area that is not required to be counted toward meeting the requirements of this subsection is not required to have windows with a view of the outside.

(E) Any path used as an escape route through any common living area must always be free of obstructions.

(2) Common dining areas. [ ~~A new small Type B assisted living facility must provide a dining area with appropriate furniture.~~ ]

(A) A new small Type B assisted living facility must provide at least 15 square feet of dining area for each resident in the licensed capacity of the facility. [ a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum dining space. ]

(i) At least one dining area must be at least 120 square feet in area regardless of the number of residents based on the facility's licensed capacity or other provisions of this section that allow a reduction in the total minimum common dining area.

(ii) A dining area less than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) A new small Type B assisted living facility with individual living units that have both a bedroom and other living space may reduce the minimum square footage for total common dining area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common dining area. The bedroom must continue to meet the minimum dimension requirements in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. This reduction cannot be used together with the provision for reducing required bedroom usable floor space as described in subsection (a)(3) of this section.

(B) There must be a covered path from all resident living units or bedrooms to a common dining area. [ ~~A new small Type B assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.~~ ]

(C) A dining area used to meet the requirements of this subsection must have furniture suitable for dining use. [ ~~A new small Type B assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.~~ ]

(D) A dining area counted toward meeting the requirements of this subsection must have at least one window with a view of the outside. [ A new small Type B assisted living facility must ensure the total space for dining areas provides an area of at least 15 square feet for each resident in the licensed capacity of the facility. No space smaller than 120 square feet in area can be counted toward meeting this requirement. ]

(E) A dining area that is not required to be counted toward meeting the requirements of this subsection is not required to have windows with a view of the outside.

(F) Any path used as an escape route through a dining area must always be free of obstructions.

(3) Combining common living areas and dining areas. [ A new small Type B assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet. ]

(A) A new small Type B assisted living facility may have the living area and dining area together in one space as long as the combined space is at least 240 square feet.

(B) Each area within a combined common living area and dining area must have appropriate furniture for the use of the space or area.

(4) Limitations on minimum area reduction. [ ~~A new small Type B assisted living facility must ensure an escape route through a resident living or dining area is kept clear of obstructions.~~ ]

(B) A new small Type B assisted living facility cannot use both the reduction in space for common living or dining areas allowed by this subsection and the reduction in space for bedrooms allowed by subsection (a)(3) of this section at the same time.

[(5) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, a new small Type B assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social-diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.]

[(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.]

[(B) A new small Type B assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.]

(h) Storage areas. A new small Type B assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies, including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnishes linen;

(7) soiled linen, if the facility furnishes linen; and

(8) lawn and maintenance equipment.

(i) Kitchen.

~~[(1) A new small Type B assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.]~~

[(2) A new small Type B assisted living facility that prepares food on-site must provide a kitchen or dietary area meeting the general food service needs of the residents and must ensure that the kitchen:]

[(A) is equipped to store, refrigerate, prepare, and serve food;]

[(B) is equipped to clean and sterilize;]

[(C) provides for refuse storage and removal; and]

[(D) meets the requirements of the local fire, building, and health codes.]

[(3)] A new small Type B assisted living facility must ensure a kitchen uses only residential cooking equipment or, if the kitchen uses commercial cooking equipment, that the facility protects the kitchen's cooking operations, as required in §553.226 of this division (relating to Hazardous Area Requirements for a New Small Type B Assisted Living Facility).

§ 553.225. Fire Protection Systems Requirements for a New Small Type B Assisted Living Facility.

(a) Fire alarm and smoke detection system. A new small Type B assisted living facility must provide a manual fire alarm system meeting the requirements of 9.6, Fire Detection, Alarm, and Communication Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment, as modified by this section.

(1) General. A new small Type B assisted living facility must ensure the operation of any alarm initiating device automatically activates the manual fire alarm system evacuation alarm for the entire building.

(2) Smoke detectors.

(A) A new small Type B assisted living facility must install smoke detectors in resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens, laundries, attached garages used for car parking, and public or common areas, except as permitted in subparagraphs (B) and (C) of this paragraph.

(B) A new small Type B assisted living facility may install heat detectors in lieu of smoke detectors in kitchens, laundries, and attached garages used for car parking.

(C) A new small Type B assisted living facility located in a building constructed to meet the requirements of NFPA 101, Chapter 18, New Health Care Occupancies, may install a smoke detection system meeting the requirements of 18.3.4.5.3, Nursing Homes, in NFPA 101, Chapter 18, New Health Care Occupancies, in lieu of the requirements found in subparagraph (A) of this paragraph.

(3) Alarm control panel.

(A) A new small Type B assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) A new small Type B assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(4) Fire alarm power source.

[(A)] A new small Type B assisted living facility must ensure the power supply source for a fire alarm system is in accordance with NFPA 72. [ ~~powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.~~ ]

~~[(B) A new small Type B assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.]~~

(b) Fire sprinkler system.

(1) In accordance with 32.2.3.5, Extinguishment Requirements, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, a new small Type B assisted living facility must provide: [ A new small Type B assisted living facility must provide one of the following fire sprinkler systems according to the requirements of 32.2.3.5, Extinguishment Requirements, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies. ]

(A) a [ A ] fire sprinkler system meeting the requirements of NFPA 13 in accordance with 32.2.3.5.3 , in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, not later than August 31, 2026 ;

(B) a [ A ] fire sprinkler system meeting the requirements of NFPA 13R in accordance with 32.2.3.5.3.1 , in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, not later than August 31, 2026 ; or

(C) a [ A ] fire sprinkler system meeting the requirements of NFPA 13D in accordance with 32.2.3.5.3.2 , in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, not later than August 31, 2026 .

(2) A new small Type B assisted living facility must ensure a fire sprinkler system is supervised according to 9.7.2, Supervision, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment. [ ~~provide electrical supervision of any fire sprinkler system according to the requirements of 32.2.3.5.4, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.~~ ]

(c) Protection of attics. A new small Type B assisted living facility must ensure an attic is protected according to the requirements of 32.2.3.5.7, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(d) Portable fire extinguishers. A new small Type B assisted living facility must provide and maintain portable fire extinguishers according to the requirements of NFPA 10.

(1) A new small Type B assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) A new small Type B assisted living facility must ensure portable fire extinguishers are located so the travel distance from any point in the facility to an extinguisher is no more than 75 feet.

(3) A new small Type B assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10.

(B) All other portable fire extinguishers must have a rating of at least 2-A:10-B:C according to NFPA 10.

(4) A new small Type B assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or mounted in an approved cabinet.

(5) A new small Type B assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) A new small Type B assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the door leading from the room and on the latch or knob side of the door.

§ 553.228. Electrical Requirements for a New Small Type B Assisted Living Facility.

(a) Electrical system. A new small Type B assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. A new small Type B assisted living facility must provide illumination throughout the building. Minimum lighting levels must not be lower than the following. [ : ]

(2) In [ ~~20 footcandles in~~ ] each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator , illumination must be at least 20 footcandles during the day when [ ~~during the day--illumination requirements for these areas apply to lighting throughout the space, as~~ ] measured anywhere in the space at 30 inches above the floor . [ ~~anywhere in the room.~~ ]

(c) Telephone. A new small Type B assisted living facility must provide at least one telephone in the facility that is available to both staff and residents. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. A new small Type B assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must include at least :

~~[(A) be a direct telephone, emergency call system, or intercom;]~~

~~[(B) include at least:]~~

(A) [ ~~(i)~~ ] one central notification station accessible to staff at all times [ ~~at a fixed location~~ ] that receives all calls processed through the system; and

(B) [ ~~(ii)~~ ] one [ ~~permanently fixed~~ ] call station or device accessible to residents at all times in their living unit. [ ~~in every resident living unit.~~ ]

(2) A new small Type B assisted living facility may provide:

(A) additional or portable notification stations or devices in addition to the central notification station; or

(B) additional call stations or devices in private or common resident areas.

(3) A new small Type B assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands , but these devices must not replace a call station in a resident living unit . [ ~~However, a device may not be a substitute for a fixed call station in a resident living unit.~~ ]

§ 553.229. Miscellaneous Requirements for a New Small Type B Assisted Living Facility.

(a) A new small Type B assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located.

(b) A new small Type B assisted living facility must ensure an [ ~~any new~~ ] elevator, escalator, or conveyor meets the requirements of 32.2.5.3, Elevators, Escalators, and Conveyors, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(c) A new small Type B assisted living facility must ensure furnishings, mattresses, and decorations meet the requirements of 32.7.5, Furnishings, Mattresses, and Decorations, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 18, 2026.

TRD-202603600

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 4, 2026

For further information, please call: (512) 438-3161

DIVISION 10. NEW LARGE TYPE A ASSISTED LIVING FACILITIES

26 TAC §§553.231 - 553.233, 553.235, 553.237 - 553.239

STATUTORY AUTHORITY

The amendments implement Texas Government Code §524.0005 and §524.0151 and Texas Health and Safety Code §247.025 and §247.026.

§ 553.231. Construction Requirements for a New Large Type A Assisted Living Facility.

(a) Structurally sound. A new large Type A assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads according to applicable building codes.

(b) Separation of occupancies. A new large Type A assisted living facility must be separated from other occupancies, including other assisted living facilities, hospitals or nursing facilities, by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards.

(c) Construction type. A new large Type A assisted living facility must ensure a building housing the facility meets the requirements of 32.3.1.3, Minimum Construction Requirements, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(d) Interior finish. A new large Type A assisted living facility must ensure interior wall , [ ~~and~~ ] ceiling , and floor finish materials meet the requirements of 32.3.3.3, Interior Finish, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(e) Vertical openings. A new large Type A assisted living facility must ensure vertical openings are protected according to the requirements of 32.3.3.1, Protection of Vertical Openings, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

§ 553.232. Space Planning and Utilization Requirements for a New Large Type A Assisted Living Facility.

(a) Resident bedrooms.

(1) A new large Type A assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below finished ground level.

(2) A new large Type A assisted living facility must ensure bedroom usable floor space is not less than 80 square feet for a bedroom housing one resident and not less than 60 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted in paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than eight feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by HHSC.

(3) A new large Type A assisted living facility with individual living units that have both a bedroom and other living space may reduce the required bedroom usable floor space for a bedroom for more than one resident by up to 10 percent. The bedroom must continue to meet the minimum dimension requirements in paragraph (2) of this subsection. This reduction cannot be used together with the provision for reducing common living areas or common dining areas as described in subsection (g) of this section. [ A new large Type A assisted living facility containing individual living units that include living space for the residents, in addition to their bedroom, may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. A new large Type A assisted living facility must not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in subsection (g)(6) of this section. ]

(4) A new large Type A assisted living facility must house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. A new large Type A assisted living facility must ensure each bedroom has at least one operable window with outside exposure and meeting the following requirements.

(1) The windowsill [ ~~window sill~~ ] must be no higher than 44 inches above the floor.

(2) The window must be easy for all residents [ ~~operable by a resident~~ ] occupying the bedroom to open and close from the inside without using [ ~~, from the inside, without the use of~~ ] tools or special devices to unlatch or unlock the window .

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space according to the requirements of subsection (a)(3) of this section.

(c) Bedroom furnishings. When a resident does not provide their own furnishings, a new large Type A assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed, including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) private clothes storage space, which must have closable doors, and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) A new large Type A assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) A new large Type A assisted living facility must ensure a resident room is arranged for convenient resident access to dining and recreation areas.

(e) Staff area. A new large Type A assisted living facility must provide a staff area on each floor of a new large Type A assisted living facility and in each separate building containing resident sleeping rooms, except as permitted under paragraph (1) of this subsection.

(1) A new large Type A assisted living facility that is not more than two stories in height and is composed of separate buildings grouped together and connected by covered walks, is not required to provide a staff area on each floor or in each building, provided that a staff area is located not more than 200 feet walking distance from the farthest resident living unit.

(2) A new large Type A assisted living facility must provide the following at each staff area:

(A) a desk or writing surface;

(B) a telephone; and

(C) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.235 of this division (relating to Fire Protection Systems Requirements for a New Large Type A Assisted Living Facility).

(f) Resident toilet and bathing facilities. A new large Type A assisted living facility must ensure each resident bedroom is served by a separate private toilet room, a connecting toilet room, or a general toilet room.

(1) A new large Type A assisted living facility that houses individuals of more than one sex [ ~~gender~~ ] must provide toilet rooms for each sex, [ ~~gender,~~ ] or individual single-occupant toilet rooms for use by either sex [ ~~any gender~~ ].

(2) A new large Type A assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) A new large Type A assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.237 of this division (relating to Mechanical Requirements for a New Large Type A Assisted Living Facility).

(g) Common living areas and dining areas. [ ~~Resident living areas.~~ ]

(1) Common living areas. [ A new large Type A assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms. ]

(A) A new large Type A assisted living facility must ensure the total space for common living areas is provided on a sliding scale according to the following table. [ provide a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space. ]

Figure: 26 TAC §553.232(g)(1)(A) (.pdf)

(ii) A common living area less than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) A new large Type A assisted living facility with individual living units that have both a bedroom and other living space may reduce the minimum square footage for the total common living area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common living area. The bedroom must continue to meet the minimum dimension requirements in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. This reduction cannot be used together with the provision for reducing required bedroom usable floor space as described in subsection (a)(3) of this section.

(B) A common living area used to meet the requirements of this subsection must have appropriate furniture. [ ~~A new large Type A assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.~~ ]

(C) A common living area counted toward meeting the requirements of this subsection must have at least one exterior window with a view of the outside. [ A new large Type A assisted living facility must ensure the total space for social-diversional areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement. ]

[ ~~Figure: 26 TAC §553.232(g)(1)(C)~~ ]

(D) A common living area that is not required to be counted toward meeting the requirements of this subsection is not required to have windows with a view of the outside.

(E) If a means of egress passes through a common living area, the facility must subtract the space required for that means of egress, based on the minimum required width for a corridor according to §553.233 of this division (relating to Means of Egress Requirements for a new Large Type A Assisted Living Facility), from the total size of the room when determining the size of the common living area.

(2) Common dining areas. [ ~~A new large Type A assisted living facility must provide a dining area with appropriate furniture.~~ ]

(A) A new large Type A assisted living facility must ensure the total space for dining areas is provided on a sliding scale according to the following table. [ provide a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of the number of residents or other provisions of this section permitting a reduction in the total minimum dining space. ]

Figure: 26 TAC §553.232(g)(2)(A) (.pdf)

(i) At least one dining area must be at least 120 square feet in area regardless of the number of residents based on the facility's licensed capacity or other provisions of this section that allow a reduction in the total minimum common dining area.

(ii) A dining area less than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) A new large Type A assisted living facility with individual living units that have both a bedroom and other living space may reduce the minimum square footage for total common dining area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common dining area. The bedroom must continue to meet the minimum dimension requirements in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. This reduction cannot be used together with the provision for reducing required bedroom usable floor space as described in subsection (a)(3) of this section.

(B) There must be a covered path from all resident living units or bedrooms to a common dining area. [ ~~A new large Type A assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.~~ ]

(C) A dining area used to meet the requirements of this subsection must have furniture suitable for dining use. [ ~~A new large Type A assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.~~ ]

(D) A dining area counted toward meeting the requirements of this subsection must have at least one exterior window with a view of the outside. [ A new large Type A assisted living facility must ensure the total space for dining areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement. ]

[ ~~Figure: 26 TAC §553.232(g)(2)(D)~~ ]

(E) A dining area that is not required to be counted toward meeting the requirements of this subsection is not required to have windows with a view of the outside.

(F) If a means of egress passes through a common dining area, the facility must subtract the space required for that means of egress, based on the minimum required width for a corridor according to §553.233 of this division, from the total size of the room when determining the size of the common dining area.

(3) Combining common living areas and dining areas. [ A new large Type A assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet. ]

(A) A new large Type A assisted living facility may have the living area and dining area together in one space as long as the combined space is at least 240 square feet.

(B) Each area within a combined common living area and dining area must have appropriate furniture for the use of the space or area.

(4) Limitations on minimum area reduction. [ For calculation purposes, where a means of egress passes through a living or dining area, a new large Type A assisted living facility must deduct a pathway, equal to the minimum corridor width according to §553.233 of this division (relating to Means of Egress Requirements for a New Large Type A Assisted Living Facility), from the measured area of the space. ]

(B) A new large Type A assisted living facility cannot use both the reduction in space for common living or dining areas allowed by this subsection and the reduction in space for bedrooms allowed by subsection (a)(3) of this section at the same time.

~~[(5) A new large Type A assisted living facility must ensure a means of egress through a resident living or dining area is kept clear of obstructions, except as permitted by NFPA 101.]~~

[(6) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, a new large Type A assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social-diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.]

[(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.]

[(B) A new large Type A assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.]

(h) Storage areas. A new large Type A assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnishes linen;

(7) soiled linen, if the facility furnishes linen; and

(8) lawn and maintenance equipment.

(i) General kitchen.

~~[(1) A new large Type A assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.]~~

~~[(2) A new large Type A assisted living facility must ensure a kitchen meets the requirements of the local fire, building, and health codes.]~~

(1) [ ~~(3)~~ ] A new large Type A assisted living facility that prepares food onsite [ ~~on-site~~ ] must provide a kitchen or dietary area that includes space for: [ ~~to meet the general food service needs of the residents and must include space for the following:~~ ]

(A) storage, refrigeration, preparation, and serving food;

(B) dish and utensil cleaning which includes:

(i) a three-compartment sink large enough to immerse pots and pans; and

(ii) a mechanical dishwasher for washing and sanitizing dishes;

(D) a handwashing station in every food preparation area with a supply of hot and cold water, soap, a towel dispenser and a waste receptacle;

(E) a handwashing lavatory that is readily accessible to every dish room area; [ ~~and~~ ]

(F) refuse storage and removal; and

(G) floor drains in the kitchen and dishwashing areas, unless the facility was created through conversion and the facility can keep the floor clean . [ ~~; and~~ ]

~~[(H) a grease trap, if required by local authorities.]~~

(2) [ ~~(4)~~ ] A new large Type A assisted living facility must ensure a kitchen is designed so that room temperature, at peak load or in the summer, does not exceed 85 degrees Fahrenheit measured throughout the room at five feet above the floor.

(3) [ ~~(5)~~ ] A new large Type A assisted living facility must ensure the volume of supply air provided takes into account the large quantities of air that may be exhausted at the range hood and dishwashing area.

(4) [ ~~(6)~~ ] A new large Type A assisted living facility must provide a supply of hot and cold water.

(A) Hot water for sanitizing purposes must be 180 degrees Fahrenheit.

(B) When chemical sanitizers are used, hot water must meet the manufacturer's suggested temperature.

(5) [ ~~(7)~~ ] A new large Type A assisted living facility must maintain a separation between soiled and clean dish areas.

(6) [ ~~(8)~~ ] A new large Type A assisted living facility must maintain a separation of air flow between soiled and clean dish areas.

(j) Kitchen restrooms.

(1) A new large Type A assisted living facility must provide a restroom facility for kitchen staff, including a lavatory, except as described in paragraph (2) of this subsection.

(A) The restroom facility must be directly accessible to kitchen staff without traversing resident use areas.

(B) The restroom must open into a service corridor or vestibule and not open directly into the kitchen.

(2) A new large Type A assisted living facility created through conversion may provide a staff restroom that may be located outside the kitchen area.

(k) Kitchen janitorial facility.

(1) A new large Type A assisted living facility must provide janitorial facilities exclusively for the kitchen and located in the kitchen area except as described in paragraph (2) of this subsection.

(2) A new large Type A assisted living facility created through conversion must provide a janitorial facility for the kitchen. The janitorial facility may be located outside the kitchen if sanitary procedures are used to reduce the possibility of cross-contamination.

(3) A new large Type A assisted living facility must provide a garbage can or cart washing area with a floor drain and a supply of hot water. The garbage can or cart washing area may be in the interior or on the exterior of the facility.

(l) Finishes.

(1) A new large Type A assisted living facility must provide non-absorbent, smooth finishes or surfaces on all kitchen floors, walls and ceilings.

(2) A new large Type A assisted living facility must provide non-absorbent, smooth, cleanable finishes on counter surfaces and all cabinet surfaces.

(3) A new large Type A assisted living facility must ensure surfaces are capable of being routinely cleaned and sanitized to maintain a healthful environment.

(m) Vision panels in communicating doors. A new large Type A assisted living facility must ensure a door between a kitchen and a dining area, serving area, or resident-use area, is provided with a vision panel with fixed safety glass. Where the door is a required fire door or is located in a fire barrier or other fire resistance-rated enclosure, the vision panel, including the glazing and the frame, must meet the requirements of NFPA 101.

(n) Auxiliary serving kitchens.

(1) A new large Type A assisted living facility must ensure an auxiliary serving kitchen is equipped to maintain required food temperatures.

(2) A new large Type A assisted living facility must ensure an auxiliary serving kitchen is equipped with a handwashing lavatory meeting the requirements of this section.

(3) A new large Type A assisted living facility must ensure all surfaces in an auxiliary serving kitchen meet the requirements for finishes in this section.

(o) Protection of cooking operations.

(1) A new large Type A assisted living facility must protect cooking facilities according to the requirements in §553.236 of this division (relating to Hazardous Area Requirements for a New Large Type A Assisted Living Facility).

(2) The following commercial or residential cooking equipment used only for reheating, and not for meal preparation, is not required to comply with the requirements of §553.236 of this division:

(A) microwave ovens;

(B) hot plates; or

(p) Food storage areas.

(1) A new large Type A assisted living facility must provide a food storage area large enough to consistently maintain a four-day minimum supply of non-perishable food. A food storage area may be located away from the food preparation area as long as there is space adjacent to the kitchen for necessary daily usage.

(2) A new large Type A assisted living facility must provide dollies, racks, pallets, wheeled containers, or shelving, so that food is not stored on the floor, and must ensure shelves are adjustable wire type shelving.

(3) A new large Type A assisted living facility must provide non-absorbent finishes or surfaces on all floors and walls in food storage areas.

(4) A new large Type A assisted living facility must provide effective ventilation in dry food storage areas to ensure positive air circulation.

(5) A new large Type A assisted living facility must ensure the maximum room temperature in a food storage area does not exceed 85 degrees Fahrenheit at any time, when measured at the highest food storage level, but not less than five feet above the floor.

(q) Laundry and linen services.

(1) A new large Type A assisted living facility that co-mingles and processes laundry onsite [ ~~on-site~~ ] in a central location, regardless of the type of laundry equipment used, must ensure a laundry area:

(A) is separated from the assisted living building by a fire barrier having a one-hour fire resistance rating extending [ ~~. This separation must extend~~ ] from the floor to the floor or roof above;

(B) is protected throughout by a fire sprinkler system; [ ~~and~~ ]

(C) has access doors that open to the exterior or to an interior non-resident use area, such as a vestibule or service corridor; and

(D) is provided with:

(i) a soiled linen receiving, holding, and sorting room with a floor drain and forced exhaust to the exterior;

(I) the exhaust must always operate when soiled linen is held in this area; and

(II) the area may be combined with the washer section;

(ii) a general laundry work area that is separated by partitioning a washer section and a dryer section;

(iii) a storage area for laundry supplies;

(iv) a folding area;

(v) an adequate air supply and ventilation for staff comfort without having to rely on opening a door that is part of the fire barrier separation required by subparagraph (A) of this paragraph; and

(vi) provisions to exhaust heat from dryers and to separate dryer make-up air from the habitable work areas of the laundry.

(2) If linen is processed off site, the facility must provide:

(A) a soiled linen holding room with adequate forced exhaust ducted to the exterior; and

(B) a clean linen receiving, holding, inspection, sorting or folding, and storage room.

(3) A new large Type A assisted living facility must ensure a laundry area for resident use [ ~~resident-use~~ ] meets the following requirements.

(A) A new large Type A assisted living facility must ensure only residential type washers and dryers are provided in a laundry area for resident use [ ~~resident-use~~ ].

(B) When more than three washers and three dryers are provided in one laundry area for resident-use, the area must be:

(i) protected throughout by a fire sprinkler system; or

(ii) separated from the facility by a fire barrier having a one-hour fire resistance rating.

§ 553.233. Means of Egress Requirements for a New Large Type A Assisted Living Facility.

(a) A new large Type A assisted living facility must meet the requirements of 32.3.2, Means of Egress, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, except as described in this section.

(b) The provisions of 32.3.2.11.2, Lockups, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, are not permitted.

(c) A new large Type A assisted living facility must ensure doors meet the requirements of 32.3.2.2.2, Doors, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, and the additional requirements of this section.

(1) A resident room door in a new large Type A assisted living facility must latch in its frame to resist the passage of smoke.

(2) In a new large Type A assisted living facility comprised of buildings that contain living units with independent cooking equipment within the living unit, a door between the living unit and a corridor or hallway must:

(A) be self-closing or automatic-closing; and

(B) latch in its frame to resist the passage of smoke.

(3) A resident room door or living unit door must not be arranged to prevent the occupant from closing the door.

(4) A new large Type A assisted living facility must ensure doors in a means of egress that are required to swing in the direction of egress travel according to NFPA 101 are inspected and tested according to 32.7.7, Inspection of Door Openings, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(d) A new large Type A assisted living facility providing spaces for use by residents on floors other than the ground floor must provide at least two separate approved stairs and must ensure stairs used as a means of egress meet the requirements of 32.3.2.2.3, Stairs, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(e) A new large Type A assisted living facility must ensure means of egress are marked according to the requirements of 32.3.2.10, Marking of Means of Egress, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(f) A new large Type A assisted living facility must provide emergency lighting according to the requirements of 32.3.2.9, Emergency Lighting, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, unless each sleeping room has a direct exit to the outside at the finished ground level.

§ 553.235. Fire Protection Systems Requirements for a New Large Type A Assisted Living Facility.

(a) Fire alarm and smoke detection system. A new large Type A assisted living facility must provide a manual fire alarm system meeting the requirements of 9.6, Fire Detection, Alarm, and Communication Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment, as modified by this section.

(1) General. A new large Type A assisted living facility must ensure the operation of any alarm initiating device automatically activates the manual fire alarm system evacuation alarm for the entire building.

(2) Smoke detectors.

(A) A new large Type A assisted living facility must install smoke detectors in resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens, laundries, attached garages used for car parking, and public or common areas, except as permitted in subparagraphs (B) - (D) of this paragraph.

(B) A new large Type A assisted living facility may install heat detectors in lieu of smoke detectors in kitchens, laundries, and attached garages used for car parking.

(C) A new large Type A assisted living facility located in a building constructed to meet the requirements of NFPA 101, Chapter 18, New Health Care Occupancies, may install a smoke detection system meeting the requirements of 18.3.4.5.3, Nursing Homes, [ ~~19.3.4.5.1, Corridors,~~ ] in NFPA 101, Chapter 18, New Health Care Occupancies, in lieu of the requirements found in subparagraphs (A) and (B) of this paragraph.

(D) A new large Type A assisted living facility comprised of buildings containing living units with independent cooking equipment must additionally have:

(i) a smoke alarm or smoke detector installed in all [ in ] resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens , and laundries within the living unit, that sounds an alarm only within the living unit; and

(ii) a heat detector installed in the kitchen within the living unit that activates the general alarm.

(E) A new large Type A assisted living facility is not required to install smoke alarms, as required by 32.3.3.4.7, [ ~~32.3.4.7,~~ ] Smoke Alarms, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, in addition to the smoke detectors required by subparagraphs (A) - (D) of this paragraph.

(3) Alarm control panel.

(A) A new large Type A assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) A new large Type A assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(C) A new large Type A assisted living facility must ensure a fire alarm panel indicates each floor and smoke compartment, as applicable, as a separate zone. Each zone must provide an alarm and trouble indication. When all alarm initiating devices are addressable and the status of each device is identified on the fire alarm panel, zone indication is not required.

(4) Fire alarm power source.

[(A)] A new large Type A assisted living facility must ensure the power supply source for a fire alarm system is in accordance with NFPA 72. [ ~~a fire alarm system is powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.~~ ]

~~[(B) A new large Type A assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.]~~

(5) Emergency forces notification. A new large Type A assisted living must ensure a fire alarm system provides emergency forces notification according to the requirements of 32.3.3.4.6, Emergency Forces Notification, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(b) Fire sprinkler system. A new large Type A assisted living facility must provide a fire sprinkler system meeting the requirements of NFPA 13 in accordance with 32.3.3.5, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(c) Portable Fire Extinguishers. A new large Type A assisted living facility must provide and maintain portable fire extinguishers according to the requirements of 32.3.3.5.7, Portable Fire Extinguishers, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies, and the additional requirements of this subsection.

(1) A new large Type A assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) A new large Type A assisted living facility must ensure portable fire extinguishers are located in resident corridors so the travel distance from any point in the facility to an extinguisher is no more than 75 feet.

(3) A new large Type A assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10.

(B) All other portable fire extinguishers must have a rating of at least 2-A:10-B:C according to NFPA 10.

(C) A facility must provide at least one approved 20-B:C portable fire extinguisher in each laundry, kitchen and walk-in mechanical room.

(4) A new large Type A assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or is mounted in an approved cabinet.

(5) A new large Type A assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) A new large Type A assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the exit access door leading from the room and on the latch or knob side of the door.

§ 553.237. Mechanical Requirements for a New Large Type A Assisted Living Facility.

(a) Wastewater and water supply.

(1) Wastewater. A new large Type A assisted living facility must ensure wastewater and sewage are discharged into a sewerage system or an onsite sewerage facility approved by the Water Quality Division of TCEQ, or to a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Quality Division of TCEQ.

(2) Water supply. A new large Type A assisted living facility must ensure the water supply is of safe, sanitary quality, suitable for use, adequate in quantity and pressure, and obtained from a public or private water supply system or a private well.

(b) Resident-use plumbing fixtures.

(1) Water closets and lavatories.

(A) A new large Type A assisted living facility must provide at least one water closet and one lavatory for every six residents , and for any fraction thereof [ ~~each additional resident fewer than six~~ ]. Multiple toilets in a single space must comply with paragraph (2)(B) of this subsection.

(B) A new large Type A assisted living facility must ensure a lavatory is readily accessible to each water closet.

(C) A new large Type A assisted living facility must provide at least one water closet, lavatory, and bathing unit, that are accessible to residents, on each floor containing resident sleeping rooms.

(2) Bathing units.

(A) A new large Type A assisted living facility must provide one tub or shower for every 10 residents, and for any fraction thereof.

(B) Where multiple water closets or bathing units are provided in a single space, a new large Type A assisted living facility must provide partitions or curtains to separate plumbing fixtures for resident privacy.

(C) A new large Type A assisted living facility must ensure tubs and showers have non-slip bottoms or floor surfaces, either built-in or applied to the surfaces.

(3) Hot water supply. A new large Type A assisted living facility must provide a supply of hot water for resident use [ ~~resident-use~~ ]. Hot water for lavatories and bathing units accessible to residents must be maintained between 100 and 120 degrees Fahrenheit.

(4) Supplies. A new large Type A assisted living facility must supply towels, soap, and toilet tissue for individual resident use.

(c) Public- and staff-use plumbing fixtures. In addition to the staff toilets required for the dietary staff according to §553.232(j) of this division (relating to Space Planning and Utilization Requirements for a New Large Type A Assisted Living Facility), an existing large Type A assisted living facility must provide toilets, including water closets and lavatories, for use by the public and by [ ~~facility~~ ] staff as follows:

(1) if licensed for 60 or fewer residents, a new large Type A assisted living facility must provide a toilet for use by the public and by [ ~~facility~~ ] staff; or

(2) if licensed for more than 60 residents, a new large Type A assisted living facility must provide a toilet for use by the public and a separate toilet for use by [ ~~facility~~ ] staff.

(d) Gas. A new large Type A assisted living facility must ensure equipment using natural gas or propane and related gas piping meets the requirements of 9.1.1, Gas, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(e) Heating, ventilation, and air-conditioning (HVAC) and exhaust systems.

(1) General requirements. A new large Type A assisted living facility must ensure HVAC equipment meets the requirements of 32.3.6.2, Heating, Ventilating, and Air-Conditioning, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(2) Heating and cooling. A new large Type A assisted living facility must provide heating and cooling for resident comfort.

(A) A new large Type A assisted living facility must ensure air conditioning systems can maintain and does maintain the comfort range of 68 to 82 degrees Fahrenheit in resident-use areas.

(B) A new large Type A assisted living facility must have a central air conditioning system, or a substantially similar air conditioning system, that can maintain and does maintain a temperature range required under subparagraph (A) of this paragraph within areas used by residents.

(C) A new large Type A assisted living facility may not use an open flame heating device in the facility, except as permitted by subparagraphs (D) and [ - ] (E) of this paragraph.

(D) A new large Type A assisted living facility must ensure a fuel-fired heating device, other than a working fireplace, meets the following requirements.

(i) A fuel-fired heating device must be connected to a chimney or vent.

(ii) A fuel-fired heating device must take air for combustion directly from outside.

(iii) A fuel-fired heating device must be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area.

(iv) A fuel-fired heating device must have safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.

(E) A new large Type A assisted living facility must ensure a working fireplace meets the following requirements.

(i) A building containing a working fireplace must be protected by an approved, supervised automatic sprinkler system with listed quick response or listed residential sprinklers.

(ii) A working fireplace must be installed, maintained and used according to NFPA 54 and NFPA 211.

(iii) A working [ ~~work~~ ] fireplace may not be located in a resident sleeping room.

(iv) The room where a working fireplace is located must be provided with electrically supervised carbon monoxide detection connected to the fire alarm system according to NFPA 720.

(v) A direct-vent gas fireplace, as defined in NFPA 54, must meet the following requirements.

(I) A direct-vent gas fireplace must include a sealed glass front with a wire mesh panel or screen.

(II) The controls for a direct-vent gas fireplace must be locked or located in a restricted location.

(vi) A solid-fuel burning fireplace must be equipped with:

(I) a raised hearth at least four inches above the surrounding finished floor; and

(II) a fireplace enclosure that is guaranteed against breakage up to a temperature of 650 degrees Fahrenheit and constructed of heat-tempered glass or other approved material.

(3) Ventilation.

(A) A new large Type A assisted living facility must be ventilated using windows, mechanical ventilation, or a combination of both.

(B) A new large Type A assisted living facility with interior areas designated for smoking within the building must provide mechanical ventilation directed to the exterior to remove smoke at the rate of 10 air changes per hour.

(4) Exhaust. A new large Type A assisted living facility must ensure bathrooms, toilet rooms, janitorial facilities, and other odor-producing rooms or areas for soiled or unsanitary operations are exhausted with powered exhaust vented to the exterior for odor control.

§ 553.238. Electrical Requirements for a New Large Type A Assisted Living Facility.

(a) Electrical system. A new large Type A assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. A new large Type A assisted living facility must provide illumination throughout the building. Minimum lighting levels must not be lower than the following. [ : ]

(2) In [ ~~20 footcandles in~~ ] each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator , illumination must be at least 20 footcandles during the day when [ ~~during the day--illumination requirements for these areas apply to lighting throughout the space, as~~ ] measured anywhere in the space at 30 inches above the floor . [ ~~anywhere in the room; and~~ ]

(c) Telephone. A new large Type A assisted living facility must provide at least one telephone in the facility that is available to both staff and residents. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. A new large Type A assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must include at least :

~~[(A) be a direct telephone, emergency call system or intercom;]~~

~~[(B) include at least:]~~

(A) [ ~~(i)~~ ] one central notification station accessible to staff at all times [ ~~at a fixed location~~ ] that receives all calls processed through the system; and

(B) [ ~~(ii)~~ ] one [ ~~permanently fixed~~ ] call station or device accessible to residents at all times in each resident's living unit. [ ~~in every resident living unit.~~ ]

(2) A new large Type A assisted living facility may provide:

(A) additional or portable notification stations or devices in addition to the central notification station; or

(B) additional call stations or devices in private or common resident areas.

(3) A new large Type A assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands , but these devices must not replace a call station in a resident living unit . [ ~~However, a device may not be a substitute for a fixed call station in a resident living unit.~~ ]

(e) Generator.

(1) A new large Type A assisted living facility that provides a system to supply, distribute, and control electricity for emergency lighting and illumination of exit signs required by NFPA 101, such as a system that uses a generator set as an alternate source of power, must comply with the requirements of Article 700, Emergency Systems, in NFPA 70, Chapter 7, Special Conditions.

(A) The emergency system may not include any systems or equipment except:

(i) emergency lighting, as required by NFPA 101;

(ii) secondary power to ensure illumination of exit signs, as required by NFPA 101; and

(iii) secondary power for detection, alarm, and communications systems, as required by NFPA 72.

(B) A new large Type A assisted living facility must ensure wiring from an emergency source to emergency loads is kept entirely independent of all other wiring and equipment except as permitted by Article 700.10, Wiring, Emergency System, in NFPA 70. Two or more emergency circuits supplied from the same source may be routed in the same raceway, cable, box, or cabinet.

(C) A new large Type A assisted living facility must ensure that transfer equipment for an emergency system does not serve another facility, including a hospital, a nursing facility, or an independent living facility.

(2) A new large Type A assisted living facility that provides a system to supply, distribute, and control electricity for systems and equipment not identified in paragraph (1) of this subsection must comply with the requirements of Article 702, Optional Standby Systems, in NFPA 70.

(3) The alternate power source for the emergency system may supply other emergency loads, legally required standby loads, and optional standby system loads where the source has adequate capacity to ensure adequate power to the different circuits . [ ~~in the following priority:~~ ]

~~[(A) emergency circuits for the assisted living facility;]~~

~~[(B) legally required standby circuits, if any; and]~~

~~[(C) optional standby circuits, if any.]~~

§ 553.239. Miscellaneous Requirements for a New Large Type A Assisted Living Facility.

(a) A new large Type A assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located.

(b) A new large Type A assisted living facility must ensure an elevator, dumbwaiter, or vertical conveyor meets the requirements of 32.3.6.3, Elevators, Dumbwaiters, and Vertical Conveyors, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(c) A new large Type A assisted living facility must ensure a rubbish chute, incinerator, or laundry chute meets the requirements of 32.3.6.4, Rubbish Chutes, Incinerators, and Laundry Chutes, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

(d) A new large Type A assisted living facility must ensure furnishings, mattresses, and decorations meet the requirements of 32.7.5, Furnishings, Mattresses, and Decorations, in NFPA 101, Chapter 32, New Residential Board and Care Occupancies.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 18, 2026.

TRD-202603601

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 4, 2026

For further information, please call: (512) 438-3161

DIVISION 11. NEW LARGE TYPE B ASSISTED LIVING FACILITIES

26 TAC §§553.241 - 553.243, 553.245 - 553.249

STATUTORY AUTHORITY

The amendments implement Texas Government Code §524.0005 and §524.0151 and Texas Health and Safety Code §247.025 and §247.026.

§ 553.241. Construction Requirements for a New Large Type B Assisted Living Facility.

(a) Structurally sound. A new large Type B assisted living facility must ensure any building is structurally sound regarding actual or expected dead, live, and wind loads according to applicable building codes.

(b) Separation of occupancies.

(1) A new large Type B assisted living facility must be separated from other occupancies , including small assisted living facilities or large Type A assisted living facilities, by a fire barrier having at least a 2-hour fire resistance rating constructed according to the requirements of NFPA 101 and its referenced standards.

(2) A large Type B assisted living facility is not required to be separated from a hospital or nursing facility unless the separation is required by NFPA 101 or the standards for licensing the hospital or nursing facility.

(c) Construction type. A new large Type B assisted living facility must ensure a building housing the facility meets the requirements of 18.1.6, Minimum Construction Requirements, in NFPA 101, Chapter 18, New Health Care Occupancies.

(d) Interior finish. A new Large Type B assisted living facility must ensure interior wall, ceiling , and floor finish materials meet the requirements of 18.3.3, Interior Finish, in NFPA 101, Chapter 18, New Health Care Occupancies.

(e) Vertical openings. A new large Type B assisted living facility must ensure vertical openings are protected according to the requirements of 18.3.1, Protection of Vertical Openings, in NFPA 101, Chapter 18, New Health Care Occupancies.

§ 553.242. Space Planning and Utilization Requirements for a New Large Type B Assisted Living Facility.

(a) Resident bedrooms.

(1) A new large Type B assisted living facility must ensure a resident bedroom or living unit is not located on a floor that is below finished ground level.

(2) A new large Type B assisted living facility must ensure bedroom usable floor space is not less than 100 square feet for a bedroom housing one resident and not less than 80 square feet per resident for a bedroom housing multiple residents, unless otherwise permitted by paragraphs (3) and (4) of this subsection. Portions of a bedroom that are less than 10 feet in the smallest dimension cannot be included in the measurement of bedroom usable floor space, unless approved by HHSC.

(3) A new large Type B assisted living facility with individual living units that have both a bedroom and other living space may reduce the required bedroom usable floor space for a bedroom for more than one resident by up to 10 percent. The bedroom must continue to meet the minimum dimension requirements in paragraph (2) of this subsection. This reduction cannot be used together with the provision for reducing common living areas or common dining areas as described in subsection (g) of this section. [ A new large Type B assisted living facility containing individual living units that include living space for the residents, in addition to their bedroom, may reduce the bedroom usable floor space for a bedroom housing multiple residents within a living unit by up to 10 percent of the required bedroom usable floor space, as long as the minimum dimensional criteria are maintained. A new large Type B assisted living facility must not use this provision in conjunction with the provision permitting the reduction of common social-diversional areas or common dining areas found in subsection (g)(6) of this section. ]

(4) A new large Type B assisted living facility must house no more than 50 percent of its licensed resident capacity in bedrooms housing three or more residents. A bedroom must not house more than four residents.

(b) Bedroom windows. A new large Type B assisted living facility must ensure each bedroom has at least one operable window with outside exposure and meeting the following requirements.

(1) The windowsill [ ~~window sill~~ ] must be no higher than 44 inches above the floor.

(3) The total area of all windows in a bedroom must not be less than eight percent of the minimum bedroom usable floor space required by subsection (a)(2) of this section. [ ~~(a)(3) of this section.~~ ]

(c) Bedroom furnishings. When a resident does not provide their own furnishings, a new large Type B assisted living facility must provide the following furnishings for each resident, which must be maintained in good repair:

(1) a bed including a mattress;

(2) a chair;

(3) a table or dresser; and

(4) private clothes storage space, which must have closable doors, and drawer space for clothing and personal belongings.

(d) Arrangement of resident living units or rooms.

(1) A new large Type B assisted living facility must ensure all resident rooms open on an exit, corridor, living area, or public area.

(2) A new large Type B assisted living facility must ensure a resident room is arranged for convenient resident access to dining and recreation areas.

(e) Staff area. A new large Type B assisted living facility must provide a staff area on each floor of a new large Type B assisted living facility and in each separate building containing resident sleeping rooms. A new large Type B assisted living facility must provide the following at each staff area:

(1) a desk or writing surface;

(2) a telephone; and

(3) a fire alarm control unit or a fire alarm annunciator panel meeting the requirements of §553.245 of this division (relating to Fire Protection Systems Requirements for a New Large Type B Assisted Living Facility).

(f) Resident toilet and bathing facilities. A new large Type B assisted living facility must ensure each resident bedroom is served by a separate private toilet room, a connecting toilet room, or a general toilet room.

(1) A new large Type B assisted living facility that houses individuals of more than one sex [ ~~gender~~ ] must provide toilet rooms for each sex, [ ~~gender,~~ ] or individual single-occupant toilet rooms for use by either sex [ ~~any gender~~ ].

(2) A new large Type B assisted living facility must ensure a general toilet room or bathing room is accessible from a corridor or public space.

(3) A new large Type B assisted living facility must ensure resident toilet and bathing facilities comply with the requirements for resident-use plumbing fixtures according to §553.247 of this division (relating to Mechanical Requirements for a New Large Type B Assisted Living Facility).

(g) Common living areas and dining areas. [ ~~Resident living areas.~~ ]

(1) Common living areas. [ A new large Type B assisted living facility must provide, in a common area of the facility, social-diversional spaces with appropriate furniture. Examples of social-diversional spaces include living rooms, day rooms, lounges, dens, game rooms, and sunrooms. ]

(A) A new large Type B assisted living facility must ensure the total space for common living areas is provided on a sliding scale according to the following table. [ provide a social-diversional space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of number of residents or other provisions of this section permitting a reduction in the total minimum social-diversional space. ]

Figure: 26 TAC §553.242(g)(1)(A) (.pdf)

(ii) A common living area less than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) A new large Type B assisted living facility with individual living units that have both a bedroom and other living space may reduce the minimum square footage for the total common living area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common living area. The bedroom must continue to meet the minimum dimension requirements in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. This reduction cannot be used together with the provision for reducing required bedroom usable floor space as described in subsection (a)(3) of this section.

(B) A common living area used to meet the requirements of this subsection must have appropriate furniture. [ ~~A new large Type B assisted living facility must ensure a social-diversional space has one or more exterior windows providing a view of the outside.~~ ]

(C) A common living area counted toward meeting the requirements of this subsection must have at least one exterior window with a view of the outside. [ A new large Type B assisted living facility must ensure the total space for social-diversional areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement. ]

[ ~~Figure: 26 TAC §553.242(g)(1)(C)~~ ]

(D) A common living area that is not required to be counted toward meeting the requirements of this subsection is not required to have windows with a view of the outside.

(E) If a means of egress passes through a common living area, the facility must subtract the space required for that means of egress, based on the minimum required width for a corridor according to §553.243 of this division (relating to Means of Egress Requirements for a new Large Type B Assisted Living Facility), from the total size of the room when determining the size of the common living area.

(2) Common dining areas. [ ~~A new large Type B assisted living facility must provide a dining area with appropriate furniture.~~ ]

(A) A new large Type B assisted living facility must ensure the total space for dining areas is provided on a sliding scale according to the following table. [ provide a dining space with a minimum area of 120 square feet in at least one space within a common area of the facility, regardless of number of residents or other provisions of this section permitting a reduction in the total minimum dining space. ]

Figure: 26 TAC §553.242(g)(2)(A) (.pdf)

(i) At least one dining area must be at least 120 square feet regardless of the number of residents based on the facility's licensed capacity or other provisions of this section allowing a reduction in the total minimum common dining area.

(ii) A dining area less than 120 square feet cannot be counted toward meeting the requirements of this paragraph.

(iii) If a new large Type B assisted living facility has individual living units that include both a bedroom and other living space, the facility may reduce the minimum square footage for total common dining area required by this subparagraph by including up to 10 percent of the required bedroom usable floor space in the calculation of the total common dining area. A bedroom must still meet the minimum dimensional criteria in subsection (a)(2) of this section. A facility may only use this provision within the limitations of paragraph (4) of this subsection. A facility must not use this provision at the same time as the provision allowing the reduction of required bedroom usable floor space in subsection (a)(3) of this section.

(B) There must be a covered path from all resident living units or bedrooms to a common dining area. [ ~~A new large Type B assisted living facility must ensure a dining space has one or more exterior windows providing a view of the outside.~~ ]

(C) A dining area used to meet the requirements of this subsection must have furniture suitable for dining use. [ ~~A new large Type B assisted living facility must ensure a dining area is accessible from resident living units or bedrooms via a covered path.~~ ]

(D) A dining area counted toward meeting the requirements of this subsection must have at least one exterior window with a view of the outside. [ A new large Type B assisted living facility must ensure the total space for dining areas is provided on a sliding scale according to the following table. No space smaller than 120 square feet in area can be counted toward meeting this requirement. ]

[ ~~Figure: 26 TAC §553.242(g)(2)(D)~~ ]

(E) A dining area that is not required to be counted toward meeting the requirements of this subsection is not required to have windows with a view of the outside.

(F) If a means of egress passes through a common dining area, the facility must subtract the space required for that means of egress, based on the minimum required width for a corridor according to §553.243 of this division, from the total size of the room when determining the size of the common dining area.

(3) Combining common living areas and dining areas. [ A new large Type B assisted living facility may provide a total living and dining area combined in a single or interconnecting space where the minimum area of the combined space is at least 240 square feet. ]

(A) A new large Type B assisted living facility may have the living area and dining area together in one space as long as the combined space is at least 240 square feet.

(B) Each area within a combined common living area and dining area must have appropriate furniture for the use of the space or area.

(4) Limitations on minimum area reduction. [ For calculation purposes, where a means of egress passes through a living or dining area, a new large Type B assisted living facility must deduct a pathway, equal to the minimum corridor width according to §553.243 of this division (relating to Means of Egress Requirements for a New Large Type B Assisted Living Facility), from the measured area of the space. ]

(B) A new large Type B assisted living facility cannot use both the reduction in space for common living or dining areas allowed by this subsection and the reduction in space for bedrooms allowed by subsection (a)(3) of this section at the same time.

~~[(5) A new large Type B assisted living facility must ensure a means of egress through a resident living or dining area is kept clear of obstructions, except as permitted by NFPA 101.]~~

[(6) Subject to the limitations of paragraphs (1)(A) and (2)(A) of this subsection and subparagraphs (A) and (B) of this paragraph, a new large Type B assisted living facility containing individual living units may reduce the minimum square footage required by paragraphs (1)(C) and (2)(D) of this subsection for total common social-diversional or common dining areas, respectively, by including up to 10 percent of the individual living unit area in the calculation of the total social-diversional area or total dining area.]

[(A) The individual living unit area contributed toward total social-diversional space or total dining space must not be counted more than once per living unit but may be split between social-diversional and dining space calculations.]

[(B) A new large Type B assisted living facility must not utilize both this paragraph and subsection (a)(3) of this section to reduce both the minimum square footage otherwise required for its common social-diversional or dining areas and the minimum square footage of usable floor space otherwise required in bedrooms housing multiple residents within a living unit.]

(h) Storage areas. A new large Type B assisted living facility must provide sufficient separate storage spaces or areas for at least:

(1) administrative records, office supplies, and other storage needs related to administration;

(2) medications and medical supplies;

(3) equipment supplied by the facility for resident needs, including wheelchairs, walkers, beds, and mattresses;

(4) cleaning supplies, including for janitorial needs;

(5) food;

(6) clean linens and towels, if the facility furnishes linen;

(7) soiled linen, if the facility furnishes linen; and

(8) lawn and maintenance equipment.

(i) General kitchen.

~~[(1) A new large Type B assisted living facility that prepares food off-site or in a separate building must ensure food is served at the proper temperature and transported in a sanitary manner.]~~

~~[(2) A new large Type B assisted living facility must ensure a kitchen meets the requirements of the local fire, building, and health codes.]~~

(1) [ ~~(3)~~ ] A new large Type B assisted living facility that prepares food onsite [ ~~on-site~~ ] must provide a kitchen or dietary area that includes spaces for: [ ~~to meet the general food service needs of the residents and must include space for the following:~~ ]

(A) storage, refrigeration, preparation, and serving food;

(B) dish and utensil cleaning which includes:

(i) a three-compartment sink large enough to immerse pots and pans; and

(ii) a mechanical dishwasher for washing and sanitizing dishes;

(D) a handwashing station in every food preparation area with a supply of hot and cold water, soap, a towel dispenser, and a waste receptacle;

(E) a handwashing lavatory that is readily accessible to every dish room area;

(F) refuse storage and removal; and

(G) floor drains in the kitchen and dishwashing areas . [ ~~; and~~

~~[(H) a grease trap, if required by local authorities.]~~

(2) [ ~~(4)~~ ] A new large Type B assisted living facility must ensure a kitchen is designed so that room temperature, at peak load or in the summer, does not exceed 85 degrees Fahrenheit measured throughout the room at five feet above the floor.

(3) [ ~~(5)~~ ] A new large Type B assisted living facility must ensure the volume of supply air provided takes into account the large quantities of air that may be exhausted at the range hood and dishwashing area.

(4) [ ~~(6)~~ ] A new large Type B assisted living facility must provide a supply of hot and cold water.

(A) Hot water for sanitizing purposes must be 180 degrees Fahrenheit.

(B) When chemical sanitizers are used, hot water must meet the manufacturer's suggested temperature.

(5) [ ~~(7)~~ ] A new large Type B assisted living facility must maintain a separation between soiled and clean dish areas.

(6) [ ~~(8)~~ ] A new large Type B assisted living facility must maintain a separation of air flow between soiled and clean dish areas.

(j) Kitchen restrooms.

(1) A new large Type B assisted living facility must provide a restroom facility for kitchen staff, including a lavatory, except as described in paragraph (2) of this subsection.

(A) The restroom facility must be directly accessible to kitchen staff without traversing resident use areas.

(B) The restroom must open into a service corridor or vestibule and not open directly into the kitchen.

(2) A new large Type B facility must ensure a kitchen serving a neighborhood or household provides a restroom accessible to kitchen staff located in close proximity to the kitchen.

(k) Kitchen janitorial facility.

(1) A new large Type B assisted living facility must provide janitorial facilities exclusively for the kitchen and located in the kitchen area except as described in paragraph (2) of this subsection.

(2) A new large Type B facility must ensure a kitchen serving a neighborhood or household provides a janitorial facility exclusively for the kitchen that is located in close proximity to the kitchen.

(3) A new large Type B assisted living facility must provide a garbage can or cart washing area with a floor drain and a supply of hot water. The garbage can or cart washing area may be in the interior or on the exterior of the facility.

(l) Finishes.

(1) A new large Type B assisted living facility must provide non-absorbent, smooth finishes or surfaces on all kitchen floors, walls, and ceilings.

(2) A new large Type B assisted living facility must provide non-absorbent, smooth, cleanable finishes on counter surfaces and all cabinet surfaces.

(3) A new large Type B assisted living facility must ensure surfaces are capable of being routinely cleaned and sanitized to maintain a healthful environment.

(m) Vision panels in communicating doors. A new large Type B assisted living facility must ensure a door between a kitchen and a dining area, serving area, or resident-use area, is provided with a vision panel with fixed safety glass. Where the door is a required fire door or is located in a fire barrier or other fire resistance-rated enclosure, the vision panel, including the glazing and the frame, must meet the requirements of NFPA 101.

(n) Auxiliary serving kitchens.

(1) A new large Type B assisted living facility must ensure an auxiliary serving kitchen is equipped to maintain required food temperatures.

(2) A new large Type B assisted living facility must ensure an auxiliary serving kitchen is equipped with a handwashing lavatory meeting the requirements of this subsection.

(3) A new large Type B assisted living facility must ensure all surfaces in an auxiliary serving kitchen meet the requirements for finishes in this section.

(o) Protection of cooking operations.

(1) A new large Type B assisted living facility must protect cooking facilities according to the requirements in §553.246 of this division (relating to Hazardous Area Requirements for a New [ ~~new~~ ] Large Type B Assisted Living Facility).

(2) The following commercial or residential cooking equipment used only for reheating, and not for meal preparation, is not required to comply with the requirements of §553.246 of this division:

(A) microwave ovens;

(B) hot plates; or

(p) Food storage areas.

(1) A new large Type B assisted living facility must provide a food storage area large enough to consistently maintain a four-day minimum supply of non-perishable food. A food storage area may be located away from the food preparation area as long as there is space adjacent to the kitchen for necessary daily usage.

(2) A new large Type B assisted living facility must provide dollies, racks, pallets, wheeled containers, or shelving so that food is not stored on the floor and must ensure shelves are adjustable wire type shelving.

(3) A new large Type B assisted living facility must provide non-absorbent finishes or surfaces on all floors and walls in food storage areas.

(4) A new large Type B assisted living facility must provide effective ventilation in dry food storage areas to ensure positive air circulation.

(5) A new large Type B assisted living facility must ensure the maximum room temperature in a food storage area does not exceed 85 degrees Fahrenheit at any time when measured at the highest food storage level, but not less than five feet above the floor.

(q) Laundry and linen services.

(1) A new large Type B assisted living facility that co-mingles and processes laundry onsite [ ~~on-site~~ ] in a central location, regardless of the type of laundry equipment used, must ensure a laundry area:

(B) is protected throughout by a fire sprinkler system;

(C) has access doors that open to the exterior or to an interior non-resident use area, such as a vestibule or service corridor; and

(D) is provided with:

(i) a soiled linen receiving, holding, and sorting room with a floor drain and forced exhaust to the exterior;

(I) The exhaust must always operate when soiled linen is held in this area; and

(II) The area may be combined with the washer section;

(ii) a general laundry work area that is separated by partitioning a washer section and a dryer section;

(iii) a storage area for laundry supplies;

(iv) a folding area;

(v) an adequate air supply and ventilation for staff comfort without having to rely on opening a door that is part of the fire barrier separation required by subparagraph (A) of this paragraph; and

(vi) provisions to exhaust heat from dryers and to separate dryer make-up air from the habitable work areas of the laundry.

(2) If linen is processed off site, the facility must provide:

(A) a soiled linen holding room with adequate forced exhaust ducted to the exterior; and

(B) a clean linen receiving, holding, inspection, sorting or folding, and storage room.

(3) A new large Type B assisted living facility must ensure a laundry area for resident use [ ~~resident-use~~ ] meets the following requirements.

(A) A new large Type B assisted living facility must ensure only residential type washers and dryers are provided in a laundry area for resident-use.

(B) When more than three washers and three dryers are provided in one laundry area for resident-use, the area must be:

(i) protected throughout by a fire sprinkler system; or

(ii) separated from the facility by a fire barrier having a one-hour fire resistance rating.

§ 553.243. Means of Egress Requirements for a New Large Type B Assisted Living Facility.

(a) A new large Type B assisted living facility must meet the requirements of 18.2, Means of Egress, in NFPA 101, Chapter 18, New Health Care Occupancies, except as described in this section.

(b) A new large Type B assisted living facility must ensure doors meet the requirements of 18.2.2.2, Doors, in NFPA 101, Chapter 18, New Health Care Occupancies, and the additional requirements of this section.

(1) A resident room door in a new large Type B assisted living facility must latch in its frame to resist the passage of smoke.

(2) In a new large Type B assisted living facility comprised of buildings containing living units with independent cooking equipment within the living unit, a door between the living unit and a corridor or hallway must:

(A) be self-closing or automatic-closing; and

(B) latch in its frame to resist the passage of smoke.

(3) A resident room door or living unit door must not be arranged to prevent the occupant from closing the door.

(4) A new large Type B assisted living facility must not use the door-locking arrangements described in 18.2.2.2.5, in NFPA 101, Chapter 18, New Health Care Occupancies.

(c) A new large Type B assisted living facility providing spaces for use by residents on floors other than the ground floor must provide at least two separate approved stairs and must ensure stairs used as a means of egress meet the requirements of 18.2.2.3, Stairs, in NFPA 101, Chapter 18, New Health Care Occupancies.

(d) A new large Type A assisted living facility must ensure means of egress are marked according to the requirements of 18.2.10, Marking of Means of Egress, in NFPA 101, Chapter 18, New Health Care Occupancies.

(e) A new large Type B assisted living facility must provide emergency lighting according to the requirements of 18.2.9, Emergency Lighting, in NFPA 101, Chapter 18, New Health Care Occupancies.

(f) A new large Type B assisted living facility must maintain means of egress according to the requirements of 18.7.3, Maintenance of Means of Egress, in NFPA 101, Chapter 18, New Health Care Occupancies.

§ 553.245. Fire Protection Systems Requirements for a New Large Type B Assisted Living Facility.

(a) Fire alarm and smoke detection system. A new large Type B assisted living facility must provide a fire alarm system meeting the requirements of 18.3.4, Detection, Alarm, and Communications Systems, in NFPA 101, Chapter 18, New Health Care Occupancies, as modified by this section.

(1) General. A new large Type B assisted living facility must ensure the operation of any alarm initiating device automatically activates the manual fire alarm system evacuation alarm for the entire building.

(2) Smoke detectors.

(A) A new large Type B assisted living facility must install smoke detectors meeting the requirements of 18.3.4.5.3, Nursing Homes, [ ~~18.3.4.5.1, Corridors,~~ ] in NFPA 101, Chapter 18, New Health Care Occupancies.

(B) A new large Type B assisted living facility comprised of buildings containing living units with independent cooking equipment within the living unit, must additionally have:

(i) a smoke alarm or smoke detector installed in all resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, kitchens and laundries within the living unit, that sounds an alarm only within the living unit; and

(ii) a heat detector installed in the kitchen within the living unit that activates the general alarm.

(3) Alarm control panel.

(A) A new large Type B assisted living facility must provide a fire alarm control unit, or a fire alarm annunciator providing annunciation of all fire alarm, supervisory, and trouble signals by audible and visible indicators, in a location visible to staff at or near the staff area that is attended 24 hours a day.

(B) A new large Type B assisted living facility is not required to ensure a fire alarm control unit or fire alarm annunciator is visible to staff if the fire alarm is monitored by devices carried by all staff.

(C) A new large Type B assisted living facility must ensure a fire alarm panel indicates each floor and smoke compartment, as applicable, as a separate zone. Each zone must provide an alarm and trouble indication. When all alarm initiating devices are addressable and the status of each device is identified on the fire alarm panel, zone indication is not required.

(4) Fire alarm power source.

[(A)] A new large Type B assisted living facility must ensure the power supply source for a fire alarm system is in accordance with NFPA 72. [ ~~a fire alarm system is powered by a permanently-wired, dedicated branch circuit that is powered from a commercial power source in accordance with NFPA 70.~~ ]

~~[(B) A new large Type B assisted living facility must provide a secondary, emergency power source meeting the requirements of NFPA 72.]~~

(5) Emergency forces notification. A new large Type B assisted living facility must ensure a fire alarm system automatically notifies emergency forces according to the requirements of 18.3.4.3.2, Emergency Forces Notification, in NFPA 101, Chapter 18, New Health Care Occupancies

(b) Fire sprinkler system. A new large Type B assisted living facility must provide a fire sprinkler system meeting the requirements of NFPA 13 in accordance with 18.3.5, Extinguishment Requirements, in NFPA 101, Chapter 18, New Health Care Occupancies.

(c) Portable Fire Extinguishers. A new large Type B assisted living facility must provide and maintain portable fire extinguishers according to the requirements of NFPA 10.

(1) A new large Type B assisted living facility must ensure all requirements of NFPA 10 are followed for all extinguisher types, including requirements for location, spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent, any necessary servicing, and hydrostatic testing as recommended by the manufacturer.

(2) A new large Type B assisted living facility must ensure portable fire extinguishers are located in resident corridors so the travel distance from any point in the facility to an extinguisher is no more than 75 feet.

(3) A new large Type B assisted living facility must ensure the actual size of any portable fire extinguisher meets the requirements of NFPA 10 for maximum floor area per unit covered, but an extinguisher must be no smaller than the following.

(A) A water-type portable fire extinguisher must have a rating of at least 1-A according to NFPA 10.

(B) All other portable fire extinguishers must have a rating of at least 2-A:10-B:C according to NFPA 10.

(C) A facility must provide at least one approved 20-B:C portable fire extinguisher in each laundry, kitchen, and walk-in mechanical room.

(4) A new large Type B assisted living facility must ensure portable fire extinguishers are installed on hangers or brackets supplied with the extinguisher or mounted in an approved cabinet.

(5) A new large Type B assisted living facility must ensure a portable fire extinguisher is protected from impact or dislodgement.

(6) A new large Type B assisted living facility must ensure a portable fire extinguisher is installed at an appropriate height.

(A) A portable fire extinguisher having a gross weight of up to 40 pounds must be installed so the top of the extinguisher is not more than five feet above the floor.

(B) A portable fire extinguisher having a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than three and a half feet above the floor.

(C) A portable fire extinguisher must be installed so the clearance between the bottom of the extinguisher and the floor is at least four inches.

(7) A portable extinguisher provided in a hazardous room must be located as close as possible to the exit access door leading from the room and on the latch or knob side of the door.

§ 553.246. Hazardous Area Requirements for a New Large Type B Assisted Living Facility.

(a) A new large Type B assisted living facility must meet the requirements of 18.3.2, [ ~~19.3.2,~~ ] Protection from Hazards, in NFPA 101, Chapter 18, [ ~~Chapter 19,~~ ] New Health Care Occupancies.

(b) A new large Type B assisted living facility must not store [ ~~ensure~~ ] flammable or combustible liquids, including gasoline, oil-based paint, charcoal lighter fluid, or similar liquids [ ~~products are not stored~~ ] in any [ a ] building where residents live. [ ~~housing residents.~~ ]

(c) A new large Type B assisted living facility must protect any cooking operation according to the requirements of 18.3.2.5, Cooking Facilities, in NFPA 101, Chapter 18, New Health Care Occupancies.

§ 553.247. Mechanical Requirements for a New Large Type B Assisted Living Facility.

(a) Wastewater and water supply.

(1) Wastewater. A new large Type B assisted living facility must ensure wastewater and sewage are discharged into a sewerage system or an onsite sewerage facility approved by the Water Quality Division of TCEQ, or to a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Quality Division of TCEQ.

(2) Water supply. A new large Type B assisted living facility must ensure the water supply is of safe, sanitary quality, suitable for use, adequate in quantity and pressure, and obtained from a public or private water supply system or a private well.

(b) Resident-use plumbing fixtures.

(1) Water closets and lavatories.

(A) A new large Type B assisted living facility must provide at least one water closet and one lavatory for every [ ~~each~~ ] six residents and for any fraction thereof. [ ~~each additional resident fewer than six.~~ ] Multiple toilets in a single space must comply with paragraph (2)(B) of this subsection.

(B) A new large Type B assisted living facility must ensure a lavatory is readily accessible to each water closet.

(C) A new large Type B assisted living facility must provide at least one water closet, lavatory, and bathing unit, that are accessible to residents, on each floor containing resident sleeping rooms.

(2) Bathing units.

(A) A new large Type B assisted living facility must provide one tub or shower for every 10 residents and for any fraction thereof.

(B) Where multiple water closets or bathing units are provided in a single space, a new large Type B assisted living facility must provide partitions or curtains to separate plumbing fixtures for resident privacy.

(C) A new large Type B assisted living facility must ensure tubs and showers have non-slip bottoms or floor surfaces, either built-in or applied to the surfaces.

(3) Hot water supply. A new large Type B assisted living facility must provide a supply of hot water for resident use [ ~~resident-use~~ ]. Hot water for lavatories and bathing units accessible to residents must be maintained between 100 and 120 degrees Fahrenheit.

(4) Supplies. A new large Type B assisted living facility must supply towels, soap, and toilet tissue for individual resident use [ ~~resident-use~~ ].

(c) Public- and staff-use plumbing fixtures. In addition to the staff toilets required for the dietary staff according to §553.242(j) of this division (relating to Space Planning and Utilization Requirements for a New Large Type B Assisted Living Facility), a new large Type B assisted living facility must provide toilets, including water closets and lavatories, for use by the public and by [ ~~facility~~ ] staff as follows:

(1) if licensed for 60 or fewer residents, a new large Type B assisted living facility must provide a toilet for use by the public and by [ ~~facility~~ ] staff; or

(2) if licensed for more than 60 residents, a new large Type B assisted living facility must provide a toilet for use by the public and a separate toilet for use by [ ~~facility~~ ] staff.

(d) Gas. A new large Type B assisted living facility must ensure equipment using natural gas or propane and related gas piping meets the requirements of 9.1.1, Gas, in NFPA, Chapter 9, Building Service and Fire Protection Equipment.

(e) Heating, ventilation, and air-conditioning (HVAC) and exhaust systems.

(1) General requirements. A new large Type B assisted living facility must ensure HVAC equipment meets the requirements of 18.5.2, Heating, Ventilating and Air-Conditioning, in NFPA 101, Chapter 18, New Health Care Occupancies.

(2) Heating and cooling. A new large Type B assisted living facility must provide heating and cooling for resident comfort.

(A) A new large Type B assisted living facility must ensure air conditioning systems can maintain and does maintain the comfort range of 68 to 82 degrees Fahrenheit in resident-use areas.

(B) A new large Type B assisted living facility must have a central air conditioning system, or a substantially similar air conditioning system, that can maintain and does maintain a temperature range required under subparagraph (A) of this paragraph within areas used by residents.

(C) A new large Type B assisted living facility may not use an open flame heating device in the facility, except as permitted by subparagraphs (D) - (F) of this paragraph.

(D) A new large Type B assisted living facility must ensure any heating device, other than a central heating plant, suspended unit heater, or working fireplace, meets the requirements of 18.5.2.2, in NFPA 101, Chapter 18, New Health Care Occupancies.

(E) A new large Type B assisted living facility must ensure a suspended unit heater meets the requirements of 18.5.2.3(1), in NFPA 101, Chapter 18, New Health Care Occupancies.

(F) A new large Type B assisted living facility must ensure a working fireplace meets the following requirements.

(i) A direct-vent gas fireplace must meet the requirements of 18.5.2.3(2), in NFPA 101, Chapter 18, New Health Care Occupancies.

(ii) A solid fuel-burning fireplace must meet the requirements of 18.5.2.3(3), in NFPA 101, Chapter 18, New Health Care Occupancies.

(G) A new large Type B assisted living facility must ensure portable space heating devices, including electric space heaters, meet the requirements of 18.7.8, Portable Space-Heating Devices, in NFPA 101, Chapter 18, New Health Care Occupancies.

(3) Ventilation.

(A) A new large Type B assisted living facility must be ventilated using mechanical ventilation.

(B) A new large Type B assisted living facility with interior areas designated for smoking within the building must provide mechanical ventilation directed to the exterior to remove smoke at the rate of 10 air changes per hour.

(4) Exhaust. A new large Type B assisted living facility must ensure bathrooms, toilet rooms, janitorial facilities, and other odor-producing rooms or areas for soiled or unsanitary operations are exhausted with powered exhaust vented to the exterior for odor control.

§ 553.248. Electrical Requirements for a New Large Type B Assisted Living Facility.

(a) Electrical system. A new large Type B assisted living facility must ensure an electrical system meets the requirements of 9.1.2, Electrical Systems, in NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

(b) Lighting. A new large Type B assisted living facility must provide illumination throughout the building. Minimum lighting levels must not be lower than the following. [ : ]

(2) In [ ~~20 footcandles in~~ ] each corridor, staff station, dining room, lobby, toilet room, bathroom, bathing facility, laundry room, stairway, and elevator , illumination must be at least 20 footcandles during the day when [ ~~during the day--illumination requirements for these areas apply to lighting throughout the space, as~~ ] measured anywhere in the space at 30 inches above the floor . [ ~~anywhere in the room.~~ ]

(c) Telephone. A new large Type B assisted living facility must provide at least one telephone in the facility that is available to both staff and residents. Emergency telephone numbers must be posted conspicuously at or near the telephone, including fire, police, emergency medical services, and poison control center services.

(d) Communication system. A new large Type B assisted living facility that consists of two or more floors or separate buildings must provide a communication system from each resident living unit to a central staff station.

(1) The communication system must include at least :

~~[(A) be a direct telephone, emergency call system, or intercom;]~~

~~[(B) include at least:]~~

(A) [ ~~(i)~~ ] one central notification station accessible to staff at all times [ ~~at a fixed location~~ ] that receives all calls processed through the system; and

(B) [ ~~(ii)~~ ] one [ ~~permanently fixed~~ ] call station or device accessible to residents at all times in each resident's living unit. [ ~~in every resident living unit.~~ ]

(2) A new large Type B assisted living facility may provide:

(A) additional or portable notification stations or devices in addition to the central notification; or

(B) additional call stations or devices in private or common resident areas.

(3) A new large Type B assisted living facility may provide residents with portable, wireless call transmitters, such as pendants or wrist bands , but these devices must not replace a call station in a resident living unit . [ ~~However, a device may not be a substitute for a fixed call station in a resident living unit.~~ ]

(e) Generator.

(1) A new large Type B assisted living facility that provides a system to supply, distribute, and control electricity for emergency lighting and illumination of exit signs required by NFPA 101, such as a system that uses a generator set as an alternate source of power, must comply with the requirements of Article 700, Emergency Systems, in NFPA 70, Chapter 7, Special Conditions.

(A) The emergency system may not include any systems or equipment except:

(i) emergency lighting, as required by NFPA 101;

(ii) secondary power to ensure illumination of exit signs, as required by NFPA 101; and

(iii) secondary power for detection, alarm, and communications systems, as required by NFPA 72.

(B) A new large Type B assisted living facility must ensure wiring from an emergency source to emergency loads is kept entirely independent of all other wiring and equipment except as permitted by Article 700.10, Wiring, Emergency System, in NFPA 70. Two or more emergency circuits supplied from the same source may be routed in the same raceway, cable, box, or cabinet.

(C) A new large Type B assisted living facility must ensure that transfer equipment for an emergency system does not serve another facility, including a hospital, a nursing facility or an independent living facility.

(2) A new large Type B assisted living facility that provides a system to supply, distribute, and control electricity for systems and equipment not identified in paragraph (1) of this subsection must comply with the requirements of Article 702, Optional Standby Systems, in NFPA 70.

~~[(A) emergency circuits for the assisted living facility]~~

~~[(B) legally required standby circuits, if any; and]~~

~~[(C) optional standby circuits, if any.]~~

(4) A new large Type B assisted living facility is not required to comply with the requirements of Article 517, Health Care Facilities, in NFPA 70.

§ 553.249. Miscellaneous Requirements for a New Large Type B Assisted Living Facility.

(a) A new large Type B assisted living facility must provide an elevator if:

(1) the building in which the facility is located is three or more stories in height; or

(2) the facility provides services or social activities to residents in spaces located on a floor other than the floor where the entrance to the facility is located.

(b) A new large Type B assisted living facility must ensure an elevator , escalator, or conveyor meets the requirements of 18.5.3, Elevators, Escalators, and Conveyors, in NFPA 101, Chapter 18, New Health Care Occupancies.

(c) A new large Type B assisted living facility must ensure a rubbish chute, incinerator, or laundry chute meets the requirements of 18.5.4, Rubbish Chutes, Incinerators, and Laundry Chutes, in NFPA 101, Chapter 18, New Health Care Occupancies.

(d) A new large Type B assisted living facility must ensure furnishings, mattresses, and decorations meet the requirements of 18.7.5, Furnishings, Mattresses, and Decorations, in NFPA 101, Chapter 18, New Health Care Occupancies.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 18, 2026.

TRD-202603602

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 4, 2026

For further information, please call: (512) 438-3161

DIVISION 12. SPECIALIZED ASSISTED LIVING FACILITIES

26 TAC §553.250

STATUTORY AUTHORITY

The new section is authorized by Texas Government Code §524.0005, which provides that the executive commissioner of HHSC shall adopt rules to implement the executive commissioner's authority under Texas Government Code Chapter 524 with respect to the health and human services system, and §524.0151, which provides that the executive commissioner of HHSC shall adopt rules necessary to carry out the commission's duties under Texas Government Code Chapter 531 and adopt rules and policies for the operation and provision of services by the health and human services agencies; and Texas Health and Safety Code §247.025 and §247.026, which provide that the executive commissioner of HHSC shall adopt rules necessary to implement Texas Health and Safety Code Chapter 247 and to ensure the quality of care and protection of assisted living facility residents' health and safety, respectively.

The new section implements Texas Government Code §524.0005 and §524.0151 and Texas Health and Safety Code §247.025 and §247.026.

§ 553.250. Construction Requirements for a Certified Alzheimer's Assisted Living Facility.

(a) Applicability. This section only applies to a Type B assisted living facility that is a certified Alzheimer's assisted living facility according to the requirements of §553.27 of this chapter (relating to Certification of a Type B Facility or Unit for Persons with Alzheimer's Disease and Related Disorders) or §553.29 of this chapter (relating to Alzheimer's Certification of a Type B Facility for an Initial License Applicant in Good Standing) that chooses to:

(1) secure the means of escape or exit doors of a certified Alzheimer's assisted living facility using the approved locking arrangements described in this section; or

(2) create one or more certified Alzheimer's assisted living units separated from other parts of the Type B assisted living facility by control doors that use the approved locking arrangements described in this section.

(b) Staff training. An assisted living facility that uses the locking arrangements described in this section for escape or exit doors or for control doors must train all staff in all the methods of unlocking the doors.

(c) Keypads. An assisted living facility may install a keypad, credential reader, switch or button at escape doors, exit doors, and control doors for staff use.

(d) Small, fully locked certified Alzheimer's assisted living facility. A small Type B assisted living facility that has an Alzheimer's certification for the full licensed capacity of the small Type B assisted living facility that chooses to secure control doors or exterior doors using the approved locking arrangements in this subsection must meet the requirements for a small Type B assisted living facility according to §553.100(e) of this subchapter (relating to General Requirements), as applicable, except as modified by this subsection.

(1) Resident living areas.

(A) An existing small Type B assisted living facility must ensure resident living areas meet the requirements of §553.122(g) of this subchapter (relating to Space Planning and Utilization Requirements for an Existing Small Type B Assisted Living Facility).

(B) A new small Type B assisted living facility must ensure resident living areas meet the requirements of §553.222(g) of this subchapter (relating to Space Planning and Utilization Requirements for a New Small Type B Assisted Living Facility).

(C) If a small, fully locked certified Alzheimer's assisted living facility has more than one certified Alzheimer's assisted living unit, each certified Alzheimer's assisted living unit must separately meet the requirements for resident living areas in a small Type B assisted living facility for the capacity of the certified Alzheimer's assisted living unit.

(2) Resident-use plumbing fixtures.

(A) An existing small Type B assisted living facility must ensure resident use plumbing fixtures meet the requirements of §553.127(b) of this subchapter (relating to Mechanical Requirements for an Existing Small Type B Assisted Living Facility).

(B) A new small Type B assisted living facility must ensure resident use plumbing fixtures meet the requirements of §553.227(b) of this subchapter (relating to Mechanical Requirements for a New Small Type B Assisted Living Facility).

(C) If a small, fully locked certified Alzheimer's assisted living facility has more than one certified Alzheimer's assisted living unit, each certified Alzheimer's assisted living unit must separately meet the requirements for resident-use plumbing fixtures in a small Type B assisted living facility for the capacity of the certified Alzheimer's assisted living unit.

(3) Staff areas and monitoring stations.

(A) A small, fully locked certified Alzheimer's assisted living facility that occupies only one floor of a building and is not divided into two or more separate certified Alzheimer's assisted living units must have a staff area as follows.

(i) An existing small Type B assisted living facility must provide a staff area as required by §553.122(e) of this subchapter.

(ii) A new small Type B assisted living facility must provide a staff area as required by §553.222(e) of this subchapter.

(B) If a small, fully locked certified Alzheimer's assisted living facility occupies more than one floor of a building or more than one building, the facility must have a staff area meeting the requirements of subparagraph (A) of this paragraph on each floor and in each building.

(C) If a small, fully locked certified Alzheimer's assisted living facility is divided into two or more separate certified Alzheimer's assisted living units on one floor, the facility must have:

(i) a staff area meeting the requirements of subparagraph (A) of this paragraph in one certified Alzheimer's assisted living unit; and

(ii) a monitoring station in each of the other certified Alzheimer's assisted living unit that includes:

(I) a writing surface, such as a desk or counter;

(II) a chair;

(III) task illumination at the task surface;

(IV) a telephone or intercom; and

(V) lockable storage for resident records.

(4) Means of escape.

(A) An existing small Type B assisted living facility must meet the requirements of §553.123 of this subchapter (relating to Means of Escape Requirements for an Existing Small Type B Assisted Living Facility). Each building and each floor must have at least two means of escape, as required by NFPA 101.

(B) A new small Type B assisted living facility must meet the requirements of §553.223 of this subchapter (relating to Means of Escape Requirements for a New Small Type B Assisted Living Facility). Each building and each floor must have at least two means of escape, as required by NFPA 101.

(5) Control doors. Control doors must not be locked in a small, fully locked certified Alzheimer's assisted living facility unless all the following requirements are met.

(A) The building must have an approved fire alarm system and an approved fire sprinkler system meeting the requirements of this subchapter.

(B) The door must unlock when any of the following occurs:

(i) the fire alarm is activated;

(ii) the fire sprinkler system is activated;

(iii) the locking device loses power; or

(iv) staff activate a switch or button located at any staff area or at any monitoring station required by paragraph (3) of this subsection.

(6) Exterior doors. Exterior doors of a small, fully locked certified Alzheimer's assisted living facility may be locked against escape by one of the following means if the building has an approved fire alarm system and an approved fire sprinkler system meeting the requirements of this subchapter.

(A) The locking arrangement must meet the requirements for Delayed Egress Locking Systems in NFPA 101; or

(B) the locking arrangement must meet all the following requirements:

(i) the door must unlock when any of the following occurs:

(I) the fire alarm is activated;

(II) the fire sprinkler system is activated;

(III) the locking device loses power; or

(IV) staff activate a switch or button located at any staff area or at any monitoring station required by paragraph (3) of this subsection;

(ii) a manual fire alarm pull must be placed within five feet of every exterior door that uses this type of lock; and

(iii) a sign must be placed next to the fire alarm pull required by clause (ii) of this subparagraph, which must state, "Pull to release door in an emergency," or, "Pull to unlock door in an emergency."

(7) Outdoor area. A small, fully locked certified Alzheimer's assisted living facility must provide an outdoor area meeting the following requirements.

(A) All outdoor areas combined must be at least 600 square feet in size.

(B) Each individual outdoor area must be at least 300 square feet in size.

(C) All outdoor areas must be connected to, be part of, be controlled by, and be directly accessible from the assisted living facility.

(D) The outdoor areas must be enclosed with walls or fences that do not allow climbing or present a hazard to residents.

(i) If a bedroom window faces a wall or fence required by this paragraph, a solid wall or fence must be at least 20 feet from the building. An open wall or fence must be at least 15 feet away from the building.

(ii) If a bedroom window does not face a wall or fence required by this paragraph, a wall or fence must be at least eight feet away from the building, as long as the wall or fence is parallel to the building.

(iii) If site conditions are unusual, or a wall or fence is not parallel to the building, outdoor areas may be configured differently with approval from HHSC.

(iv) The minimum dimensions in this paragraph do not apply to:

(I) additional walls or fences built along the edges of the property;

(II) building setback lines for privacy or for meeting the requirements of local building authorities; or

(III) the locations of other buildings or structures on the facility property.

(E) A small, certified Alzheimer's assisted living facility must have a walkway made of concrete, asphalt, or another approved material. The walkway must extend from the building to at least one gate in the wall or fence.

(i) If any gate in the wall or fence is locked, the gate closest to the building and connected by a walkway must have a lock that unlocks in the manner described in paragraph (5) or (6) of this subsection. The lock must be safe for outdoor use. An existing gate closest to the building that does not meet these requirements may continue in use if approved by HHSC.

(ii) Any gate, other than the gate described in clause (i) of this subparagraph, may be locked using the lock type described in paragraph (5) or (6) of this subsection, or with a keyed lock. If a keyed lock is used, all staff who are on duty must carry a key to the lock.

(iii) All gates may be locked using a keyed lock if all staff on duty carry a key to the lock. The outdoor area must include an area of refuge that meets the following requirements.

(I) If the small Type B assisted living facility received its Alzheimer's certification before January 31, 2027, the area of refuge must extend beyond a line parallel to the building at a distance of at least 30 feet from the building.

(II) If the small Type B assisted living facility received its Alzheimer's certification on or after January 31, 2027, the area of refuge must be located completely beyond a line parallel to the building at a distance of at least 30 feet from the building.

(III) The area of refuge must include at least 15 square feet for each person, including residents, staff, and visitors, who may be present at the time of an emergency.

(e) Small Type B assisted living facility with one or more certified Alzheimer's assisted living units. A small Type B assisted living facility that has a certified Alzheimer's capacity lower than the assisted living facility's full licensed capacity and that has one or more certified Alzheimer's assisted living units must meet the requirements for a small Type B assisted living facility according to §553.100(e) of this subchapter, as applicable, except as modified by this subsection.

(1) Resident living areas.

(A) An existing small Type B assisted living facility must ensure resident living areas meet the requirements of §553.122(g) of this subchapter.

(B) A new small Type B assisted living facility must ensure resident living areas meet the requirements of §553.222(g) of this subchapter.

(C) If a small Type B assisted living facility has more than one certified Alzheimer's assisted living unit, each certified Alzheimer's assisted living unit must separately meet the requirements for resident living areas in a small Type B assisted living facility for the capacity of the certified Alzheimer's assisted living unit.

(2) Resident-use plumbing fixtures.

(A) An existing small Type B assisted living facility must ensure resident-use plumbing fixtures meet the requirements of §553.127(b) of this subchapter.

(B) A new small Type B assisted living facility must ensure resident-use plumbing fixtures meet the requirements of §553.227(b) of this subchapter.

(C) If a small Type B assisted living facility has more than one certified Alzheimer's assisted living unit, each certified Alzheimer's assisted living unit must separately meet the requirements for resident-use plumbing fixtures in a small Type B assisted living facility for the capacity of the certified Alzheimer's assisted living unit.

(3) Staff areas and monitoring stations.

(A) A small Type B assisted living facility with one or more certified Alzheimer's assisted living unit must provide a staff area as follows.

(i) An existing small Type B assisted living facility must provide a staff area as required by §553.122(e) of this subchapter.

(ii) A new small Type B assisted living facility must provide a staff area as required by §553.222(e) of this subchapter.

(B) If a small Type B assisted living facility occupies more than one floor of a building or more than one building the facility must have a staff area meeting the requirements of subparagraph (A) of this paragraph on each floor and in each building.

(C) A small Type B assisted living facility must have a monitoring station in each certified Alzheimer's assisted living unit that includes:

(i) a writing surface, such as a desk or counter;

(ii) a chair;

(iii) task illumination at a task surface;

(iv) a telephone or intercom; and

(v) lockable storage for resident records.

(4) Means of escape.

(A) An existing small Type B assisted living facility must comply with §553.123 of this subchapter. Each building and each floor must have at least two means of escape, as required by NFPA 101.

(B) A new small Type B assisted living facility must comply with §553.223 of this subchapter. Each building and each floor must have at least two means of escape, as required by NFPA 101.

(5) Control doors. Control doors must not be locked in a small Type B assisted living facility that is not a fully locked certified Alzheimer's assisted living facility and has one or more certified Alzheimer's assisted living units unless all of the following requirements are met.

(A) The building must have an approved fire alarm system and an approved fire sprinkler system meeting the requirements of this subchapter.

(B) The door must unlock when any of the following occurs:

(i) the fire alarm system is activated;

(ii) the fire sprinkler system is activated;

(iii) the locking device loses power; or

(iv) staff activate a switch or button located at any staff area or at any monitoring station required by paragraph (3) of this subsection.

(6) Exterior doors. Exterior doors of a small Type B assisted living facility that is not a fully locked certified Alzheimer's assisted living facility and has one or more certified Alzheimer's assisted living units may be locked against escape by one of the following means if the building has an approved fire alarm system and an approved fire sprinkler system meeting the requirements of this subchapter.

(A) The locking arrangement must meet the requirements for Delayed Egress Locking Systems in NFPA 101; or

(B) the locking arrangement must meet all of the following requirements:

(i) the door must unlock when any of the following occurs:

(I) the fire alarm is activated;

(II) the fire sprinkler system is activated;

(III) the locking device loses power; or

(IV) staff activate a switch or button located at any staff area or at any monitoring station required by paragraph (3) of this subsection;

(ii) a manual fire alarm pull must be placed within five feet of every exterior door that uses this type of lock; and

(iii) a sign must be placed next to the fire alarm pull required by clause (ii) of this subparagraph which must state, "Pull to release door in an emergency," or, "Pull to unlock door in an emergency."

(7) Outdoor area. A small Type B assisted living facility that is not a fully locked certified Alzheimer's assisted living facility and has one or more certified Alzheimer's assisted living unit must provide an outdoor area meeting the following requirements.