Basis in legislation. The licensing standards for assisted living facilities are promulgated under the authority of the Health and Safety Code, Chapter 247. Assisted living services are driven by a service philosophy that emphasizes personal dignity, autonomy, independence, and privacy. Assisted living services should enhance a person's ability to age in place in a residential setting while receiving increasing or decreasing levels of service as the person's needs change.

Scope. The licensing standards for assisted living facilities contain the minimum standards that a facility must meet in order to be licensed as an assisted living facility. The standards serve as a basis for survey activities for licensure.

An assisted living facility is an establishment that furnishes, in one or more facilities, food and shelter to four or more persons who are unrelated to the proprietor of the establishment; and provides personal care services.

The Texas Department of Human Services 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:

shared services, personnel, or equipment in any part of the facilities' operations; and

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

The presence or absence of any one factor in subparagraph (A) of this paragraph is not conclusive.

A health care professional may provide services within the professional's scope of practice to a resident of an assisted living facility; however, a facility is not authorized to provide ongoing services comparable to the services available in a nursing facility licensed under Chapter 242, Health and Safety Code. Residents may contract to have home health services delivered.

Assisted living residents. General characteristics of assisted living residents include, but are not limited to, the following. A resident may:

exhibit symptoms of mental or emotional disturbance, but is not considered at risk of imminent harm to self or others;

need assistance with movement;

require assistance with bathing, dressing, and grooming;

require assistance with routine skin care, such as application of lotions, or treatment of minor cuts and burns;

need reminders to encourage toilet routine and prevent incontinence;

require temporary services by professional personnel;

need assistance with medications, supervision of self-medication, or administration of medication;

require encouragement to eat or monitoring due to social or psychological reasons of temporary illness;

be hearing impaired or speech impaired;

be incontinent without pressure sores;

require established therapeutic diets;

require self-help devices; and

need assistance with meals.

§92.3.Definitions.

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

Affiliate - With respect to a:

partnership, each partner thereof;

corporation, each officer, director, principal stockholder, subsidiary, and each person with a disclosable interest, as the term is defined in this section;

natural person:

each person's spouse;

each partnership and each partner thereof of which said person or any affiliate of said person is a partner; and

each corporation in which said person is an officer, director, principal stockholder, or person with a disclosable interest.

Applicant - A person applying for an assisted living license under Health and Safety Code, Chapter 247.

Attendants - A facility employee who provides direct care to residents. This individual may serve other functions which may include, but are not limited to, aides, cooks, janitors, porters, maids, laundry workers, security personnel, bookkeepers, managers, etc.

Change of ownership - A change: of 50% or more in the ownership of the business organization that is licensed to operate the facility; in the owner holding the facility license; or in the federal tax payer identification number.

Co-mingles - The laundering of wearing apparel and/or linens of two or more individuals together.

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 an assisted living facility or other person. A controlling person includes:

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

any 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

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. This 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.

Dietitian - A person who currently holds a license or provisional license issued by the Texas State Board of Examiners of Dietitians.

Disclosure statement - A department-designed form for prospective residents or their representatives which each assisted living facility must complete. The form contains information regarding the preadmission, admission and discharge process; resident assessment and service plans; staffing patterns; the physical environment of the facility; resident activities; and facility services.

Facility - An establishment under the scope of Personal Care Facility Licensing Act, Health and Safety Code, Chapter 247, which furnishes room, board, and one or more personal care services.

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.

Health care professional - An individual licensed, certified, or otherwise 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.

Immediately available - The capacity of facility staff to immediately respond to an emergency after being notified through a communication and/or alarm system. The staff is to be no more than 600 feet from the farthest resident.

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

(14)

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

(15)

Medication - Medication is:

any substance 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;

any substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease;

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

any substance intended for use as a component of any substance specified in this definition. It does not include devices or their components, parts, or accessories.

(16)

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.

(17)

Medication assistance or supervision - The assistance or supervision of the medication regimen by facility staff. Refer to §92.41(i) of this title (relating to Standards for Type A and Type B Facilities).

(18)

Medication (self-administration) - The capability of residents to administer their own medication/treatments without assistance from the facility staff.

(19)

NFPA 101 - The 1988 publication titled "NFPA 101 Life Safety Code" published by the National Fire Protection Association, Inc., Batterymarch Park, Quincy, Massachusetts 02269.

(20)

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

(21)

Person with a disclosable interest - A person with a disclosable interest is any person who owns five percent interest in any corporation, partnership, or other business entity that is required to be licensed under Health and Safety Code, Chapter 247. A person with a disclosable interest does not include a bank, savings and loan, savings bank, trust company, building and loan association, credit union, individual loan and thrift company, investment banking firm, or insurance company unless such entity participates in the management of the facility.

(22)

Personal care services - Assistance with meals, dressing, movement, bathing, or other personal needs or maintenance; the administration of medication or the assistance with or supervision of medication; 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 personal life, regardless of whether a guardian has been appointed for the person.

(23)

Physician - A practitioner licensed by the Texas State Board of Medical Examiners.

(24)

Resident - Anyone accepted for care in the assisted living facility.

(25)

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.

(26)

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.

(27)

Service plan - A written description of the medical care or the supervision and nonmedical care needed by a person.

(28)

Short-term acute episode - An illness of less than 30 days duration.

(29)

Staff - Any employee of an assisted living facility.

(30)

Standards - The minimum licensing standards in Subchapter C of this chapter (relating to Standards for Licensure) intended to protect the health and safety of the residents.

(31)

Terminal condition - A medical diagnosis, certified by a physician, of an illness which will result in death in six months or less.

(32)

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 bloodborne pathogens.

§92.4.Types of Assisted Living Facilities.

Types of assisted living facilities are as follows.

Type A. In a Type A facility a resident:

must be physically and mentally capable of evacuating the facility unassisted. This may include mobile nonambulatory persons such as those who are in wheelchairs or electric carts and have the capacity to transfer and evacuate themselves in an emergency;

does not require routine attendance during nighttime sleeping hours; and

must be capable of following directions under emergency conditions.

Type B. In a Type B facility a resident may:

require staff assistance to evacuate;

be incapable of following directions under emergency conditions;

require attendance during nighttime sleeping hours; or

not be permanently bedfast, but may require assistance in transferring to and from a wheelchair.

Type C. A four-bed facility which meets the minimum standards and program rules for enrollment with the Texas Department of Human Services as an adult foster care facility and is so enrolled on the effective date of this rule will be deemed licensed as a Type C facility without having to apply for an assisted living facility license.

At least 45 days prior to the renewal of its enrollment as an adult foster care facility, the facility must submit an application and fee for an assisted living license.

Failure to submit the application and fee prior to the date of re-enrollment as an adult foster care facility will result in loss of deemed licensure.

A facility seeking licensure as a Type C facility must meet the requirements of this chapter with the exception of those found in §92.41 of this title (relating to Standards for Assisted Living Facilities) and §§92.61-92.63 of this title (relating to Introduction and Application; General Requirements; and Plans, Approvals, and Construction Procedures), in lieu of which the facility must meet the minimum standards found in §§48.8901-48.8907 of this title (relating to Minimum Standards; Provider Qualifications; Substitute Provider Qualifications; Individuals Who May Not Provide Adult Foster Care Services; Home Enrollment Requirements; Enrollment and Licensure Requirements; and Provider Responsibilities).

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 12, 2000.

TRD-200004125

For further information, please call: (512) 438-3108

Subchapter B. APPLICATION PROCEDURES

40 TAC §§92.10 - 92.12, 92.15, 92.17 - 92.22

The amendments and new sections are adopted under the Health and Safety Code, Chapter 247, which authorizes the department to license personal care facilities.

The amendments and new sections implement the Health and Safety Code, Chapter 247.001-247.066.

§92.20.License Fees.

Basic fees.

Type A and Type B. The license fee is $100 plus $5 for each bed for which a license is sought, with a maximum of $750. The fee must be paid with each initial application and annually with each application for renewal of the license.

Type C. The license fee is $50. The fee must be paid with each initial application and annually with each application for renewal of the license.

Provisional license. The license fee is $75, plus $5 for each bed for which a license is sought, with a maximum of $750.

Increase in beds. An approved increase in beds is subject to an additional fee of $5 for each bed.

Alzheimer's certification. In addition to the basic license fee described in subsection (a) of this section, a facility that applies for certification to provide specialized services to persons with Alzheimer's disease or related conditions under Subchapter C of this chapter (relating to Standards for Licensure) must pay an annual fee of $100.

Trust fund fee.

In addition to the basic license fee described in subsection (a) of this section, the Texas Department of Human Services (DHS) has established a trust fund for the use of a court-appointed trustee as described in the Health and Safety Code, Chapter 242, Subchapter D, and Chapter 247, §247.003(b).

DHS charges and collects an annual fee from each institution licensed under Health and Safety Code, Chapter 247, each calendar year if the amount of the nursing and convalescent trust fund is less than $10,000,000. The fee is based on a monetary amount specified for each licensed unit of capacity or bed space, not to exceed $20 annually, and is in an amount sufficient to provide not more than $10,000,000 in the trust fund. In calculating the fee, the amount will be rounded to the next whole cent.

DHS may charge and collect a trust fund fee more than once a year only if necessary to ensure that the amount in the nursing and convalescent trust fund is sufficient to make the disbursements required under Health and Safety Code, §242.096.

(d)

Fees for plan reviews.

DHS charges a fee to review plans for new buildings, additions, conversion of buildings not licensed by DHS, or remodeling of existing licensed facilities.

The fee schedule is as follows.

New small Type A (4 to 16 beds based on residential board and care occupancy of the Life Safety Code, Chapter 21-2 Slow):

Single story - $900;

Multiple story - $1,100; and

Additions or remodeling - 2% of construction cost with a $350 minimum fee and a maximum of 50% of the plan review fee for a new facility of the same type.

New large Type A (17 or more beds based on residential board and care of the Life Safety Code, Chapter 21-3):

Single story:

facilities with 17-80 beds - $1,100;

facilities with 81-120 beds - 1,650; and

facilities with 121+ beds - $14 per bed.

Multiple story:

facilities with 17-80 beds - $1,650;

facilities with 81-120 beds - $2,150; and

facilities with 121+ beds - $18 per bed.

Additions or remodeling - 2% of construction cost with a $400 minimum fee and a maximum of 50% of the plan review fee for a new facility of the same type.

New small Type B (4 to 16 beds based on residential board and care occupancy of the Life Safety Code, Chapter 21-2 Impractical):

Single story - $1,100;

Multiple story - $1,650;

Additions or remodeling - 2% of construction cost with a $350 minimum fee and a maximum of 50% of the plan review fee for a new facility of the same type; and

Alzheimer's certification - $350 (in addition to above fees).

New large Type B (17 or more beds based on the health care occupancy of the Life Safety Code, Chapter 12):

Single story:

facilities with 17-80 beds - $1,600;

facilities with 81-120 beds - $2,150;

facilities with 121+ beds - $18 per bed;

Multiple story:

facilities with 17-80 beds - $2,100;

facilities with 81-120 beds - $2,650;

facilities with 121+ beds - $22 per bed;

Additions or remodeling - 2% of construction cost with $500 minimum fee and a maximum of 50% of the plan review fee for a new facility of the same type; and

Alzheimer's certification - $550 (in addition to the fees specified in clauses (i)-(iii) of this subparagraph).

(e)

Payment of fees. Payment of fees must be by check, cashier's check, or money order made payable to the Texas Department of Human Services. All fees are nonrefundable, except as provided by the Texas Government Code, Chapter 2005.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 12, 2000.

TRD-200004127

For further information, please call: (512) 438-3108

40 TAC §§92.18 - 92.20

The repeals are adopted under the Health and Safety Code, Chapter 247, which authorizes the department to license personal care facilities.

The repeals implement the Health and Safety Code, Chapter 247.001-247.066.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 12, 2000.

TRD-200004126

For further information, please call: (512) 438-3108

Subchapter C. STANDARDS FOR LICENSURE

40 TAC §92.41

The repeal is adopted under the Health and Safety Code, Chapter 247, which authorizes the department to license personal care facilities.

The repeal implements the Health and Safety Code, Chapter 247.001-247.066.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 12, 2000.

TRD-200004128

For further information, please call: (512) 438-3108

40 TAC §92.41, §92.53

The amendment and new section are adopted under the Health and Safety Code, Chapter 247, which authorizes the department to license personal care facilities.

The amendment and new section implement the Health and Safety Code, Chapter 247.001-247.066.

§92.41.Standards for Type A and Type B Assisted Living Facilities.

Employees.

Manager. Each facility must designate, in writing, a manager to have authority over the operation.

Qualifications. In small facilities, the manager must have proof of graduation from an accredited high school or certification of equivalency of graduation. In large facilities, a manager must have:

an associate's degree in nursing, health care management, or a related field;

a bachelor's degree; or

proof of graduation from an accredited high school or certification of equivalency of graduation and at least one year of experience working in management of in health care industry management.

Training in management of assisted living facilities. After August 1, 2000, a manager must have completed at least one educational course on the management of assisted living facilities, which must include information on the assisted living standards; resident characteristics (including dementia), resident assessment and skills working with residents; basic principles of management; food and nutrition services; federal laws, with an emphasis on the Americans with Disability Act's accessibility requirements; community resources; ethics, and financial management.

The course must be at least 24 hours in length.

Eight hours of training on the assisted living standards must be completed within the first three months of employment.

The 24-hour training requirement may not be met through inservices at the facility, but may be met through structured, formalized classes, correspondence courses, training videos, distance learning programs, or off-site training courses. All training must be provided or produced by academic institutions, assisted living corporations, or recognized state or national organizations or associations. Subject matter dealing with the internal affairs of an organization will not qualify for credit.

Evidence of training must be on file at the facility and must contain documentation of content, hours, dates, and provider.

Managers hired after August 1, 2000, who can show documentation of a previously completed comparable course of study are exempt from the training requirements.

Managers hired after August 1, 2000, must complete the course by the first anniversary of employment as manager.

An assisted living manager who was employed by a licensed assisted living facility on August 1, 2000, is exempt from the training requirement. An assisted living manager who was employed by a licensed assisted living facility as the manager prior to August 1, 2000, and changes employment to another licensed assisted living facility as the manager, with a break in employment of no longer than 30 days, is also exempt from the training requirement.

Continuing education. All managers must show evidence of 12 hours of annual continuing education. This requirement will be met during the first year of employment by the 24-hour assisted living management course. The annual continuing education requirement must include at least two of the following areas:

resident and provider rights and responsibilities, abuse/neglect, and confidentiality;

basic principles of management;

skills for working with residents, families, and other professional service providers;

resident characteristics and needs;

community resources;

accounting and budgeting;

basic emergency first aid; or

federal laws, such as Americans with Disabilities Act, Civil Rights Act of 1991, the Rehabilitation Act of 1993, Family and Medical Leave Act of 1993, and the Fair Housing Act.

Manager's responsibilities. The manager must be on duty 40 hours per week and may manage only one facility, except for managers of small Type A facilities, who may have responsibility for no more than 16 residents in no more than four facilities. The managers of small Type A facilities must be available by telephone or pager when conducting facility business off-site.

Manager's absence. An employee competent and authorized to act in the absence of the manager must be designated in writing.

Attendants. Full-time facility attendants must be at least 18 years old or a high-school graduate.

An attendant must be in the facility at all times when residents are in the facility.

Attendants are not precluded from performing other functions as required by the assisted living facility.

Staffing.

A facility must develop and implement staffing policies, which require staffing ratios based upon the needs of the residents, as identified in their service plans.

Prior to admission, a facility must disclose, to prospective residents and their families, the facility's normal 24-hour staffing pattern and post it monthly in accordance with §92.127 of this title (relating to Required Postings).

A facility must have sufficient staff to:

maintain order, safety, and cleanliness;

assist with medication regimens;

prepare and service meals that meet the daily nutritional and special dietary needs of each resident, in accordance with each resident's service plan.;

assist with laundry;

assure that each resident receives the kind and amount of supervision and care required to meet his basic needs; and

ensure safe evacuation of the facility in the event of an emergency.

A facility must meet the staffing requirements described in this subparagraph.

Type A facility: Night shift staff in a small facility must be immediately available. In a large facility, the staff must be immediately available and awake.

Type B facility: Night shift staff must be immediately available and awake, regardless of the number of licensed beds.

Staff training. The facility must document that staff members are competent to provide personal care prior to assuming responsibilities and have received the following training.

All staff members must complete four hours of orientation prior to assuming any job responsibilities. Training must cover, at a minimum, the following topics:

reporting of abuse and neglect;

confidentiality of resident information;

universal precautions;

conditions about which they should notify the facility manager;

residents' rights; and

emergency and evacuation procedures.

Attendants must complete 16 hours of on-the-job supervision and training within the first 16 hours of employment following orientation. Training must include:

providing assistance with the activities of daily living;

resident's health conditions and how they may affect provision of tasks;

safety measures to prevent accidents and injuries;

emergency first aid procedures, such as the Heimlich maneuver and actions to take when a resident falls, suffers a laceration, or experiences a sudden change in physical and/or mental status; and

managing dysfunctional behavior.

Direct care staff must complete six documented hours of education annually, based on each employee's hire date. Subject matter must address the unique needs of the facility. Suggested topics include:

promoting resident dignity, independence, individuality, privacy, and choice;

resident rights and principles of self-determination;

communication techniques for working with persons with hearing, visual, or cognitive impairment;

communicating with families and other persons interested in the resident;

common physical, psychological, social, and emotional changes that may accompany the aging process and how these changes affect residents' care;

essential facts about common physical and mental disorders that may increase with aging, for example, arthritis, cancer, dementia, depression, heart and lung diseases, sensory problems, or stroke;

cardiopulmonary resuscitation; and

common medications and side effects.

Facilities that employ licensed nurses, certified nurse aides, or certified medication aides must provide annual inservice training, appropriate to their job responsibilities, from one or more of the following areas:

communication techniques and skills useful when providing geriatric care (skills for communicating with the hearing impaired, visually impaired and cognitively impaired; therapeutic touch; recognizing communication that indicates psychological abuse);

assessment and nursing interventions related to the common physical and psychological changes of aging for each body system;

geriatric pharmacology, including treatment for pain management, food and drug interactions, and sleep disorders;

common emergencies of geriatric residents and how to prevent them, for example falls, choking on food or medicines, injuries from restraint use; recognizing sudden changes in physical condition, such as stroke, heart attack, acute abdomen, acute glaucoma; and obtaining emergency treatment;

common mental disorders with related nursing implications; and

ethical and legal issues regarding advance directives, abuse and neglect, guardianship, and confidentiality.

Social services. The facility must provide an activity and/or social program at least weekly for the residents.

Resident assessment. Within 14 days of admission, a facility must assess an individual and develop an individual service plan for providing care, which is based on the assessment. The service plan must be approved and signed by the resident or a person responsible for the resident's health care decisions. The facility must provide care according to the service plan.

The service plan must be updated annually and upon a significant change in condition, based upon an assessment of the resident.

For respite clients, the facility may keep a service plan for six months from the date on which it is developed. During that period, the facility may admit the individual as frequently as needed.

Emergency admissions must be assessed and a service plan developed for them.

(d)

Resident policies.

Prior to admitting a resident, facility staff must explain and provide a copy of the disclosure statement to the resident, family, or responsible party. An assisted living facility that provides brain injury rehabilitation services must attach to its disclosure statement a specific statement that licensure as an assisted living facility does not indicate state review, approval, or endorsement of the facility's rehabilitative services. The facility must document receipt of the disclosure statement.

The facility must provide residents with a copy of the Resident Bill of Rights.

The facility must have written policies regarding residents accepted, services provided, charges, refunds, responsibilities of facility and residents, privileges of residents, and other rules and regulations.

Each facility must make available copies of the resident policies to staff and to residents and/or residents' responsible parties at time of admission. Documented notification of any changes to the policies must occur before the effective date of the changes.

(e)

Admission policies.

A facility must not admit or retain:

residents whose needs cannot be met by the assisted living facility, or the necessary services secured by the resident. 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 at the facility. If the individual is appropriate for placement in an assisted living facility, then the decision that additional services are necessary and can be secured shall be the responsibility of facility management with written concurrence of the resident, resident's attending physician, or legal representative. Regardless of the possibility of "aging in place" or securing additional services, the facility must meet all life safety code requirements based on each resident's evacuation capabilities.

an individual requiring the services of facility employees who are licensed nurses on a daily or regular basis. Individuals with a terminal condition or experiencing a short-term, acute episode are excluded from this requirement.

There must be a written admission agreement between the facility and the resident. The agreement must specify such details as services to be provided and the charges for the services, including any nursing services and supplies, with a statement that such services and supplies could be a Medicare benefit.

A facility must share a copy of the facility disclosure statement, rate schedule, and individual resident service plan with outside resources providing any additional services to a resident. Outside resources must provide facilities with a copy of their resident care plans and must document, at the facility, any services provided, on the day provided.

Each resident must have a health examination by a physician performed within 30 days prior to admission or 14 days after admission, unless a transferring hospital or facility has a physical examination in the medical record.

The assisted living facility must secure at the time of admission of a resident the following identifying information: full name of resident; social security number; usual residence (where resident lived before admission); sex; marital status; date of birth; place of birth; usual occupation (during most of working life); family, other persons named by the resident, and physician for emergency notification; pharmacy preference; and Medicaid/Medicare number, if available.

(f)

Advance directives.

The facility must maintain written policies regarding the implementation of advance directives. The policies must include a clear and precise statement of any procedure the facility is unwilling or unable to provide or withhold in accordance with an advance directive.

The facility must provide written notice of these policies to residents at the time they are admitted to receive services from the facility.

If, at the time notice is to be provided, the resident is incompetent or otherwise incapacitated and unable to receive the notice, the facility must provide the written notice, in the following order of preference, to:

the resident's legal guardian;

a person responsible for the resident's health care decisions;

the resident's spouse;

the resident's adult child;

the resident's parents; or

the person admitting the resident.

If the facility is unable, after diligent search, to locate an individual listed under subparagraph (A) of this paragraph, the facility is not required to give notice.

If a resident who was incompetent or otherwise incapacitated and unable to receive notice regarding the facility's advance directives policies later becomes able to receive the notice, the facility must provide the written notice at the time the resident becomes able to receive the notice.

Failure to inform the resident of facility policies regarding the implementation of advance directives will result in an administrative penalty of $500.

Facilities will receive written notice of the recommendation for an administrative penalty.

Within 20 days after the date on which written notice is sent to a facility, the facility must give written consent to the penalty or make written request for a hearing to the Texas Department of Human Services (DHS).

Hearings will be held in accordance with DHS's formal hearing procedures in Chapter 79 of this title (relating to Legal Services).

(g)

Resident records.

Records pertaining to residents must be treated as confidential and properly safeguarded from unauthorized use, loss, or destruction.

Resident records must contain:

information contained in the facility's standard and customary admission form;

a record of the resident's assessments;

the resident's service plan;

physician's orders, if any;

any advance directives;

documentation of a health examination by a physician performed within 30 days prior to admission or 14 days after admission, unless a transferring hospital or facility has a physical examination in the medical record. Christian Scientists are excluded from this requirement; and

documentation by health care professionals of any services delivered in accordance with the licensing, certification, or other regulatory standards applicable to the health care professional under law.

Records must be available to residents, their legal representatives, and DHS staff.

(h)

Personnel records. The facility must keep personnel records on all staff in a central location.

Medications.

Administration. Medications must be administered according to physician's orders.

Residents who choose not to or can not self-administer their medications must have their medications administered by a person who:

holds a current license under state law which authorizes the licensee to administer medication; or

holds a current medication aide permit and acts under the authority of a person who holds a current nursing license under state law which authorizes the licensee to administer medication. A medication aide must function under the direct supervision of a licensed nurse on duty or on call by the facility.

is an employee of the facility to whom the administration of medication has been delegated by a registered nurse, who has trained them to administer medications or verified their training. The delegation of the administration of medication is governed by 22 TAC 218 (Delegation of Selected Nursing Tasks), which implements the Nurse Practice Act.

All resident's prescribed medication shall be dispensed through a pharmacy or by the resident's treating physician or dentist.

Physician sample medications may be given to a resident by the facility provided the medication has specific dosage instructions for the individual resident.

Each resident's medications must be listed on an individual resident's medication profile record. The recorded information obtained from the prescription label must include, but is not limited to, the medication name, strength, dosage, amount received, directions for use, route of administration, prescription number, pharmacy name, and the date each medication was issued by the pharmacy.

Supervision. Supervision of a resident's medication regimen by facility staff may be provided to residents who are incapable of self-administering without assistance to include and limited to:

reminders to take their medications at the prescribed time;

opening containers or packages and replacing lids;

pouring prescribed dosage according to medication profile record;

returning medications to the proper locked areas;

obtaining medications from a pharmacy; and

listing on a individual resident's medication profile record the medication name, strength, dosage, amount received, directions for use, route of administration, prescription number, pharmacy name, and the date each medication was issued by the pharmacy.

Self-administration.

Residents who self-administer their own medications and keep them locked in their room shall be counseled at least once a month by facility staff to ascertain if the residents continue to be capable of self-administering their medications/treatments and if security of medications can continue to be maintained. A written record of counseling shall be kept by the facility.

Residents who choose to keep their medications locked in the central medication storage area may be permitted entrance or access to the area for the purpose of self-administering their own medication/treatment regimen. A facility staff member shall remain in or at the storage area the entire time any resident is present.

General.

Facility staff will immediately report to the resident's physician and responsible party any unusual reactions to medications or treatments.

When the facility supervises or administers the medications, a written record shall be kept when the resident does not receive or take his/her medications/treatments as prescribed. The documentation shall include the date and time the dose should have been taken, and the name and strength of medication missed; however, the recording of missed doses of medication does not apply when the resident is away from the assisted living facility.

Storage.

The facility must provide a locked area for all medications. Examples of areas but are not limited to:

Each resident's medication must be stored separately from other resident's medications within the storage area.

central storage area;

A refrigerator must have a designated and locked storage area for medications requiring refrigeration, unless it is inside a locked medication room.

Poisonous substances and medications labeled for "external use only" must be stored separately within the locked medication area.

If facilities store controlled drugs, facility policies and procedures must address the prevention of the diversion of the controlled drugs.

Disposal.

Medications no longer being used by the resident for the following reasons are to be kept separate from current medications and are to be disposed of by a registered pharmacist licensed in the State of Texas:

medications discontinued by order of the physician;

medications which remain after a resident is deceased; or

medications which have passed the expiration date.

Needles and hypodermic syringes with needles attached must be disposed as required by 25 TAC §§1.131-1.137 (Definition, Treatment, and Disposal of Special Waste from Health Care Related Facilities).

Medications kept in a central storage area are released to discharged residents when a receipt has been signed by the resident or responsible party.

(j)

Accident, injury, or acute illness.

In the event of accident or injury requiring emergency medical, dental or nursing care, or in the event of apparent death, the assisted living facility will:

make arrangements for emergency care and/or transfer to an appropriate place for treatment, such as a physician's office, clinic, or hospital;

immediately notify the resident's physician and next of kin, responsible party, or agency who placed the resident in the facility; and

describe and document the injury, accident, or illness on a separate report. The report must contain a statement of final disposition and be maintained on file.

The facility must stock and maintain in a single location first aid supplies to treat burns, cuts, and poisoning.

Residents who need the services of professional nursing or medical personnel due to a temporary illness or injury may have those services delivered by persons qualified to deliver the necessary service.

(k)

Resident finances. The assisted living facility must keep a simple financial record on all charges billed to the resident for care and these records must be available to DHS. If the resident entrusts the handling of any personal finances to the assisted living facility, a simple financial record must be maintained to document accountability for receipts and expenditures, and these records must be available to DHS. Receipts for payments from residents or family members must be issued upon request.

(l)

Food and nutrition services.

A person designated by the facility is responsible for the total food service of the facility.

At least three meals or their equivalent must be served daily, at regular times, with no more than a 16-hour span between a substantial evening meal and breakfast the following morning. All exceptions must be specifically approved by DHS.

Menus must be planned one week in advance and must be followed. Variations from the posted menus must be documented. Menus must be prepared to provide a balanced and nutritious diet, such as that recommended by the National Food and Nutrition Board. Food must be palatable and varied. Records of menus as served must be filed and maintained for 30 days after the date of serving.

Therapeutic diets as ordered by the resident's physician must be provided according to the service plan. Therapeutic diets which cannot customarily be prepared by a lay person must be calculated by a qualified dietician. Therapeutic diets which can customarily be prepared by a person in a family setting may be served by the assisted living facility.

Supplies of staple foods for a minimum of a four-day period and perishable foods for a minimum of a one-day period must be maintained on the premises.

Food must be obtained from sources that comply with all laws relating to food and food labeling. If food, subject to spoilage, is removed from its original container, it must be kept sealed, and labeled. Food subject to spoilage must also be dated.

Plastic containers with tight fitting lids are acceptable for storage of staple foods in the pantry.

Potentially hazardous food, such as meat and milk products, must be stored at 45 degrees Fahrenheit or below. Hot food must be kept at 140 degrees Fahrenheit or above during preparation and serving. Food which is reheated must be heated to a minimum of 165 degrees Fahrenheit.

Freezers must be kept at a temperature of 0 degrees Fahrenheit or below and refrigerators must be 41 degrees Fahrenheit or below. Thermometers must be placed in the warmest area of the refrigerator and freezer to assure proper temperature.

Food must be prepared and served with the least possible manual contact, with suitable utensils, and on surfaces that prior to use have been cleaned, rinsed, and sanitized to prevent cross-contamination.

Facilities must prepare food in accordance with established food preparation practices and safety techniques.

A food service employee, while infected with a communicable disease that can be transmitted by foods, or who is a carrier of organisms that cause such a disease or while afflicted with a boil, an infected wound, or an acute respiratory infection, must not work in the food service area in any capacity in which there is a likelihood of such person contaminating food or food-contact surfaces with pathogenic organisms or transmitting disease to other persons.

Effective hair restraints must be worn to prevent the contamination of food.

(14)

Tobacco products must not be used in the food preparation and service areas.

(15)

Kitchen employees must wash their hands before returning to work after using the lavatory.

(16)

Dishwashing chemicals used in the kitchen may be stored in plastic containers if they are the original in which the manufacturer packaged the chemicals.

(17)

Sanitary dishwashing procedures and techniques must be followed.

(18)

Facilities housing 17 or more residents must comply with 25 TAC §§229.161-229.171 and §§229.173-229.175 (Texas Food Establishment rules) and local health ordinances or requirements must be observed in the storage, preparation, and distribution of food; in the cleaning of dishes, equipment, and work area; and in the storage and disposal of waste.

(m)

Infection control.

Each facility must establish and maintain an infection control policy and procedure designated to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection.

The facility must comply with departmental rules regarding special waste in 25 TAC §§1.131-1.137 (Definition, Treatment, and Disposition of Special Waste from Health Care Related Facilities).

The name of any resident of a facility with a reportable disease as specified in 25 TAC §§97.1-97.13 (Control of Communicable Diseases) shall be reported immediately to the city health officer, county health officer, or health unit director having jurisdiction, and appropriate infection control procedures shall be implemented as directed by the local health authority.

The facility must have written policies for the control of communicable disease in employees and residents, which includes tuberculosis (TB) screening and provision of a safe and sanitary environment for residents and employees.

If employees contract a communicable disease that is transmissible to residents through food handling or direct resident care, the employee must be excluded from providing these services as long as a period of communicability is present.

The facility must maintain evidence of compliance with local and/or state health codes or ordinances regarding employee and resident health status.

The facility must screen all employees for tuberculosis within two weeks of employment and annually, according to Center for Disease Control (CDC) screening guidelines. All persons providing services under an outside resource contract must, upon request of the facility, provide evidence of compliance with this requirement.

All residents should be screened upon admission and after exposure to tuberculosis, in accordance with the attending physician's recommendations and CDC guidelines.

Personnel must handle, store, process, and transport linens so as to prevent the spread of infection.

Universal precautions must be used in the care of all residents.

(n)

Access to residents. The facility must allow an employee of the Texas Department of Mental Health and Mental Retardation or an employee of a local mental health and mental retardation authority into the facility as necessary to provide services to a resident.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 12, 2000.

TRD-200004129

For further information, please call: (512) 438-3108

Subchapter D. FACILITY CONSTRUCTION

40 TAC §§92.61, 92.62, 92.64

The amendments and new section are adopted under the Health and Safety Code, Chapter 247, which authorizes the department to license personal care facilities.

The amendments and new section implement the Health and Safety Code, Chapter 247.001-247.066.

§92.62.General Requirements.

General. The concept of the National Fire Protection Association (NFPA) 101 Life Safety Code requirements for fire safety with regard to the residents, is based on evacuation capability. In accordance with Chapter 21 of this title (relating to Residential Board and Care Occupancies), Type A facilities are classified "slow" evacuation capability and Type B facilities are classified "impractical" evacuation capability.

Evacuation procedures. Residents in Type A facilities must be able to demonstrate to the Texas Department of Human Services (DHS) that they can travel from their living unit to a centralized space, such as lobby, living or dining room on the level of discharge within a 13-minute period without continuous staff assistance. Elevators cannot be used as an evacuation route.

Operational features.

All fires causing damage to the facility and/or equipment must be reported to DHS within 72 hours. Any fire causing injury or death to a resident shall be reported immediately. A telephone report must be followed by a written report on a form which will be supplied by DHS.

Fire drills must be conducted quarterly on each shift and with at least one drill conducted each month. The drills may be announced in advance to the residents. The drills must involve the participation of the staff in accordance with the emergency plan. Residents must be informed of evacuation procedures and locations of exits. All fire drills must be documented on a form provided by DHS. In large Type B facilities, the drill must include the activation of the fire alarm signal, except between 9:00 p.m. and 6:00 a.m.

Smoking regulations must be established, and smoking areas must be designated for residents and staff. Ashtrays of noncombustible material and safe design must be provided in smoking areas.

All facilities, except small, one-story facilities, must post an emergency evacuation floor plan.

The administration must have in effect and available to all supervisory personnel written copies of a plan for the protection of all persons in the event of fire and for their remaining in place, for their evacuation to areas of refuge, and from the building when necessary. The plan must include special staff actions including fire protection procedures needed to ensure the safety of any resident and must be amended or revised when needed. All employees must be periodically instructed and kept informed with respect to their duties and responsibilities under the plan. A copy of the plan must be readily available at all times within the facility. This written plan must reflect the current evacuation capabilities of the residents.

(d)

Safety operations. The facility must have a written emergency preparedness and response plan. Procedures to be followed in an internal or external disaster should be attached to the plan. The plan must address, at a minimum, the eight core functions of emergency management, which are: direction and control; warning (how the facility will be notified of emergencies and who they will notify); communication (with whom and by what mechanism); sheltering arrangements; evacuation (destinations, routes); transportation; health and medical needs; and resource management (supplies, staffing, emergency equipment, records). Plans must be coordinated with the local emergency management coordinator and should address those natural, technological and man-made emergencies that could affect the facility. Information about the local emergency management coordinator may be obtained from the office of the local mayor or county judge.

(e)

Construction.

There must be separation from other occupancies. A common wall between an assisted living facility and another occupancy must be not less than a two-hour fire-rated partition. (The partition must be as defined by National Fire Protection Association Standards.) A licensed nursing facility or licensed hospital is not considered another occupancy for this purpose. An exception is where an unlicensed occupancy occurs in the same building or structure and is so intermingled that separate safeguards are impracticable. The means of egress, construction, protection and other safeguards must comply with the National Fire Protection Association (NFPA) 101 requirements of the licensed occupancy.

Interior wall and ceiling surfaces must have as the finished surface or as substrate or sheathing a fire resistance of not less than that provided by 3/8" gypsum board (20 minute fire rating), unless approved otherwise by DHS. A sprinkler system will not substitute for the minimum construction requirements. An exception is Type B large facilities shall meet the construction requirements of NFPA 101, Chapter 12, §12-1.6.

Flame spread rate requirements must be as specified in NFPA 101, §6-5. Flame spread is 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).

Doors between resident rooms and corridors or public spaces must be not less than 1-3/4" thick solid core wood construction or 20-minute fire-rated, self-closing or automatic-closing, and latch in their frames. Exceptions are as follows.

Small Type A facilities can have smoke resisting doors, with self-closing or automatic closing devices, provided the interior finish is Class 'B' or better and there are two remote exit routes.

Small Type A facilities that have 20-minute fire-rated doors (or 1-3/4" solid core wood), Class 'B' or better interior finish, and two remote exit routes are not required to be self-closing or automatic-closing.

In Small and Large Type A facilities protected throughout by an approved automatic sprinkler system, doors to resident bedrooms are not required to be self-closing or automatic-closing, except a three story or larger building which does not meet construction requirements of NFPA 101, Chapter 12.

In small and large Type B facilities protected throughout by an approved automatic sprinkler system, the facility may have smoke resisting doors. Door-closing devices are not required.

Upper floors must have at least two separate approved stairs. Each stair must be arranged and located so that it is not necessary to go through another room (such as bedroom or bath) to reach the stair. All stairs must be provided with handrails and with normal lighting. Refer to NFPA 101 for Class 'A' stair details. An exception is that for existing 16 beds or less: at least one main stair may be Class 'B'. Such stairs may be constructed of wood.

All hazardous areas, as defined in the NFPA 101, Chapter 21 or 12, must be one-hour fire-separated or provided with sprinkler protection or both if considered severe. Gasoline, volatile materials, oil base paint, or similar products must not be stored in the building housing residents.

Exit signs, with emergency power, must be provided in all large facilities and installed in accordance with NFPA 101, §5-10.

Emergency lighting must be provided in all buildings with 25 or more rooms; in apartment buildings with 12 or more living units or which are 3 or more stories in height; and in all large facilities that are designed for Type B. The system must be installed in accordance with NFPA 101, §5-9.

Emergency motor generators, if required or provided, must be installed in accordance with NFPA 37 or NFPA 110 or other applicable standard.

(f)

Fire alarm and sprinkler systems.

Fire alarm and smoke detection system. An underwriter's laboratory (U.L.) listed manual fire alarm initiating system, with an interconnected automatic smoke detection and alarm initiation system, must be provided in accordance with the NFPA 101, §7-6. The operation of any alarm initiating device will sound an audible/visual alarm(s) at the site.

Smoke detectors must be installed in resident bedrooms, corridors, hallways, living rooms, dining rooms, offices, and public or common areas. Service areas, such as kitchens, laundries and attached garages used for car parking may have heat detectors in lieu of smoke detectors. Exceptions are as follows.

Large facilities with apartment units may use listed smoke detectors with an alarm device and separate heat detector contacts in the living area. The smoke detectors must provide an audible signal within the apartment, and annunciate at the main staff station or location. The heat detector contacts must be connected into the fire alarm system and provide a general alarm when activated.

A facility constructed to meet NFPA 101, Chapter 12, need only meet §12-3.4.5.1. for smoke detector locations.

The fire alarm control panel must be visible to staff at or near the staff area that is attended 24 hours a day. An exception to this requirement is a fire alarm control panel that is monitored by a device carried by the staff.

The primary power source for the complete fire alarm system must be commercial electric and permanently wired for power on a dedicated circuit in accordance with the National Electrical Code.

Emergency power source must be from approved storage batteries or on-site engine-driven generator set.

The facility must have a written contract with a fire alarm firm which has been issued an Alarm Certificate of Registration (ACR) number from the Texas State Fire Marshal's Office to perform the inspection, test and maintenance requirements of NFPA 72 semiannually. Inspections stipulated in the contract must be performed. The person performing the semiannual service must have an individual fire alarm license from the Texas State Fire Marshal's Office. All other NFPA 72 requirements should be performed and documented by a knowledgeable individual.

Smoke detector sensitivity must be checked within one year after installation and every alternate year thereafter in accordance with NFPA 72. Documentation, including as-built installation drawings, operation and maintenance manuals, and a written sequence of operation, must be available for examination by DHS.

In large facilities, the fire alarm panel must indicate as a separate zone, each floor and/or smoke compartment. Each zone must have an alarm and trouble indication.

In large Type B facilities the fire alarm must automatically notify the fire department in accordance with NFPA 101, §7-6.4.

Small Type A facilities, licensed for eight beds or less, may provide a manual fire alarm system, with smoke detection that complies with Household Fire Warning Equipment (NFPA 74), at a minimum.

Sprinkler systems. When installed or required, sprinkler systems must be inspected, tested, and maintained in accordance with NFPA 25. The facility must have a written contract with a fire protection sprinkler firm, that has been issued a Sprinkler Certificate of Registration number (SCR) from the Texas State Fire Marshal's Office, to perform the required services semiannually. The facility must have documentation available to show that all the requirements of NFPA 25 have been met including the annual inspection, test, and maintenance by the registered fire sprinkler firm. The facility should retain one set of the fire sprinkler system plans and hydraulic calculations on the property.

Small Type A facilities housing 16 or fewer residents may have a system that meets NFPA 13D requirements. Small Type B facilities housing 16 or fewer residents must be protected by a sprinkler system in compliance with NFPA 13 or NFPA 13D, with additional requirements for coverage in all habitable areas and closets as specified by NFPA 101, Chapter 21.

Large Type B facilities must have a complete NFPA 13 system.

Large Type A facilities may have an NFPA 13R system (up to and including three stories).

(g)

Site and location.

The facility must be serviced by a paid or volunteer fire fighting unit as approved by DHS. Water supply for fire fighting purposes must be as required and approved by the fire fighting unit.

Any site or building conditions that are a fire hazard, health hazard, or physical hazard must have corrections made as determined by DHS.

The facility must provide or arrange for nearby parking spaces for private vehicles of residents and visitors. A minimum of one space must be provided for each four beds or fraction thereof, or per local code, whichever is more stringent.

Ramps, walks, and steps must be of slip-resistive texture and uniform, without irregularities. Ramps must not exceed 1:12 slope, and shall meet handicap standards for width. Guardrails, fences, or handrails must be provided where grades make an abrupt change in level.

All outside areas, grounds, adjacent buildings, etc., on the site must be maintained in good condition and kept free of rubbish, garbage, untended growth, etc., that may constitute a fire or health hazard. Site grades must provide for water drainage away from the structure to prevent ponding or standing water at or near the building.

(h)

Sanitation and housekeeping.

Waste water and sewage must be discharged into an approved sewerage system or an onsite sewerage facility approved by the Texas Natural Resource Conservation Commmission or its authorized agent.

The water supply must be of safe, sanitary quality, suitable for use, and adequate in quantity and pressure, and must be obtained from a water supply system, the location, construction, and operation of which are approved by DHS.

Waste, trash, and garbage must be disposed of from the premises at regular intervals in accordance with state and local practices. Excessive accumulations are not permitted. The facility must comply with 25 TAC §§1.131-1.137 (Definition, Treatment, and Disposal of Special Waste from Health Care Related Facilities).

Operable windows must be insect screened.

An ongoing pest control program must be provided by facility staff or by contract with a licensed pest control company. The least toxic and least flammable effective chemicals must be used.

All bathrooms, toilet rooms, and other odor-producing rooms or areas for soiled and unsanitary operations must be ventilated with operable windows or powered exhaust to the exterior for odor control. An exception is that small facilities may vent into an attic in accordance with the Uniform Building Code or local building code.

In kitchens and in laundries, there must be procedures utilized by facility staff to avoid cross-contamination between clean and soiled utensils and linens.

The facility must be kept free of accumulations of dirt, rubbish, dust, and hazards. Floors must be maintained in good condition and cleaned regularly; walls and ceilings must be structurally maintained, repaired, and repainted or cleaned as needed. Storage areas and cellars must be kept in an organized manner. No storage will be permitted in the attic spaces.

The facility must be capable of being ventilated through the use of windows, mechanical ventilation, or a combination of both. Interior areas designated for smoking within the building must have mechanical ventilation directed to the exterior to remove smoke at the rate of 10 air changes per hour.

In addition to janitor closet(s) called for in specific departments of large facilities, other janitor closet(s) must be provided throughout the facility to maintain a clean and sanitary environment. Each janitor closet must have a service sink and forced air ventilation ducted to the outside.

A public/staff toilet, i.e. commode and lavatory, complying with accessibility standards is required for every large facility up to and including 60 beds. Facilities over 60 beds must have separate public and staff toilets in addition to the staff toilet(s) required for the dietary staff.

If the facility provides linens to the residents, the quantity of available linen must meet the sanitary and cleanliness needs of the residents. Clean linens must be stored in a clean area.

General safety features.

The facility must have an annual inspection by the local fire marshal as part of the renewal procedures listed in §92.15 of this title (relating to Renewal Procedures and Qualifications).

The building must be kept in good repair; electrical, heating, and cooling must be maintained in a safe manner. DHS may require the facility sponsor or licensee to submit evidence to this effect, consisting of a report from the fire marshal, city/county building official having jurisdiction, licensed electrician, or a registered professional engineer. Use of electrical appliances, devices, and lamps must be such as not to overload circuits or cause excessive lengths of extension cords.

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

In large Type B facilities, all draperies and other window coverings in public or common areas, and in bedrooms and/or living units must be flame resistant. In large Type A facilities, draperies must be flame resistant, where smoking is permitted.

In large facilities, all new floor carpet installed in public or common spaces after the initial inspection by DHS must be Class I or II based on the "Critical Radiant Flux" ratings. Proper documentation must be provided.

Open flame heating devices are prohibited. All fuel burning heating devices must be vented. Working fireplaces are acceptable if of safe design and construction and if screened or otherwise enclosed.

There must be at least one telephone in the facility available to both staff and residents for use in case of an emergency. Emergency telephone numbers, including at least fire, police, ambulance, EMS, and poison control center, must be posted conspicuously at or near the telephone.

An initial pressure test of facility gas lines from the meter must be provided. Additional pressure tests will be required when the facility has major renovations or additions where the gas service is interrupted. All gas heating systems must be checked prior to the heating season for proper operation and safety by persons who are licensed or approved by the State of Texas to inspect such equipment. A record of this service must be maintained by the facility. Any unsatisfactory conditions must be corrected promptly.

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

Cooling and heating must be provided for occupant comfort. Conditioning systems must be capable of maintaining the comfort ranges of 68 degrees Fahrenheit to 82 degrees Fahrenheit in resident-use areas. Heating, ventilating, and air conditioning (HVAC) equipment must comply with the provisions of NFPA 90A or 90B, as applicable. NFPA 90A requires automatic shut down upon activation of the fire alarm in HVAC systems of over 2,000 cubic feet per minute (cfm) capacity.

The Illumination Engineering Society of North America recommendations must be followed to achieve proper illumination characteristics and lighting levels throughout the facility. Minimum illumination must be 10 footcandles in resident rooms during the day and 20 footcandles in corridors, staff stations, dining rooms, lobbies, toilets, bathing facilities, laundries, stairways and elevators during the day. Illumination requirements for these areas apply to lighting throughout the space and should be measured at approximately 30 inches above the floor anywhere in the room. Minimum illumination for medication preparation or storage areas, kitchens, and staff station desks must be 50 footcandles during the day. Illumination requirements for these areas apply to the task performed and should be measured on the tasks.

All buildings three floors or higher and in facilities that provide services, treatment, or social activities on floors above or below the level of discharge and which house mobility impaired residents must have a passenger elevator. The lowest level of discharge will be the first floor for determining floor level.

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

(14)

All equipment requiring periodic maintenance, testing, and servicing must be reasonably accessible. Necessary equipment to conduct these services, such as ladders, specific tools, and keys, must be readily available on site. Access panels (20" x 20" minimum) must be provided for building maintenance and must be located for reasonable access to equipment or barriers installed in the attic or other concealed spaces.

(15)

The facility must implement procedures, in accordance with the standards and recommendations of the Compressed Gas Association, that assure safe and sanitary use and storage of oxygen. Liquid oxygen containers must be certified by Underwriters Laboratory (UL) or other approved testing laboratory for compliance with NFPA 50 requirements. The facility is responsible for defining all potential hazards both graphically and verbally to all persons involved in the use of liquid oxygen and ensuring the liquid oxygen provider does also.

(j)

Portable fire extinguishers. Portable fire extinguishers must be provided and maintained to comply with the provisions of the National Fire Protection Association (NFPA) 10. This includes such items as type of extinguishers (A, B, or C), location and spacing, mounting heights, monthly inspections by staff, yearly inspections by a licensed agent (with any necessary servicing), and hydrostatic testing as recommended by the manufacturer.

Extinguishers in resident corridors must be spaced so that travel distance is not more than 75 feet. The minimum size of extinguishers must be either 2 1/2 gallon for water type or five pound for ABC type. In large facilities, at least one portable Underwriters Laboratory (U.L.) or factory mutual (F.M.)-approved five-pound Class B:C dry chemical fire extinguisher, rechargeable type, is required in each laundry, kitchen and walk-in mechanical room.

Extinguishers must be installed on supplied hangers or brackets or be mounted in cabinets approved by the Texas Department of Human Services (DHS).

Extinguishers must be surface wall-mounted or recessed in cabinets where they are not subject to physical damage or dislodgement.

Extinguishers having a gross weight not exceeding 40 pounds must be installed so that the top of the extinguisher is not more than five feet above the floor. Extinguishers with a gross weight greater than 40 pounds must be installed so the top of the extinguisher is not more than 3 1/2 feet above the floor. The clearance between the bottom of the extinguisher and the floor must not be less than four inches.

Portable extinguishers provided in hazardous rooms must be located as close as possible to the exit door opening and on the latch (knob) side.

Staff must be appropriately trained in the use of each type of extinguisher in the facility.

Regular monthly inspections or "quick checks" must be made by facility representatives to assure that extinguishers are in the proper location, condition, and working order. Annual maintenance or "thorough checks" must be accomplished in accordance with National Fire Protection Association Standard Number 10A (NFPA 10A) by competent personnel licensed or certified to perform servicing by the State Fire Marshal. Unserviceable extinguishers must be replaced.

(k)

Waste and storage containers.

Metal waste baskets of substantial gauge or any U.L. or F.M. approved containers must be provided in large Type B facilities and in all facilities in all areas where smoking is permitted.

Garbage, waste, or trash containers provided for kitchens, janitor closets, laundries, mechanical or boiler rooms, general storage, and similar places must be made of metal or any U.L. or F.M. approved material, having a close fitting cover. Disposable plastic liners may be used in these containers for sanitation.

(l)

Accessibility provisions. The physical plant of all large facilities and all other facilities housing residents with physical disabilities and/or mobility impairments must comply with applicable federal, state and local requirements for persons with disabilities.

(m)

Resident accommodations.

Resident bedrooms.

Bedroom usable floor space for Type A facilities must not be less than 80 square feet for a one-bed room and not less than 60 square feet per bed for a multiple bed room. A bedroom must be not less than eight feet in the smallest dimension, unless specifically approved otherwise by the department. Bedrooms for persons with physical disabilities and/or mobility impairment must meet accessibility standards for access around the bed or beds, i.e., minimum of 3'-0" clear width for access aisles.

Bedroom usable floor space for Type B facilities must be not less than 100 square feet per bed for a single-bed room and not less than 80 square feet per bed for a multiple-bed room. Bedrooms for persons with physical disabilities and/or mobility impairment must meet accessibility standards for access around the bed or beds, i.e., minimum of 3'-0" clear width for access aisles. A bedroom must not be less than ten feet in the smallest dimension unless specifically approved otherwise by DHS.

In facilities that have living units consisting of separate living/dining spaces and bedrooms, 10% of the required bedroom square footage may be included as part of the living/dining space.

A facility must have no more than 50% of its beds in bedrooms of three or more. A bedroom must have no more than four beds.

Each bedroom must have at least one operable window with outside exposure. The window sill must be no higher than 44" from the floor and must be at or above grade level. The window will be operable from the inside, without the use of tools or special devices, and provide an operable section with a clear opening of not less than 5.7 square feet (minimum width of 20" x 41.2" high and minimum height of 24" x 34.2" wide). Windows required for evacuation will not be blocked by bars, shrubs, or any obstacle that would impede evacuation. Exceptions are as follows.

In large Type B facilities and other facilities protected throughout by an approved automatic sprinkler system, the window opening size may be smaller than the minimum size listed but must permit the venting of products of combustion in accordance with the Life Safety Code for Healthcare Occupancy. The total window area in a bedroom must not be less than 8% of the required bedroom size.

In existing buildings, if the window is not required for the secondary means of escape, the window size and sill height requirements will not apply provided the windows meet the Uniform Building Code requirements or local building code.

In the event the resident does not provide his or her own furnishings, the facility must provide for each resident a bed with mattress, chair, table or dresser, and enclosed closet space for clothing and personal belongings. Drawer space must be provided. Furnishings provided by the facility must be maintained in good repair.

All resident rooms must open upon an exit, corridor, living area, or public area and must be arranged for convenient resident access to dining and recreation areas.

A staff or attendant area must be provided on each floor or in each separate building. The area must consist of a desk or writing surface and telephone. An exception is that Type A facilities, two-story or less in height, with separate buildings grouped together, and connected by covered walks, need not have staff or attendant areas on each floor or in each building, provided that the areas are not more than 200 feet walking distance from the furthest resident living unit. The areas must have a communication system and fire alarm annunciation indicating the units served.

Facilities which consist of two or more floors or separate buildings must have a communication system from each resident living unit to a central staff location. This communication system may be a direct telephone, nurse call, or intercom.

Resident toilet and bathing facilities.

All bedrooms must be served by separate private, connecting, or general toilet rooms for each sex (if facility houses both sexes). General toilet room or bathing room must be accessible from a corridor or public space. A lavatory must be readily accessible to each water closet. At least one water closet, lavatory, and bathing unit must be provided on each sleeping floor accessible to residents of that floor.

One water closet and one lavatory for each six occupants or fraction thereof (portion less than six) is required. One tub or shower for each ten occupants or fraction thereof is required.

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

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

Resident-use hot water for lavatories and bathing units will be maintained between 100 degrees Fahrenheit and 120 degrees Fahrenheit.

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

Resident living areas.

Social-diversional spaces such as living rooms, day rooms, lounges, sun rooms, etc., must be provided and have appropriate furniture. A minimum of 120 square feet must be provided in at least one space regardless of number of residents. This space must have exterior windows providing a view of the outside.

The total space requirement for social-diversional areas must be provided on a sliding scale as follows:

Figure: 40 TAC §92.62(m)(3)(B)

Where a required way of exit (or a service way) is through such living or dining area, a pathway equal to the corridor width will normally be deducted for calculation purposes and discounted from that area. Such exit pathways must be kept clear of obstructions.

Resident dining areas.

A dining area must be provided and have appropriate furnishings. A minimum of 120 square feet must be provided in at least one space, regardless of number of residents. This space must have exterior windows providing a view of the outside.

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

The total space requirement for a dining area must be provided on a sliding scale as follows:

Figure: 40 TAC §92.62(m)(4)(C)

The total living-dining area(s) can be a single or interconnecting space with a minimum of 240 square feet of area.

Storage areas. The facility must provide sufficient separate storage spaces or areas for the following:

administration for records and office supplies;

locked areas for medications and medical supplies. Poisons must be stored in a locked area and separate from all medications and preparation;

equipment supplied by the facility for resident needs such as wheelchairs, walkers, beds, mattresses, etc.;

cleaning supplies (janitorial needs);

food storage;

clean linens and towels if furnished by the facility;

lawn and maintenance equipment, if needed;

janitor(s) closet with deep sink and hot and cold water (large facilities only); and

soiled linen storage or holding room(s), if the facility furnishes linen.

Kitchen.

The facility must have a kitchen or dietary area to meet the general food service needs of the residents. It must include provisions for the storage, refrigeration, preparation, and serving of food; for dish and utensil cleaning; and for refuse storage and removal. Exception: Food may be prepared off-site or in a separate building provided that the food is served at the proper temperature and transported in a sanitary manner.

Kitchens (main/dietary) for facilities serving 17 or more non-employees per meal, on a routine basis, must be as follows.

Kitchens will be evaluated on the basis of their performance in the sanitary and efficient preparation and serving of meals to residents and compliance with provisions covering dietary service in §92.41(h)(18) of this title (relating to Standards for Type A and Type B Assisted Living Facilities).

Consideration must be given to planning for the type of meals served, the overall building design, the food service equipment, arrangement, and the work flow involved in the preparation and delivery of food.

Plans must include a detailed kitchen layout designed by a registered or licensed dietitian or architect having knowledge in the design of food service operations.

Kitchens must be designed so that room temperature, at peak load (summertime), must not exceed 85 degrees Fahrenheit measured over the room at the five foot level. The amount of supply air must take into account the large quantities of air that may be exhausted at the range hood and dishwashing area.

Facilities for washing and sanitizing dishes and cooking utensils must be provided. The kitchen must contain a multi-compartment pot sink large enough to immerse pots and pans, and a mechanical dishwasher for washing and sanitizing dishes. Separation of soiled and clean dish areas must be maintained, including air flow.

A food preparation sink must be provided. It must be separate from the pot and hand sinks.

A supply of hot and cold water must be provided. Hot water for sanitizing purposes must be 180 degrees Fahrenheit or the manufacturer's suggested temperature for chemical sanitizers.

The kitchen must be provided with a hand-washing lavatory in the food preparation area with hot and cold water, soap, towel dispenser, and waste receptacle. The dish room area must have ready access to a handwashing lavatory.

Staff restroom facilities with lavatory must be directly accessible to kitchen staff without traversing resident use areas. The rest room must not open directly into the kitchen (i.e., provide a vestibule). An exception is that staff rest rooms in existing facilities must be provided, but may be located outside of the kitchen area.

Janitorial facilities must be provided exclusively for the kitchen and must be located in the kitchen area. An exception is that Janitorial closets in existing facilities may be located outside of the kitchen area provided sanitary procedures are used to reduce the possibility of cross-contamination.

(ix)

Non-absorbent smooth finishes or surfaces must be used on kitchen floors, walls and ceilings. Such surfaces must be capable of being routinely cleaned and sanitized to maintain a healthful environment. Counter and cabinet surfaces, inside and outside, must also have smooth, cleanable, non-porous finishes.

(x)

Doors between kitchen and dining or serving areas must have 1/4-inch fixed wire glass view panel mounted in a steel frame.

(xi)

A garbage can or cart washing area with drain and hot water must be provided either on the interior or exterior of the facility.

(xii)

Floor drains must be provided in the kitchen and dishwashing areas. Exception: Floor drains are not required in existing facilities provided the floors are kept clean.

(xiii)

A commercial range must be provided and equipped with a commercial range hood and exhaust designed and installed in accordance with NFPA 96. Small facilities with residential ranges may have residential range hoods, if they meet the Uniform Building Code (or local building code).

(xiv)

Grease traps must be provided as required.

Food storage areas for large facilities must be as follows.

Food storage areas must provide for storage of a four-day minimum supply of non-perishable foods at all times.

Shelves must be adjustable wire type. An exception is that existing facilities with wood shelves may continue to use the shelves provided they are kept sealed and clean.

Walls and floors must have a non-absorbent finish to provide a cleanable surface.

Food must not be stored on the floor. Dollies, racks, pallets, or wheeled containers may be used to elevate foods not stored on shelving.

Dry foods storage must have an effective venting system to provide for positive air circulation.

The maximum room temperature for food storage must not exceed 85 degrees Fahrenheit at any time. The measurement must be taken at the highest food storage level, but not less than five feet from the floor.

Food storage areas may be located apart from the food preparation area as long as there is space adjacent to the kitchen for necessary daily usage.

Auxiliary serving kitchens (not contiguous to food preparation/serving area) must be as follows.

Where service areas other than the kitchen are used to dispense foods, these must be designated as food service areas and must have equipment for maintaining required food temperatures while serving.

Separate food service areas must have handwashing facilities as part of the food service area.

Finishes of all surfaces must be the same as those required for food and nutrition services or comparable areas.

Laundry/linen services.

A large assisted living facility which co-mingles and processes laundry on-site in a central location must comply with the following.

The laundry must be separated and provided with sprinkler protection if located in the main building. (Separation must consist of a one-hour fire rated partition carried to the underside of the floor or roof deck above.) Access doors must be from the exterior or interior non-resident use areas, such as a small vestibule or service corridor.

The laundry must be provided with the following physical features:

a soiled linen receiving, holding, and sorting room with a floor drain and forced exhaust to the exterior which must operate at all times there is soiled linen being held in this area. (This may be combined with the washer section.);

a general laundry work area which is separated by partitioning two areas - a washer section and a dryer section;

a storage area for laundry supplies;

(IV)

a folding area;

(V)

adequate air supply and ventilation for staff comfort without having to rely on opening a door that is part of the fire wall separation; and

(VI)

provisions to exhaust heat from dryers and to separate dryer make-up air from the habitable work areas of the laundry.

If linen is processed off the site, the following must be provided on the premises:

a soiled linen holding room (provided with adequate forced exhaust ducted to the exterior); and

a clean linen receiving, holding, inspection, sorting or folding, and storage room(s).

Resident-use laundry, if provided, must utilize residential type washers and dryers. If more than three washers and three dryers are located in one space, the area must be one-hour fire separated or provided with sprinkler protection.

§92.64.Plans, Approvals, and Construction Procedures.

At the option of the applicant, the Texas Department of Human Services (DHS) will review plans for new buildings, additions, conversion of buildings not licensed by DHS, or remodeling of existing licensed facilities. DHS will, within 30 days, inform the applicant of the results of the review. If the plans comply with DHS's architectural requirements, DHS may not subsequently change the architectural requirement applicable to the project unless the change is required by federal law or the applicant fails to complete the project within a reasonable time.

Submittal of plans.

For review of plans, before construction is begun, submit one copy of working drawings and specifications (contract documents) in sufficient detail to interpret compliance with these standards and assure proper construction. Documents must be prepared according to accepted architectural practice and must include general construction, special conditions, and schedules.

Final copies of plans must have (in the reproduction process by which plans are reproduced) a title block showing name of facility, person, or organization preparing the sheet, sheet numbers, facility address, and drawing date. Sheets and sections covering structural, electrical, mechanical, and sanitary engineering final plans, designs, and specifications must bear the seal of a registered professional engineer approved by the State Board of Registration for Professional Engineers to operate in Texas. Contract documents for additions, remodeling, and construction of an entirely new facility must be prepared by an architect licensed by the Texas State Board of Architectural Examiners. Drawings must bear the seal of the architect.

A final plan for a major addition to a facility must include a basic layout to scale of the entire building onto which the addition connects. North direction must be shown. Usually the entire basic layout can be to scale such as 1/16 inch per foot or 1/32 inch per foot for very large buildings.

Plans and specifications for conversions or remodeling must be complete for all parts and features involved.

The sponsor is responsible for employing qualified personnel to prepare the contract documents for construction. If the contract documents have errors or omissions to the extent that conformance with standards cannot be reasonably assured or determined, a revised set of documents for review may be requested.

The review of plans and specifications by DHS is based on general utility, the minimum licensing standards, and conformance of the Life Safety Code, and is not to be construed as all-inclusive approval of the structural, electrical, or mechanical components, nor does it include a review of building plans for compliance with the Texas Accessibility Standards as administered and enforced by the Texas Department of Licensing and Regulation.

Fees for plan review will be required in accordance with §92.20 of this title (relating to License Fees).

Contract documents.

Site plan documents must include grade contours; streets (with names); North arrow; fire hydrants, fire lanes, utilities, public or private; fences; and unusual site conditions, such as ditches, low water levels, other buildings on-site, and indications of buildings five feet or less beyond site property lines.

Foundation plan documents must include general foundation design and details.

Floor plan documents must include room names, numbers, and usages; doors (numbered) including swing; windows; legend or clarification of wall types; dimensions; fixed equipment; plumbing fixtures; kitchen basic layout; and identification of all smoke barrier walls (outside wall to outside wall) or fire walls.

For both new construction and additions or remodeling to existing buildings, an overall plan of the entire building must be drawn or reduced to fit on an 8 1/2 inch by 11 inch sheet.

Schedules must include door materials, widths, and types; window materials, sizes, and types; room finishes; and special hardware.

Elevations and roof plan must include exterior elevations, including material note indications and any roof top equipment; roof slopes, drains, gas piping, etc., and interior elevations where needed for special conditions.

Details must include wall sections as needed, especially for special conditions; cabinet and built-in work, basic design only; cross sections through buildings as needed and miscellaneous details and enlargements as needed.

Building structure documents must include structural framing layout and details (primarily for column, beam, joist, and structural building); roof framing layout (when cannot be adequately shown on cross section); and cross sections in quantity and detail to show sufficient structural design and structural details as necessary to assure adequate structural design and calculated design loads.

Electrical documents must include electrical layout, including lights, convenience outlets, equipment outlets, switches, and other electrical outlets and devices; service, circuiting, distribution, and panel diagrams; exit light system (exit signs and emergency egress lighting); emergency electrical provisions (such as generators and panels); staff communication system; fire alarm and similar systems (such as control panel, devices, and alarms); and sizes and details sufficient to assure safe and properly operating systems.

(J)

Plumbing documents must include plumbing layout with pipe sizes and details sufficient to assure safe and properly operating systems, water systems, sanitary systems, gas systems, and other systems normally considered under the scope of plumbing, fixtures, and provisions for combustion air supply.

(K)

Heating, ventilating and air-conditioning systems (HVAC) documents must include sufficient details of HVAC systems and components to assure a safe and properly operating installation including, but not limited to, heating, ventilating, and air-conditioning layout, ducts, protection of duct inlets and outlets, combustion air, piping, exhausts, and duct smoke and/or fire dampers; and equipment types, sizes, and locations.

(L)

Sprinkler system documents must include plans and details of National Fire Protection Association (NFPA) designed systems; plans and details of partial systems provided only for hazardous areas; and electrical devices interconnected to the alarm system.

(M)

Specifications must include installation techniques; quality standards and/or manufacturers; references to specific codes and standards; design criteria; special equipment; hardware; finishes; and any others as needed to amplify drawings and notes.

(N)

Other layout, plans, or details as may be necessary for a clear understanding of the design and scope of the project, including plans covering private water or sewer systems, must be reviewed by local health or wastewater authority having jurisdiction.

Construction phase.

DHS must be notified in writing prior to construction start.

All construction not done in accordance with the completed plans and specifications as submitted for review and as modified in accordance with review requirements will require additional drawings if the change is significant.

Initial survey of completed construction.

Upon completion of construction, including grounds and basic equipment and furnishings, a final construction inspection (initial survey) of the facility must be performed by DHS prior to admitting residents, unless a provisional license has been granted. An initial architectural inspection will be scheduled after DHS receives a notarized licensure application, required fee, fire marshall approval, and a letter from an architect or engineer stating to the best of their knowledge that the facility meets the architectural requirements for licensure.

After the completed construction has been surveyed by DHS and found acceptable, this information will be forwarded to the DHS Licensing Section as part of the information needed to issue a license to the facility. In the case of additions or remodeling of existing facilities, a revision or modification to an existing license may be necessary. Note that the building, including basic furnishings and operational needs, grades, drives, and parking must essentially be 100% complete at the time of this initial visit for occupancy approval and licensing. A facility may accept up to three residents between the time it receives initial approval from DHS and the time the license is issued unless a provisional license has been granted.

The following documents must be available to DHS's NFPA 101 inspecting surveyor at the time of the survey of the completed building:

written approval of local authorities as required in subparagraph (A) of this paragraph;

written certification of the fire alarm system by the installing agency (Form FML-009) of the Texas State Fire Marshal);

documentation of materials used in the building which are required to have a specific limited fire or flame spread rating, including special wall finishes or floor coverings, flame retardant curtains (including cubicle curtains), rated ceilings, etc., and, in the case of carpeting, a signed letter from the installer verifying that the carpeting installed is named in the laboratory test document;

approval of the completed sprinkler system installation by the Texas Department of Insurance or designing engineer. A copy of the material list and test certification must be available;

service contracts for maintenance and testing of alarm systems, sprinkler systems, etc.;

a copy of gas test results of the facility's gas lines from the meter;

a written statement from an architect/engineer stating, to the best of his/her knowledge, the building was constructed in substantial compliance with the construction documents, the Life Safety Code, DHS licensure standards, and local codes; and

any other such documentation as needed.

Nonapproval of new construction.

If, during the initial on-site survey of completed construction, the surveyor finds certain basic requirements not met, DHS may recommend that the facility not be licensed and approved for occupancy. Such items may include the following:

substantial changes made during construction which were not submitted to DHS for review and which may require revised "as-built" drawings to cover the changes. This may include architectural, structural, mechanical, and electrical items as specified in paragraph (3)(B) of this section);

construction which does not meet minimum code or licensure standards, such as corridors being less than required width, ceilings installed at less than the minimum seven-foot six-inch height, resident bedroom dimensions less than required, and other such features which would disrupt or otherwise adversely affect the residents and staff if corrected after occupancy;

no written approval by local authorities;

fire protection systems, including, but not limited to, fire alarm systems, emergency power and lighting, and sprinkler systems, not completely installed or not functioning properly;

required exits not all usable according to NFPA 101 requirements;

telephone not installed or not properly working;

sufficient basic furnishings, essential appliances, and equipment not installed or not functioning; and

any other basic operational or safety feature which would preclude safe and normal occupancy by residents on that day.

If the surveyor encounters only minor deficiencies, licensure may be recommended based on an approved written plan of correction from the facility's administrator.

Copies of reduced size floor plans on an 8 1/2 inch by 11 inch sheet must be submitted in duplicate to DHS for record/file use and for the facility's use for evacuation plan, fire alarm zone identification, etc. The plan must contain basic legible information such as scale, room usage names, actual bedroom numbers, doors, windows, and any other pertinent information.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 12, 2000.

TRD-200004130

For further information, please call: (512) 438-3108

Subchapter E. INSPECTIONS, SURVEYS, AND VISITS

40 TAC §92.82

The repeal is adopted under the Health and Safety Code, Chapter 247, which authorizes the department to license personal care facilities.

The repeal implements the Health and Safety Code, Chapter 247.001-247.066.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 12, 2000.

TRD-200004131

For further information, please call: (512) 438-3108

The new section is adopted under the Health and Safety Code, Chapter 247, which authorizes the department to license personal care facilities.

The new section implements the Health and Safety Code, Chapter 247.001-247.066.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 12, 2000.

TRD-200004132

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Effective date: August 1, 2000

Proposal publication date: December 31, 1999

For further information, please call: (512) 438-3108

Subchapter F. ABUSE, NEGLECT AND EXPLOITATION; COMPLAINT AND INCIDENT REPORTS AND INVESTIGATIONS

40 TAC §92.102

The amendment is adopted under the Health and Safety Code, Chapter 247, which authorizes the department to license personal care facilities.

The amendment implements the Health and Safety Code, Chapter 247.001-247.066.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 12, 2000.

TRD-200004133

For further information, please call: (512) 438-3108

Subchapter G. MISCELLANEOUS PROVISIONS

40 TAC §92.123, §92.125

The amendments are adopted under the Health and Safety Code, Chapter 247, which authorizes the department to license personal care facilities.

The amendments implement the Health and Safety Code, Chapter 247.001-247.066.

§92.123.Investigation of Facility Employees.

Each facility must comply with the provisions of Chapter 250 of the Health and Safety Code (relating to Criminal History Checks of Employees and Applicants for Employment in Certain Facilities Serving the Elderly or Persons with Disabilities).

Before a facility hires an employee, the facility must search the employee misconduct registry established under §253.007, Health and Safety Code, and the Texas Department of Human Services nurse aide registry to determine whether the individual is designated in either registry as having abused, neglected, or exploited a resident or a consumer of a facility. Both registries can be contacted at 1-800-452-3934.

A facility may not employ a person who is listed in either registry as having abused, neglected, or exploited a resident or a consumer of a facility.

Each facility is required to provide written notification upon hiring and to all employees:

about the employee misconduct registry; and

that a person may not be employed if listed on the registry.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 12, 2000.

TRD-200004134

For further information, please call: (512) 438-3108

Subchapter H. ENFORCEMENT

40 TAC §§92.152, 92.153, 92.155, 92.158

The amendments are adopted under the Health and Safety Code, Chapter 247, which authorizes the department to license personal care facilities.

The amendments implement the Health and Safety Code, Chapter 247.001-247.066.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 12, 2000.

TRD-200004135