EMERGENCY RULESAn agency may adopt a new or amended section or repeal an 
existing section on an emergency basis if it determines that such action is 
necessary for the public health, safety, or welfare of this state. The section 
may become effective immediately upon filing with the Texas Register, or on a 
stated date less than 20 days after filing and remaining in effect no more than 
120 days. The emergency action is renewable once for no more than 60 additional 
days.
Symbology in amended emergency sections. New language added to an existing 
section is indicated by the use of bold text. [Brackets] indicate deletion of 
existing material within a section.

TITLE 22. EXAMINING BOARDS
PART XIII. Texas Board of Nursing Facility Administrators 
CHAPTER 241. Nursing Facility Administrators
22 TAC sec.241.19, sec.241.20
The Texas Board of Nursing Facility Administrators (board) adopts on an 
emergency basis new sec.241.19 and sec.241.20 concerning nursing facility 
administration. In compliance with the Texas Nursing Facility Administrators 
Licensure Act, Texas Civil Statutes, Article 4512q, sec.8 and sec.22 (Act), new 
sec.241.19 establishes standards of licensing conduct as a code of ethics, and 
new sec.241.20 empowers the board to impose administrative penalties on nursing 
facility administrators who fail to comply with the new standards of conduct. 
The new sections are adopted on an emergency basis to prevent further improper 
actions by nursing facility administrators regulated by the Act that could have 
posed an imminent threat to the health, safety, and welfare of residents of 
nursing facilities. These improper actions include abuse and neglect, both of 
which have caused or contributed to unnatural deaths. It is imperative that the 
board address the serious and potential harm to residents of nursing facilities 
as soon as possible. The new sections are also proposed for permanent adoption 
in this issue of the Texas Register.
The new sections are adopted on an emergency basis under the Nursing Facility 
Administrators Licensure Act, Texas Civil Statutes, Article 4512q, Health and 
Safety Code, sec.8(b)(1) which provides the board the authority to adopt rules 
consistent with this article regarding a code of ethics, and sec.20(a) 
authorizing the board to assess administrative penalties, and sec.22(a) 
authorizing the board to impose administrative penalties; and under the 
Government Code, sec.2001.034, which provides the board with the authority to 
adopt rules on an emergency basis. concerning nursing facility administration.

sec.241.19. Standards of Conduct. 
(a) A nursing facility administrator (licensee) who fails to comply with the 
provisions of the Texas Nursing Facility Administration Act, TCS, Art. 4512q, 
sec.8 (Act), or this chapter, may be disciplined by the board in accordance with 
sec.sec.20 or 22 of the Act or sec.241.11 of this title (relating to Adverse 
Licensure Actions) and sec.241.20 of this title relating to (Administrative 
Penalties). 
(1) A licensee shall ensure that sufficient personnel are present in number and 
ability to assure the health and safety of a resident. 
(2) A licensee shall ensure that sufficient resources are present to assure that 
nutrition, medications and treatments, including restraints, are in accordance 
with physician orders. 
(3) A licensee, either knowingly or through negligence, shall not personally 
commit or allow or direct actions by employees, contractors, or volunteers which 
result or could result in failure to protect and promote the rights of each 
resident. 
(4) A licensee, either knowingly or through negligence, shall not allow or 
direct actions which result or could result in failure to protect residents from 
harmful actions of the nursing facility employees, including but not limited to 
coercion, threat, intimidation, solicitation, harassment, cruelty or 
indifference to the welfare of the residents. 
(5) A licensee, either knowingly or through negligence, shall not personally 
commit or allow or direct actions by employees, contractors, or volunteers which 
result or could result in inadequate care, harm, or injury to the resident. 
(6) A licensee, either knowingly or through negligence, shall not allow or 
direct actions which result or could result in failure to follow a physician's 
order or the altering in any way of a physician's order for any resident's 
medical or therapeutic care. 
(7) A licensee shall not commit or knowingly allow another to commit any act of 
abuse or neglect of a resident, as defined by 40 TAC sec.19.101. 
(8) A licensee shall not fail to notify, or allow or direct actions which result 
in failure to notify, an appropriate governmental agency of any suspected cases 
of abuse or neglect as defined by 40 TAC sec.19.101.
(9) A licensee shall not permit his or her license to be used by another person. 
(10) A licensee shall not knowingly allow, aid, abet, sanction, or condone a 
violation of the Act or this chapter by another licensed nursing facility 
administrator and shall report such violations to the board.
(11) A licensee shall not advertise or knowingly participate in the 
advertisement of nursing home services in a manner which is fraudulent, false, 
deceptive, or misleading in form or content. 
(12) A licensee shall not make or allow employees, contractors, or volunteers to 
make misrepresentations or fraudulent statements about the operation of the 
nursing facility. 
(13) A licensee shall not allow or direct actions which result in bribery, 
harassment or intimidation of any person designed to cause that person to use 
the services or equipment of any particular health agency or facility. 
(14) A licensee shall not bill or knowingly allow another person to bill for 
services other than those actually rendered. 
(15) A licensee shall not make or file or allow employees, contractors, or 
volunteers to make or file a report or record which the licensee knows to be 
false. 
(16) A licensee shall not intentionally fail to file a report or record required 
by state or federal law; impede or obstruct such filing; or induce another 
person to impede or obstruct such filing. 
(17) A licensee shall not fail to notify, allow, or direct actions which result 
in failure to notify an appropriate governmental agency of any suspected cases 
of criminal activity as defined by state and federal laws. 
(18) A licensee shall notify the board of changes in the licensee's name, 
preferred mailing address, and place of employment within 30 days of such 
change. 
(19) A licensee shall not use or knowingly allow an employee or another person 
to use alcohol, narcotics or other drugs in a manner which interferes with the 
performance of the administrator or other person's duties.
(20) A licensee shall be subject to disciplinary action for having had a license 
to practice nursing home administration revoked or suspended or having other 
disciplinary action imposed or consenting to the imposition of such other 
disciplinary action by the proper licensing authority of another state, 
territory, or country. 
(21) A licensee shall not knowingly violate any confidentiality provisions as 
prescribed by state or federal law concerning a resident. 
(22) A licensee shall post in the nursing facility where the administrator is 
employed in a conspicuous place and in clearly legible type the notice provided 
by the board giving the name, address, and telephone number of the board and 
stating that complaints about the administrator may be made to the board. 
(23) A licensee shall not interfere with a board investigation by 
misrepresenting facts to the board or its authorized representative, or by using 
threats or harassment against any person involved or participating in the 
investigation. 
(24) A licensee shall not display a license issued by the board which has been 
reproduced, altered, expired, suspended, or revoked.
(25) A licensee shall not or knowingly allow other individuals to mismanage the 
personal funds of residents deposited with the facility.
(26) A licensee shall establish written policies that address the safeguarding 
of personal property of residents of the facility and shall monitor the 
effectiveness of the policies. 
(27) A licensee shall ensure that the nursing facility is physically maintained 
in a way that protects the health and safety of residents and the public. 
(28) A licensee shall not bribe or attempt to bribe, harass or intimidate a 
governmental agency, its employees, or its agents in regard to the 
administration of the nursing facility. 
(b) In determining disciplinary action the board may consider:
(1) responsibility and response of the licensee prior to, during, and after the 
occurrence; 
(2) extenuating circumstances; 
(3) repeat complaints against a licensee; and 
(4) severity of harm to residents.

sec.241.20. Administrative Penalties. 
The purpose of this section is to provide for monetary penalties for a nursing 
facility administrator who fails to comply with the Standards of Conduct as 
proposed in new sec.241.19, of this title (relating to Standards of Conduct.) 
(1) The assessment of an administrative penalty is governed by the Texas Nursing 
Facility Administration Act (Act) sec.22. 
(2) The board may impose an administrative penalty against a person licensed or 
regulated under the Act who violates the Act, this chapter, or an order adopted 
by the board under the Act. 
(3) The penalty for a violation may be in an amount not to exceed $1,000. Each 
day a violation continues or occurs is a separate violation for purposes of 
imposing a penalty. 
(4) The executive secretary may issue a report that states the facts in which 
the determination is based and the executive secretary's recommendation on the 
imposition of a penalty, including a recommendation on the amount of the penalty 
as required by the Act, sec.22(d) to the complaints committee of the board. The 
report shall not be considered to be issued under the Act, sec.22(e) until and 
unless the complaints committee decides to recommend the imposition of an 
administrative penalty.
(5) The chairman of the board shall appoint a hearing examiner from the Texas 
Department of Health (TDH). 
(6) A hearing to assess administrative penalties shall be governed by sec.241.17 
of this title (relating to Formal Hearings Procedures) except where the section 
is in conflict with the Act. 
(7) The seriousness of a violation shall be categorized by one of the following 
severity levels: 
(A) Level I - violations that have or have had an adverse impact on the health 
or safety of a resident to include serious harm, permanent injury or death to a 
resident; 
(B) Level II - violations which have or have had a potential or adverse impact 
on the health and safety of a resident, but less than Level I; or 
(C) Level III - violations that have no or minor health or safety significance. 
(8) The ranges of administrative penalties by severity levels are as follows: 
(A) Level I - $500 - $1,000; 
(B) Level II - $250 - $500; and 
(C) Level III - no more than $250.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Issued in Austin, Texas, on October 18, 1996.
TRD-9615316
Michael O. Sims
Chair
Texas Board of Nursing Facility Administrators
Effective date: October 18, 1996
Expiration date: February 16, 1997
For further information, please call: (512) 458-7236