Part 1.
TEXAS DEPARTMENT OF HUMAN SERVICES
Chapter 19.
NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
Subchapter T. ADMINISTRATION
40 TAC §19.1921, 19.1929
The Texas Department of Human Services (DHS) adopts amendments
to §19.1921 and §19.1929 in its Nursing Facility Requirements for
Licensure and Medicaid Certification chapter. The amendment to §19.1929
is adopted with changes to the proposed text published in the January 24,
2003, issue of the
Texas Register
(28 TexReg
656). The amendment to §19.1921 is adopted without changes to the proposed
text.
Justification for the amendment to §19.1921 is to further enhance
resident and public understanding of the level of staffing within all licensed
facilities. Regarding those facilities that are Medicaid-certified, this amendment
implements 42 United States Code (U.S.C.) 1396r(b), which requires nursing
facilities to post the number of licensed and unlicensed nursing staff directly
responsible for resident care daily in the facility for each shift and to
provide this information to the public upon request. Although the federal
law applies only to Medicaid nursing facilities, DHS chose to apply the requirement
to all licensed facilities, because consumer access to information on staffing
patterns is important across all facilities. The amendment also adds language
pertaining to notification requirements regarding facility closures. This
language was deleted inadvertently from the rule base during a previous rule
change, and this amendment corrects the deletion.
Justification for the amendment to §19.1929 is to fulfill a pledge
DHS made to the Senate Committee on Health and Human Services to add annual
staff training requirements on restraints to nursing facility licensure rules.
The amendment also corrects a citation.
DHS received a written comment regarding the §19.1921 staff posting
amendment from the Texas Health Care Association (THCA). DHS also received
written comments from Advocacy, Inc., regarding the §19.1929 restraint
amendment. A summary of the comments and DHS's responses follow. Advocacy,
Inc., also addressed a similar proposal to §92.41 in DHS's Licensing
Standards for Assisted Living Facilities chapter, which was published in the
same issue of the
Texas Register
(28 TexReg
665).
Comment: THCA objects to the proposed requirement of providing the posted
staff information to the public upon request and recommends deleting the second
sentence of §19.1921(e)(12). This sentence is vague and could be interpreted
to mean that the posted numbers could be requested at a later date. DHS could
be creating an unnecessary record- keeping requirement for facilities that
use non-permanent methods of displaying the required information. Nursing
facility staffing data is already available in other formats, and this requirement
would make it necessary to collect this data, too.
Response: DHS does not agree with the comment and retains the language
as proposed. The proposed language is taken verbatim from the federal language
at 42 U.S.C. 1396r(b)(8)(B). DHS interprets this to mean that a facility will
provide the daily staffing numbers, either by writing down the information
written on a non-permanent display or by copying the posted document, if requested.
Facilities would be required to provide the staffing numbers on a daily basis
only on request. This requirement should not create unnecessary record keeping
for facilities.
Comment: Advocacy, Inc., commented that the proposed language at §19.1929
mandates one hour of training on restraint reduction and fall prevention;
however, the training needs to recognize other situations in which restraints
are used. The training should specifically address de-escalation techniques
and how to apply a restraint appropriately. One hour is insufficient to provide
the information necessary to address prevention issues and application of
restraints adequately. Additionally, rather than mandate clock hours, the
training should be competency-based. An individual must be able to demonstrate
physically and in writing what he or she learned. The regulations need to
define restraint more clearly and describe the difference between a personal/physical
restraint, which is involuntary, and an escort or physical support, which
is voluntary. The nursing facility regulations should reflect the proposed
language in the assisted living facility regulations on this issue specific
to training. The regulation at §92.41(a)(4)(B)(vi) reads, "behavior management,
including prevention of aggressive behavior and de-escalation techniques,
or fall prevention, or alternatives to restraints"; and at §92.41(a)(4)(C)
reads in part, "Direct care staff must ... One hour of annual training must
address behavior management, including prevention of aggressive behavior and
de-escalation techniques, or fall prevention or alternatives to restraints";
however, the language in (C) should not be an "or," it should be "and."
The federal regulations define a restraint as any manual method, or physical
or mechanical device, material or equipment attached or adjacent to the resident
that restricts freedom of movement. It also addresses the use of medication
as a restraint.
The proposed language focuses on prevention of falls, which implies that
restraints in nursing facilities are used solely as protective and supportive
devices. While this is certainly a need for this population, providers and
DHS fail to acknowledge and address other situations in which restraints are
used, specifically emergency situations. To do so, the regulations must define
an emergency. Advocacy, Inc., recommends the following language: Emergency
is a situation in which attempted preventative, de-escalatory or redirection
techniques have not effectively reduced the potential for injury and it is
immediately necessary to intervene to prevent:
(A) imminent probable death or substantial bodily harm to the person, because
the person overtly or continually threatens to or attempts to commit suicide
or serious bodily harm; or
(B) imminent physical harm to another because the person overtly or continually
makes or commits threats, attempts, or other acts.
Restraints, particularly personal restraints, often are used in situations
where a resident is not in control of his or her behavior and there is imminent
risk of harm to a resident or someone else. A restraint used in this manner
should be regulated differently from redirecting someone who may be lost or
supporting someone who is unsteady on their feet. Nursing facility residents
sometimes exhibit behaviors that necessitate restraints that are not supportive
or protective devices. Individuals diagnosed as having Alzheimer's disease
often manifest certain behavior problems. A report published by the Office
of Inspector General in January 2001 speaks to the large and growing number
of younger nursing facility residents with mental illness. The behaviors that
often justified admission to an inpatient psychiatric facility require use
of personal restraints, as opposed to supportive or protective devices. Residents
in nursing facilities who have mental illness may exhibit behavior problems.
Staff, on occasion, restrain residents physically. As a result, it is imperative
that the state assume its responsibility to adopt regulations that provide
direction on how such restraints should be implemented and that staff be adequately
trained on the use of physical restraints and de-escalation.
Response: Although DHS agrees that nursing facility residents have a right
to be free of unnecessary, excessive or inappropriate restraints, it does
not agree with all suggested changes to the proposed rules. DHS retains most
of the language as proposed.
DHS believes that focusing restraint reduction education on the common
clinical problems that lead to the majority of restraint use is the most direct
and effective way to bring about restraint reduction. DHS research into restraint
use shows that 96% of all restraints used in Texas nursing facilities are
intended to prevent falls and wandering, despite the fact that this is an
inappropriate practice. The proposed language does not imply that restraints
are used solely as protective and supportive devices.
In response to comments regarding the need for training on behavior management,
DHS added rule language that allows facilities to choose to train on behavior
management, including prevention of aggressive behavior and de-escalation
techniques. DHS agrees that requiring competency-based training should be
required to confirm that learning has taken place and adds the following language
to proposed §19.1929(1)(B): restraint reduction and the prevention of
falls through competency-based training. Facilities also may choose to train
on behavior management, including prevention of aggressive behavior and de-escalation
techniques.
The proposed sections do not require one hour of training on the reduction
of restraints and fall prevention. The proposal requires those topics to be
covered in orientation and annual training. Each facility determines the amount
of time to allocate to the training and may choose to allocate more than one
hour to the training.
Regarding the need for a definition of emergency, §19.101(37) defines
emergency as sudden change in a resident's condition requiring immediate medical
or surgical intervention. This definition reflects the fact that nursing facilities
serve persons with medical problems. An individual must have a medical condition
that requires physician oversight and regular skilled nursing care to obtain
Medicaid payment for a nursing facility stay. Nursing facility residents,
even those discharged from a state hospital, must have a bona fide medical
condition. Mental illness does not qualify an individual for eligibility for
nursing facility care. As stated before, DHS's research shows restraint use
is overwhelmingly directed at the prevention of falls and wandering. DHS,
therefore, does not believe an additional definition for emergency that focuses
on behavioral problems is necessary.
Finally, the current definitions of restraints (chemical and physical)
are federal definitions developed under the Omnibus Budget Reconciliation
Act of 1987. The definitions have been in use since October 1990 and are well
accepted and understood by surveyors and providers. The survey process is
based on the federal definitions, so new definitions were not introduced.
The amendments are adopted under the Health and Safety Code,
Chapter 242, which authorizes DHS to license and regulate convalescent and
nursing homes and related institutions.
The amendments implement the Health and Safety Code, §§242.001-242.852
§19.1929.Staff Development.
Each facility must implement and maintain programs of orientation,
training, and continuing in-service education to develop the skills of its
staff, as described in §19.1903 of this title (relating to Required Training
of Nurse Aides).
(1)
As part of orientation and annually, each employee must
receive instruction regarding:
(A)
Human Immunodeficiency Virus (HIV), as outlined in the
educational information provided by the Texas Department of Health Model Workplace
Guidelines. At a minimum the HIV curriculum must include:
(i)
modes of transmission;
(ii)
methods of prevention;
(iii)
behaviors related to substance abuse;
(iv)
occupational precautions;
(v)
current laws and regulations concerning the rights of an
acquired immune deficiency syndrome/HIV-infected individual; and
(vi)
behaviors associated with HIV transmission which are in
violation of Texas law; and
(B)
restraint reduction and the prevention of falls through
competency-based training. Facilities also may choose to train on behavior
management, including prevention of aggressive behavior and de-escalation
techniques.
(2)
Nursing staff, licensed nurses, and nurse aides must receive
annual in-service training which includes components, appropriate to their
job responsibilities, from one or more of the following categories:
(A)
communication techniques and skills useful when providing
geriatric care, such as skills for communicating with the hearing impaired,
visually impaired and cognitively impaired; therapeutic touch; and recognizing
communication that indicates psychological abuse;
(B)
assessment and nursing interventions related to the common
physical and psychological changes of aging for each body system;
(C)
geriatric pharmacology, including treatment for pain management
and sleep disorders;
(D)
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, and acute glaucoma; and obtaining emergency treatment;
(E)
common mental disorders with related nursing implications;
and
(F)
ethical and legal issues regarding advance directives,
abuse and neglect, guardianship, and confidentiality.
(3)
Facilities with pediatric residents must comply with the
following:
(A)
Facility staff must be trained in the use of pediatric
equipment and supplies, including emergency equipment and supplies.
(B)
Facility staff should receive annual continuing education
dealing with pediatric issues, including child growth and development and
pediatric assessment.
(4)
Minimum continuing in-service education requirements are
listed in subparagraphs (A)-(B) of this paragraph. Attendance at relevant
outside training may be used to satisfy the in-service education requirement.
The facility must keep in-service records for each employee listed. The minimum
requirements are:
(A)
licensed personnel--two hours per quarter; and
(B)
nurse aides--12 hours annually. For the purpose of this
paragraph, a medication aide is considered a nurse aide and must receive the
same continuing in-service education. This in- service education does not
qualify as continuing education units required for renewal of a medication
aide permit.
(5)
A rural hospital participating in the Medicaid Swing Bed
Program as specified in §19.2326 of this title (relating to Medicaid
Swing Bed Program for Rural Hospitals) is not required to meet the requirements
of this section, if the swing beds are used for no more than one 30-day length
of stay per year, per 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 April 25, 2003.
TRD-200302647
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: June 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
The Texas Department of Human Services (DHS) adopts the repeal of §§92.151
- 92.158; amendments to §§92.3, 92.15 - 92.17, 92.19, 92.20, 92.41,
92.53, 92.61, 92.62, 92.64, and 92.82; and new §§92.151, 92.152,
92.201 - 92.220, 92.251 - 92.267, 92.301, 92.302, 92.351 - 92.374, 92.401,
92.402, 92.451 - 92.456, 92.501 - 92.506, 92.551 - 92.595, and 92.601 - 92.616
in its Licensing Standards for Assisted Living Facilities chapter. DHS adopts
amendments to §§92.41, 92.53, and 92.64 with changes to the proposed
text published in the January 24, 2003, issue of the
Texas Register
(28 TexReg 661). DHS adopts the repeal of §§92.151
- 92.158; amendments to §§92.3, 92.15 - 92.17, 92.19, 92.20, 92.61,
92.62, and 92.82; and new §§92.151, 92.152, 92.201 - 92.220, 92.251
- 92.267, 92.301, 92.302, 92.351 - 92.374, 92.401, 92.402, 92.451 - 92.456,
92.501 - 92.506, 92.551 - 92.595, and 92.601 - 92.616 without changes to the
proposed text.
Justification for the repeals, amendments, and new sections is to comply
with the Health and Safety Code, §§247.0025, 247.041, 247.0451 -
247.0455, and 247.0457, as amended by Senate Bill (SB) 527, 77th Legislature.
The adoption allows DHS to assess administrative penalties against assisted
living facilities. These rules, including the administrative penalties and
fee schedule, were developed with a stakeholders' workgroup that included
providers, advocates, and consumers. The rules allow assisted living facilities
to ameliorate violations, and give penalty gradations. Subchapter H, Enforcement,
incorporates SB 527's enforcement regulations and also has been reorganized
as part of a DHS project to rewrite agency rules in a plain-language, question-and-answer
format to make them easier for clients, providers, and the general public
to understand. The adoption also corrects references and incorporates administrative
penalties, technical changes, and clarifications.
The proposed text of §92.64 contained a publication error. As published, §92.64
omitted the first seven words that followed the section title, which read:
"At the option of the applicant, the ..." This correction is included in the
adoption.
DHS received written comments from Advocacy, Inc., and Atria. A summary
of the comments and DHS's responses follow.
Comment: Advocacy, Inc., recommends that the language in §92.41(a)(4)(B)(vi)
be inclusive.
Response: DHS will not change the language. Assisted living facilities
have a diverse population. Not all facilities have a resident population that
would require staff to be trained in all suggested topics. The facility may
decide which topics should be addressed in staff training, based upon the
facility's resident population.
Comment: Additionally, rather than mandating clock hours, the training
should be competency-based (the individual must be able to demonstrate both
physically and in writing what they learned).
Response: This comment addresses §92.41(a)(4)(C). DHS concurs with
the recommendation. The rule language will be changed to read:
(C) Direct care staff must complete six documented hours of education annually,
based on each employee's hire date. Training must address behavior management,
including prevention of aggressive behavior and de-escalation techniques,
or fall prevention, or alternatives to restraints; training for these subjects
must be competency-based. Subject matter must address the unique needs of
the facility. Suggested topics include:
(i) - (xi) (No change.)
The change will also be made to §92.53(b)(3):
(3) Direct care staff must annually complete 12 hours of in-service education
regarding Alzheimer's disease. One hour of annual training must address behavior
management, including prevention of aggressive behavior and de-escalation
techniques, or fall prevention, or alternatives to restraints; training for
these subjects must be competency-based. Subject matter must address the unique
needs of the facility. Additional suggested topics include:
(A) - (I) (No change.)
Comment: The regulations need to more clearly define restraint and the
difference between a personal/physical restraint (which is involuntary) and
an escort or physical support (which is voluntary).
Response: DHS will not make these changes at this time. A workgroup of
providers, consumers, and advocates will be convened this summer to more fully
address restraints in assisted living facilities.
Comment: The training is limited to direct care staff. It is critical for
purposes of supervision and training that supervisory staff--in fact, any
staff having direct contact with patients--be trained in these areas.
Response: DHS will not make a change because the requirement already applies
to direct care staff. "Direct care" staff includes any facility staff who
has direct contact with residents.
Comment: Additionally, regulatory staff must also be trained if they are
to effectively perform their function and understand what to look for.
Response: DHS will not make a change because regulatory staff is being
trained. Regulations address requirements for the provider base and do not
address DHS staff requirements. Policies for DHS staff are provided through
handbooks and manuals.
Comment: Since restraints are used in emergency situations when behaviors
must be managed externally, the regulations must define what an emergency
is.
Response: DHS will not make a change at this time. This proposed definition
has not been presented to the stakeholders' workgroup or to the Advisory Committee
on Assisted Living Facilities. The recommendation will be placed on the agenda
this summer when a workgroup is convened to address restraints.
Comment: In 40 TAC §92.3 a new definition is proposed for (14) Immediate
Threat ("Immediate Threat"). However, we find the definition itself and the
context in which it applies vague and ambiguous.
Response: DHS will not change the definition. The definition for "immediate
threat" is taken from statute.
Comment: What is the definition of "serious injury" and who determines
that a violation may cause a serious injury?
Response: DHS will not make a change at this time. The recommendation will
be placed on the agenda this summer when a workgroup is convened to address
restraints and other issues. The expectation of DHS is that staff will use
professional judgment in determining serious injury.
Comment: Proposed 40 TAC §92.351 allows DHS to suspend or order an
immediate closing of a facility if an Immediate Threat to the residents exist;
therefore we are requesting clarity and a more comprehensive definition of
Immediate Threat.
Response: DHS will not change the definition. The definition for "immediate
threat" is taken from statute.
Comment: We are also requesting more definitive guidelines regarding the
definition of Immediately Available, defined in 40 TAC §92.3(15) ("Immediately
Available"). If DHS chooses not to revise the proposed rule, then we request
DHS issue interpretive guidelines further addressing this standard.
Response: DHS does not concur because "immediately available" is defined
at §92.3(15). Life Safety Code personnel are familiar with travel distance
and measurement of normal paths of travel. These terms are used in the National
Fire Protection Association (NFPA) codes and standards. Life Safety Code surveyors
have been trained in the NFPA codes and how to measure these distances. No
change will be made in the language.
Comment: 40 TAC §§92.551 - 92.595 address the issue of "Administrative
Penalties" and while arguably well-defined, §92.557 appears to allow
DHS to arbitrarily set the penalty amount. We respectfully request that DHS
develop an objective schedule of Administrative Penalties and assign set fee
amounts for clearly defined violations.
Response: DHS has already developed a fee schedule that was published with
the proposed rules. The administrative penalty fee schedule was developed
in consultation with a workgroup that included providers, advocates, and consumers.
Comment: Paragraph (5) the license holder's efforts to correct the violations
and paragraph (4) deterrence of future violations in §92.557 are also
vague provisions. As such, we suggest that these factors be eliminated from
the proposed rule, as they appear overly subjective and unnecessary. We respectfully
suggest DHS specify a time frame and the means of comparison in the final
rule so that the process does not amount to a form of "double jeopardy."
Response: The criteria DHS uses to determine the amount of the administrative
penalty is taken from statute; therefore, no change will be made.
Comment: The proposed §92.557 contemplates the size of the facility
and the size of the business that owns the facility when determining the administrative
penalty amount. This standard suggests that not all facilities will be treated
equally and implies larger facilities and/or companies will be assessed penalties
at higher amounts. This appears discriminatory in nature and application and
therefore we urge that these factors be eliminated from the final rules.
Response: The criteria DHS uses to determine the amount of the administrative
penalty is taken from statute. The size of the facility and the size of the
business entity that owns the facility are criteria taken from statute. The
schedule of administrative penalty fees is based on those criteria.
Subchapter A. INTRODUCTION
40 TAC §92.3
The amendment is adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The amendment implements the Health and Safety Code, §§247.001
- 247.068.
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 April 28, 2003.
TRD-200302651
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
40 TAC §§92.15 - 92.17, 92.19, 92.20
The amendments are adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The amendments implement the Health and Safety Code, §§247.001
- 247.068.
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 April 28, 2003.
TRD-200302652
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
40 TAC §92.41, §92.53
The amendments are adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The amendments implement the Health and Safety Code, §§247.001
- 247.068.
§92.41.Standards for Type A, Type B, and Type E Assisted Living Facilities.
(a)
Employees.
(1)
Manager. Each facility must designate, in writing, a manager
to have authority over the operation.
(A)
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:
(i)
an associate's degree in nursing, health care management,
or a related field;
(ii)
a bachelor's degree; or
(iii)
proof of graduation from an accredited high school or
certification of equivalency of graduation and at least one year of experience
working in management or in health care industry management.
(B)
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.
(i)
The course must be at least 24 hours in length.
(I)
Eight hours of training on the assisted living standards
must be completed within the first three months of employment.
(II)
The 24-hour training requirement may not be met through
in-services 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 that deals with the
internal affairs of an organization will not qualify for credit.
(III)
Evidence of training must be on file at the facility
and must contain documentation of content, hours, dates, and provider.
(ii)
Managers hired after August 1, 2000, who can show documentation
of a previously completed comparable course of study are exempt from the training
requirements.
(iii)
Managers hired after August 1, 2000, must complete the
course by the first anniversary of employment as manager.
(iv)
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 before 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.
(C)
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:
(i)
resident and provider rights and responsibilities, abuse/neglect,
and confidentiality;
(ii)
basic principles of management;
(iii)
skills for working with residents, families, and other
professional service providers;
(iv)
resident characteristics and needs;
(v)
community resources;
(vi)
accounting and budgeting;
(vii)
basic emergency first aid; or
(viii)
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.
(D)
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.
(E)
Manager's absence. An employee competent and authorized
to act in the absence of the manager must be designated in writing.
(2)
Attendants. Full-time facility attendants must be at least
18 years old or a high-school graduate.
(A)
An attendant must be in the facility at all times when
residents are in the facility.
(B)
Attendants are not precluded from performing other functions
as required by the assisted living facility.
(3)
Staffing.
(A)
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.
(B)
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).
(C)
A facility must have sufficient staff to:
(i)
maintain order, safety, and cleanliness;
(ii)
assist with medication regimens;
(iii)
prepare and service meals that meet the daily nutritional
and special dietary needs of each resident, in accordance with each resident's
service plan;
(iv)
assist with laundry;
(v)
assure that each resident receives the kind and amount
of supervision and care required to meet his basic needs; and
(vi)
ensure safe evacuation of the facility in the event of
an emergency.
(D)
A facility must meet the staffing requirements described
in this subparagraph.
(i)
Type A and Type E facilities: Night shift staff in a small
facility must be immediately available. In a large facility, the staff must
be immediately available and awake.
(ii)
Type B facility: Night shift staff must be immediately
available and awake, regardless of the number of licensed beds.
(4)
Staff training. The facility must document that staff members
are competent to provide personal care before assuming responsibilities and
have received the following training.
(A)
All staff members must complete four hours of orientation
before assuming any job responsibilities. Training must cover, at a minimum,
the following topics:
(i)
reporting of abuse and neglect;
(ii)
confidentiality of resident information;
(iii)
universal precautions;
(iv)
conditions about which they should notify the facility
manager;
(v)
residents' rights; and
(vi)
emergency and evacuation procedures.
(B)
Attendants must complete 16 hours of on-the-job supervision
and training within the first 16 hours of employment following orientation.
Training must include:
(i)
in Type A and B facilities, providing assistance with the
activities of daily living; in Type E facilities, medications and recognizing,
reporting, and recording side effects;
(ii)
resident's health conditions and how they may affect provision
of tasks;
(iii)
safety measures to prevent accidents and injuries;
(iv)
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;
(v)
managing disruptive behavior; and
(vi)
behavior management, including prevention of aggressive
behavior and de-escalation techniques, or fall prevention, or alternatives
to restraints.
(C)
Direct care staff must complete six documented hours of
education annually, based on each employee's hire date. One hour of annual
training must address behavior management, including prevention of aggressive
behavior and de-escalation techniques, or fall prevention, or alternatives
to restraints. Training for these subjects must be competency-based. Subject
matter must address the unique needs of the facility. Suggested topics include:
(i)
promoting resident dignity, independence, individuality,
privacy, and choice;
(ii)
resident rights and principles of self-determination;
(iii)
communication techniques for working with residents with
hearing, visual, or cognitive impairment;
(iv)
communicating with families and other persons interested
in the resident;
(v)
common physical, psychological, social, and emotional conditions
and how these conditions affect residents' care;
(vi)
essential facts about common physical and mental disorders,
for example, arthritis, cancer, dementia, depression, heart and lung diseases,
sensory problems, or stroke;
(vii)
cardiopulmonary resuscitation;
(viii)
common medications and side effects, including psychotropic
medications, when appropriate;
(ix)
understanding mental illness;
(x)
conflict resolution and de-escalation techniques; and
(xi)
information regarding community resources.
(D)
Facilities that employ licensed nurses, certified nurse
aides, or certified medication aides must provide annual in-service training,
appropriate to their job responsibilities, from one or more of the following
areas:
(i)
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);
(ii)
assessment and nursing interventions related to the common
physical and psychological changes of aging for each body system;
(iii)
geriatric pharmacology, including treatment for pain
management, food and drug interactions, and sleep disorders;
(iv)
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;
(v)
common mental disorders with related nursing implications;
and
(vi)
ethical and legal issues regarding advance directives,
abuse and neglect, guardianship, and confidentiality.
(b)
Social services. The facility must provide an activity
and/or social program at least weekly for the residents.
(c)
Resident assessment. Within 14 days of admission, a resident
comprehensive assessment and an individual service plan for providing care,
which is based on the comprehensive assessment, must be completed. The comprehensive
assessment must be completed by the appropriate staff and documented on a
form developed by the facility. When a facility is unable to obtain information
required for the comprehensive assessment, the facility should document its
attempts to obtain the information.
(1)
The comprehensive assessment must include the following
items:
(A)
the location from which the resident was admitted;
(B)
primary language;
(C)
sleep-cycle issues;
(D)
behavioral symptoms;
(E)
psychosocial issues (i.e., a psychosocial functioning assessment
that includes an assessment of mental or psychosocial adjustment difficulty;
a screening for signs of depression, such as withdrawal, anger or sad mood;
assessment of the resident's level of anxiety; and determining if the resident
has a history of psychiatric diagnosis that required in-patient treatment);
(F)
Alzheimer's/dementia history;
(G)
activities of daily living patterns (i.e., wakened to toilet
all or most nights, bathed in morning/night, shower or bath);
(H)
involvement patterns and preferred activity pursuits (i.e.,
daily contact with relatives, friends, usually attended religious services,
involved in group activities, preferred activity settings, general activity
preferences);
(I)
cognitive skills for daily decision-making (independent,
modified independence, moderately impaired, severely impaired);
(J)
communication (ability to communicate with others, communication
devices);
(K)
physical functioning (transfer status; ambulation status;
toilet use; personal hygiene; ability to dress, feed and groom self);
(L)
continence status;
(M)
nutritional status (weight changes, nutritional problems
or approaches);
(N)
oral/dental status;
(O)
diagnoses;
(P)
medications (administered, supervised, self-administers);
(Q)
health conditions and possible medication side effects;
(R)
special treatments and procedures;
(S)
hospital admissions within the past six months or since
last assessment; and
(T)
preventive health needs (i.e., blood pressure monitoring,
hearing-vision assessment).
(2)
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.
(3)
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.
(4)
Emergency admissions must be assessed and a service plan
developed for them.
(d)
Resident policies.
(1)
Before 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.
(2)
The facility must provide residents with a copy of the
Resident Bill of Rights.
(3)
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.
(4)
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.
(1)
A facility must not admit or retain:
(A)
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 is 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, except as provided in subsection (f) of this section.
(B)
an individual who requires the services of facility employees
who are licensed nurses on a daily or regular basis. Individuals with a terminal
condition or who are experiencing a short-term, acute episode are excluded
from this requirement.
(2)
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.
(3)
A facility must share a copy of the facility disclosure
statement, rate schedule, and individual resident service plan with outside
resources that provide 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.
(4)
Each resident must have a health examination by a physician
performed within 30 days before admission or 14 days after admission, unless
a transferring hospital or facility has a physical examination in the medical
record.
(5)
The assisted living facility must secure at the time of
admission of a resident the following identifying information:
(A)
full name of resident;
(B)
social security number;
(C)
usual residence (where resident lived before admission);
(D)
sex;
(E)
marital status;
(F)
date of birth;
(G)
place of birth;
(H)
usual occupation (during most of working life);
(I)
family, other persons named by the resident, and physician
for emergency notification;
(J)
pharmacy preference; and
(K)
Medicaid/Medicare number, if available.
(f)
Inappropriate placement in Type A or Type B facilities.
(1)
A facility is not required to move a resident who a Texas
Department of Human Services (DHS) surveyor determines is inappropriately
placed if the facility submits the following to DHS not later than the 10th
business day after the date the facility is informed in writing of the specific
basis of the surveyor's determination:
(A)
a written assessment from a physician that states the resident
is appropriately placed. The assessment must address the resident's medical
conditions and related nursing needs, ambulatory and transfer abilities, and
mental status;
(B)
a written statement from the resident that he wishes to
remain in the facility. If the resident lacks capacity to give a written statement,
a family member or guardian may give a statement that he wishes the resident
to remain in the facility; and
(C)
a statement from the facility that the facility wishes
the resident to remain in the facility.
(2)
A facility that does not meet all requirements for the
evacuation of a designated resident must apply for a waiver from DHS of all
applicable requirements for evacuation not met with respect to the resident.
Documentation must be submitted not later than the 10th business day after
the date the facility is informed in writing of the specific basis of the
surveyor's determination.
(A)
Documentation. When an evacuation waiver is requested,
the following documentation must be submitted to DHS in addition to the documentation
required in paragraph (1)(A) - (C) of this subsection:
(i)
a detailed plan that explains how the facility will meet
the evacuation needs of the resident. The plan should include, for example,
(I)
the specific staff positions that will be on duty to assist
with evacuation and their shift times;
(II)
specific staff positions that will be on duty and awake
at night; and
(III)
specific staff training that relates to resident evacuation;
(ii)
a copy of the facility floor plan that indicates the specific
resident's room;
(iii)
a copy of the facility's emergency evacuation plan;
(iv)
copies of the facility fire drills for the last 12-month
period;
(v)
a copy of the DHS notice form to the local fire marshal,
or state fire marshal, if applicable (authority having jurisdiction), advising
that the facility is requesting a waiver of the change of capability of resident
evacuation. The DHS form must contain the signature of the fire authority
having jurisdiction;
(vi)
a copy of the DHS notice form to the local fire suppression
authority advising that the facility is requesting a waiver of the change
of capability of resident evacuation. The DHS form must contain the signature
of the fire suppression authority having jurisdiction;
(vii)
a copy of a comprehensive assessment of the resident,
completed within the last 60 days, that addresses the areas required by subsection
(c) of this section, and the service plan, that addresses all aspects of the
resident's care, particularly those areas identified by DHS. The facility
must address the resident's medical condition(s) and related nursing needs,
hospitalizations within the last 60 days, any significant change in condition
in the last 60 days, specific staffing needs, and services that are provided
by an outside provider; and
(viii)
any other information that relates to the required fire
safety features of the facility that will ensure the evacuation capability
of any resident.
(B)
Criteria. Each facility has specific characteristics that
vary from other facilities, which prevents the specification of a universal
emergency procedure. A facility must meet the following criteria to receive
a waiver from DHS:
(i)
The facility must have an emergency plan to meet the evacuation
needs of the resident. The plan must ensure that:
(I)
staff is adequately trained;
(II)
a sufficient number of staff is on all shifts to move
all residents to a place of safety;
(III)
residents will be moved to appropriate locations, given
health and safety issues;
(IV)
inclusion of all possible locations of the fire origin
area is included in the emergency plan;
(V)
the emergency plan addresses all possible locations of
fire origin areas and the necessity for full evacuation of the building;
(VI)
the fire alarm signal is adequate;
(VII)
there is an effective method for warning residents and
staff during a malfunction of the building fire alarm system;
(VIII)
the plan is effective for communicating the actual location
of the fire to staff; and
(IX)
the plan satisfies any other safety concerns that could
have an effect on the residents' safety in the event of a fire.
(ii)
The facility must show that the emergency plan will not
have an adverse effect on other residents of the facility who have waivers
of evacuation and other residents of the facility who have special needs that
require staff assistance. In evaluating whether the emergency plan will have
an adverse effect on other residents, DHS may also review the service plans
provided by the facility.
(C)
Determination. DHS will review the documentation submitted
under this subsection to determine whether to grant or deny a request for
a waiver under this section. DHS will notify the facility in writing of its
determination within 10 working days from the date the request is received
in the DHS regional office.
(D)
Plan of Action. Upon notification that DHS has approved
a waiver of evacuation, the facility must immediately initiate all provisions
of the proposed plan of action. If the facility does not follow the proper
plan of action, and there are health and safety concerns, DHS may cite the
facility for immediate threat to the health or safety of a resident.
(E)
Waiver Renewal. A waiver of evacuation from DHS will be
reviewed by DHS during the facility's annual renewal licensing inspection.
(3)
If a DHS surveyor determines that a resident is inappropriately
placed at a facility and the facility either agrees with the determination
or fails to obtain the written statements required in this subsection, the
facility must discharge the resident.
(A)
The resident is allowed 30 days after the date of discharge
to move from the facility.
(B)
A discharge required under this subsection must be made
notwithstanding:
(i)
any other law, including any law relating to the rights
of residents and any obligations imposed under the Property Code; and
(ii)
the terms of any contract.
(C)
DHS will not assess an administrative penalty against the
facility because of the inappropriate placement.
(g)
Advance directives.
(1)
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.
(2)
The facility must provide written notice of these policies
to residents at the time they are admitted to receive services from the facility.
(A)
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:
(i)
the resident's legal guardian;
(ii)
a person responsible for the resident's health care decisions;
(iii)
the resident's spouse;
(iv)
the resident's adult child;
(v)
the resident's parents; or
(vi)
the person admitting the resident.
(B)
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.
(3)
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.
(4)
Failure to inform the resident of facility policies regarding
the implementation of advance directives will result in an administrative
penalty of $500.
(A)
Facilities will receive written notice of the recommendation
for an administrative penalty.
(B)
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 DHS.
(C)
Hearings will be held in accordance with DHS's formal hearing
procedures in Chapter 79 of this title (relating to Legal Services).
(h)
Resident records.
(1)
Records that pertain to residents must be treated as confidential
and properly safeguarded from unauthorized use, loss, or destruction.
(2)
Resident records must contain:
(A)
information contained in the facility's standard and customary
admission form;
(B)
a record of the resident's assessments;
(C)
the resident's service plan;
(D)
physician's orders, if any;
(E)
any advance directives;
(F)
documentation of a health examination by a physician performed
within 30 days before 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
(G)
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.
(3)
Records must be available to residents, their legal representatives,
and DHS staff.
(i)
Personnel records. The facility must keep personnel records
on all staff in a central location.
(j)
Medications.
(1)
Administration. Medications must be administered according
to physician's orders.
(A)
Residents who choose not to or cannot self-administer their
medications must have their medications administered by a person who:
(i)
holds a current license under state law that authorizes
the licensee to administer medication; or
(ii)
holds a current medication aide permit and acts under
the authority of a person who holds a current nursing license under state
law that 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.
(iii)
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 Chapter 218 (concerning
Delegation of Selected Nursing Tasks by Registered Professional Nurses to
Unlicensed Personnel), which implements the Nurse Practice Act.
(B)
All resident's prescribed medication must be dispensed
through a pharmacy or by the resident's treating physician or dentist.
(C)
Physician sample medications may be given to a resident
by the facility provided the medication has specific dosage instructions for
the individual resident.
(D)
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:
(i)
name;
(ii)
strength;
(iii)
dosage;
(iv)
amount received;
(v)
directions for use;
(vi)
route of administration;
(vii)
prescription number;
(viii)
pharmacy name; and
(ix)
the date each medication was issued by the pharmacy.
(2)
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:
(A)
reminders to take their medications at the prescribed time;
(B)
opening containers or packages and replacing lids;
(C)
pouring prescribed dosage according to medication profile
record;
(D)
returning medications to the proper locked areas;
(E)
obtaining medications from a pharmacy; and
(F)
listing on an individual resident's medication profile
record the medication
(i)
name;
(ii)
strength;
(iii)
dosage;
(iv)
amount received;
(v)
directions for use;
(vi)
route of administration;
(vii)
prescription number;
(viii)
pharmacy name; and
(ix)
the date each medication was issued by the pharmacy.
(3)
Self-administration.
(A)
Residents who self-administer their own medications and
keep them locked in their room must 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. The facility must keep a written record of counseling.
(B)
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 must remain in or at the storage area the
entire time any resident is present.
(4)
General.
(A)
Facility staff will immediately report to the resident's
physician and responsible party any unusual reactions to medications or treatments.
(B)
When the facility supervises or administers the medications,
a written record must be kept when the resident does not receive or take his/her
medications/treatments as prescribed. The documentation must 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.
(5)
Storage.
(A)
The facility must provide a locked area for all medications.
Examples of areas include, but are not limited to:
(i)
central storage area;
(ii)
medication cart; and
(iii)
resident room.
(B)
Each resident's medication must be stored separately from
other resident's medications within the storage area.
(C)
A refrigerator must have a designated and locked storage
area for medications that require refrigeration, unless it is inside a locked
medication room.
(D)
Poisonous substances and medications labeled for "external
use only" must be stored separately within the locked medication area.
(E)
If facilities store controlled drugs, facility policies
and procedures must address the prevention of the diversion of the controlled
drugs.
(6)
Disposal.
(A)
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:
(i)
medications discontinued by order of the physician;
(ii)
medications that remain after a resident is deceased;
or
(iii)
medications that have passed the expiration date.
(B)
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).
(C)
Medications kept in a central storage area are released
to discharged residents when a receipt has been signed by the resident or
responsible party.
(k)
Accident, injury, or acute illness.
(1)
In the event of accident or injury that requires emergency
medical, dental or nursing care, or in the event of apparent death, the assisted
living facility will:
(A)
make arrangements for emergency care and/or transfer to
an appropriate place for treatment, such as a physician's office, clinic,
or hospital;
(B)
immediately notify the resident's physician and next of
kin, responsible party, or agency who placed the resident in the facility;
and
(C)
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.
(2)
The facility must stock and maintain in a single location
first aid supplies to treat burns, cuts, and poisoning.
(3)
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.
(l)
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.
(m)
Food and nutrition services.
(1)
A person designated by the facility is responsible for
the total food service of the facility.
(2)
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.
(3)
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.
(4)
Therapeutic diets as ordered by the resident's physician
must be provided according to the service plan. Therapeutic diets that cannot
customarily be prepared by a layperson must be calculated by a qualified dietician.
Therapeutic diets that can customarily be prepared by a person in a family
setting may be served by the assisted living facility.
(5)
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.
(6)
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.
(7)
Plastic containers with tight fitting lids are acceptable
for storage of staple foods in the pantry.
(8)
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 that
is reheated must be heated to a minimum of 165 degrees Fahrenheit.
(9)
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.
(10)
Food must be prepared and served with the least possible
manual contact, with suitable utensils, and on surfaces that have been cleaned,
rinsed, and sanitized before use to prevent cross-contamination.
(11)
Facilities must prepare food in accordance with established
food preparation practices and safety techniques.
(12)
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.
(13)
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 containers in which the manufacturer
packaged the chemicals.
(17)
Sanitary dishwashing procedures and techniques must be
followed.
(18)
Facilities that house 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.
(n)
Infection control.
(1)
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.
(2)
The facility must comply with departmental rules regarding
special waste in 25 TAC §§1.131 - 1.137.
(3)
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) must be reported immediately to the city health officer, county
health officer, or health unit director having jurisdiction, and appropriate
infection control procedures must be implemented as directed by the local
health authority.
(4)
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.
(A)
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.
(B)
The facility must maintain evidence of compliance with
local and/or state health codes or ordinances regarding employee and resident
health status.
(C)
The facility must screen all employees for TB within two
weeks of employment and annually, according to Centers for Disease Control
and Prevention (CDC) screening guidelines. All persons who provide services
under an outside resource contract must, upon request of the facility, provide
evidence of compliance with this requirement.
(D)
All residents should be screened upon admission and after
exposure to TB, in accordance with the attending physician's recommendations
and CDC guidelines.
(5)
Personnel must handle, store, process, and transport linens
so as to prevent the spread of infection.
(6)
Universal precautions must be used in the care of all residents.
(o)
Access to residents. The facility must allow an employee
of the Texas Department of Mental Health and Mental Retardation (TDMHMR) or
an employee of a local mental health and mental retardation authority into
the facility as necessary to provide services to a resident.
(p)
Restraints. All restraints for purposes of behavioral management,
staff convenience, or resident discipline are prohibited. Seclusion is prohibited.
For more information regarding restraints, see §92.125 of this chapter
(relating to Resident's Bill of Rights and Provider Bill of Rights).
§92.53.Standards for Certified Alzheimer's Assisted Living Facilities.
(a)
Manager qualifications and training.
(1)
The manager of the certified Alzheimer facility or the
supervisor of the certified Alzheimer unit must be 21 years of age, and have:
(A)
an associate's degree in nursing, health care management;
(B)
a bachelor's degree in psychology, gerontology, nursing,
or a related field; or
(C)
proof of graduation from an accredited high school or certification
of equivalency of graduation and at least one year of experience working with
persons with dementia.
(2)
The manager or supervisor must complete six hours of annual
continuing education regarding dementia care.
(b)
Staff training.
(1)
All staff members must receive four hours of dementia-specific
orientation prior to assuming any job responsibilities. Training must cover,
at a minimum, the following topics:
(A)
basic information about the causes, progression, and management
of Alzheimer's disease;
(B)
managing dysfunctional behavior; and
(C)
identifying and alleviating safety risks to residents with
Alzheimer's disease.
(2)
Direct care staff must receive 16 hours of on-the-job supervision
and training within the first 16 hours of employment following orientation.
Training must cover:
(A)
providing assistance with the activities of daily living;
(B)
emergency and evacuation procedures specific to the dementia
population;
(C)
managing dysfunctional behavior; and
(D)
behavior management, including prevention of aggressive
behavior and de-escalation techniques, or fall prevention, or alternatives
to restraints.
(3)
Direct care staff must annually complete 12 hours of in-service
education regarding Alzheimer's disease. One hour of annual training must
address behavior management, including prevention of aggressive behavior and
de-escalation techniques, or fall prevention, or alternatives to restraints.
Training for these subjects must be competency-based. Subject matter must
address the unique needs of the facility. Additional suggested topics include:
(A)
assessing resident capabilities and developing and implementing
service plans;
(B)
promoting resident dignity, independence, individuality,
privacy and choice;
(C)
planning and facilitating activities appropriate for the
dementia resident;
(D)
communicating with families and other persons interested
in the resident;
(E)
resident rights and principles of self-determination;
(F)
care of elderly persons with physical, cognitive, behavioral
and social disabilities;
(G)
medical and social needs of the resident;
(H)
common psychotropics and side effects; and
(I)
local community resources.
(c)
Staffing. A facility must employ sufficient staff to provide
services for and meet the needs of its Alzheimer's residents. In large facilities
or units with 17 or more residents, two staff members must be immediately
available when residents are present.
(d)
Pre-admission. The facility must establish procedures,
such as an application process, interviews, and home visits, to ensure that
prospective residents are appropriate and their needs can be met.
(1)
Prior to admitting a resident, facility staff must discuss
and explain the disclosure statement with the family or responsible party.
(2)
The facility must give the required Texas Department of
Human Services (DHS) disclosure statement to any individual seeking information
about the facility's care or treatment of residents with Alzheimer's disease
or a related disorder.
(e)
Assessment. The facility must make a comprehensive assessment
of each resident within 14 days of admission and annually. The assessment
must include the items listed in §92.41(c)(1)(A) - (T) of this chapter
(relating to Standards for Type A, Type B, and Type E Assisted Living Facilities).
(f)
Service plan. Facility staff, with input from the family,
if available, must develop an individualized service plan for each resident,
based upon the resident assessment, within 14 days of admission. The service
plan must address the individual needs, preferences, and strengths of the
resident. The service plan must be designed to help the resident maintain
the highest possible level of physical, cognitive, and social functioning.
The service plan must be updated annually and upon a significant change in
condition, based upon an assessment of the resident.
(g)
Activities. A facility must encourage socialization, cognitive
awareness, self-expression, and physical activity in a planned and structured
activities program. Activities must be individualized, based upon the resident
assessment, and appropriate for each resident's abilities.
(1)
The activity program must contain a balanced mixture of
activities addressing cognitive, recreational, and activity of daily living
(ADL) needs.
(A)
Cognitive activities include, but are not limited to, arts,
crafts, story telling, poetry readings, writing, music, reading, discussion,
reminiscences, and reviews of current events.
(B)
Recreational activities include all socially interactive
activities, such as board games and cards, and physical exercise. Care of
pets is encouraged.
(C)
Self-care ADLs include grooming, bathing, dressing, oral
care, and eating. Occupational ADLs include cleaning, dusting, cooking, gardening,
and yard work. Residents must be allowed to perform self-care ADLs as long
as they are able to promote independence and self worth.
(2)
Residents must be encouraged, but never forced, to participate
in activities. Residents who choose not to participate in a large group activity
must be offered at least one small group or one-on-one activity per day.
(3)
Facilities must have an employee responsible for leading
activities.
(A)
Facilities with 16 or fewer residents must designate an
employee to plan, supply, implement, and record activities.
(B)
Facilities with 17 or more residents must employ, at a
minimum, an activity director for 20 hours weekly. The activity director must
be a qualified professional who:
(i)
is a qualified therapeutic recreation specialist or an
activities professional who is eligible for certification as a therapeutic
recreation specialist, therapeutic recreation assistant, or an activities
professional by a recognized accrediting body, such as the National Council
for Therapeutic Recreation Certification, the National Certification Council
for Activity Professionals, or the Consortium for Therapeutic Recreation/Activities
Certification, Inc.; or
(ii)
has two years of experience in a social or recreational
program within the last five years, one year of which was full-time in an
activities program in a health care setting; or
(iii)
has completed an activity director training course approved
by the National Association for Activity Professionals or the National Therapeutic
Recreation Society.
(4)
The activity director or designee must review each resident's
medical and social history, preferences, and dislikes, in determining appropriate
activities for the resident. Activities must be tailored to the residents'
unique requirements and skills.
(5)
The activities program must provide opportunities for group
and individual settings. On weekdays, each resident must be offered at least
one cognitive activity, two recreational activities and three ADL activities
each day. The cognitive and recreational activities (structured activities)
must be at least 30 minutes in duration, with a minimum of six and a half
hours of structured activity for the entire week. At least an hour and a half
of structured activities must be provided during the weekend and must include
at least one cognitive activity and one physical activity.
(6)
The activity director or designee must create a monthly
activities schedule. Structured activities should occur at the same time and
place each week to ensure a consistent routine within the facility.
(7)
The activity director or designee must annually attend
at least six hours of continuing education regarding Alzheimer's disease or
related disorders.
(8)
Special equipment and supplies necessary to accommodate
persons with a physical disability or other persons with special needs must
be provided as appropriate.
(h)
Physical plant. Alzheimer's units, if segregated from other
parts of the Type B facility with approved security devices, must meet the
following requirements within the Alzheimer's unit:
(1)
Resident living area(s) must be in compliance with §92.62(m)(3)
of this chapter (relating to General Requirements).
(2)
Resident dining area(s) must be in compliance with §92.62(m)(4)
of this chapter.
(3)
Resident toilet and bathing facilities must be in compliance
with §92.62(m)(2) of this chapter.
(4)
A monitoring station must be provided within the Alzheimer's
unit with a writing surface such as a desk or counter, chair, task illumination,
telephone or intercom, and lockable storage for resident records.
(5)
Access to at least two approved exits remote from each
other must be provided in order to meet the Life Safety Code requirements.
(6)
In large facilities, cross corridor control doors, if used
for the security of the residents, must be similar to smoke doors, which are
each 34 inches in width and swing in opposite directions. A latch or other
fastening device on a door must be provided with a knob, handle, panic bar,
or other simple type of releasing device.
(7)
An outdoor area of at least 800 square feet must be provided
in at least one contiguous space. This area must be connected to, be a part
of, be controlled by, and be directly accessible from the facility.
(A)
Such areas must have walls or fencing that do not allow
climbing or present a hazard and meet the following requirements. These minimum
dimensions do not apply to additional fencing erected along property lines
or building setback lines for privacy or to meet requirements of local building
authorities.
(i)
Minimum distance of the enclosure fence from the building
is 8 feet if the fence is parallel to the building and there are no window
openings;
(ii)
Minimum distance of the enclosure fence (parallel with
building walls) from bedroom windows is 20 feet if the fencing is solid and
15 feet from bedroom windows if the fencing is open; or
(iii)
For unusual or unique site conditions, areas of enclosure
may have alternate configurations with DHS approval.
(B)
Access to at least two approved exits remote from each
other must be provided from the enclosed area in order to meet the Life Safety
Code requirements.
(C)
If the enclosed area involves a required exit from the
building, the following additional requirements must be met:
(i)
A minimum of two gates must be remotely located from each
other if only one exit is enclosed. If two or more exits are enclosed by the
fencing and entry access can be made at each door, a minimum of one gate is
required.
(ii)
The gate(s) must be located to provide a continuous path
of travel from the building exit to a public way, including walkways of concrete,
asphalt, or other approved materials.
(iii)
If gate(s) are locked, the gate nearest the exit from
the building must be locked with an electronic lock that operates the same
as electronic locks on control doors and/or exit doors and is in compliance
with the National Electrical Code for exterior exposure. Additional gates
may also have electronic locks or may have keyed locks provided staff carry
the keys. All gates may have keyed locks, provided all staff carry the keys,
and the outdoor area has an area of refuge which:
(I)
extends beyond a minimum of 30 feet from the building;
and
(II)
the area of refuge allows at least 15 square feet per
person (resident, staff, visitor) potentially present at the time of a fire.
(8)
Locking devices may be used on the control doors provided
the following criteria are met:
(A)
The building must have an approved sprinkler system and
an approved fire alarm system to meet the licensing standards.
(B)
The locking device must be electronic and must be released
when any one of the following occurs:
(i)
activation of the fire alarm or sprinkler system;
(ii)
power failure to the facility; or
(iii)
activation of a switch or button located at the monitoring
station and at the main staff station.
(C)
A key pad or buttons may be located at the control doors
for routine use by staff.
(9)
Locking devices may be used on the exit doors provided:
(A)
the locking arrangements meet §5-2.1.6 of the Life
Safety Code; or
(B)
the following criteria are met:
(i)
The building must have an approved sprinkler system and
an approved fire alarm system to meet the licensing standards.
(ii)
The locking device must be electro-magnetic; that is,
no type of throw-bolt is to be used.
(iii)
The device must release when any one of the following
occurs:
(I)
activation of the fire alarm or sprinkler system;
(II)
power failure to the facility; or
(III)
activation of a switch or button located at the monitoring
station and at the main staff station.
(iv)
A key pad or buttons may be located at the control doors
for routine use by staff.
(v)
A manual fire alarm pull must be located within five feet
of each exit door with a sign stating, "Pull to release door in an emergency."
(vi)
Staff must be trained in the methods of releasing the
door device.
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 April 28, 2003.
TRD-200302653
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
40 TAC §§92.61, 92.62, 92.64
The amendments are adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The amendments implement the Health and Safety Code, §§247.001
- 247.068.
§92.64.Plans, Approvals, and Construction Procedures.
At the option of the applicant, the Texas Department of Human Services
(DHS) reviews plans for new buildings, additions, conversion of buildings
not licensed by DHS, or remodeling of existing licensed facilities. DHS informs
the applicant of the results of the review within 30 days. 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.
(1)
Submittal of plans.
(A)
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.
(B)
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.
(C)
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.
(D)
Plans and specifications for conversions or remodeling
must be complete for all parts and features involved.
(E)
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.
(F)
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.
(G)
Fees for plan review will be required in accordance with §92.20
of this title (relating to License Fees).
(2)
Contract documents.
(A)
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.
(B)
Foundation plan documents must include general foundation
design and details.
(C)
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.
(D)
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.
(E)
Schedules must include door materials, widths, and types;
window materials, sizes, and types; room finishes; and special hardware.
(F)
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.
(G)
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.
(H)
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.
(I)
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.
(3)
Construction phase.
(A)
DHS must be notified in writing prior to construction start.
(B)
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.
(4)
Initial survey of completed construction.
(A)
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 marshal 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.
(B)
After DHS surveys the completed construction and finds
it acceptable, DHS forwards this information to the Facility Enrollment 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
be essentially 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.
(C)
The following documents must be available to DHS's NFPA
101 inspecting surveyor at the time of the survey of the completed building:
(i)
written approval of local authorities as required in subparagraph
(A) of this paragraph;
(ii)
written certification of the fire alarm system by the
installing agency (Form FML-009) of the Texas State Fire Marshal);
(iii)
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;
(iv)
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;
(v)
service contracts for maintenance and testing of alarm
systems, sprinkler systems, etc.;
(vi)
a copy of gas test results of the facility's gas lines
from the meter;
(vii)
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
(viii)
any other such documentation as needed.
(5)
Nonapproval of new construction.
(A)
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:
(i)
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;
(ii)
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;
(iii)
no written approval by local authorities;
(iv)
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;
(v)
required exits not all usable according to NFPA 101 requirements;
(vi)
telephone not installed or not properly working;
(vii)
sufficient basic furnishings, essential appliances, and
equipment not installed or not functioning; and
(viii)
any other basic operational or safety feature which
would preclude safe and normal occupancy by residents on that day.
(B)
If the surveyor encounters only minor deficiencies, licensure
may be recommended based on an approved written plan of correction from the
facility's administrator.
(C)
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 April 28, 2003.
TRD-200302654
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
40 TAC §92.82
The amendment is adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The amendment implements the Health and Safety Code, §§247.001
- 247.068.
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 April 28, 2003.
TRD-200302655
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
40 TAC §§92.151 - 92.158
The repeals are adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The repeals implement the Health and Safety Code, §§247.001 -
247.068.
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 April 28, 2003.
TRD-200302656
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
40 TAC §92.151, §92.152
The new sections are adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The new sections implement the Health and Safety Code, §§247.001
- 247.068.
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 April 28, 2003.
TRD-200302657
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
40 TAC §§92.201 - 92.220
The new sections are adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The new sections implement the Health and Safety Code, §§247.001
- 247.068.
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 April 28, 2003.
TRD-200302658
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
40 TAC §92.251 - 92.267
The new sections are adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The new sections implement the Health and Safety Code, §§247.001-247.068.
Filed
with the Office of the Secretary of State on April 28, 2003.
TRD-200302659
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
40 TAC §92.301, §92.302
The new sections are adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The new sections implement the Health and Safety Code, §§247.001-247.068.
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 April 28, 2003.
TRD-200302660
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
40 TAC §§92.351 - 92.374
The new sections are adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The new sections implement the Health and Safety Code, §§247.001-247.068.
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 April 28, 2003.
TRD-200302661
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
40 TAC §92.401, §92.402
The new sections are adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The new sections implement the Health and Safety Code, §§247.001-247.068.
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 April 28, 2003.
TRD-200302662
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
40 TAC §§92.451 - 92.456
The new sections are adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The new sections implement the Health and Safety Code, §§247.001-247.068.
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 April 28, 2003.
TRD-200302663
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
40 TAC §§92.501 - 92.506
The new sections are adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The new sections implement the Health and Safety Code, §§247.001-247.068.
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 April 28, 2003.
TRD-200302664
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
40 TAC §§92.551 - 92.595
The new sections are adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The new sections implement the Health and Safety Code, §§247.001-247.068.
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 April 28, 2003.
TRD-200302665
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
40 TAC §§92.601 - 92.616
The new sections are adopted under the Health and Safety Code,
Chapter 247, which authorizes DHS to license and regulate assisted living
facilities.
The new sections implement the Health and Safety Code, §§247.001-247.068.
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 April 28, 2003.
TRD-200302666
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Effective date: September 1, 2003
Proposal publication date: January 24, 2003
For further information, please call: (512) 438-3734
Chapter 175.
GENERAL RULES OF THE VETERANS LAND BOARD
Subchapter A. GENERAL RULES AND CONTRACTING FINANCING
Chapter 92.
LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
Subchapter B. APPLICATION PROCEDURES
Subchapter C. STANDARDS FOR LICENSURE
Subchapter D. FACILITY CONSTRUCTION
Subchapter E. INSPECTIONS, SURVEYS, AND VISITS
Subchapter H. ENFORCEMENT
1.
GENERAL INFORMATION
2.
ACTIONS AGAINST A LICENSE: SUSPENSION
3.
ACTIONS AGAINST A LICENSE: REVOCATION
4.
ACTIONS AGAINST A LICENSE: TEMPORARY RESTRAINING ORDERS AND INJUNCTIONS
5.
ACTIONS AGAINST A LICENSE: EMERGENCY LICENSE SUSPENSION AND CLOSING ORDER
6.
ACTIONS AGAINST A LICENSE: CIVIL PENALTIES
7.
TRUSTEES: INVOLUNTARY APPOINTMENT OF A TRUSTEE
8.
TRUSTEES: APPOINTMENT OF A TRUSTEE BY AGREEMENT
9.
ADMINISTRATIVE PENALTIES
10.
AMELIORATION
Part 5.
TEXAS VETERANS LAND BOARD