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RULE §412.312Environment of Care and Safety

(a) Safe environment. The LMHA, MCO, and provider must:

  (1) ensure service delivery sites (including, but not limited to, facilities and vehicles) are safe, sanitary, and free from hazards, including but not limited to:

    (A) hand washing facilities and supplies in restrooms and in areas where staff have routine physical contact with individuals (e.g., exam rooms, medication areas, laboratories);

    (B) a utility area with necessary equipment for the safe and required cleaning or disposal of instruments, equipment, and sharps;

    (C) locked areas for storing drugs, needles, syringes, hazardous materials, other potentially dangerous equipment, and toxic chemical products; and

    (D) adequate prevention of exposure to tobacco smoke and other environmental pollutants.

  (2) ensure delivery sites are prepared to manage onsite life threatening emergencies, and that each site will have:

    (A) a written plan for the management of onsite medical emergencies requiring ambulance services, hospitalization, or hospital treatment;

    (B) emergency resuscitative drugs, supplies, and equipment appropriate to the needs of individuals and staff qualifications;

    (C) written protocols and instructions for disasters and other emergencies; and

    (D) documented disaster drills appropriate for local conditions.

  (3) comply with the most current edition of the National Fire Protection Association's Life Safety Code, and related codes, standards, and other applicable requirements;

  (4) implement an infection control plan and procedures for group residential services, clinics, and other areas where a high volume of people congregate, that address the prevention, education, management, and monitoring of significant infections. Components addressed in the plan must include:

    (A) prevention and management of infection in the service delivery site(s);

    (B) reporting of reportable diseases as required by Chapter 97, Subchapter A of this title (relating to Control of Communicable Diseases);

    (C) compliance with the Human Immunodeficiency Virus Services Act (Texas Health and Safety Code, §85.001 et seq.), the Communicable Disease Prevention and Control Act (Texas Health and Safety Code, §81.001 et seq.), and other applicable laws (e.g., the Americans with Disabilities Act of 1990, 42 U.S.C. §12101 et seq.; and the Rehabilitation Act of 1973, 29 U.S.C. §701 et seq.);

    (D) identification of illnesses and conditions for which an individual's participation in mental health community services is safely allowed;

    (E) identification of illnesses and conditions for which an individual's participation in mental health community services is restricted and the procedures for minimizing exposure and facilitating an individual's transfer to a more appropriate setting;

  (5) implement safeguards regarding hazardous equipment and weather; and

  (6) implement procedures for the disposal of biohazardous wastes that minimize the risks of contamination, injury, and disease transmission.

(b) Sufficient staff. The provider must have sufficient number of qualified and competent staff members on duty to ensure the safety of individuals and adequacy of mental health community services, including responding to crises during the provision of mental health community services.

(c) Compliance with state and federal law. The provider must comply with all applicable state and federal law and regulations, including those relating to:

  (1) blood borne pathogens;

  (2) food borne pathogen exposure controls; and

  (3) tuberculosis exposure controls.

(d) Limited use of restraint or seclusion.

  (1) Restraint. In outpatient settings, a provider may only use restraint if the intervention is:

    (A) necessary to address a behavioral health emergency, as defined in Chapter 415, Subchapter F of this title (relating to Interventions in Mental Health Programs); and

    (B) performed according to the department's rules described in Chapter 415, Subchapter F of this title.

  (2) Seclusion. Seclusion is prohibited in outpatient settings with the exception of partial hospitalization programs for children or adolescents. A provider may only use seclusion in those programs if the conditions in paragraph (1)(A) - (B) of this subsection are met.

Source Note: The provisions of this §412.312 adopted to be effective April 29, 2009, 34 TexReg 2603

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