| (a) Staff qualifications.
(1) Director. A facility must employ a director.
(A) The director must:
(i) have graduated from an accredited four-year college
or university and have no less than one year of experience in working
with people in a human service or medically related program, or have
an associate degree or 60 semester hours from an accredited college
or university with three years of experience working with people in
a human service or medically related program;
(ii) be an RN with one year of experience in a human
service or medically related program;
(iii) meet the training and experience requirements
for a license as a nursing facility administrator under Texas Administrative
Code (TAC), Title 40, Chapter 18, Nursing Facility Administrators;
or
(iv) have met, on July 16, 1989, the qualifications
for a director required at that time and have served continuously
in the capacity of director since that date.
(B) The director must show evidence of 12 hours of
annual continuing education in at least two of the following areas:
(i) individual and provider rights and responsibilities,
abuse, neglect, exploitation and confidentiality;
(ii) basic principles of supervision;
(iii) skills for working with individuals, families,
and other professional service providers;
(iv) individual characteristics and needs;
(v) community resources;
(vi) basic emergency first aid, such as cardiopulmonary
resuscitation (CPR) or choking; or
(vii) federal laws, such as Americans with Disabilities
Act, Civil Rights Act of 1991, the Rehabilitation Act of 1993, and
the Family and Medical Leave Act of 1993.
(C) The activities director may fulfill the function
of director if the activities director meets the qualifications for
facility director.
(D) One person may not serve as facility nurse, activities
director, and director, regardless of qualifications.
(E) The facility must have a policy regarding the
delegation of responsibility in the director's absence from the facility.
(F) The facility must notify the HHSC regional office
in which the facility is located if the director is absent from the
facility for more than 10 working days.
(2) Nurse. A facility must employ a nurse.
(A) An RN must have a license from the Texas Board
of Nursing and practice in compliance with the Nurse Practice Act
and rules and regulations of the Texas Board of Nursing.
(B) An LVN must have a license from the Texas Board
of Nursing and practice in compliance with the Nurse Practice Act
and rules and regulations of the Texas Board of Nursing.
(C) If a nurse serving as director leaves the facility
to perform other duties related to the DAHS program, an LVN or another
RN must fulfill the duties of the facility nurse.
(D) A facility that does not have a DAHS contract,
but has a Special Services to Persons with Disabilities contract,
is not required to have an RN on duty, if the individual receiving
services has no medical needs and is able to self-administer medication.
(3) Activities director. A facility must employ an
activities director.
(A) Except as provided in subparagraph (B) of this
paragraph, an activities director must have graduated from a high
school or have a certificate recognized by a state of the United States
as the equivalent of a high-school diploma and have:
(i) a bachelor's degree from an accredited college
or university, and one year of full-time experience working with elderly
people or people with disabilities in a human service or medically
related program;
(ii) 60 semester hours from an accredited college or
university, and two years of full-time experience working with elderly
people or people with disabilities in a human service or medically
related program; or
(iii) completed an activities director's course, and
two years of full-time experience working with elderly people or people
with disabilities in a human service or medically related program.
(B) An activities director hired before May 1, 1999,
with four years of full-time experience working with elderly people
or people with disabilities in a human service or medically related
program is not subject to the requirements of subparagraph (A) of
this paragraph.
(4) Attendants. An attendant must be at least 18 years
of age and may be employed as a driver, aide, cook, janitor, porter,
housekeeper, or laundry worker.
(A) If a facility employs a driver, the driver must
have a current operator's license, issued by the Texas Department
of Public Safety, which is appropriate for the class of vehicle used
to transport individuals.
(B) If an attendant handles food in the facility, the
attendant must meet requirements of the Department of State Health
Services rules on food service sanitation as described in 25 TAC,
Chapter 228, Subchapters A - J (relating to Retail Food).
(5) Food service personnel. If a facility prepares
meals on site, the facility must have sufficient food service personnel
to prepare meals and snacks. Food service personnel must meet the
requirements of the Department of State Health Services rules on food
service sanitation as described in 25 TAC, Chapter 228, Subchapters
A - J (relating to Retail Food).
(6) Additional requirements for a facility that contracts
with HHSC.
(A) Housekeeper. A facility that contracts with HHSC
may employ a part-time or full-time housekeeper.
(B) Driver. If a facility that contracts with HHSC
employs a driver, the driver must:
(i) operate the facility's vehicles in a safe manner;
and
(ii) maintain adult cardiopulmonary resuscitation (CPR)
certification.
(b) Staffing. A facility must ensure that:
(1) the ratio of direct service staff to individuals
is at least one to eight, which must be maintained during provision
of all DAHS except during facility-provided transportation;
(2) at least one RN or LVN is working at the facility
for at least eight hours per day and sufficient nurses are at the
facility to meet the nursing needs of the individuals at all times;
(3) the facility director routinely works at least
40 hours per week performing duties relating to the provision of the
DAHS program;
(4) the activities director routinely works at least
40 hours a week;
(5) individuals whose needs cannot be met by the facility
are not admitted or retained; and
(6) sufficient staff are on duty at all times to meet
the needs of the individuals who are served by the facility.
(c) Staff health. All direct service staff must be
free of communicable diseases.
(1) A facility must screen all employees for tuberculosis
within two weeks of employment and annually, according to Center for
Disease Control and Prevention (CDC) screening guidelines. All persons
providing services under an outside resource contract must also screen
all employees for tuberculosis within two weeks of employment and
annually according to CDC screening guidelines.
(2) If an employee contracts a communicable disease
that is transmissible to individuals through food handling or direct
individual care, the facility must exclude the employee from providing
these services while the employee is infectious.
(d) Staff responsibilities.
(1) The facility director:
(A) manages the DAHS program and the facility;
(B) trains and supervises facility staff;
(C) monitors the facility building and grounds to
ensure compliance;
(D) maintains all financial and individual records;
(E) develops relationships with community groups and
agencies for identification and referral of individuals;
(F) maintains communication with an individual's family
members or responsible parties;
(G) assures the development and maintenance of the
individual's plan of care; and
(H) ensures that, if the facility director serves as
the RN consultant, the facility director fulfills the responsibility
as director.
(2) The facility nurse:
(A) assesses an individual's nursing and medical needs;
(B) develops an individual's plan of care;
(C) obtains physician's orders for medication and treatments
to be administered;
(D) determines whether self-administered medications
have been appropriately taken, applied, or used;
Cont'd... |
