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RULE §46.41Required Services

(a) Service delivery. The facility must provide services according to the service plan completed for the client.

(b) Required services. Services include:

  (1) Personal care. The facility must provide or assist with personal care services identified on the service plan completed for the client. Personal care services are activities related to the care of the client's physical health that include at a minimum:

    (A) bathing;

    (B) dressing;

    (C) grooming;

    (D) routine hair and skin care;

    (E) exercising;

    (F) toileting;

    (G) medication administration, including injections, except in the Community Care for Aged and Disabled (CCAD) Residential Care (RC) Program;

    (H) transferring/ambulating, except in a Type A assisted living facility;

    (I) twenty-four-hour supervision, which means the facility must:

      (i) conduct checks or visits to each client as identified in the client's service plan, to ensure that each client is safe and well; and

      (ii) document the checks and visits in the client's file;

    (J) meal services, which means the facility must:

      (i) provide meal services as described in §92.41(m) of this title (relating to Standards for Type A, Type B, and Type E Assisted Living Facilities);

      (ii) offer dietary counseling and nutrition education to the client;

      (iii) modify food texture, including:

        (I) chopping, grinding, and mashing foods for clients who have trouble chewing; and

        (II) cutting up food into bite size pieces for clients who have trouble cutting food; and

      (iv) assist with eating, including:

        (I) assistance with spoon-feeding in instances when the client is temporarily ill;

        (II) bread buttering; and

        (III) opening containers or pouring liquids for clients with hand deformities, paralysis, or hand tremors.

  (2) Home management. The facility must provide or assist with activities related to housekeeping that are essential to the client's health and comfort, including:

    (A) changing bed linens;

    (B) housecleaning;

    (C) laundering;

    (D) shopping;

    (E) storing purchased items in the client's living unit, including medical supplies delivered to Community Based Alternatives (CBA) Assisted Living/Residential Care (AL/RC) clients; and

    (F) washing dishes.

  (3) Transportation and escort.

    (A) The facility must provide the client with transportation, escort, or both to:

      (i) local community areas where a client may purchase items to meet his or her personal needs or conduct personal business according to the facility's published schedule;

      (ii) recreational activities, field/community trips according to the facility's published schedule; and

      (iii) the nearest available medical provider for medical appointments, therapies, and other medical care.

    (B) The facility must make arrangements for other transportation for the client to the medical care provider of the client's choice if the client's medical provider is not the nearest available provider.

  (4) Social and recreational activities. The facility must provide a minimum of four scheduled social and recreational activities per week.

    (A) Activity requirements. The social and recreational activities must be:

      (i) planned to meet the social needs and interests of the clients; and

      (ii) listed on a monthly calendar that is posted in plain view at the facility at least one week in advance.

    (B) Types of activities. Social and recreational activities include:

      (i) activities that require group and client-initiated activities;

      (ii) opportunities to interact with other people;

      (iii) interaction, cultural enrichment, educational, or recreational activities; and

      (iv) other social activities on site or in the community.

  (5) Participation in the client assessment. The facility must designate someone who is familiar with the CBA AL/RC client's needs and service plan to participate in the client's assessment by a home and community support services agency's licensed nurse. A facility is not required to designate someone to participate in a client's assessment in the CCAD RC Program.

  (6) Emergency care. The facility must provide emergency care as authorized by the case manager.

    (A) Emergency care is assisted living services provided to clients while the case manager seeks a permanent living arrangement.

    (B) Emergency care services do not apply to the CBA AL/RC program.

Source Note: The provisions of this §46.41 adopted to be effective September 1, 2003, 28 TexReg 6941; amended to be effective September 1, 2008, 33 TexReg 7285

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