| (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;
(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; and
(H) a copy of the most recent court order appointing
a guardian of a resident or a resident's estate and letters of guardianship
that the facility received in response to the request made in accordance
with §92.42 of this subchapter (relating to Guardianship Record
Requirements).
(3) Records must be available to residents, their legal
representatives, and DADS staff.
(i) Personnel records. An assisted living facility
must keep current and complete personnel records on a facility employee
for review by DADS staff including:
(1) documentation that the facility performed a criminal
history check;
(2) an annual employee misconduct registry check;
(3) an annual nurse aide registry check;
(4) documentation of initial tuberculosis screenings
referenced in subsection (n) of this section;
(5) documentation of the employee's compliance with
or exemption from the facility vaccination policy referenced in subsection
(r) of this section; and
(6) the signed statement from the employee referenced
in §92.102 of this chapter acknowledging that the employee may
be criminally liable for the failure to report abuse, neglect and
exploitation.
(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
225 (concerning RN Delegation to Unlicensed Personnel and Tasks Not
Requiring Delegation in Independent Living Environments for Clients
with Stable and Predictable Conditions), which implements the Nursing
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 (relating
to Definition, Treatment, and Disposition 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
Cont'd... |
