| (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 DADS. 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 DADS. 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 DADS.
(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 Chapter 228, Subchapters A - J (relating to 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 (relating
to 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 DADS or an employee of a local 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.
(1) As provided in §92.125(a)(3) of this chapter
(relating to Resident's Bill of Rights and Provider Bill of Rights),
a facility may use physical or chemical restraints only:
(A) if the use is authorized in writing by a physician
and specifies:
(i) the circumstances under which a restraint may be
used; and
(ii) the duration for which the restraint may be used;
or
(B) if the use is necessary in an emergency to protect
the resident or others from injury.
(2) A behavioral emergency is a situation in which
severely aggressive, destructive, violent, or self-injurious behavior
exhibited by a resident:
(A) poses a substantial risk of imminent probable death
of, or substantial bodily harm to, the resident or others;
(B) has not abated in response to attempted preventive
de-escalatory or redirection techniques;
(C) could not reasonably have been anticipated; and
(D) is not addressed in the resident's service plan.
(3) Except in a behavioral emergency, a restraint must
be administered only by qualified medical personnel.
(4) A restraint must not be administered under any
circumstance if it:
(A) obstructs the resident's airway, including a procedure
that places anything in, on, or over the resident's mouth or nose;
(B) impairs the resident's breathing by putting pressure
on the resident's torso;
(C) interferes with the resident's ability to communicate;
or
(D) places the resident in a prone or supine position.
(5) If a facility uses a restraint hold in a circumstance
described in paragraph (2) of this subsection, the facility must use
an acceptable restraint hold.
(A) An acceptable restraint hold is a hold in which
the individual's limbs are held close to the body to limit or prevent
movement and that does not violate the provisions of paragraph (4)
of this subsection.
(B) After the use of restraint, the facility must:
(i) with the resident's consent, make an appointment
with the resident's physician no later than the end of the first working
day after the use of restraint and document in the resident's record
that the appointment was made; or
(ii) if the resident refuses to see the physician,
document the refusal in the resident's record.
(C) As soon as possible but no later than 24 hours
after the use of restraint, the facility must notify one of the following
persons, if there is such a person, that the resident has been restrained:
(i) the resident's legally authorized representative;
or
(ii) an individual actively involved in the resident's
care, unless the release of this information would violate other law.
(D) If, under the Health Insurance Portability and
Accountability Act, the facility is a "covered entity," as defined
in 45 Code of Federal Regulations (CFR) §160.103, any notification
provided under subparagraph (C)(ii) of this paragraph must be to a
person to whom the facility is allowed to release information under
45 CFR §164.510.
(6) In order to decrease the frequency of the use of
restraint, facility staff must be aware of and adhere to the findings
of the resident assessment required in subsection (c) of this section
for each resident.
(7) A facility may adopt policies that allow less use
of restraint than allowed by the rules of this chapter.
(8) A facility must not discharge or otherwise retaliate
against:
(A) an employee, resident, or other person because
the employee, resident, or other person files a complaint, presents
a grievance, or otherwise provides in good faith information relating
to the misuse of restraint or seclusion at the facility; or
(B) a resident because someone on behalf of the resident
files a complaint, presents a grievance, or otherwise provides in
good faith information relating to the misuse of restraint or seclusion
at the facility.
(q) Accreditation status. If a license holder uses
an on-site accreditation survey by an accreditation commission instead
of a licensing survey by DADS, as provided in §92.11(c)(2) and
§92.15(j) of this chapter (relating to Criteria for Licensing;
and Renewal Procedures and Qualifications), the license holder must
provide written notification to DADS within five working days after
the license holder receives a notice of change in accreditation status
from the accreditation commission. The license holder must include
a copy of the notice of change with its written notification to DADS.
(r) Vaccine Preventable Diseases.
(1) Effective September 1, 2012, a facility must develop
and implement a policy to protect a resident from vaccine preventable
diseases in accordance with Texas Health and Safety Code, Chapter
224.
(2) The policy must:
(A) require an employee or a contractor providing direct
care to a resident to receive vaccines for the vaccine preventable
diseases specified by the facility based on the level of risk the
employee or contractor presents to residents by the employee's or
contractor's routine and direct exposure to residents;
(B) specify the vaccines an employee or contractor
is required to receive in accordance with paragraph (1) of this subsection;
(C) include procedures for the facility to verify that
an employee or contractor has complied with the policy;
(D) include procedures for the facility to exempt an
employee or contractor from the required vaccines for the medical
conditions identified as contraindications or precautions by the Centers
for Disease Control and Prevention;
Cont'd... |
