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TITLE 26HEALTH AND HUMAN SERVICES
PART 1HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 553LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
SUBCHAPTER C
RULE §553.41Standards for Type A and Type B Assisted Living Facilities
Repealed Date:08/31/2021

    (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...

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