| (v) procedures to conduct emergency response drills
at least annually either in response to an actual disaster or in a
planned drill, which may be in addition to or combined with the drills
required by the LSC as specified in subsection (c)(1) of this section.
(b) Physical plant and equipment. A hospice must develop
procedures for controlling the reliability and quality of:
(1) the routine storage and prompt disposal of trash
and medical waste;
(2) light, temperature, and ventilation and air exchanges
throughout the hospice inpatient unit;
(3) emergency gas and water supply; and
(4) the scheduled and emergency maintenance and repair
of all equipment.
(c) Fire protection. Except as otherwise provided in
this subsection:
(1) A hospice must meet the provisions applicable to
the health care occupancy chapters of the 2000 edition of the LSC
of the National Fire Protection Association (NFPA). Chapter 19.3.6.3.2,
exception number 2 of the 2000 edition of the LSC does not apply to
hospices.
(2) In consideration of a recommendation by HHSC, CMS
may waive, for periods deemed appropriate, specific provisions of
the LSC which if rigidly applied would result in unreasonable hardship
for the hospice, but only if the waiver would not adversely affect
the health and safety of clients.
(3) The provisions of the adopted edition of the LSC
do not apply in the State of Texas if CMS finds that a fire and safety
code imposed by State law adequately protects clients in hospices.
(4) Notwithstanding any provisions of the 2000 edition
of the LSC to the contrary, a hospice inpatient unit may place alcohol-based
hand rub dispensers in its facility if:
(A) use of alcohol-based hand rub dispensers does not
conflict with any State or local codes that prohibit or otherwise
restrict the placement of alcohol-based hand rub dispensers in health
care facilities;
(B) the dispensers are installed in a manner that minimizes
leaks and spills that could lead to falls;
(C) the dispensers are installed in a manner that adequately
protects against access by vulnerable populations; and
(D) the dispensers are installed in accordance with
chapter 18.3.2.7 or chapter 19.3.2.7 of the 2000 edition of the LSC,
as amended by NFPA Temporary Interim Amendment 00-1(101), issued by
the Standards Council of the NFPA on April 15, 2004.
(d) Client areas. A hospice inpatient unit must provide
a home-like atmosphere and ensure that client areas are designed to
preserve the dignity, comfort, and privacy of clients. A hospice inpatient
unit must provide:
(1) physical space for private client and family visiting;
(2) accommodations for family members to remain with
the client throughout the night;
(3) physical space for family privacy after a client's
death; and
(4) the opportunity for the client to receive visitors
at any hour, including infants and small children.
(e) Client rooms. A hospice must ensure that client
rooms are designed and equipped for nursing care, as well as the dignity,
comfort, and privacy of clients. A hospice must accommodate a client
and family request for a single room whenever possible. A client's
room must:
(1) be at or above grade level;
(2) contain a suitable bed and other appropriate furniture
for the client;
(3) have closet space that provides security and privacy
for clothing and personal belongings;
(4) accommodate no more than two clients and their
family members; and
(5) provide at least 80 square feet for a client residing
in a double room and at least 100 square feet for a client residing
in a single room.
(f) Toilet and bathing facilities. A client room in
an inpatient unit must be equipped with, or conveniently located near,
toilet and bathing facilities.
(g) Plumbing facilities. A hospice inpatient unit must:
(1) always have an adequate supply of hot water; and
(2) have plumbing fixtures with control valves that
automatically regulate the temperature of the hot water used by a
client.
(h) Infection control. A hospice inpatient unit must
maintain an infection control program that protects clients, staff,
and others by preventing and controlling infections and communicable
disease in accordance with §558.853 of this subchapter (relating
to Hospice Infection Control Program).
(i) Sanitary environment. A hospice inpatient unit
must provide a sanitary environment by following accepted standards
of practice, including nationally recognized infection control precautions,
and avoiding sources and transmission of infections and communicable
diseases.
(j) Linen. A hospice inpatient unit must always have
available a quantity of clean linen in sufficient amounts for a client's
use. Linens must be handled, stored, processed, and transported in
such a manner as to prevent the spread of contaminants.
(k) Meal service and menu planning. A hospice inpatient
unit must furnish meals to a client that are:
(1) consistent with the client's plan of care, nutritional
needs, and therapeutic diet;
(2) palatable, attractive, and served at the proper
temperature; and
(3) obtained, stored, prepared, distributed, and served
under sanitary conditions.
(l) Use of restraint or seclusion. A client in a hospice
inpatient unit has the right to be free from restraint or seclusion,
of any form, imposed as a means of coercion, discipline, convenience,
or retaliation by staff. Restraint or seclusion may only be imposed
to ensure the immediate physical safety of the client, a staff member,
or others and must be discontinued at the earliest possible time.
(1) Restraint or seclusion may only be used when less
restrictive interventions are determined to be ineffective to protect
the client, a staff member, or others from harm.
(2) The type or technique of restraint or seclusion
used must be the least restrictive intervention that is effective
to protect the client, a staff member, or others from harm.
(3) The use of restraint or seclusion must be:
(A) in accordance with a written modification to the
client's plan of care; and
(B) implemented in accordance with safe and appropriate
restraint and seclusion techniques as determined by hospice policy.
(4) The use of restraint or seclusion must be in accordance
with the order of a physician authorized to order restraint or seclusion
by hospice policy.
(5) An order for the use of restraint or seclusion
must never be written as a standing order or on an as needed basis.
(6) The medical director or physician designee must
be consulted as soon as possible if the attending practitioner did
not order the restraint or seclusion.
(7) An order for restraint or seclusion used for the
management of violent or self-destructive behavior that jeopardizes
the immediate physical safety of the client, a staff member, or others
may only be renewed in accordance with the following limits for up
to a total of 24 hours:
(A) four hours for adults 18 years of age or older;
(B) two hours for children and adolescents nine to
17 years of age; or
(C) one hour for children under nine years of age.
(8) After 24 hours, before writing a new order for
the use of restraint or seclusion for the management of violent or
self-destructive behavior, a physician authorized to order restraint
or seclusion by hospice policy must see and assess the client.
(9) Each order for restraint used to ensure the physical
safety of a non-violent or non-self-destructive client may be renewed
as authorized by hospice policy.
(10) Restraint or seclusion must be discontinued at
the earliest possible time, regardless of the length of time identified
in the order.
(11) The condition of the client who is restrained
or secluded must be monitored by a physician or trained staff who
have completed the training criteria specified in subsection (o) of
this section at an interval determined by hospice policy.
(12) Training requirements for a physician and for
an attending practitioner must be specified in hospice policy. At
a minimum, a physician and an attending practitioner authorized to
order restraint or seclusion by hospice policy must have a working
knowledge of hospice policy regarding the use of restraint or seclusion.
(13) When restraint or seclusion is used for the management
of violent or self-destructive behavior that jeopardizes the immediate
physical safety of the client, a staff member, or others:
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