| (B) The facility must maintain evidence of compliance
with local and 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) The facility's policies and practices for resident
TB screening must ensure compliance with the recommendations of a
resident's attending physician and consistency with CDC guidelines.
(5) The facility's infection prevention and control
program established under paragraph (1) of this subsection must include
written policies and procedures for:
(A) monitoring key infectious agents, including multidrug-resistant
organisms, as those terms are respectively defined in §553.3
of this chapter (relating to Definitions);
(B) wearing personal protective equipment, such as
gloves, a gown, or a mask when called on for anticipated exposure,
and properly cleaning hands before and after touching another resident;
(C) cleaning and disinfecting environmental surfaces,
including door knobs, handrails, light switches, and hand held electronic
(D) using universal precautions for blood and bodily
(E) removing soiled items (such as used tissues, wound
dressings, incontinence briefs, and soiled linens) from the environment
at least once daily, or more often if an infection or infectious disease
is present or suspected.
(6) The facility must establish, implement, enforce,
and maintain a written policy and procedures for making a rapid influenza
diagnostic test, as defined in §553.3 of this chapter, available
to a resident who is exhibiting flu like symptoms.
(7) Personnel must handle, store, process, and transport
linens to prevent the spread of infection.
(8) A facility must use universal precautions in the
care of all residents.
(9) A facility must establish, implement, enforce,
and maintain a written policy to protect a resident from vaccine preventable
diseases in accordance with Texas Health and Safety Code, Chapter
(A) The policy must:
(i) 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;
(ii) specify the vaccines an employee or contractor
is required to receive in accordance with clause (i) of this subparagraph;
(iii) include procedures for the facility to verify
that an employee or contractor has complied with the policy;
(iv) 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 CDC;
(v) include procedures the employee or contractor must
follow to protect residents from exposure to disease for an employee
or contractor who is exempt from the required vaccines, such as the
use of protective equipment, like gloves and masks, 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;
(vi) prohibit discrimination or retaliatory action
against an employee or contractor who is exempt from the required
vaccines for the medical conditions identified as contraindications
or precautions by the CDC, except that required use of protective
medical equipment, including gloves and masks, may not be considered
(vii) require the facility to maintain a written or
electronic record of each employee's or contractor's compliance with
or exemption from the policy; and
(viii) include disciplinary actions the facility may
take against an employee or contractor who fails to comply with the
(B) The policy may:
(i) include procedures for an employee or contractor
to be exempt from the required vaccines based on reasons of conscience,
including religious beliefs; and
(ii) prohibit an employee or contractor who is exempt
from the required vaccines from having contact with residents during
a public health disaster, as defined in Texas Health and Safety Code §81.003.
(g) Restraints and seclusion. All restraints for purposes
of behavioral management, staff convenience, or resident discipline
are prohibited. Seclusion is prohibited.
(1) As provided in §553.267(a)(3) of this subchapter
(relating to Rights), a facility may use physical or chemical restraints
(A) if the use is authorized in writing by a physician
(i) the circumstances under which a restraint may be
(ii) the duration for which the restraint may be used;
(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;
(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;
(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 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 §553.259(b) of this subchapter
(relating to Admission Policies and Procedures) 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 may not discharge or otherwise retaliate
(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.
(h) Wheelchair self-release seat belts.
(1) For the purposes of this section, a "self-release
seat belt" is a seat belt on a resident's wheelchair that the resident
demonstrates the ability to fasten and release without assistance.
A self-release seat belt is not a restraint.
(2) Except as provided in paragraph (3) of this subsection,
a facility must allow a resident to use a self-release seat belt if:
(A) the resident or the resident's legal guardian requests
that the resident use a self-release seat belt;
(B) the resident consistently demonstrates the ability
to fasten and release the self-release seat belt without assistance;
(C) the use of the self-release seat belt is documented
in and complies with the resident's individual service plan; and
(D) the facility receives written authorization, signed
by the resident or the resident's legal guardian, for the resident
to use the self-release seat belt.
(3) A facility that advertises as a restraint-free
facility is not required to allow a resident to use a self-release
seat belt if the facility:
(A) provides a written statement to all residents that
the facility is restraint-free and is not required to allow a resident
to use a self-release seat belt; and
(B) makes reasonable efforts to accommodate the concerns
of a resident who requests a self-release seat belt in accordance
with paragraph (2) of this subsection.
(4) A facility is not required to continue to allow
a resident to use a self-release seat belt in accordance with paragraph
(2) of this subsection if:
(A) the resident cannot consistently demonstrate the
ability to fasten and release the seat belt without assistance;
(B) the use of the self-release seat belt does not
comply with the resident's individual service plan; or
(C) the resident or the resident's legal guardian revokes
in writing the authorization for the resident to use the self-release