| (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 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 (relating to Retail Food) 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.
(f) Infection prevention and control.
(1) Each facility must establish, implement, enforce,
and maintain an infection prevention and 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 rules regarding special
waste in 25 TAC Chapter 1, Subchapter K (relating to Definition, Treatment,
and Disposition of Special Waste from Health Care-Related Facilities).
(3) The facility must immediately report the name of
any resident of a facility with a reportable disease as specified
in 25 TAC Chapter 97, Subchapter A (relating to Control of Communicable
Diseases) to the city health officer, county health officer, or health
unit director having jurisdiction, and implement appropriate infection
control procedures as directed by the local health authority.
(4) The facility must have, implement, enforce, and
maintain written policies for the control of communicable disease
among employees and residents, which must address tuberculosis (TB)
screening and provision of a safe and sanitary environment for residents
and employees.
(A) If an employee contracts a communicable disease
that is transmissible to residents through food handling or direct
resident care, the facility must exclude the employee from providing
these services for the applicable period of communicability.
(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
control devices;
(D) using universal precautions for blood and bodily
fluids; and
(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
224.
(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
retaliatory action;
(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
policy.
(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
Cont'd... |
