| (C) A 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.
(D) A 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
the provision of a safe and sanitary environment for residents and
(i) 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.
(ii) A facility must maintain evidence of compliance
with local and state health codes or ordinances regarding employee
and resident health status.
(iii) A facility must screen all employees for TB within
two weeks of employment and annually, according to the Centers for
Disease Control and Prevention (CDC) screening guidelines. A person
who provides services under an outside resource contract must, upon
request of the facility, provide evidence of compliance with this
(iv) A 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.
(E) A facility's infection prevention and control program
established under subparagraph (A) of this subsection must include
written policies and procedures for:
(i) monitoring of key infectious agents, including
multidrug-resistant organisms, as those terms are defined in §551.3
of this chapter (relating to Definitions);
(ii) wearing personal protective equipment, such as
gloves, a gown, or a mask based on anticipated exposure, and properly
cleaning hands before and after touching another resident;
(iii) cleaning and disinfecting environmental surfaces,
including doorknobs, handrails, light switches, and handheld electronic
(iv) using universal precautions for blood and bodily
(v) removing soiled items (such as used tissues, wound
dressings, adult briefs, and soiled linens) from the environment at
least once daily, or more often if an infection or infectious disease
is present or suspected.
(F) A facility must establish, implement, enforce,
and maintain written policies and procedures for making a rapid influenza
diagnostic test, as defined in §551.3 of this chapter (relating
to Definitions), available to a resident who is exhibiting flu-like
(G) Staff must handle, store, process, and transport
linens to prevent the spread of infection.
(H) A facility must use universal precautions in the
care of all residents.
(9) Water activities. A facility must ensure the safety
of all residents who participate in facility-sponsored events. For
this section, a water activity is defined as an activity which occurs
in or on water that is knee deep or deeper on the majority of residents
participating in the event. To ensure the safety of all individuals
who participate, the requirements in subparagraphs (A) - (F) of this
(A) A facility must develop a policy statement regarding
the water sites utilized by the facility. Water sites include lakes,
amusement parks, and pools.
(B) A minimum of one staff person, who is certified
and has demonstrated proficiency in CPR must be on duty and at the
site when residents are involved in water activities.
(C) A minimum of one person with demonstrated proficiency
in water life-saving skills must be on duty and at the site when activities
take place in or on water that is deep enough to require swimming
for life-saving retrieval. This person must maintain supervision of
the activity for its duration.
(D) A sufficient number of staff or a combination of
staff and volunteers must be available to meet the safety requirements
of the group and specific residents.
(E) Each resident's IPP must address each person's
needs for safety when participating in water activities including
medical conditions; physical disabilities and behavioral needs which
could pose a threat to safety; the ability of residents to follow
directions and instructions pertaining to water safety; the ability
of residents to swim independently; and, when called for, special
(F) If the IDT recommends the use of a flotation device
as a precaution for any resident to engage in water activities, it
must be identified and the precautions outlined in the IPP. The device
must be approved by the United States Coast Guard or be a specialized
therapy flotation device utilized in the individual's therapy program.
(10) Communication. A facility may not prohibit a resident
or employee from communicating in the person's native language with
another resident or employee for acquiring or providing care, training,
(11) Physical exams. A facility must ensure that a
resident is given at least one physical exam on a yearly basis by:
(A) a person licensed to practice medicine in accordance
with Texas Occupations Code, Chapter 155 (relating to License to Practice
(B) a person licensed as a physician assistant in accordance
with Texas Occupations Code, Chapter 204 (relating to Physician Assistants);
(C) a person licensed to practice professional nursing
in accordance with Texas Occupations Code, Chapter 301 (relating to
Nurses), and authorized by the Texas Board of Nursing to practice
as an advanced practice nurse.
(f) Governing body and management. A facility must
establish a governing body and the governing body must adopt, implement,
and enforce the facility's policies and procedures. The governing
body must review and update the facility policies and procedures at
(g) Client protections. A facility must ensure the
rights of a resident and through oversight, policy, and investigative
procedures to ensure a resident is free from all abuse, neglect, and
(h) Facility staffing. A facility must ensure a resident
receives professional and non-professional program services needed
to implement the active treatment program defined by a resident's
(i) Active treatment services. A facility must ensure
a resident receives a continuous active treatment program, which includes
aggressive, consistent implementation of a program of specialized
and generic training, treatment, health services, and related services
in the IPP created by the IDT.
(j) Client behavior and facility practices. A facility
must develop and implement written policies and procedures for the
management of conduct between staff and residents and the management
of inappropriate resident behavior.
(k) Health care services. A facility must provide or
obtain preventative and general medical care for a resident and ensure
a resident receives nursing services in accordance with the resident's
(l) Physical environment. A facility must provide sufficient
space and equipment in dining, living, health services, recreation,
and program areas to enable staff to provide a resident with needed
services as required or identified in a resident's IPP. Additionally,
a facility must ensure all fire safety and surrounding safety conditions
are maintained in accordance with federal, state, and local regulations.
(m) Emergency preparedness. A facility must establish
and maintain an emergency preparedness program that meets all federal,
state, and local emergency preparedness requirements.
(n) Dietetic services. A facility must ensure a resident
receives a nourishing, well-balanced diet including any modified or
specifically prescribed diets.
|Source Note: The provisions of this §551.42 adopted to be effective August 31, 1993, 18 TexReg 2557; transferred effective September 1, 1993, as published in the Texas Register September 3, 1993, 18 TexReg 5885; amended to be effective April 1, 1994, 19 TexReg 1832; amended to be effective September 1, 1994, 19 TexReg 5731; amended to be effective June 1, 1995, 20 TexReg 3573; amended to be effective July 1, 1996, 21 TexReg 5328; amended to be effective May 1, 1998, 23 TexReg 4060; amended tobeeffective April 1, 1999, 24 TexReg 1816; amended to be effective May 1, 2000, 25TexReg 3557; amended to be effective July 1, 2002, 27 TexReg 5525; amended to be effective June 1, 2006, 31 TexReg 4463; amended to be effective November 1, 2009, 34 TexReg 7654; amended to be effective June 1, 2010, 35 TexReg 4469; amended to be effective September 1, 2012, 37 TexReg 3871; amended to be effective June 17, 2013, 38 TexReg 3806; transferred effective May 1, 2019, as published in the Texas Register April 12, 2019, 44 TexReg 1883; amended to be effective February 24, 2022, 47 TexReg 787