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RULE §551.42Standards for a Facility

    (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 employees.

      (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 requirement.

      (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 control devices;

      (iv) using universal precautions for blood and bodily fluids; and

      (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 symptoms.

    (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 paragraph apply.

    (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 precautions.

    (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, or treatment.

  (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 Medicine);

    (B) a person licensed as a physician assistant in accordance with Texas Occupations Code, Chapter 204 (relating to Physician Assistants); or

    (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 least annually.

(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 exploitation.

(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 IPP.

(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 needs.

(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

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