| (A) If, during a site visit, HHSC determines that a
resident is inappropriately placed at the facility and the facility
is willing to retain the resident, the facility must request an evacuation
waiver, as described in subparagraph (C) of this paragraph, to the
HHSC regional office within 10 working days after the date the facility
receives the Statement of Licensing Violations and Plan of Correction,
Form 3724, and the Report of Contact, Form 3614-A. If the facility
is not willing to retain the resident, the facility must discharge
the resident within 30 days after receiving the Statement of Licensing
Violations and Plan of Correction and the Report of Contact.
(B) If the facility initiates the request for a resident
to remain in the facility, the facility must request an evacuation
waiver, as described in subparagraph (C) of this paragraph, from the
HHSC regional office within 10 working days after the date the facility
determines the resident is inappropriately placed, as indicated on
the HHSC prescribed forms.
(C) To request an evacuation waiver for an inappropriately
placed resident, a facility must submit to the HHSC regional office:
(i) Physician's Assessment, Form 1126, indicating that
the resident is appropriately placed and describing the resident's
medical conditions and related nursing needs, ambulatory and transfer
abilities, and mental status;
(ii) Resident's Request to Remain in Facility, Form
1125, indicating that:
(I) the resident wants to remain at the facility; or
(II) if the resident lacks capacity to provide a written
statement, the resident's family member or legally authorized representative
wants the resident to remain at the facility;
(iii) Facility Request, Form 1124, indicating that
the facility agrees that the resident may remain at the facility;
(iv) a detailed emergency plan that explains how the
facility will meet the evacuation needs of the resident, including:
(I) specific staff positions that will be on duty to
assist with evacuation and their shift times;
(II) specific staff positions that will be on duty
and awake at night; and
(III) specific staff training that relates to resident
evacuation;
(v) a copy of an accurate facility floor plan, to scale,
that labels all rooms by use and indicates the specific resident's
room;
(vi) a copy of the facility's emergency evacuation
plan;
(vii) a copy of the facility fire drill records for
the last 12 months;
(viii) a copy of a completed Fire Marshal/State Fire
Marshal Notification, Form 1127, signed by the fire authority having
jurisdiction (either the local Fire Marshal or State Fire Marshal)
as an acknowledgement that the fire authority has been notified that
the resident's evacuation capability has changed;
(ix) a copy of a completed Fire Suppression Authority
Notification, Form 1129, signed by the local fire suppression authority
as an acknowledgement that the fire suppression authority has been
notified that the resident's evacuation capability has changed;
(x) a copy of the resident's most recent comprehensive
assessment that addresses the areas required by subsection (c) of
this section and that was completed within 60 days, based on the date
stated on the evacuation waiver form submitted to HHSC;
(xi) the resident's service plan that addresses all
aspects of the resident's care, particularly those areas identified
by HHSC, including:
(I) the resident's medical condition and related nursing
needs;
(II) hospitalizations within 60 days, based on the
date stated on the evacuation waiver form submitted to HHSC;
(III) any significant change in condition in the last
60 days, based on the date stated on the evacuation waiver form submitted
to HHSC;
(IV) specific staffing needs; and
(V) services that are provided by an outside provider;
(xii) any other information that relates to the required
fire safety features of the facility that will ensure the evacuation
capability of any resident; and
(xiii) service plans of other residents, if requested
by HHSC.
(D) A facility must meet the following criteria to
receive a waiver from HHSC:
(i) The emergency plan submitted in accordance with
subparagraph (C)(iv) of this paragraph must ensure that:
(I) staff is adequately trained;
(II) a sufficient number of staff are on all shifts
to move all residents to a place of safety;
(III) residents will be moved to appropriate locations,
given health and safety issues;
(IV) all possible locations of fire origin areas and
the necessity for full evacuation of the building are addressed;
(V) the fire alarm signal is adequate;
(VI) there is an effective method for warning residents
and staff during a malfunction of the building fire alarm system;
(VII) there is a method to effectively communicate
the actual location of the fire; and
(VIII) the plan satisfies any other safety concerns
that could have an effect on the residents' safety in the event of
a fire; and
(ii) the emergency plan will not have an adverse effect
on other residents of the facility who have waivers of evacuation
or who have special needs that require staff assistance.
(E) HHSC reviews the documentation submitted under
this subsection and notifies the facility in writing of its determination
to grant or deny the waiver within 10 working days after the date
the request is received in the HHSC regional office.
(F) Upon notification that HHSC has granted the evacuation
waiver, the facility must immediately initiate all provisions of the
proposed emergency plan. If the facility does not follow the emergency
plan, and there are health and safety concerns that are not addressed,
HHSC may determine that there is an immediate threat to the health
or safety of a resident.
(G) HHSC reviews a waiver of evacuation during the
facility's annual renewal licensing inspection.
(3) If an HHSC surveyor determines that a resident
is inappropriately placed at a facility and the facility either agrees
with the determination or fails to obtain the written statements or
waiver required in this subsection, the facility must discharge the
resident.
(A) The resident is allowed 30 days after the date
of notice of discharge to move from the facility.
(B) A discharge required under this subsection must
be made notwithstanding:
(i) any other law, including any law relating to the
rights of residents and any obligations imposed under the Property
Code; and
(ii) the terms of any contract.
(4) If a facility is required to discharge the resident
because the facility has not submitted the written statements required
by paragraph (1) of this subsection to the HHSC regional office, or
HHSC denies the waiver as described in paragraph (2) of this subsection,
HHSC may:
(A) assess an administrative penalty if HHSC determines
the facility has intentionally or repeatedly disregarded the waiver
process because the resident is still residing in the facility when
HHSC conducts a future onsite visit; or
(B) seek other sanctions, including an emergency suspension
or closing order, against the facility under Texas Health and Safety
Code, Chapter 247, Subchapter C, if HHSC determines there is a significant
risk and immediate threat to the health and safety of a resident of
the facility.
(5) The facility's disclosure statement must notify
the resident and resident's legally authorized representative of the
waiver process described in this section and the facility's policies
and procedures for aging in place.
(6) After the first year of employment and no later
than the anniversary date of the facility manager's hire date, the
manager must show evidence of annual completion of HHSC training on
aging in place and retaliation.
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