| (1) The facility must maintain written policies regarding
the implementation of advance directives. The policies must include
a clear and precise statement of any procedure the facility is unwilling
or unable to provide or withhold in accordance with an advance directive.
(2) The facility must provide written notice of these
policies to residents at the time they are admitted to receive services
from the facility.
(A) If, at the time notice is to be provided, the resident
is incompetent or otherwise incapacitated and unable to receive the
notice, the facility must provide the written notice, in the following
order of preference, to:
(i) the resident's legal guardian;
(ii) a person responsible for the resident's health
care decisions;
(iii) the resident's spouse;
(iv) the resident's adult child;
(v) the resident's parents; or
(vi) the person admitting the resident.
(B) If the facility is unable, after diligent search,
to locate an individual listed under subparagraph (A) of this paragraph,
the facility is not required to give notice.
(3) If a resident who was incompetent or otherwise
incapacitated and unable to receive notice regarding the facility's
advance directives policies later becomes able to receive the notice,
the facility must provide the written notice at the time the resident
becomes able to receive the notice.
(4) HHSC imposes an administrative penalty of $500
for failure to inform the resident of facility policies regarding
the implementation of advance directives.
(A) HHSC sends a facility written notice of the recommendation
for an administrative penalty.
(B) Within 20 days after the date on which HHSC sends
written notice to a facility, the facility must give written consent
to the penalty or make written request to HHSC for an administrative
hearing.
(C) Hearings are held in accordance with the formal
hearing procedures at 1 TAC Chapter 357, Subchapter I (relating to
Hearings Under the Administrative Procedures Act).
(e) Inappropriate placement in Type A or Type B facilities.
(1) HHSC or a facility may determine that a resident
is inappropriately placed in the facility if the resident experiences
a change of condition but continues to meet the facility evacuation
criteria.
(A) If HHSC determines the resident is inappropriately
placed and the facility is willing to retain the resident, the facility
is not required to discharge the resident if, within 10 working days
after receiving the Statement of Licensing Violations and Plan of
Correction, Form 3724, and the Report of Contact, Form 3614-A, from
HHSC, the facility submits the following 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; and
(iii) Facility Request, Form 1124, indicating that
the facility agrees that the resident may remain at the facility.
(B) If the facility initiates the request for an inappropriately
placed resident to remain in the facility, the facility must complete
and date the forms described in subparagraph (A) of this paragraph
and submit them to 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.
(2) HHSC or a facility may determine that a resident
is inappropriately placed in the facility if the facility does not
meet all requirements for the evacuation of a designated resident
referenced in §553.5 of this chapter (relating to Types of Assisted
Living Facilities).
(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;
Cont'd... |
