| (a) General. The resident has the right to be free
from abuse, neglect, misappropriation of resident property, and exploitation
as defined in §554.101 of this chapter (relating to Definitions).
This includes freedom from any physical or chemical restraint not
required to treat the resident's medical symptoms.
(b) Abuse. The resident has the right to be free from
verbal, sexual, physical, and mental abuse, corporal punishment, and
involuntary seclusion.
(c) Policies and procedures. The facility must develop
and implement written policies and procedures that prohibit and prevent
mistreatment, abuse, neglect, and exploitation of a resident, and
misappropriation of a resident's property.
(1) The facility must:
(A) not use verbal, mental, sexual, or physical abuse,
corporal punishment, or involuntary seclusion;
(B) not employ or otherwise engage an individual who
has:
(i) been found guilty of abuse, neglect, exploitation,
misappropriation of property, or mistreatment of a resident by a court
of law;
(ii) had a finding entered into the state nurse aide
registry concerning abuse, neglect, exploitation or mistreatment of
a resident, or misappropriation of a resident's property;
(iii) been convicted of any crime contained in §250.006,
Texas Health and Safety Code; or
(iv) a disciplinary action in effect against the individual's
professional license by a state licensure body as a result of a finding
of abuse, neglect, exploitation, mistreatment of a resident or misappropriation
of a resident's property;
(C) report any knowledge it has of actions by a court
of law against an employee that would indicate unfitness for service
as a nurse aide or other staff to the state nurse aide registry or
licensing authority; and
(D) suspend the employment of an employee who HHSC
finds has engaged in reportable conduct, as defined in section §554.101
of this chapter, while the employee exhausts any applicable appeals
process, including informal and formal appeals and any hearing or
judicial review, pending a final decision by an administrative law
judge. A facility must not reinstate the employee's employment or
contract during any applicable appeals process.
(2) The written policies and procedures must:
(A) establish protocols to investigate any such allegations;
and
(B) include training as required by §554.1929
of this chapter (relating to Staff Development).
(d) Restraints. The facility must ensure that the resident
is free from physical or chemical restraints imposed for purposes
of discipline or convenience and that are not required to treat the
resident's medical symptoms. If the use of restraints is indicated,
the facility must use the least restrictive alternative for the least
amount of time and document ongoing re-evaluation of the need for
restraints.
(1) If physical restraints are used because they are
required to treat the resident's medical condition, the restraints
must be released and the resident repositioned as needed to prevent
deterioration in the resident's condition. Residents must be monitored
hourly and, at a minimum, restraints must be released every two hours
for a minimum of ten minutes, and the resident repositioned.
(2) A facility must not administer to a resident a
restraint that:
(A) obstructs the resident's airway, including a procedure
that places anything in, on, or over the resident's mouth or nose;
(B) impairs the resident's breathing by putting pressure
on the resident's torso;
(C) interferes with the resident's ability to communicate;
or
(D) places the resident in a prone or supine hold.
(3) A behavioral emergency is a situation in which
severely aggressive, destructive, violent, or self-injurious behavior
exhibited by a resident:
(A) poses a substantial risk of imminent probable death
of, or substantial bodily harm to, the resident or others;
(B) has not abated in response to attempted preventive
de-escalatory or redirection techniques;
(C) could not reasonably have been anticipated; and
(D) is not addressed in the resident's comprehensive
care plan.
(4) If restraint is used in a behavioral emergency,
the facility must use only an acceptable restraint hold. An acceptable
restraint hold is a hold in which the resident's limbs are held close
to the body to limit or prevent movement and that does not violate
the provisions of paragraph (2) of this subsection.
(5) A staff person may use a restraint hold only for
the shortest period of time necessary to ensure the protection of
the resident or others in a behavioral emergency.
(6) A facility may adopt policies that allow less use
of restraint than allowed by the rules of this chapter.
(7) A resident, or the resident's legally authorized
representative, must agree to the use of a physical restraint in accordance
with §554.402 of this chapter (relating to Exercise of Rights)
and §554.406 of this chapter (relating to Free Choice).
(8) A physical restraint must be ordered by a physician.
The order must include why the restraint is necessary to treat the
resident's medical condition and the specified timeframe for re-evaluation
of the order.
(9) Use of restraints and their release must be documented
in the resident's clinical record and in the resident's care plan
in accordance with §554.802 of this chapter (relating to Comprehensive
Person-Centered Care Planning).
|
| Source Note: The provisions of this §554.601 adopted to be effective May 1, 1995, 20 TexReg 2393; amended to be effective March 1, 1998, 23 TexReg 1314; amended to be effective June 1, 2006, 31 TexReg 4449; amended to be effective March 24, 2020, 45 TexReg 2025; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871; amended to be effective September 18, 2024, 49 TexReg 7331 |
