|(a) Admission policies and disclosure statement.
(1) A facility must not admit or retain a resident
whose needs cannot be met by the facility and who cannot secure the
necessary services from an outside resource. As part of the facility's
general supervision and oversight of the physical and mental well-being
of its residents, the facility remains responsible for all care provided
at the facility. If the individual is appropriate for placement in
a facility, then the decision that additional services are necessary
and can be secured is the responsibility of facility management with
written concurrence of the resident, resident's attending physician,
or legal representative. Regardless of the possibility of "aging in
place" or securing additional services, the facility must meet all
NFPA 101 and physical plant requirements in Subchapter D of this chapter
(relating to Facility Construction), and, as applicable, §553.311
(relating to Physical Plant Requirements for Alzheimer's Units), based
on each resident's evacuation capabilities, except as provided in
subsection (e) of this section.
(2) There must be a written admission agreement between
the facility and the resident. The agreement must specify such details
as services to be provided and the charges for the services. If the
facility provides services and supplies that could be a Medicare benefit,
the facility must provide the resident a statement that such services
and supplies could be a Medicare benefit.
(3) A facility must share a copy of the facility disclosure
statement, rate schedule, and individual resident service plan with
outside resources that provide any additional services to a resident.
Outside resources must provide facilities with a copy of their resident
care plans and must document, at the facility, any services provided,
on the day provided.
(4) Each resident must have a health examination by
a physician performed within 30 days before admission or 14 days after
admission, unless a transferring hospital or facility has a physical
examination in the medical record.
(5) The facility must secure at the time of admission
of a resident the following identifying information:
(A) full name of resident;
(B) social security number;
(C) usual residence (where resident lived before admission);
(E) marital status;
(F) date of birth;
(G) place of birth;
(H) usual occupation (during most of working life);
(I) family, other persons named by the resident, and
physician for emergency notification;
(J) pharmacy preference; and
(K) Medicaid/Medicare number, if available.
(b) Resident assessment and service plan. Within 14
days of admission, a resident comprehensive assessment and an individual
service plan for providing care, which is based on the comprehensive
assessment, must be completed. The comprehensive assessment must be
completed by the appropriate staff and documented on a form developed
by the facility. When a facility is unable to obtain information required
for the comprehensive assessment, the facility should document its
attempts to obtain the information.
(1) The comprehensive assessment must include the following
(A) the location from which the resident was admitted;
(B) primary language;
(C) sleep-cycle issues;
(D) behavioral symptoms;
(E) psychosocial issues (i.e., a psychosocial functioning
assessment that includes an assessment of mental or psychosocial adjustment
difficulty; a screening for signs of depression, such as withdrawal,
anger or sad mood; assessment of the resident's level of anxiety;
and determining if the resident has a history of psychiatric diagnosis
that required in-patient treatment);
(F) Alzheimer's disease/dementia history;
(G) activities of daily living patterns (e.g., wakened
to toilet all or most nights, bathed in morning/night, shower or bath);
(H) involvement patterns and preferred activity pursuits
(i.e., daily contact with relatives, friends, usually attended religious
services, involved in group activities, preferred activity settings,
general activity preferences);
(I) cognitive skills for daily decision-making (e.g.,
independent, modified independence, moderately impaired, severely
(J) communication (i.e., ability to communicate with
others, communication devices);
(K) physical functioning (i.e., transfer status; ambulation
status; toilet use; personal hygiene; ability to dress, feed and groom
(L) continence status;
(M) nutritional status (e.g., weight changes, nutritional
problems or approaches);
(N) oral/dental status;
(P) medications (e.g., administered, supervised, self-administers);
(Q) health conditions and possible medication side
(R) special treatments and procedures;
(S) hospital admissions within the past six months
or since last assessment; and
(T) preventive health needs (e.g., blood pressure monitoring,
(2) The service plan must be approved and signed by
the resident or a person responsible for the resident's health care
decisions. The facility must provide care according to the service
plan. The service plan must be updated annually and upon a significant
change in condition, based upon an assessment of the resident.
(3) For respite clients, the facility may keep a service
plan for six months from the date on which it is developed. During
that period, the facility may admit the individual as frequently as
(4) Emergency admissions must be assessed, and a service
plan developed for them.
(c) Resident policies.
(1) Before admitting a resident, facility staff must
explain and provide a copy of the disclosure statement to the resident,
family, or responsible party. A facility that provides brain injury
rehabilitation services must attach to its disclosure statement a
specific statement that licensure as an assisted living facility does
not indicate state review, approval, or endorsement of the facility's
rehabilitative services. The facility must document receipt of the
(2) The facility must provide residents with a copy
of the Resident's Bill of Rights.
(3) When a resident is admitted, the facility must
provide to the resident's immediate family, and document the family's
receipt of, the HHSC telephone hotline number to report suspected
abuse, neglect, or exploitation, as referenced in §553.273 of
this subchapter (relating to Abuse, Neglect, or Exploitation Reportable
to HHSC by Facilities).
(4) The facility must have written policies regarding
residents accepted, services provided, charges, refunds, responsibilities
of facility and residents, privileges of residents, and other rules
(5) The facility must make available copies of the
resident policies to staff and to residents or residents' responsible
parties at time of admission. Documented notification of any changes
to the policies must occur before the effective date of the changes.
(6) Before or upon admission of a resident, a facility
must notify the resident and, if applicable, the resident's legally
authorized representative, of HHSC rules and the facility's policies
related to restraint and seclusion.
(7) The facility must provide a resident and the resident's
legally authorized representative with a written copy of the facility's
emergency preparedness plan or an evacuation summary, as required
under §553.275(d) of this subchapter (relating to Emergency Preparedness
(d) Advance directives.
(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
(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
(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
(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
(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: