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TITLE 26HEALTH AND HUMAN SERVICES
PART 1HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 551INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS
SUBCHAPTER CSTANDARDS FOR LICENSURE
RULE §551.42Standards for a Facility

(a) Purpose. The purpose of this section is to promote the public health, safety, and welfare by providing for the development, establishment, and enforcement of standards:

  (1) for the habilitation of residents based on an active treatment program in facilities governed by this chapter; and

  (2) for the establishment, construction, maintenance, and operation of such facilities that view an intellectual disability and related conditions within the context of a developmental model in accordance with the principle of normalization.

(b) Active treatment. A facility regulated by the standards in this section is known as an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID). A resident living in a facility has the same civil rights, equal liberties, and due process of law as other individuals, plus the right to receive active treatment and habilitation. A facility must provide and promote services that enhance the development of each resident, maximize their achievement through an interdisciplinary approach, and create an environment, to the extent possible, that is normalized and normalizing. A facility must:

  (1) have the interdisciplinary team (IDT) prepare and implement, for each resident, an individual program plan (IPP) within 30 days after admission;

  (2) ensure each resident receives a continuous active treatment program consisting of needed interventions and services in sufficient number and frequency to support the achievement of the objectives identified in the IPP, as identified by the IDT; and

  (3) ensure each resident's IPP is reviewed at least annually by a qualified intellectual disability professional (QIDP) and revised as necessary, including situations in which a resident has successfully completed an objective identified in the IPP.

(c) Standards. Each ICF/IID must comply with regulations promulgated by the United States Department of Health and Human Services in 42 CFR, Part 483, Subpart I §§483.400 - 483.480. Additionally, HHSC adopts by reference the federal regulations governing conditions of participation for the ICF/IID program as specified in 42 CFR Part 483, Subpart I §§483.410, 483.420, 483.430, 483.440, 483.450, 483.460, 483.470, 483.475, and 483.480 as licensing standards.

(d) Precertification training conference for new providers of service. Each new provider must attend the precertification/prelicensure training conference prior to licensing by HHSC. The purpose of the training is to ensure that providers of services are familiar with the licensing requirements and to facilitate the delivery of quality services to residents in facilities serving persons with an intellectual disability or related conditions.

  (1) A new provider is an entity that has not had at least one year of administering services in a facility serving persons with an intellectual disability or related conditions in Texas. All new providers must attend a precertification training conference prior to the life safety code survey.

  (2) Each new provider must designate at least one individual who will be involved with the direct management of the facility to attend the training conference prior to a health survey being scheduled.

  (3) Each new provider will be responsible for taking the required training.

(e) Additional requirements.

  (1) Abuse, neglect, and exploitation. A facility must develop and implement policies and procedures for reporting abuse, neglect, and exploitation, and other reportable incidents, to HHSC.

  (2) Cardiopulmonary resuscitation (CPR). A facility must ensure:

    (A) at least one staff person per shift and on duty is trained by a CPR instructor and certified by an organization, such as the American Heart Association or the Red Cross, whose training includes a hands-on in-person skills assessment; and

    (B) that staff members maintain their certification as recommended by the training organization.

  (3) Behavior management. Seclusion of residents may not be used.

  (4) Physical restraints.

    (A) A facility must not use a restraint:

      (i) in a manner that:

        (I) obstructs a resident's airway, including the placement of anything in, on, or over the resident's mouth or nose;

        (II) impairs a resident's breathing by putting pressure on the resident's torso;

        (III) interferes with a resident's ability to communicate;

        (IV) extends a resident's muscle groups away from each other;

        (V) uses hyperextension of joints on a resident; or

        (VI) uses pressure points or pain on a resident;

      (ii) for disciplinary purposes, that is, as retaliation or retribution;

      (iii) for the convenience of staff or other residents; or

      (iv) as a substitute for effective treatment or habilitation.

    (B) A facility may use a restraint:

      (i) in a behavioral emergency;

      (ii) as an intervention in a behavior therapy program that addresses inappropriate behavior exhibited voluntarily by a resident;

      (iii) during a medical or dental procedure if necessary to protect the resident or others and as a follow-up after a medical or dental procedure or following an injury to promote the healing of wounds;

      (iv) to protect the resident from involuntary self-injury; or

      (v) to provide postural support to the resident or to assist the resident in obtaining and maintaining normative bodily functioning.

    (C) In order to decrease the frequency of the use of restraint and to minimize the risk of harm to a resident, a facility must ensure that the IDT:

      (i) with the participation of a physician, or a physician assistant or an advanced practice nurse acting within the scope of his or her practice, identifies:

        (I) the resident's known physical or medical conditions that might constitute a risk to the resident during the use of restraint;

        (II) the resident's ability to communicate; and

        (III) other factors that must be taken into account if the use of restraint is considered, including the resident's:

          (-a-) cognitive functioning level;

          (-b-) height;

          (-c-) weight;

          (-d-) emotional condition (including whether a resident has a history of having been physically or sexually abused); and

          (-e-) age;

      (ii) documents the conditions and factors identified in accordance with clause (i) of this subparagraph, and, as applicable, limitations on specific restraint techniques or mechanical restraint devices in the resident's record; and

      (iii) reviews and updates with a physician, physician assistant, or licensed nurse, at least annually or when a condition or factor documented in accordance with clause (ii) of this subparagraph changes significantly, information in the resident's record related to the identified condition, factor, or limitation.

    (D) If a facility restrains a resident as provided in subparagraph (B) of this paragraph, the facility must:

      (i) take into account the conditions, factors, and limitations on specific restraint techniques or mechanical restraint devices documented in accordance with subparagraph (C)(ii) and (iii) of this paragraph;

      (ii) use the minimal amount of force or pressure that is reasonable and necessary to ensure the safety of the resident and others;

      (iii) safeguard the resident's dignity, privacy, and well-being; and

      (iv) not secure the resident to a stationary object while the resident is in a standing position.

    (E) If a facility uses a restraint in a circumstance described in subparagraph (B)(i) or (ii) of this paragraph:

      (i) the facility may only use a personal 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 subparagraph (A)(i) of this paragraph; and

      (ii) if a resident rolls into a prone or supine position during restraint, the facility must transition the resident to a side, sitting, or standing position as soon as possible. A facility may only use a prone or supine hold:

        (I) as a transitional hold, and only for the shortest period of time necessary to ensure the protection of the resident or others;

        (II) as a last resort, when other less restrictive interventions have proven to be ineffective; and

Cont'd...

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