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RULE §19.601Resident Behavior and Facility Practice

(a) Restraints. The resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms.

  (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) Use of restraints and their release must be documented in the clinical record.

(b) Abuse. The resident has the right to be free from verbal, sexual, physical and mental abuse, corporal punishment, and involuntary seclusion.

(c) Staff treatment of residents. The facility must develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents, and misappropriation of residents' property.

  (1) The facility must:

    (A) not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion; and

    (B) not employ individuals who have:

      (i) been found guilty of abusing, neglecting, or mistreating residents by a court of law, or

      (ii) had a finding entered into the state nurse aide registry concerning abuse, neglect, mistreatment of residents, or misappropriation of their property; or

      (iii) been convicted of any crime contained in §250.006, Health and Safety Code; and

    (C) report any knowledge it has of actions by a court of law against an employee, which would indicate unfitness for service as a nurse aide or other staff to the state nurse aide registry or licensing authority.

  (2) The facility must ensure that all alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source, and misappropriation of resident property, are reported immediately to the administrator of the facility and to other officials in accordance with Texas law through established procedures (see §19.602 of this title (relating to Incidents of Abuse and Neglect Reportable to the Texas Department of Human Services and Law Enforcement Agencies by Facilities)).

  (3) The facility must have evidence that all alleged violations are thoroughly investigated and must prevent further potential abuse while the investigation is in progress.

  (4) The results of all investigations must be reported to the administrator or his designated representative and to other officials in accordance with Texas law (including to the state survey and certification agency) within five workdays of the incident, and if the alleged violation is verified, appropriate corrective action must be taken.

Source Note: The provisions of this §19.601 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

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