TITLE 26 HEALTH AND HUMAN SERVICES
PART 1 HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 553 LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
SUBCHAPTER E STANDARDS FOR LICENSURE
RULE §553.261 Coordination of Care
(B) The facility must maintain evidence of compliance with local and state health codes or ordinances regarding employee and resident health status.
(C) The facility must screen all employees for TB within two weeks of employment and annually, according to Centers for Disease Control and Prevention (CDC) screening guidelines. All persons who provide services under an outside resource contract must, upon request of the facility, provide evidence of compliance with this requirement.
(D) The facility's policies and practices for resident TB screening must ensure compliance with the recommendations of a resident's attending physician and consistency with CDC guidelines.
(5) The facility's infection prevention and control program established under paragraph (1) of this subsection must include written policies and procedures for:
(A) monitoring key infectious agents, including multidrug-resistant organisms, as those terms are respectively defined in §553.3 of this chapter (relating to Definitions);
(B) wearing personal protective equipment, such as gloves, a gown, or a mask when called on for anticipated exposure, and properly cleaning hands before and after touching another resident;
(C) cleaning and disinfecting environmental surfaces, including door knobs, handrails, light switches, and hand held electronic control devices;
(D) using universal precautions for blood and bodily fluids; and
(E) removing soiled items (such as used tissues, wound dressings, incontinence briefs, and soiled linens) from the environment at least once daily, or more often if an infection or infectious disease is present or suspected.
(6) The facility must establish, implement, enforce, and maintain a written policy and procedures for making a rapid influenza diagnostic test, as defined in §553.3 of this chapter, available to a resident who is exhibiting flu like symptoms.
(7) Personnel must handle, store, process, and transport linens to prevent the spread of infection.
(8) A facility must use universal precautions in the care of all residents.
(9) A facility must establish, implement, enforce, and maintain a written policy to protect a resident from vaccine preventable diseases in accordance with Texas Health and Safety Code, Chapter 224.
(A) The policy must:
(i) require an employee or a contractor providing direct care to a resident to receive vaccines for the vaccine preventable diseases specified by the facility based on the level of risk the employee or contractor presents to residents by the employee's or contractor's routine and direct exposure to residents;
(ii) specify the vaccines an employee or contractor is required to receive in accordance with clause (i) of this subparagraph;
(iii) include procedures for the facility to verify that an employee or contractor has complied with the policy;
(iv) include procedures for the facility to exempt an employee or contractor from the required vaccines for the medical conditions identified as contraindications or precautions by the CDC;
(v) include procedures the employee or contractor must follow to protect residents from exposure to disease for an employee or contractor who is exempt from the required vaccines, such as the use of protective equipment, like gloves and masks, based on the level of risk the employee or contractor presents to residents by the employee's or contractor's routine and direct exposure to residents;
(vi) prohibit discrimination or retaliatory action against an employee or contractor who is exempt from the required vaccines for the medical conditions identified as contraindications or precautions by the CDC, except that required use of protective medical equipment, including gloves and masks, may not be considered retaliatory action;
(vii) require the facility to maintain a written or electronic record of each employee's or contractor's compliance with or exemption from the policy; and
(viii) include disciplinary actions the facility may take against an employee or contractor who fails to comply with the policy.
(B) The policy may:
(i) include procedures for an employee or contractor to be exempt from the required vaccines based on reasons of conscience, including religious beliefs; and
(ii) prohibit an employee or contractor who is exempt from the required vaccines from having contact with residents during a public health disaster, as defined in Texas Health and Safety Code §81.003.
(g) Restraints and seclusion. All restraints for purposes of behavioral management, staff convenience, or resident discipline are prohibited. Seclusion is prohibited.
(1) As provided in §553.267(a)(3) of this subchapter (relating to Rights), a facility may use physical or chemical restraints only:
(A) if the use is authorized in writing by a physician and specifies:
(i) the circumstances under which a restraint may be used; and
(ii) the duration for which the restraint may be used; or
(B) if the use is necessary in an emergency to protect the resident or others from injury.
(2) 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 service plan.
(3) Except in a behavioral emergency, a restraint must be administered only by qualified medical personnel.
(4) A restraint must not be administered under any circumstance if it:
(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 position.
(5) If a facility uses a restraint hold in a circumstance described in paragraph (2) of this subsection, the facility must use an acceptable restraint hold.
(A) An acceptable restraint hold is a hold in which the individual's limbs are held close to the body to limit or prevent movement and that does not violate the provisions of paragraph (4) of this subsection.
(B) After the use of restraint, the facility must:
(i) with the resident's consent, make an appointment with the resident's physician no later than the end of the first working day after the use of restraint and document in the resident's record that the appointment was made; or
(ii) if the resident refuses to see the physician, document the refusal in the resident's record.
(C) As soon as possible but no later than 24 hours after the use of restraint, the facility must notify one of the following persons, if there is such a person, that the resident has been restrained:
(i) the resident's legally authorized representative; or
(ii) an individual actively involved in the resident's care, unless the release of this information would violate other law.
(D) If, under the Health Insurance Portability and Accountability Act, the facility is a "covered entity," as defined in 45 CFR §160.103, any notification provided under subparagraph (C)(ii) of this paragraph must be to a person to whom the facility is allowed to release information under 45 CFR §164.510.
(6) In order to decrease the frequency of the use of restraint, facility staff must be aware of and adhere to the findings of the resident assessment required in §553.259(b) of this subchapter (relating to Admission Policies and Procedures) for each resident.
(7) A facility may adopt policies that allow less use of restraint than allowed by the rules of this chapter.
(8) A facility may not discharge or otherwise retaliate against:
(A) an employee, resident, or other person because the employee, resident, or other person files a complaint, presents a grievance, or otherwise provides in good faith information relating to the misuse of restraint or seclusion at the facility; or
(B) a resident because someone on behalf of the resident files a complaint, presents a grievance, or otherwise provides in good faith information relating to the misuse of restraint or seclusion at the facility.
(h) Wheelchair self-release seat belts.
(1) For the purposes of this section, a "self-release seat belt" is a seat belt on a resident's wheelchair that the resident demonstrates the ability to fasten and release without assistance. A self-release seat belt is not a restraint.
(2) Except as provided in paragraph (3) of this subsection, a facility must allow a resident to use a self-release seat belt if:
(A) the resident or the resident's legal guardian requests that the resident use a self-release seat belt;
(B) the resident consistently demonstrates the ability to fasten and release the self-release seat belt without assistance;
(C) the use of the self-release seat belt is documented in and complies with the resident's individual service plan; and
(D) the facility receives written authorization, signed by the resident or the resident's legal guardian, for the resident to use the self-release seat belt.
(3) A facility that advertises as a restraint-free facility is not required to allow a resident to use a self-release seat belt if the facility:
(A) provides a written statement to all residents that the facility is restraint-free and is not required to allow a resident to use a self-release seat belt; and
(B) makes reasonable efforts to accommodate the concerns of a resident who requests a self-release seat belt in accordance with paragraph (2) of this subsection.
(4) A facility is not required to continue to allow a resident to use a self-release seat belt in accordance with paragraph (2) of this subsection if:
(A) the resident cannot consistently demonstrate the ability to fasten and release the seat belt without assistance;
(B) the use of the self-release seat belt does not comply with the resident's individual service plan; or
(C) the resident or the resident's legal guardian revokes in writing the authorization for the resident to use the self-release seat belt.
Source Note: The provisions of this §533.261 adopted to be effective August 31, 2021, 46 TexReg 5017