26 Tex. Admin. Code § 553.259 - Admission Policies and Procedures
(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) In addition to the
facility disclosure statement, a facility that advertises, markets, or
otherwise promotes that it provides services, including memory care services,
to residents with Alzheimer's disease and related disorders, must provide to
each resident the Assisted Living Facility Memory Care Disclosure Statement.
The facility must disclose whether the facility is certified to provide
specialized care to residents with Alzheimer's disease or related disorders.
(A) A facility that is Alzheimer's certified
and provides the Assisted Living Facility Memory Care Disclosure Statement to a
resident, must also provide HHSC Form 3641, Alzheimer's Assisted Living
Facility Disclosure Statement.
(B)
A facility that is not Alzheimer's certified and provides the Assisted Living
Facility Memory Care Disclosure Statement, to a resident does not need to
provide HHSC form 3641, Alzheimer's Assisted Living Disclosure
Statement.
(5) 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.
(6) 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);
(D)
sex;
(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 items:
(A) the
location from which the resident was admitted;
(B) primary language;
(C) sleep-cycle issues;
(D) behavioral symptoms;
(E) psychosocial issues (e.g., 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 (e.g., 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 impaired);
(J)
communication (e.g., ability to communicate with others, communication
devices);
(K) physical functioning
(e.g., transfer status; ambulation status; toilet use; personal hygiene;
ability to dress, feed and groom self);
(L) continence status;
(M) nutritional status (e.g., weight changes,
nutritional problems or approaches);
(N) oral/dental status;
(O) diagnoses;
(P) medications (e.g., administered,
supervised, self-administers);
(Q)
health conditions and possible medication side effects;
(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, hearing-vision assessment).
(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
needed.
(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 disclosure statement.
(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 and regulations.
(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 and Response).
(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 care decisions;
(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 hearing.
(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 criteria.
(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 Living Facilities).
(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:
(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;
(iii) Facility Request, Form 1124,
indicating that the facility agrees that the resident may remain at the
facility;
(iv) a detailed emergency
plan that explains how the facility will meet the evacuation needs of the
resident, including:
(I) specific staff
positions that will be on duty to assist with evacuation and their shift
times;
(II) specific staff
positions that will be on duty and awake at night; and
(III) specific staff training that relates to
resident evacuation;
(v)
a copy of an accurate facility floor plan, to scale, that labels all rooms by
use and indicates the specific resident's room;
(vi) a copy of the facility's emergency
evacuation plan;
(vii) a copy of
the facility fire drill records for the last 12 months;
(viii) a copy of a completed Fire
Marshal/State Fire Marshal Notification, Form 1127, signed by the fire
authority having jurisdiction (either the local Fire Marshal or State Fire
Marshal) as an acknowledgement that the fire authority has been notified that
the resident's evacuation capability has changed;
(ix) a copy of a completed Fire Suppression
Authority Notification, Form 1129, signed by the local fire suppression
authority as an acknowledgement that the fire suppression authority has been
notified that the resident's evacuation capability has changed;
(x) a copy of the resident's most recent
comprehensive assessment that addresses the areas required by subsection (c) of
this section and that was completed within 60 days, based on the date stated on
the evacuation waiver form submitted to HHSC;
(xi) the resident's service plan that
addresses all aspects of the resident's care, particularly those areas
identified by HHSC, including:
(I) the
resident's medical condition and related nursing needs;
(II) hospitalizations within 60 days, based
on the date stated on the evacuation waiver form submitted to HHSC;
(III) any significant change in condition in
the last 60 days, based on the date stated on the evacuation waiver form
submitted to HHSC;
(IV) specific
staffing needs; and
(V) services
that are provided by an outside provider;
(xii) any other information that relates to
the required fire safety features of the facility that will ensure the
evacuation capability of any resident; and
(xiii) service plans of other residents, if
requested by HHSC.
(D)
A facility must meet the following criteria to receive a waiver from HHSC:
(i) The emergency plan submitted in
accordance with subparagraph (C)(iv) of this paragraph must ensure that:
(I) staff is adequately trained;
(II) a sufficient number of staff are on all
shifts to move all residents to a place of safety;
(III) residents will be moved to appropriate
locations, given health and safety issues;
(IV) all possible locations of fire origin
areas and the necessity for full evacuation of the building are
addressed;
(V) the fire alarm
signal is adequate;
(VI) there is
an effective method for warning residents and staff during a malfunction of the
building fire alarm system;
(VII)
there is a method to effectively communicate the actual location of the fire;
and
(VIII) the plan satisfies any
other safety concerns that could have an effect on the residents' safety in the
event of a fire; and
(ii) the emergency plan will not have an
adverse effect on other residents of the facility who have waivers of
evacuation or who have special needs that require staff assistance.
(E) HHSC reviews the documentation
submitted under this subsection and notifies the facility in writing of its
determination to grant or deny the waiver within 10 working days after the date
the request is received in the HHSC regional office.
(F) Upon notification that HHSC has granted
the evacuation waiver, the facility must immediately initiate all provisions of
the proposed emergency plan. If the facility does not follow the emergency
plan, and there are health and safety concerns that are not addressed, HHSC may
determine that there is an immediate threat to the health or safety of a
resident.
(G) HHSC reviews a waiver
of evacuation during the facility's annual renewal licensing
inspection.
(3) If an
HHSC surveyor determines that a resident is inappropriately placed at a
facility and the facility either agrees with the determination or fails to
obtain the written statements or waiver required in this subsection, the
facility must discharge the resident.
(A) The
resident is allowed 30 days after the date of notice of discharge to move from
the facility.
(B) A discharge
required under this subsection must be made notwithstanding:
(i) any other law, including any law relating
to the rights of residents and any obligations imposed under the Property Code;
and
(ii) the terms of any
contract.
(4)
If a facility is required to discharge the resident because the facility has
not submitted the written statements required by paragraph (1) of this
subsection to the HHSC regional office, or HHSC denies the waiver as described
in paragraph (2) of this subsection, HHSC may:
(A) assess an administrative penalty if HHSC
determines the facility has intentionally or repeatedly disregarded the waiver
process because the resident is still residing in the facility when HHSC
conducts a future onsite visit; or
(B) seek other sanctions, including an
emergency suspension or closing order, against the facility under Texas Health
and Safety Code, Chapter 247, Subchapter C, if HHSC determines there is a
significant risk and immediate threat to the health and safety of a resident of
the facility.
(5) The
facility's disclosure statement must notify the resident and resident's legally
authorized representative of the waiver process described in this section and
the facility's policies and procedures for aging in place.
(6) After the first year of employment and no
later than the anniversary date of the facility manager's hire date, the
manager must show evidence of annual completion of HHSC training on aging in
place and retaliation.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.