Licensing Standards for Prescribed Pediatric Extended Care Centers Handbook

LSPPECC, Subchapter A, Purpose, Scope, Limitations, Compliance, and Definitions

Revision 18-1

 

§15.1 Purpose

 

(a) The purpose of this chapter is to implement THSC Chapter 248A, which directs the executive commissioner of the Texas Health and Human Services Commission to adopt minimum standards that a person must meet to be licensed as a center.

(b) Except as provided by THSC §248A.002, a person may not own or operate a center unless the person holds a license issued by DADS under THSC Chapter 248A and this chapter.

(c) An applicant may not provide services under a license for which an application has been filed until DADS issues the license.

 

§15.2 Scope

 

(a) This chapter establishes the minimum standards necessary to promote the health, safety, and welfare of a minor served and to ensure that a center ensures the provision of medical, nursing, psychosocial, therapeutic, and developmental services to a minor, and meets the caregiver training needs of a minor's parent. The standards are the basis for inspection activities for licensure.

(b) For purposes of this chapter, "at a center" and "at the center" includes the premises of the center and vehicles used for transportation, if transportation is provided by the center.

 

§15.3 Limitations

 

(a) Requirements established by private or public funding sources such as health maintenance organizations or other private third-party insurance, Medicaid (Title XIX of the Social Security Act), Medicare (Title XVIII of the Social Security Act), or state-sponsored funding programs are separate and apart from the requirements in this chapter for a center. Notwithstanding the funding source requirements that apply, a center must comply with the applicable provisions of THSC Chapter 248A and this chapter. A center is responsible for researching the availability of funding to pay for the services the center provides.

(b) Admission to a center is not intended to supplant a minor's right to a Medicaid private duty nursing benefit when private duty nursing is medically necessary for the minor.

(c) The services of a center must not supplant services afforded to a minor by the Individuals with Disabilities Education Act, United States Code, Title 20, §1400 et seq., and Section 504 of the Rehabilitation Act of 1973, United States Code, Title 29, §794. A center must not act as the primary education provider or accept a delegation of responsibility for the provision of a minor's education from an education provider, such as a local education agency.

 

§15.4 Compliance

 

(a) A center must maintain satisfactory compliance with THSC Chapter 248A and this chapter to maintain licensure.

(b) To the extent of any conflict between the standards in this chapter and a standard required in a local, county, or municipal ordinance, this chapter controls.

 

§15.5 Definitions

 

The following words and terms, when used in this chapter, have the following meanings unless the context clearly indicates otherwise.

(1) Active Play — Any physical activity from which a minor derives amusement, entertainment, enjoyment, or satisfaction by taking a participatory rather than a passive role. Active play includes various forms of activities, from the exploration of objects and toys to the structured play of formal games, sports, and hobbies.

(2) Actual census — The number of minors at a center at any given time.

(3) Administration of medication — The direct application of a medication to the body of a minor by any route. This includes removing an individual or unit dose from a previously dispensed, correctly labeled container, verifying it with the medication order, giving the correct medication and the correct dose to the correct minor at the correct time by the correct route, and accurately recording the time and dose given.

(4) Administrator — The person who is responsible for implementing and supervising the administrative polices and operations of a center and for administratively supervising the provision of services to minors and their parents on a day-to-day basis.

(5) Adult minor — A minor who is 18 years of age or older or is emancipated, and has not been adjudged incompetent.

(6) Affiliate — With respect to an applicant or license holder that is:

(A) a corporation — means an officer, director, or stockholder with direct ownership or disclosable interest of at least five percent, a subsidiary, or a parent company;

(B) a limited liability company — means an officer, member, or parent company;

(C) an individual — means:

(i) the individual's spouse;

(ii) each partnership and each partner thereof of which an individual or any affiliate of an individual is a partner; and

(iii) each corporation in which an individual is an officer, director, or stockholder with a direct ownership of at least five percent;

(D) a partnership — means a partner or a parent company of the partnership; and

(E) a group of co-owners under any other business arrangement means an officer, director, or the equivalent under the specific business arrangement or a parent company.

(7) Applicant — A person who applies for a license under THSC Chapter 248A and this chapter. The applicant is the person in whose "name DADS issues the license.

(8) Audiologist — A person who has a valid license under Texas Occupations Code, Chapter 401, as an audiologist.

(9) Basic services — Include:

(A) the development, implementation, and monitoring of a comprehensive protocol of care that:

(i) is provided to a medically dependent or technologically dependent minor;

(ii) is developed in conjunction with the minor's parent; and

(iii) specifies the medical, nursing, psychosocial, therapeutic, and developmental services required by the minor; and

(B) the caregiver training needs of a medically dependent or technologically dependent minor's parent.

(10) Behavioral emergency — A situation that occurs after which preventative, or de-escalating techniques are attempted and determined to be ineffective and it is immediately necessary to restrain a minor to prevent immediate probable death or substantial bodily harm to the minor or to others because the minor is attempting serious bodily harm or immediate physical harm to the minor or to others.

(11) Business day — Any day except a national or state holiday listed in Texas Government Code §662.003(a) or (b). The term includes Saturday or Sunday if the center is open on that day.

(12) Center — A prescribed pediatric extended care center. A facility operated for profit or on a nonprofit basis that provides nonresidential basic services to four or more medically dependent or technologically dependent minors who require the services of the facility and who are not related by blood, marriage, or adoption to the owner or operator of the facility.

(13) Change of Ownership — An event that results in a change to the federal taxpayer identification number of the license holder of a facility. The substitution of a personal representative for a deceased license holder is not a change of ownership.

(14) Chemical restraint — The use of any chemical, including pharmaceuticals, through topical application, oral administration, injection, or other means, to restrict the free movement of all or a portion of a minor's body for the purpose of modifying or controlling the minor's behavior and which is not a standard treatment for a minor's medical or psychosocial condition.

(15) Chief financial officer — An individual who is responsible for supervising and managing all financial activities for a center.

(16) Clinical note — A notation of a contact with a minor or a minor's family member that is written and dated by any staff providing services on behalf of a center and that describes signs and symptoms of the minor, and treatments and medications administered to the minor, including the minor's reaction or response, and any changes in physical, emotional, psychosocial, or spiritual condition of the minor during a given period of time.

(17) Commission — The Texas Health and Human Services Commission.

(18) Commissioner — The commissioner of DADS.

(19) Community disaster resources — A local, statewide, or nationwide emergency system that provides information and resources during a disaster, including weather information, transportation, evacuation and shelter information, disaster assistance and recovery efforts, evacuee and disaster victim resources, and resources for locating evacuated friends and relatives.

(20) Complaint — An allegation against a center or involving services provided at a center that involves a violation of this chapter or THSC Chapter 248A.

(21) Continuous face-to-face observation — Maintaining an in-person line of sight of a minor that is uninterrupted and free from distraction.

(22) Contractor — An individual providing services ordered by a prescribing physician on behalf of a center that the center would otherwise provide by its employees.

(23) Controlling person — A person who has the ability, acting alone or in concert with others, to directly or indirectly influence, direct, or cause the direction of the management of, expenditure of money for, or policies of a center or other person.

(A) A controlling person includes:

(i) a management company, landlord, or other business entity that operates or contracts with another person for the operation of a center;

(ii) any person who is a controlling person of a management company or other business entity that operates a center or that contracts with another person for the operation of a center; and

(iii) any other person who, because of a personal, familial, or other relationship with the owner, manager, landlord, tenant, or provider of a center, is in a position of actual control of or authority with respect to the center, regardless of whether the person is formally "named as an owner, manager, director, officer, provider, consultant, contractor, or employee of the center.

(B) Notwithstanding any other provision of this paragraph, a controlling person of a center or of a management company or other business entity described by subparagraph (A)(i) of this paragraph that is a publicly traded corporation or is controlled by a publicly traded corporation means an officer or director of the corporation. The term does not include a shareholder or lender of the publicly traded corporation.

(C) A controlling person described by subparagraph (A)(iii) of this paragraph does not include a person, including an employee, lender, secured creditor, or landlord, who does not exercise any formal or actual influence or control over the operation of the center.

(24) Conviction — An adjudication of guilt based on a finding of guilt, a plea of guilty, or a plea of nolo contendere.

(25) DADS — Department of Aging and Disability Services or its successor agency.

(26) Daily census — The number of minors served at a center during a center's hours of operation for a 24-hour period, starting at midnight.

(27) Day — A calendar day, unless otherwise specified in the text. A calendar day includes Saturday, Sunday, and a holiday.

(28) Dietitian — A person who has a valid license under the Licensed Dietitian Act, Texas Occupations Code, Chapter 701, as a licensed dietitian or provisional licensed dietitian, or who is registered as a dietitian by the Commission on Dietetic Registration of the American Dietetic Association.

(29) Direct ownership interest — Ownership of equity in the capital, stock, or profits of, or a membership interest in, an applicant or license holder.

(30) Disclosable interest — Five percent or more direct or indirect ownership interest in an applicant or license holder.

(31) Emergency situation — An impending or actual situation that:

(A) interferes with normal activities of a center or minors at a center;

(B) may:

(i) cause injury or death to a minor or individual at the center; or

(ii) cause damage to the center's property;

(C) requires the center to respond immediately to mitigate or avoid injury, death, damage, or interference; and

(D) does not include a situation that arises from the medical condition of a minor such as cardiac arrest, obstructed airway, or cerebrovascular accident.

(32) Executive commissioner — The executive commissioner of the Texas Health and Human Services Commission.

(33) Functional assessment — An evaluation of a minor's abilities, wants, interests, and needs related to self-care, communication skills, social skills, motor skills, play with toys or objects, growth, and development appropriate for age.

(34) Health care provider — An individual or facility licensed, certified, or otherwise authorized to administer health care in the ordinary course of business or professional practice.

(35) Health care setting — A location at which licensed, certified, or otherwise regulated health care is administered.

(36) IDT — Interdisciplinary team. Individuals who work together to meet the medical, nursing, psychosocial, and developmental needs of a minor and a minor's parent's training needs.

(37) Inactive medical record — A record for a minor who was admitted by a center to receive services and was subsequently discharged by the center.

(38) Indirect ownership interest — Any ownership or membership interest in a person that has a direct ownership interest in an applicant or license holder.

(39) Inspection — An on-site examination or audit of a center by DADS to determine compliance with THSC Chapter 248A and this chapter.

(40) Isolation — The involuntary confinement of a minor in a room of a center for the purposes of infection control, assessment, and observation away from other minors in a room at the center. When in isolation, a minor is physically prevented from contact with other minors.

(41) Joint training — Training provided by DADS to service providers and DADS inspectors on subjects that address the 10 most commonly cited violations of state law governing centers, as published in DADS annual reports. DADS determines the frequency of joint training.

(42) License — A license to operate a center issued by DADS under THSC Chapter 248A and this chapter. The term includes initial, renewal, and temporary licenses unless specifically stated otherwise.

(43) Licensed assistant in speech-language pathology — A person who has a valid license under Texas Occupations Code, Chapter 401, as a licensed assistant in speech-language pathology and who provides speech language support services under the supervision of a licensed speech-language pathologist.

(44) License holder — A person that holds a license to operate a center under THSC Chapter 248A and this chapter.

(45) Licensed vocational nurse — LVN. A person who has a valid license under Texas Occupations Code, Chapter 301, as a licensed vocational nurse.

(46) Life Safety Code — A publication of the National Fire Protection Association (NFPA), also known as NFPA 101, 2000 edition.

(47) Local emergency management agencies — The local emergency management coordinator, fire, police, and emergency medical services.

(48) Local emergency management coordinator — The person identified as the emergency management coordinator by the mayor or county judge for the geographical area in which a center is located.

(49) Mechanical restraint — The use of any mechanical device, material, or equipment to restrict the free movement of all or a portion of a minor's body for the purpose of modifying or controlling the minor's behavior.

(50) Medical director — A physician who has the qualifications described in §15.307 of this chapter (relating to Medical Director Qualifications and Conditions) and has the responsibilities described in §15.308 of this chapter (relating to Medical Director Responsibilities).

(51) Medical record — A record composed first-hand for a minor who has or is receiving services at a center.

(52) Medically dependent or technologically dependent — The condition of an individual who, because of an acute, chronic, or intermittent medically complex or fragile condition or disability, requires ongoing, technology-based skilled nursing care prescribed by a physician to avert death or further disability, or the routine use of a medical device to compensate for a deficit in a life-sustaining body function. The term does not include a controlled or occasional medical condition that does not require continuous nursing care, including asthma or diabetes, or a condition that requires an epinephrine injection.

(53) Medication administration record — A record used to document the administration of a minor's medications and pharmaceuticals.

(54) Medication list — A list that includes all prescriptions, over-the-counter pharmaceuticals, and supplements that a minor is prescribed or taking, including the dosage, preparation, frequency, and the method of administration.

(55) Minor — An individual younger than 21 years of age who is medically dependent or technologically dependent.

(56) Mitigation — An action taken to eliminate or reduce the probability of an emergency or public health emergency, or reduce an emergency's severity or consequences.

(57) Nursing director — The individual responsible for supervising skilled services provided at a center and who has the qualifications described in §15.309 of this chapter (relating to the Nursing Director and Alternate Nursing Director Qualifications and Conditions).

(58) Nutritional counseling — Advising and assisting an adult minor or a minor's parent or family on appropriate nutritional intake by integrating information from a nutrition assessment with information on food and other sources of nutrients and meal preparation consistent with cultural background and socioeconomic status, with the goal being health promotion, disease prevention, and nutrition education. The term includes:

(A) dialogue with an adult minor or a minor's parent to discuss current eating habits, exercise habits, food budget, and problems with food preparation;

(B) discussion of dietary needs to help an adult minor or the minor's parent understand why certain foods should be included or excluded from the minor's diet and to help with adjustment to the new or revised or existing diet plan;

(C) a personalized written diet plan as ordered by the minor's physician, to include instructions for implementation;

(D) providing the adult minor or the minor's parent with motivation to help them understand and appreciate the importance of the diet plan in getting and staying healthy; or

(E) working with the adult minor or the minor's parent by recommending ideas for meal planning, food budget planning, and appropriate food gifts.

(59) Occupational therapist — A person who has a valid license under Texas Occupations Code, Chapter 454, as an occupational therapist.

(60) Occupational therapy assistant — A person who has a valid license under Texas Occupations Code, Chapter 454, as an occupational therapy assistant who assists in the practice of occupational therapy under the general supervision of an occupational therapist.

(61) Operating hours — The days of the week and the hours of day a center is open for services to a minor as identified in a center's written policy as required by §15.201 of this chapter (relating to Operating Hours).

(62) Overnight — The hours between 9:00 p.m. and 5:00 a.m. during the days of the week a center operates.

(63) Over-the-counter pharmaceuticals — A drug or formulary for which a physician's prescription is not needed for purchase or administration.

(64) Parent — A person authorized by law to act on behalf of a minor with regard to a matter described in this chapter. The term includes:

(A) a biological, adoptive, or foster parent;

(B) a guardian;

(C) a managing conservator; and

(D) a non-parent decision-maker as authorized by Texas Family Code §32.001.

(65) Parent company — A person, other than an individual, who has a direct 100 percent ownership interest in the owner of a center.

(66) Person — An individual, firm, partnership, corporation, association, or joint stock association, and the legal successor thereof.

(67) Personal care services — Services required by a minor, including:

(A) bathing;

(B) maintaining personal hygiene;

(C) routine hair and skin care;

(D) grooming;

(E) dressing;

(F) feeding;

(G) eating;

(H) toileting;

(I) maintaining continence;

(J) positioning;

(K) mobility and bed mobility;

(L) transfer and ambulation;

(M) range of motion;

(N) exercise; and

(O) use of durable medical equipment.

(68) Pharmaceuticals — Of or pertaining to drugs, including over-the-counter drugs and those requiring a physician's prescription for purchase or administration.

(69) Pharmacist — A person who is licensed to practice pharmacy under Texas Occupations Code, Chapter 558.

(70) Pharmacy — A facility at which a prescription drug or medication order is received, processed, or dispensed as defined in Texas Occupations Code §551.003.

(71) Physical restraint — The use of physical force, except for physical guidance or prompting of brief duration, that restricts the free movement of all or a portion of a minor's body for the purpose of modifying or controlling the minor's behavior.

(72) Physical therapist — A person who has a valid license under Texas Occupations Code, Chapter 453, as a physical therapist.

(73) Physical therapist assistant — A person who has a valid license under Texas Occupations Code, Chapter 453, as a physical therapist assistant and:

(A) who assists and is supervised by a physical therapist in the practice of physical therapy; and

(B) whose activities require an understanding of physical therapy.

(74) Physician — A person who:

(A) has a valid license in Texas to practice medicine or osteopathy in accordance with Texas Occupations Code, Chapter 155;

(B) has a valid license in Arkansas, Louisiana, New Mexico, or Oklahoma to practice medicine, who is the treating physician of a minor, and orders services for the minor, in accordance with Texas Occupations Code, Chapter 151; or

(C) is a commissioned or contract physician or surgeon who serves in the United States uniformed services or Public Health Service if the person is not engaged in private practice, in accordance with Texas Occupations Code, Chapter 151.

(75) Place of business — An office of a center where medical records are maintained and from which services are directed.

(76) Plan of care — A protocol of care.

(77) Positive intervention — An intervention that is based on or uses a minor's preferences as positive reinforcement, and focuses on positive outcomes and wellness for the minor.

(78) Pre-licensing program training — Computer-based training, available on DADS website, designed to acquaint center staff with licensure standards.

(79) Preparedness — Actions taken in anticipation of a disaster including a public health disaster.

(80) Prescribing physician — A physician who is authorized to write and issue orders for services at a center.

(81) Progress note — A dated and signed written notation summarizing facts about services provided to a minor and the minor's response during a given period of time.

(82) Protective device — A mechanism or treatment, including sedation, that is:

(A) used:

(i) for body positioning;

(ii) to immobilize a minor during a medical, dental, diagnostic, or nursing procedure;

(iii) to permit wounds to heal; or

(iv) for a medical condition diagnosed by a physician; and

(B) not used as a restraint to modify or control behavior.

(83) Protocol of care — A comprehensive, interdisciplinary plan of care that includes the medical physician's plan of care, nursing care plan and protocols, psychosocial needs, and therapeutic and developmental service needs required by a minor and family served.

(84) Psychologist — A person who has a valid license under Texas Occupations Code, Chapter 501, as a psychologist.

(85) Psychosocial treatment — The provision of skilled services to a minor under the direction of a physician that includes one or more of the following:

(A) assessment of alterations in mental status or evidence of suicide ideation or tendencies;

(B) teaching coping mechanisms or skills;

(C) counseling activities; or

(D) evaluation of a plan of care.

(86) Public health disaster declaration — A governor's announcement based on a determination by the Department of State Health Services that there exists an immediate threat from a communicable disease that:

(A) poses a high risk of death or serious long-term disability to a large number of people; and

(B) creates a substantial risk of public exposure because of the disease's high level of contagion or the method by which the disease is transmitted.

(87) Quiet time — A behavior management technique used to provide a minor with an opportunity to regain self-control, where the minor enters and remains for a limited period of time in a designated area from which egress is not prevented.

(88) Recovery — Activities implemented during and after a disaster response, including a public health disaster response, designed to return a center to its normal operations as quickly as possible.

(89) Registered nurse—RN. A person who has a valid license under Texas Occupations Code, Chapter 301, to practice professional nursing.

(90) Relocation — The closing of a center and the movement of its business operations to another location.

(91) Respiratory therapist — A person who has a valid license under Texas Occupations Code, Chapter 604, as a respiratory care practitioner.

(92) Response — Actions taken immediately before an impending disaster or during and after a disaster, including a public health disaster, to address the immediate and short-term effects of the disaster.

(93) Restraint — Physical restraint, chemical restraint, or mechanical restraint.

(94) RN delegation — Delegation of tasks by an RN in accordance with 22 TAC Chapter 224 (relating to Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel for Clients with Acute Conditions or in Acute Care Environments).

(95) Sedation — The act of allaying nervous excitement by administering medication that commonly induces the nervous system to calm. Sedation is a protective device.

(96) Social worker — A person who has a valid license under Texas Occupations Code, Chapter 505, as a social worker.

(97) Speech-language pathologist — A person who has a valid license under Texas Occupations Code, Chapter 401, as a speech-language pathologist.

(98) Substantial compliance — A finding in which a center receives no recommendation for enforcement action after an inspection.

(99) Supervision — Authoritative procedural guidance by a qualified person that instructs another person and assists in accomplishing a function or activity. Supervision includes initial direction and periodic inspection of the actual act of accomplishing the function or activity.

(100) Support services — Social, spiritual, and emotional care provided to a minor and a minor's parent by a center.

(101) THSC — Texas Health and Safety Code.

(102) Total census — The total number of minors with active plans of care at a center.

(103) Transition support — Planning, coordination, and assistance to move the location of services provided to a minor from a center to the least restrictive setting appropriate.

(104) Violation — A finding of noncompliance with this chapter or THSC Chapter 248A resulting from an inspection.

(105) Volunteer — An individual who provides assistance to a center without compensation other than reimbursement for actual expenses.

LSPPECC, Subchapter B, Licensing Application, Maintenance, and Fees

Revision 18-1

 

§15.101 Criteria and Eligibility for a License

 

(a) To obtain a license, a person must meet the application requirements in this subchapter and meet the criteria for a license.

(b) center must be located in Texas. The center must have a Texas mailing address.

(c) person may not operate a center on the same premises as:

(1) a child-care center licensed in accordance with Texas Human Resource Code, Chapter 42; or

(2) any other facility licensed by DADS or the Department of State Health Services.

(d) A separate license is required for each center located on separate premises, regardless of whether the centers are owned or operated by the same person.

(e) The actual census for a center must not exceed the capacity authorized by DADS, as indicated on the license.

(f) Before issuing a license, DADS considers the background and qualifications of:

(1) the applicant;

(2) a controlling person of the applicant;

(3) a person with a disclosable interest;

(4) an affiliate of the applicant;

(5) the administrator; and

(6) the chief financial officer, if the center has a chief financial officer.

(g) An applicant must affirmatively show that the center:

(1) obtained approval of building plans through plan review by DADS Architectural Unit as required by Subchapter E of this chapter (relating to Building Requirements);

(2) meets local building ordinances;

(3) is approved by the local fire authority;

(4) meets the standards of the Life Safety Code and the requirements in Subchapter E of this chapter; and

(5) meets the requirements of this chapter based on an on-site health inspection by DADS.

 

§15.102 General Application Requirements

 

(a) An applicant may apply for a license for a center by submitting a sworn application from the DADS Licensing and Credentialing Unit. An application may be obtained from the DADS website.

(b) An applicant must complete the application in accordance with the instructions provided on the application and the DADS website.

(c) An applicant must provide accurate and complete statements on the application and any attachments.

(d) If an applicant decides not to continue the application process for a license after submitting an application and license fee, the applicant must submit a written request to DADS to withdraw the application. DADS does not refund the license fee for an application that is withdrawn, except as provided in §15.114 of this subchapter (relating to Time Periods for Processing All Types of License Applications).

 

§15.103 Building Approval

 

(a) Fire authority. An applicant must receive approval from the local fire authority or, if the jurisdiction does not have a local fire authority, the state fire marshal, for an initial, renewal, change of ownership, relocation, or capacity increase license application. An applicant may submit a license application to DADS before receiving fire authority approval. An applicant must submit to DADS a copy of a signed and dated written approval for occupancy by the local fire authority or state fire marshal that describes the center by name and address.

(b) Local health authority. An applicant for an initial, change of ownership, relocation, or capacity increase license must submit to DADS a copy of a dated written notification to the local health authority that the applicant is submitting a license application to DADS. DADS sends the local health authority a copy of DADS license renewal notification specifying the expiration date of the center's current license. A local health authority may provide an evaluation to DADS regarding the status of the center's compliance with local codes, ordinances or regulations. The local health authority may also recommend that DADS issue or deny a license to the center, but DADS makes the final decision regarding licensure of the center.

 

§15.104 Applicant Disclosure Requirements

 

(a) A person that submits an initial, renewal, change of ownership, relocation, or increase in capacity license application must:

(1) identify the location of the place of business for which the license is sought;

(2) include documentation, signed by the appropriate local government official, stating that the center's place of business and the use of the center meet local zoning requirements;

(3) provide the name, address, and social security number of, and background and criminal history check information for:

(A) the applicant;

(B) the administrator;

(C) the financial officer; and

(D) each controlling person of the applicant;

(4) provide the federal employer identification number or taxpayer identification number of the applicant and of each controlling person, if an applicant or controlling person is not an individual;

(5) state the assumed name under which the center will be doing business;

(6) state the maximum capacity requested for the center; and

(7) include a sworn affidavit that the applicant has complied with this chapter.

(b) For an initial license and change of ownership application, an applicant must:

(1) submit to DADS evidence of the right to possess or occupy the center at the time the application is submitted, which may include:

(A) a lease agreement; or

(B) a deed;

(2) disclose to DADS the name and address of the owner of the real property, including the owner of the buildings and grounds appurtenant to the center;

(3) submit to DADS a certificate of account status issued by the Comptroller of Public Accounts; and

(4) submit to DADS a certificate of incorporation issued by the Secretary of State for a corporation or a copy of the partnership agreement for a partnership.

(c) For a renewal application, an applicant must submit to DADS a certificate of account status issued by the Comptroller of Public Accounts.

(d) An applicant or license holder must provide to DADS any additional information requested by DADS no later than 30 days after the date of DADS request.

(e) DADS may require an applicant to disclose information relating to the fiduciary-appointed administrator of the center.

 

§15.105 Initial License Application Procedures and Issuance

 

(a) The center's administrator must complete pre-licensing program training before an applicant may submit an initial application for a license.

(b) An applicant for an initial license must submit:

(1) a complete and correct application including all documents and information that DADS requires as part of the application process;

(2) the correct license fee established in §15.112 of this subchapter (relating to Licensing Fees);

(3) a letter of credit for $250,000 from a bank that is insured by the Federal Deposit Insurance Corporation, or other documentation acceptable to DADS, to demonstrate an applicant's financial viability; and

(4) all other documents described in the instructions provided on the application and on the DADS website.

(c) After DADS receives an application for an initial license and the correct license fee, DADS reviews the application and notifies the applicant if additional information is needed to complete the application.

(d) An applicant must submit written notice to DADS that the center is ready for a Life Safety Code inspection.

(1) The written notice must be submitted:

(A) with the application; or

(B) no later than 120 days after DADS Licensing and Credentialing Unit receives the application.

(2) After DADS receives the written notice for a Life Safety Code inspection and an applicant has satisfied the application submission requirements, DADS staff conducts an on-site Life Safety Code inspection.

(e) The center must meet the building requirements described in Subchapter E of this chapter (relating to Building Requirements). If a center fails to meet the building requirements and fails to implement an approved written plan of correction no later than 120 days after the initial Life Safety Code inspection, DADS denies the license application.

(f) If a center meets the building requirements in Subchapter E of this chapter, the center may admit no more than three minors. If the center admits a minor, the applicant must send written notice to DADS indicating the center is ready for a health inspection. The health inspection request must be submitted no later than 120 days after the date the center meets the building requirements.

(1) DADS conducts an on-site health inspection to determine compliance with this chapter.

(2) If the center fails to comply with this chapter and fails to implement an approved written plan of correction no later than 120 days after the date of the initial health inspection, DADS denies the license application.

(g) If an applicant receives a notice from DADS that some or all of the information is missing or incomplete, an applicant must submit the requested information no later than 30 days after the date of the notice. If the applicant fails to timely submit the requested information, DADS denies the application. If DADS denies the application, DADS does not refund the license fee.

(h) DADS issues an initial license if it determines that an applicant has met the provisions of this chapter and THSC Chapter 248A.

(i) The issuance of an initial license constitutes DADS notice to the center of the approval of the application.

(j) DADS issues a center license to the license holder named on the license at the place of business listed on the license. The license is not transferable or assignable.

(k) The license includes:

(1) the license holder's name;

(2) the name of the center;

(3) the center's place of business;

(4) the center's licensed capacity;

(5) a statement that the center provides services to minors for 12 hours or less in a 24-hour period but no overnight care; and

(6) the effective date of the license.

(l) DADS may deny an application for an initial license if the applicant, a controlling person, or a person required to submit background and qualification information fails to meet the criteria for a license established in §15.101 of this subchapter (relating to Criteria and Eligibility for a License) or for any reason specified in §15.115 of this subchapter (relating to Criteria for Denial of a License).

(m) If DADS denies an application for an initial license, DADS sends the applicant written notice of the denial and informs the applicant of the right to request an administrative hearing to appeal the denial. The administrative hearing is held in accordance with 1 TAC Chapter 357, Subchapter I (relating to Hearings Under the Administrative Procedure Act) and Chapter 91 of this title (relating to Hearings Under the Administrative Procedure Act).

(n) An initial license expires on the second anniversary after the effective date of the initial license.

 

§15.106 Renewal License Application Procedures and Issuance

 

(a) A center license expires on the second anniversary of the effective date. To renew a license, a license holder must submit a renewal application to DADS before the expiration date. DADS sends written notice of expiration of a license to the license holder at least 120 days before the expiration date of a license. The written notice includes instructions for completing the renewal application.

(b) A license holder must comply with the requirements in §15.102 of this subchapter (relating to General Application Requirements) and §15.114 of this subchapter (relating to Time Periods for Processing All Types of License Applications) to renew a license.

(c) In accordance with Texas Government Code, §2001.054, DADS considers that a license holder meets the renewal application submission deadline if the license holder submits:

(1) no later than 60 days before the expiration date of the current license:

(A) a complete application for renewal or an incomplete application for renewal with a letter explaining the circumstances that prevented the inclusion of the missing information; and

(B) the correct license fee established in §15.112 of this subchapter (relating to Licensing Fees); or

(2) during the 60-day period ending on the date the current license expires:

(A) a complete application for renewal or an incomplete application with a letter explaining the circumstances that prevented the inclusion of the missing information;

(B) the correct license fee established in §15.112 of this subchapter; and

(C) the late fee established in §15.112 of this subchapter.

(d) DADS reviews a renewal application and notifies the license holder if additional information is needed to complete the application.

(e) It is the license holder's responsibility to ensure that the application is timely received by DADS. Failure to submit a timely and sufficient renewal application with the correct license fee will result in the expiration of the license.

(f) If a license holder submits a renewal application to DADS that is postmarked after the expiration date of the license, DADS denies the renewal application and does not refund the renewal license fee. The license holder is not eligible to renew the license and must cease operation on the date the license expires. A license holder whose license expires must apply for an initial license in accordance with §15.105 of this subchapter (relating to Initial License Application Procedures and Issuance).

(g) DADS issues a renewal license after determining that an applicant and the center have met the provisions of this chapter.

(h) The issuance of a renewal license constitutes DADS notice to the center that the application is approved.

(i) A renewal license issued in accordance with this chapter expires on the second anniversary after the effective date.

(j) DADS may pend action on an application for the renewal of a license for up to six months if the center is not in compliance with this chapter based an on-site inspection.

(k) DADS may deny an application for the renewal of a license if an applicant, controlling person, or any person required to submit background and qualification information fails to meet the criteria for a license established in §15.101 of this subchapter (relating to Criteria and Eligibility for a License) or for any reason specified in §15.115 of this subchapter (relating to Criteria for Denial of a License).

(l) Before denying a license renewal application, DADS gives the license holder:

(1) notice by personal service or by registered or certified mail of the facts or conduct alleged to warrant the proposed action; and

(2) an opportunity to show compliance with all the requirements of THSC Chapter 248A and this chapter to retain the license.

(m) To request an opportunity to show compliance, the license holder must send a written request to DADS. The request must:

(1) be postmarked no later than 10 days after the date of DADS notice of proposed action and received by DADS no later than 10 days after the date of the postmark; and

(2) contain documentation that refutes DADS allegations specifically.

(n) The opportunity to show compliance is limited to a review of documentation submitted by the license holder and information DADS used as the basis for the proposed action. The opportunity to show compliance is not an administrative hearing. DADS gives the license holder a written affirmation or reversal of the proposed action.

(o) If DADS denies an application for a renewal license, DADS sends the license holder a written notice of the denial and informs the license holder of the right to request an administrative hearing to appeal the denial. The administrative hearing is held in accordance with 1 TAC Chapter 357, Subchapter I (relating to Hearings Under the Administrative Procedure Act) and DADS hearing rules found in Chapter 91 of this title (relating to Hearings Under the Administrative Procedure Act).

 

§15.108 Change of Ownership License Application Procedures and Issuance

 

(a) A center license is not assignable or transferable. If a change of ownership occurs, the applicant must obtain a license in accordance with subsection (c) of this section.

(b) An application for a center license when there is a change of ownership is an application for an initial license.

(c) An applicant must submit to DADS:

(1) a complete application for a license in accordance with §15.101 of this subchapter (relating to Criteria and Eligibility for a License) or an incomplete application with a letter explaining the circumstances that prevented the inclusion of the missing information;

(2) the application fee, in accordance with §15.112 of this subchapter (relating to Licensing Fees);

(3) a letter of credit for $250,000 from a bank that is insured by the Federal Deposit Insurance Corporation, or other documentation acceptable to DADS, to demonstrate an applicant's financial viability; and

(4) signed written notice from a center's existing license holder of intent to transfer operation of the center to an applicant beginning on a date specified by an applicant, unless waived in accordance with subsection (f) of this section.

(d) DADS may deny issuance of a license if an applicant, controlling person, or any person required to submit background and qualification information fails to meet the criteria for a license established in §15.101 of this subchapter or for any reason specified in §15.115 of this subchapter (relating to Criteria for Denial of a License).

(e) To avoid a center operating without a license, a prospective license holder must submit all items in subsection (c) of this section at least 30 days before the anticipated date of the change of ownership in accordance with DADS application instructions.

(f) The 30-day notice required by subsection (e) of this section may be waived by DADS if:

(1) the prospective license holder presents evidence to DADS demonstrating that an eviction of the center or a foreclosure of the property from which the center operates is imminent and that circumstance prevented the timely submission of the notice; or

(2) DADS, in its sole discretion, determines that circumstances are present that threaten a minor's health, safety, or welfare which necessitate waiver of timely submission of the notice.

(g) DADS conducts an on-site health inspection to verify compliance with the licensure requirements before issuing a license as a result of a change of ownership. DADS may conduct a desk review instead of an on-site health inspection before issuing a license as a result of a change of ownership if:

(1) less than 50 percent of the direct ownership interest in the former license holder changed, when compared to the new license holder; or

(2) every person with disclosable interest in the new license holder had a disclosable interest in the former license holder.

(h) DADS, in its sole discretion, may conduct an on-site Life Safety Code inspection before issuing a license as a result of a change of ownership.

(i) If an applicant meets the requirements for a license, DADS issues a license. The effective date of the license is the same date as the effective date of the change of ownership and cannot precede the date the application was received by DADS Licensing and Credentialing Unit.

(j) The initial license issued to the new license holder expires on the second anniversary of the effective date.

(k) The previous license holder’s license is invalid on the effective date of the new license holder’s initial license.

 

§15.109 Increase in Capacity

 

(a) A license holder must not increase a center's licensed capacity without approval from DADS.

(b) The license holder must submit an application for an increase in capacity in accordance with §15.102 of this subchapter (relating to General Application Requirements) and the correct fee required in §15.112 of this subchapter (relating to Licensing Fees).

(c) The license holder must arrange for an inspection of the center by the local fire marshal and provide written evidence of the fire marshal's approval to DADS.

(d) An applicant must send written notice to DADS indicating that the center is ready for a Life Safety Code inspection.

(1) The written notice must be submitted:

(A) with the application; or

(B) no later than 120 days after DADS Licensing and Credentialing Unit receives the application.

(2) After DADS receives the written notice for a Life Safety Code inspection and an applicant has satisfied the application submission requirements, DADS staff conducts an on-site Life Safety Code inspection.

(e) If an applicant receives a notice from DADS that some or all of the information is missing or incomplete, an applicant must submit the requested information no later than 30 days after the date of the notice. If an applicant fails to submit the requested information no later than 30 days after the notice date, DADS considers the application incomplete and denies the application. If DADS denies the application, DADS does not refund the license fee.

(f) The center must meet the building requirements described in Subchapter E of this chapter (relating to Building Requirements). If a center fails to meet the building requirements and fails to implement an approved written plan of correction no later than 120 days after the initial Life Safety Code inspection, DADS denies the application for a license.

(g) After a center has met Life Safety Code requirements, DADS conducts an on-site health inspection.

(h) DADS issues a new license with an increased capacity if DADS determines that the center is in compliance with this chapter.

(i) If an applicant decides not to continue the application process after submitting the application and correct license fee, an applicant must submit to DADS a written request to withdraw the application. DADS does not refund the license fee.

(j) Before denying an application for an increase in capacity, DADS gives the license holder:

(1) notice by personal service or by registered or certified mail of the facts or conduct alleged to warrant the proposed action; and

(2) an opportunity to show compliance with all the requirements of the THSC Chapter 248A and this chapter to retain the license.

(k) To request an opportunity to show compliance, the license holder must send a written request to DADS. The request must:

(1) be postmarked no later than 10 days after the date of DADS notice of proposed action and received by DADS no later than 10 days after the date of the postmark; and

(2) contain documentation that refutes DADS allegations superficially.

(l) The opportunity to show compliance is limited to a review of documentation submitted by the license holder and information DADS used as the basis for the proposed action. The opportunity to show compliance is not an administrative hearing. DADS gives the license holder a written affirmation or reversal of the proposed action.

(m) If DADS denies an application for an increase in capacity, DADS sends the license holder a written notice of the denial and informs the license holder of the right to request an administrative hearing to appeal the denial. The administrative hearing is held in accordance with Texas Health and Human Services Commission rules found at 1 TAC Chapter 357, Subchapter I (relating to Hearings Under the Administrative Procedure Act) and DADS hearing rules found in Chapter 91 of this title (relating to Hearings Under the Administrative Procedure Act).

 

§15.110 Decrease in Capacity

 

(a) A license holder who wishes to decrease the licensed capacity of the center must provide written notification to DADS. The written notification must indicate the new licensed capacity for the center.

(b) After DADS receives the written notification, DADS issues a new license with the new licensed capacity as indicated in the written notification.

 

§15.111 Relocation

 

(a) Relocation is the closing of a center and the movement of its business operations to another location.

(b) A license holder must not relocate a center or provide services to a minor at a new location without prior approval from DADS.

(c) The license holder must continue to maintain the license at the current location and must continue to meet all requirements for operation of the center until DADS has approved the relocation.

(d) Before a relocation, the license holder must submit an application for an initial license for the new location in accordance with §15.105 of this subchapter (relating to Initial License Application Procedures and Issuance) and the correct fee for an initial license required in §15.112 of this subchapter (relating to Licensing Fees).

(e) The license holder must arrange for an inspection of the center by the local fire marshal and provide written evidence of the fire marshal's approval to DADS.

(f) An applicant must send written notice to DADS indicating that the center is ready for a Life Safety Code inspection.

(1) The written notice must be submitted:

(A) with the application; or

(B) no later than 120 days after DADS Licensing and Credentialing Unit receives the application.

(2) After DADS receives the written notice for a Life Safety Code inspection and an applicant has satisfied the application submission requirements, DADS staff conducts an on-site Life Safety Code inspection.

(g) If an applicant receives a notice from DADS that some or all of the information is missing or incomplete, an applicant must submit the requested information no later than 30 days after the date of the notice. If an applicant fails to submit the requested information no later than 30 days after the notice date, DADS considers the application incomplete and denies the application. If DADS denies the application, DADS does not refund the license fee.

(h) The center must meet the building requirements described in Subchapter E of this chapter (relating to Building Requirements). If a center fails to meet the building requirements and fails to implement an approved written plan of correction no later than 120 days after the initial Life Safety Code inspection, DADS denies the application for a license.

(i) After a center has met Life Safety Code requirements, DADS conducts an on-site health inspection.

(j) Following Life Safety Code approval by DADS, the license holder must notify DADS of the date the business operations will be relocated.

(k) DADS issues a license for the new center if the new center meets the requirements in this chapter. The effective date of the license is the date all business operations are relocated.

(l) The issuance of a license constitutes DADS approval of the relocation.

(m) The license for the current location becomes invalid upon issuance of the new license for the new location.

(n) If an applicant decides not to continue the application process after submitting the application and correct license fee, an applicant must submit to DADS a written request to withdraw the application. DADS does not refund the license fee.

(o) Before denying an application for relocation, DADS gives the license holder:

(1) notice by personal service or by registered or certified mail of the facts or conduct alleged to warrant the proposed action; and

(2) an opportunity to show compliance with all the requirements of THSC Chapter 248A and the Chapter to retain the license.

(p) To request an opportunity to show compliance, the license holder must send a written request to DADS. The request must:

(1) be postmarked no later than 10 days after the date of DADS notice of proposed action and received by DADS no later than 10 days after the date of the postmark; and

(2) contain documentation that refutes DADS allegations specifically.

(q) The opportunity to show compliance is limited to a review of documentation submitted by the license holder and information DADS used as the basis for the proposed action. The opportunity to show compliance is not an administrative hearing. DADS gives the license holder a written affirmation or reversal of the proposed action.

(r) If DADS denies an application for relocation, DADS sends the license holder a written notice of the denial and informs the license holder of the right to request an administrative hearing to appeal the denial. The administrative hearing is held in accordance with Texas Health and Human Services Commission rules found in 1 TAC Chapter 357, Subchapter I (relating to Hearings Under the Administrative Procedure Act) and DADS hearing rules found in Chapter 91 of this title (relating to Hearings Under the Administrative Procedure Act).

 

§15.112 Licensing Fees

 

(a) The schedule of fees for licensure of a center is as follows:

(1) initial license fee (includes changes of ownership and relocation) — $1750;

(2) renewal license fee — $1750; and

(3) increase in capacity — $875.

(b) DADS does not waive the license fee for a change of ownership application despite a demonstration of the circumstances referenced in §15.108(f) of this subchapter (relating to Change of Ownership License Application Procedures and Issuance). DADS may waive the timely submission of an application for a change of ownership in accordance with §15.108(f) of this subchapter.

(c) The late fee established in §15.106 of this subchapter (relating to Renewal License Application Procedures and Issuance) is $50 per day to a license holder who submits a renewal application after the date as described at §15.106 of this subchapter, except that the total amount of a late fee may not exceed $500.00.

(d) DADS does not consider an application as submitted until an applicant pays the correct license fee as required in this section. The fee must accompany the application.

(e) A fee paid to DADS is not refundable, except as provided by §15.114 of this chapter (relating to Time Periods for Processing All Types of License Applications).

(f) DADS accepts payment according to methods described in the application instructions provided on the DADS website.

 

§15.113 Plan Review Fees

 

(a) A center must pay a fee to DADS for its review of plans for new buildings, additions, conversion of buildings not licensed by DADS, or remodeling of existing licensed facilities as described on the DADS website.

(b) The fee schedule follows:

(1) facilities — new construction:

(A) single-story facilities — $2,000; and

(B) multiple-story facilities — $2,500; and

(2) additions or remodeling of existing licensed facilities — 2 percent of construction cost with a $500 minimum fee and a maximum not to exceed $2,000.

 

§15.114 Time Periods for Processing All Types of License Applications

 

(a) The date of an application is the date the DADS Licensing and Credentialing Unit receives the application and the correct license fee as required in §15.112 of this subchapter (relating to Licensing Fees).

(b) DADS considers an application for an initial license complete when DADS accepts the information described in §15.105 of this subchapter (relating to Initial License Application Procedures and Issuance).

(c) DADS considers an application for a renewal license complete when DADS accepts the information described in §15.106 of this subchapter (relating to Renewal License Application Procedures and Issuance). A center may continue to operate during the renewal application process in accordance with §15.106 of this subchapter.

(d) DADS considers an application for a change of ownership license complete when DADS accepts the information described in §15.108 of this subchapter (relating to Change of Ownership License Application Procedures and Issuance).

(e) DADS reviews an application for a license no later than 45 days after the date DADS Licensing and Credentialing Unit receives the application.

(f) If an applicant receives a notice from DADS that some or all of the information required by this chapter is missing or incomplete, an applicant must submit the required information no later than 30 days after the date of the notice. If an applicant fails to submit the required information no later than 30 days after the notice date, DADS considers the application incomplete and denies the application. If DADS denies the application, DADS does not refund the license fee.

(g) DADS denies an application that remains incomplete 120 days after the date that DADS Licensing and Credentialing Unit receives the application.

(h) DADS issues a license no later than 30 days after DADS determines that an applicant and the center have met all licensure requirements referenced in §15.105 and §15.106 of this subchapter, as applicable.

(i) If DADS does not process an application in the time period described in subsections (e) and (h) of this section, an applicant may request reimbursement of the license fee paid. The applicant must submit the reimbursement request following the instructions on the DADS website.

(j) If DADS does not agree that the established time period for processing an application described in subsection (e) of this section has been violated or finds that good cause existed for exceeding the established time period, DADS will deny the request.

(k) Good cause for exceeding the established time period exists if:

(1) DADS receives an application during the time period of September 1, 2014 through June 30, 2015;

(2) the number of applications to be processed exceeds by 15 percent or more the number processed in the same fiscal quarter of the preceding year effective when DADS has obtained and published two quarters of application data;

(3) DADS must rely on another public or private entity to process all or a part of the application received by DADS, and the delay is caused by that entity; or

(4) other conditions existed giving good cause for exceeding the established time period.

(l) If DADS denies the request for reimbursement, an applicant may request that the DADS commissioner resolve the dispute. An applicant must send a written statement to the DADS commissioner describing the request for reimbursement and the reason for the request. The DADS commissioner will review the request and notify an applicant in writing of the decision.

 

§15.115 Criteria for Denial of a License

 

(a) DADS may deny an application for an initial center license or for renewal of a license for:

(1) a violation of the THSC Chapter 248A or a standard in this chapter committed by the license holder, applicant, or a person listed on the application;

(2) an intentional or negligent act by the center or an employee of the center that DADS determines significantly affects the health or safety of a minor served at the center;

(3) use of drugs or intoxicating liquors to an extent that affects the license holder's or applicant's professional competence;

(4) a felony conviction, including a finding or verdict of guilty, an admission of guilt, or a plea of nolo contendere, in this state or in any other state of any person required by this chapter to undergo a background and criminal history;

(5) fraudulent acts, including acts relating to Medicaid fraud and obtaining or attempting to obtain a license by fraud or deception, committed by any person listed on the application;

(6) a license revocation, suspension, or other disciplinary action taken in Texas or another state against the license holder or any person listed on the application;

(7) criteria described in Chapter 99 of this title (relating to Denial or Refusal of License) that applies to any person required by this chapter to undergo a background and criminal history check;

(8) aiding, abetting, or permitting a substantial violation described in paragraph (1) of this subsection about which a person listed on the application had or should have had knowledge;

(9) a license holder or applicant's failure to provide the required information as requested on the application or in follow-up to the review of the application;

(10) a license holder or applicant who knowingly:

(A) submits false or intentionally misleading statements to DADS on an application;

(B) uses subterfuge or other evasive means of filing an application;

(C) engages in subterfuge or other evasive means of filing an application on behalf of another who is unqualified for licensure; or

(D) conceals a material fact on an application;

(11) a person listed on the application failing to pay the following fees, taxes, and assessments when due:

(A) licensing fees as described in §15.112 of this subchapter (relating to Licensing Fees);

(B) franchise taxes, if applicable; and

(C) federal taxes, as applicable; or

(12) a person listed on the application having a history of any of the following actions during the five-year period preceding the date of the application:

(A) operation of a facility in Texas or another state or jurisdiction that has been decertified or had its contract canceled under the Medicare or Medicaid program;

(B) federal or state Medicare or Medicaid sanctions or penalties;

(C) an unsatisfied final court judgment;

(D) eviction in Texas or another state or jurisdiction involving any property or space used as a center; or

(E) suspension in Texas or another state or jurisdiction of a license to operate a health facility, long-term care facility, assisted living facility, or a similar facility, or a center.

(b) DADS:

(1) denies a license to an applicant to operate a center if an applicant has on the date of the application:

(A) a debarment or exclusion from the Medicare or Medicaid programs by the federal government or a state; or

(B) a court injunction prohibiting an applicant or manager from operating a center.

(2) may deny a license to an applicant to operate a new center if an applicant has a history of any of the following actions at any time preceding the date of the application:

(A) revocation of a license to operate a health care facility, long-term care facility, assisted living facility or similar facility, or center in any state;

(B) surrender of a license in lieu of revocation or while a revocation hearing is pending;

(C) expiration of a license while a revocation action is pending and the license is surrendered without an appeal of the revocation or an appeal is withdrawn; or

(D) probation period placed on a license to operate a center.

(c) DADS may consider exculpatory information provided by any person described in §15.101(f) of this subchapter (relating to Criteria and Eligibility for a License) and grant a license if DADS finds that person able to comply with THSC Chapter 248A and this chapter.

(d) In determining the denial of a license, DADS considers all final actions taken against an applicant or license holder whether issued by DADS or another state or federal agency. An action is final when administrative and judicial remedies are exhausted. All actions, whether pending or final, must be disclosed.

(e) If an applicant owns multiple centers, DADS examines the overall record of compliance in all of the centers or other facilities types and agencies. An overall record poor enough to deny issuance of a new license will not preclude the renewal of licenses of individual centers with satisfactory records.

(f) If DADS denies an application for a license or refuses to issue a renewal of a license, an applicant or license holder may request a hearing by complying with the Texas Health and Human Services Commission's rules for hearings found in 1 TAC Chapter 357, Subchapter I (relating to Hearings Under the Administrative Procedure Act) and DADS rules for hearings found in Chapter 91 of this title (relating to Hearings Under the Administrative Procedure Act). An administrative hearing is conducted in accordance with Texas Government Code, Chapter 2001; 1 TAC Chapter 357, Subchapter I; and Chapter 91 of this title.

 

§15.116 Display of License

 

A center must display the center's license in a conspicuous location readily visible to a person entering the center.

 

§15.117 License Alteration Prohibited

 

A center license may not be altered.

 

§15.118 Reporting Changes in Application Information

 

If certain information provided on an initial or renewal application changes after DADS issues the license, a center must report the change to DADS by following the instructions on the DADS website for reporting a change. For requirements on reporting a change regarding:

(1) the administrator, chief financial officer, and controlling person, a center must comply with §15.119 of this division (relating to Notification Procedures for a Change in Administration and Management) and §15.302 of this chapter (relating to Organizational Structure and Lines of Authority);

(2) the center's contact information, a center must comply with §15.120 of this subchapter (relating to Notification Procedures for a Change in Contact Information);

(3) the center's operating hours, a center must comply with §15.121 of this subchapter (relating to Notification Procedures for a Change in Operating Hours);

(4) name (legal entity or doing business as), a center must comply with §15.122 of this subchapter (relating to Notification Procedures for a Name Change).

 

§15.119 Notification Procedures for a Change in Administration and Management

 

(a) if a change occurs in the following management staff, a center must submit written notice to DADS no later than seven days after the date of a change in:

(1) administrator;

(2) chief financial officer; or

(3) controlling person, as defined in §15.5 of this chapter (relating to Definitions), including:

(A) a change of five percent or more of the controlling interest of a limited partner in a limited partnership or the addition of a controlling person to the limited partnership; or

(B) a change of five percent or more of the controlling interest in a for-profit corporation or limited liability company.

(b) A change in the management staff listed in subsection (a) of this section requires DADS evaluation and approval. DADS reviews the required documents and information submitted. DADS provides notification to a center if a person listed in subsection (a)(1)-(6) of this section does not meet the required qualifications.

 

§15.120 Notification Procedures for a Change of Contact Information

 

A center must submit written notice to DADS no later than seven days after a change in the center's:

(1) telephone number; or

(2) mailing address, if different from the physical location.

 

§15.121 Notification Procedures for a Change in Operating Hours

 

A center must submit written notice to DADS no later than seven days after a change in the center's operating hours.

 

§15.122 Notification Procedures for a Name Change

 

(a) If a center intends to change the name of its legal entity or assumed name, but does not undergo a change of ownership as defined in §15.107 of this subchapter (relating to Change of Ownership), the center must report the name change to DADS no later than seven days after the effective date of the name change.

(b) If a center changes its name but does not undergo a change of ownership, the license holder must notify DADS and submit a copy of a certificate of amendment from the Office of the Secretary of State. After DADS receives the certificate of amendment, a license is issued in the license holder's new name.

 

§15.123 Request and Issuance of Temporary License

 

(a) An applicant for an initial license under §15.105 of this subchapter (relating to Initial License Application Procedures and Issuance) may request that DADS issue a temporary license pending DADS review of the applicant’s application for an initial license.

(b) To request a temporary license, the applicant must submit to DADS Provider Licensure and Certification Unit a written request for a temporary license and a copy of the applicant’s policies, procedures and staffing plans that demonstrate compliance with the licensing standards of this chapter.

(c) DADS issues a temporary license to an applicant who has requested a temporary license if DADS:

(1) determines that the applicant has submitted an application for an initial license in accordance with §15.105 of this subchapter;

(2) determines that the applicant meets the building requirements of Subchapter E of this chapter; and

(3) approves the applicant’s policies, procedures and staffing plans submitted in accordance with subsection (b) of this section.

(d) If DADS issues a temporary license, the center may admit no more than six minors to the center until the temporary license expires or terminates.

(e) The issuance of a temporary license constitutes DADS notice to the applicant of the approval of the temporary license request.

(f) A temporary license expires on the earlier of:

(1) 90 days after DADS issues the temporary license or the last day of any extension DADS grants in accordance with subsection (g) of this section; or

(2) the date DADS issues an initial license.

(g) A temporary license holder may request that DADS extend the term of a temporary license by 90 days. To request an extension, the license holder must submit to DADS Provider License and Certification Unit, a written request for an extension. If DADS receives the request at least 30 days before the date the temporary license expires, DADS extends the term of the license for 90 days and notifies the temporary license holder of the extension in writing. DADS grants an applicant only one temporary license extension for a center.

(h) A temporary license holder must comply with the requirements of THSC Chapter 248A and the licensing standards of this chapter for the term of the temporary license. DADS may take the enforcement action described in Subchapter G of this chapter (relating to Enforcement) if the temporary license holder does not comply with THSC Chapter 248A or this chapter.

(i) DADS may visit or conduct an investigation or inspection of a center owned or operated by a temporary license holder, as described in Subchapter F of this chapter (relating to Inspections and Visits).

 

LSPPECC, Subchapter C, General Provisions

Revision 16-1

 

Division 1, Operations and Safety Provisions

 

§15.201 Operating Hours

 

(a) A center must adopt and enforce a written policy identifying the center's operating hours. A center may not:

(1) allow the provision of services to a minor at a center for more than 12 hours in any 24-hour period; or

(2) allow the provision of services to a minor at a center overnight.

(b) For the purposes of this section, the person in charge means the administrator, the alternate administrator, the nursing director, or the alternate nursing director.

(c) If a center is closed during the center's operating hours, the person in charge must:

(1) post a notice, in a location visible outside the center, that provides information regarding how to contact the person in charge by telephone; and

(2) leave an outgoing message on the center's answering machine or similar electronic mechanism or with an answering service that provides information about how to contact the person in charge by telephone.

 

§15.202 Suspension of Operations

 

(a) Suspension of operations occurs when a center suspends its normal business operations for five or more consecutive days due to:

(1) a scheduled closing of the center when a center has at least 45 days advance notice of the need to close the center; or

(2) an unscheduled closing of the center when a center has less than 45 days but more than 15 days advance notice of the need to close the center.

(b) A suspension of operations may not exceed the expiration date of the licensure period.

(c) If a center suspends operations due to a scheduled closing of the center, the center must:

(1) provide written notification to an adult minor or a minor's parent at least 30 days before the suspension of operations begins that includes:

(A) the start and end date of the suspension;

(B) instructions for obtaining a minor's medical records before and during the suspension for all services provided at the center; and

(C) information about the available options to transfer, discharge, or put a minor's services on hold depending on the needs of the minor;

(2) assist a parent or an adult minor with finding alternative services during the suspension;

(3) discharge, transfer or put a minor's services on hold in accordance with §15.608 of this chapter (relating to Discharge or Transfer Notification);

(4) ensure coordination of services for the minor's other service providers;

(5) notify the minor's physician at least 30 days before the suspension of operations begins;

(6) provide written notification to DADS at least 30 days before the suspension of operations begins; and

(7) post a notice, in a location visible outside of the center for the duration of the suspension, that provides information about the suspension of operations, including:

(A) the start and end date of the suspension; and

(B) how to obtain a minor's records during the suspension;

(8) leave an outgoing message, on the center's answering machine or other similar electronic mechanism or with an answering service, that provides the information in paragraph (7) of this subsection; and

(9) notify DADS in writing within seven days after resuming normal business operations.

(d) If a center suspends operations due to an unscheduled closing of the center, the center must:

(1) provide oral and written notification to a minor's parent no later than 15 days before the suspension of operations begins that includes:

(A) the start and estimated end date of the suspension;

(B) instructions for obtaining a minor's medical records before and during the suspension for all services provided at the center; and

(C) information about the available options to transfer, discharge, or put a minor's services on hold depending on the needs of the minor;

(2) assist a parent or an adult minor with finding alternative services during the suspension;

(3) discharge, transfer or put the minor's services on hold in accordance with §15.608 of this chapter;

(4) ensure coordination of services with the minor's other service providers;

(5) notify the minor's physician no later than 15 days before the suspension of operations begins;

(6) provide written notification to DADS no later than 15 days before the suspension of operations begins;

(7) post a notice, in a location visible outside of the center, for the duration of the suspension that provides information about the suspension of operations, including:

(A) the start and estimated end date of the suspension; and

(B) how to obtain a minor's records during the suspension;

(8) leave an outgoing message, on the center's answering machine or other similar electronic mechanism or with an answering service, that provides the information in paragraph (7) of this subsection; and

(9) notify DADS in writing within seven days after resuming normal business operations.

(e) If the center must close with less than 15 days advance notice, the center must follow the requirements in §15.209 of this division (relating to Emergency Preparedness Planning and Implementation).

 

§15.203 Financial Solvency and Business Records

 

(a) A center must have the financial ability to carry out its functions.

(b) A center must make available to DADS, upon request, business records relating to its ability to carry out its functions. DADS may conduct a more extensive review of the records if there is a question relating to the accuracy of the records or the center's financial ability to carry out its functions.

(c) A center must maintain business records in their original state. Each entry must be accurate and include the date of entry. Correction fluid or tape may not be used in the record. Corrections must be made in accordance with standard accounting practices.

 

§15.204 Billing and Insurance Claims

 

A center must adopt and enforce a written policy that includes procedures:

(1) to ensure that the center submits accurate billing and insurance claims; and

(2) to prevent, detect, and report fraud, waste, and abuse.

 

§15.205 Safety Provisions

 

(a) A center must ensure that the local fire marshal's office inspects the center annually. The center must keep a copy of the annual fire inspection report on file at the center for two years after the date of inspection.

(b) A center must prepare a fire drill plan and conduct a fire drill at least once every month.

(1) The center's administrator and nursing director must participate in the monthly fire drill.

(2)The center must conduct fire drills at various times of the day.

(3)The center must document a drill on a DADS Fire Drill Report Form.

(c) The center's administrator and nursing director must:

(1) review the center's fire drill plan;

(2) evaluate the effectiveness of the plan after each fire drill;

(3) review any problems that occurred during each drill and take corrective action, if necessary; and

(4) maintain documentation to support the requirements of this subsection.

(d) A center must have a working telephone available at all times at the center. Coin operated telephones or cellular telephones are not acceptable for this purpose. If the center has multiple buildings, a working telephone must be located in each of the buildings.

(e) A center must post at or near the immediate vicinity of all telephones:

(1) emergency telephone numbers including:

(A) the DADS abuse, neglect, and exploitation hotline;

(B) poison control;

(C) 911 or the local fire department, ambulance, and police in communities where a 911 management system is unavailable; and

(D) an emergency medical facility; and

(2) the center's address.

(f) A center must adopt and enforce written policies and procedures for a minor's medical emergency. The policy must include:

(1) a requirement that each minor has an emergency plan, developed in collaboration with a minor's parent, that:

(A) includes instructions from a minor's prescribing physician, as applicable;

(B) includes coordination with other health care providers, including hospice; and

(C) is updated and reviewed at least yearly or more often as necessary to meet the needs of a minor;

(2) a requirement that staff receive training for medical emergencies;

(3) a requirement that staff receive training in the use of emergency equipment; and

(4) procedures that staff follow when a minor's parent cannot be contacted in an emergency.

(g) If a minor must be transported to an emergency medical facility while at the center, the staff must immediately notify a minor's parent and hospice provider, if applicable. If a parent cannot be contacted, the center must ensure that an individual authorized by the parent or center staff meets a minor at the emergency facility.

(h) The center must prepare a medical emergency transfer form to give to the emergency transportation provider when transporting a minor to an emergency medical facility. The transfer form must include:

(1) the minor's name and age;

(2) the minor's diagnoses, allergies, and medication;

(3) the minor's parent name and contact information;

(4) the minor's prescribing physician name and contact information;

(5) the center's name and contact information; and

(6) the name of the administrator or nursing director.

(i) A center must maintain a first aid kit with unexpired supplies and an automated external defibrillator for minors served at the center that is easily accessible but not within reach of minors.

(j) A center must adopt and enforce written policies and procedures for the verification and monitoring of visitors, including service providers at a center. The policies and procedures must include:

(1) verification of a visitor's identity;

(2) verification of a visitor's authorization to enter a center;

(3) the recording of a visitor's name, organization, purpose of the visit, and the date and time a visitor entered and exited a center;

(4) the center's awareness of a visitor while in a center; and

(5) documentation of the requirements in this subsection.

(k) A center must adopt and enforce written policies and procedures for the release of a minor. The policy must include:

(1) procedures to verify the identity of a person authorized to pick up a minor from the center; and

(2) procedures for the release of a minor when transported by the center in accordance with Subchapter D of this chapter (relating to Transportation).

(l) A center must adopt and enforce written policies and procedures to ensure that no minor is left unattended at the center. The policy must include procedures for:

(1) a minor who arrives at the center;

(2) a minor who remains at the center during operating hours;

(3) a minor who leaves the center; and

(4) staff to conduct daily visual checks at the center at the close of business.

(m) A center must maintain daily records and documentation of the visual check at the end of each day to ensure no minor is left at the center. The documentation must include:

(1) the date and time; and

(2) the signature of the staff member conducting the daily visual checks at the center at the close of business.

(n) Except as otherwise provided in this section, a center must meet the provisions applicable to the health care occupancy chapters of the 2000 edition of the LSC of the National Fire Protection Association (NFPA) and the requirements in Subchapter E of this chapter (relating to Building Requirements). Roller latches are prohibited on corridor doors.

(o) Notwithstanding any provisions of the 2000 edition of the Life Safety Code, NFPA 101, to the contrary, a center may place alcohol-based hand-rub dispensers at the center if:

(1) use of alcohol-based hand-rub dispensers does not conflict with any state or local codes that prohibit or otherwise restrict the placement of such dispensers in health care facilities;

(2) the dispensers are installed in a manner that minimizes leaks and spills that could lead to falls;

(3) the dispensers are installed in a manner or location out of reach of a minor; and

(4) the dispensers are installed in accordance with Chapter 18.3.2.7 or Chapter 19.3.2.7 of the 2000 edition of the LSC, as amended by NFPA Temporary Interim Amendment 00-1(101), issued by the Standards Council of the National Fire Protection Association on April 15, 2004.

(p) A center's environment must be free of health and safety hazards to reduce risks to minors. The center must:

(1) use childproof electrical outlets or childproof covers on unused electrical outlets in all rooms to which minors have access at the center;

(2) use safety precautions for strings and cords, including those used on window coverings, and keep them out of the reach of minors;

(3) use safety precautions for all furnishings including cabinets, shelves, and other furniture items that are not permanently attached to the center; and

(4) use play material and equipment that is safe and free from sharp or rough edges and toxic paints.

(q) A center must adopt and enforce a written policy describing whether a center is a weapons-free location. A center must:

(1) provide a copy of the policy to staff, individuals providing services on behalf of a center, an adult minor, and a minor's parent; and

(2) provide a copy of the policy to any person who requests it.

(r) If a center is weapons-free, a center must post a visible and readable sign at the entrance of the center indicating the center is a weapons-free location.

(s) A center must adopt and enforce a written policy prohibiting the use of tobacco in any form, the use of alcohol, and the possession of illegal substances and potentially toxic substances at a center.

 

§15.206 Person-Centered Direction and Guidance

 

(a) A center must adopt and enforce written policies and procedures for the use of person-centered direction and guidance by individuals providing services to minors at the center. The policy must include:

(1) the implementation of a system-wide, person-centered direction and guidance program for minors that includes:

(A) the teaching of successful behavior and coping skills;

(B) proactive strategies to identify and manage a minor's behaviors before they escalate; and

(C) the monitoring and evaluation of the effectiveness of direction and guidance used with a minor by a committee as described in this section;

(2) procedures for ensuring consistent language, practices, and application of direction and guidance by individuals providing services at a center; and

(3) procedures for documenting and providing to a minor's parent a daily report of the minor's behavior.

(b) A center must ensure that only person-centered strategies and techniques that encourage self-esteem, self-control, and self-direction are used for the purposes of direction and guidance of a minor at a center. A center must not use a restraint as part of person-centered direction and guidance.

(c) Person-centered direction and guidance must be:

(1) individualized and consistent for each minor;

(2) differentiated in both nature and intensity based on a minor's level of behavior;

(3) appropriate to the minor's level of understanding and functional or educational development; and

(4) directed toward teaching the minor successful behavior, awareness of behavior triggers and self-control, including:

(A) encouraging a minor to develop positive behavior in accordance with a minor's individualized psychosocial program;

(B) redirecting behavior using positive statements; and

(C) teaching the minor to use effective behavior management techniques.

 

(d) A center must ensure that quiet time, if used, is:

(1) in accordance with the minor's psychosocial program and plan of care;

(2) brief and under continuous face-to-face observation by center staff;

(3) appropriate for the minor's age and development;

(4) limited to no more than one minute per year of the minor's developmental age; and

(5) does not place a minor alone in a room.

(e) A center must ensure the protection of minors at the center from harsh, cruel, or unusual treatment. Negative discipline is considered punishment and abuse and is prohibited at a center, including:

(1) corporal punishment or threats of corporal punishment;

(2) punishment associated with food, naps, or toilet training;

(3) pinching, shaking, or biting a minor;

(4) hitting a minor with a hand or object;

(5) putting anything in or on a minor's mouth;

(6) humiliating, ridiculing, rejecting, or yelling at a minor;

(7) subjecting a minor to harsh, abusive, or profane language;

(8) placing a minor alone in a locked or darkened room, bathroom, or closet without windows; and

(9) requiring a minor to remain silent or inactive for inappropriately long periods of time for the minor's developmental age.

(f) The center must establish a person-centered direction and guidance committee to review the techniques and strategies used at a center to:

(1) determine whether the individualized direction and guidance used as established in a plan of care is consistently applied for each minor in accordance with center policy;

(2) evaluate the frequency and outcomes of strategies and techniques used with a minor to:

(A) determine the impact of the direction and guidance on a minor's ability to achieve progress in goals;

(B) determine effectiveness of the minor's program; and

(C) recommend the use of new strategies and techniques when current strategies and techniques are determined to be ineffective.

 

(g) The committee must include:

(1) the center's administrator;

(2) the center's nursing director or designee;

(3) an individual providing psychosocial treatment and services on behalf of a center; and

(4) a parent or an individual from a parent council or support group for minors receiving services at the center.

(h) The center is not required to include a parent or individual from a parent council or support group if, after a good faith effort, the center is unable to include a parent or individual in a committee meeting. The center must document, for DADS review, a good faith effort to include a parent or individual from a parent council or support group at each meeting.

(i) The center must adopt and enforce written policies and procedures for the frequency, format and documentation of committee meetings.

(j) A center must provide its written person-centered direction and guidance policy to all parents, employees, volunteers and contractors. The center must maintain documentation of acknowledgment of the written policy from all employees, volunteers and contractors.

 

§15.207 Protective Devices and Restraints

 

(a) Protective Devices. A center must ensure that a protective device is used only as ordered by a minor's physician, as agreed to by an adult minor or a minor's parent, and in accordance with the minor's plan of care.

(1) A center may use a protective device only in the following circumstances:

(A) as part of a therapeutic regimen of basic services for a minor's physical health and development;

(B) during medical, nursing, diagnostic, and dental procedures as prescribed by a physician's order and to protect the health and safety of a minor; or

(C) in a medical emergency to protect the health and safety of a minor.

(2) A center must adopt and enforce written policies and procedures requiring a protective device to be used as described in this subsection and in accordance with a minor's plan of care.

(3) A center must not implement a physician's order for the use of a protective device on a pro re nata (PRN) or as-needed basis.

(4) A center must ensure a physician's order is obtained before using a protective device at the center. The physician's order must include:

(A) the circumstances under which a protective device may be used at the center;

(B) instructions on how long a protective device may be used at the center; and

(C) any individualized, less restrictive interventions described in the minor’s plan of care that must be used before using a protective device.

(5) A center must ensure that in implementing a physician's order for a protective device that an RN, with input from an adult minor, a minor's parent, and the IDT:

(A) conducts an assessment of a minor's current and ongoing need for a protective device at a center;

(B) reviews the physician's order for a protective device, as described in paragraph (4) of this subsection; and

(C) obtains and documents in a minor's medical record the written consent of an adult minor or a minor's parent to use a protective device at the center.

(6) Before using a protective device for the first time with a minor, the center must ensure an RN provides oral and written notification to the adult minor or the minor's parent of the right at any time to withdraw consent and discontinue use of a protective device at the center.

(7) The center must ensure that a staff member who will apply a protective device has been properly trained in the use of a protective device, as ordered in the minor's plan of care, in accordance with this subsection, and in accordance with §15.415(b)(8)(F) of this subchapter (relating to Staffing Policies for Staff Orientation, Development, and Training).

(8) If a protective device is used for a minor, the center must ensure:

(A) the minor is assessed by an RN, in accordance with the physician's order but no less than once every hour to determine if the protective device must be repositioned or discontinued;

(B) except for sedation, the protective device is removed to conduct the RN assessment described in subparagraph (A) of this paragraph and removed more frequently as determined necessary by the RN’s assessment;

(C) center staff replaces the protective device, if necessary, after the assessment, in accordance with the physician's order;

(D) a minor's physician is notified immediately if an assessment determines a change in the minor's condition or a negative reaction to the protective device has occurred, including notification of:

(i) the minor's psychosocial condition;

(ii) the minor's reaction to the protective device;

(iii) the minor's medical condition; and

(iv) the need to continue or discontinue the use of the protective device;

(E) the type and frequency of use of the protective device is documented in the minor's medical record;

(F) the effects of a protective device on the minor's health and welfare are evaluated and documented in the medical record; and

(G) an RN, an adult minor, a minor's parent, and the IDT, at least every 180 days, or as the minor's needs change, review, with input and direction from the minor's prescribing physician, the use of a protective device to determine its effectiveness and the need to continue the use of the protective device.

 

(b) Restraints. A center may use a restraint only in a behavioral emergency when the immediate health and safety of the minor or another minor are at risk. A center must not use a chemical or mechanical restraint. A center may use only the following restraints:

(1) The center must adopt and enforce a written policy and procedures regarding the use of restraints in a behavioral emergency, including whether a center is a restraint-free environment.

(2) A center must ensure that the use of a restraint at a center must not be in a manner that:

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

(B) impairs the minor's breathing by putting pressure on the minor's torso;

(C) interferes with the minor's ability to communicate;

(D) extends muscle groups away from each other;

(E) uses hyperextension of joints; or

(F) uses pressure points or pain.

(3) A center must ensure that a restraint is not used for:

(A) controlling a minor's behavior in a non-emergency;

(B) negative discipline as described in §15.206 of this division (relating to Person-Centered Direction and Guidance);

(C) convenience;

(D) coercion or retaliation; or

(E) as part of a behavior component of a minor's psychosocial program.

(4) A center must not implement a physician's order for the use of a restraint on a pro re nata (PRN) or as-needed basis.

(5) A center must ensure that a staff member whose job responsibilities will include the use or application of a restraint during a behavioral emergency has been properly trained in the use of a restraint for minors served at the center, in accordance with this section, and in accordance with §15.415(b)(8)(G) of this subchapter (relating to Staffing Policies for Staff Orientation, Development, and Training).

(6) If a center restrains a minor due to a behavioral emergency, the center must ensure:

(A) all less restrictive options available are exhausted before using a restraint;

(B) the restraint is limited to the use of such reasonable force as is necessary to address the emergency;

(C) the restraint is discontinued immediately at the point when the emergency no longer exists but no more than 15 minutes after the restraint was initiated;

(D) the restraint is implemented in such a way as to protect the health and safety of the minor and others;

(E) immediately after the restraint is discontinued, the minor is assessed by an RN;

(F) immediately following an RN assessment, medical attention is provided for the minor if determined necessary by the RN assessment;

(G) within three days after the use of the restraint, an assessment is conducted by an RN as described in §15.504 of this chapter (relating to Psychosocial Treatment and Services) to determine if the development and implementation of a psychosocial treatment and services program is needed for the minor to address the minor's behavior and reduce the occurrence of future behavioral emergencies; and

(H) within three days after the use of the restraint, an RN reviews and updates a minor's plan of care and psychosocial treatment and services program as determined appropriate.

(7) If a center restrains a minor due to a behavioral emergency, the center must ensure the following documentation and notifications occur:

(A) immediately after the restraint is discontinued, information about the restraint is documented, including:

(i) the name of the individual who administered the restraint;

(ii) the date and time the restraint began and ended;

(iii) the location of the restraint;

(iv) the nature of the restraint;

(v) a description of the setting and activity in which the minor was engaged immediately preceding the use of the restraint;

(vi) the behavior that prompted the restraint;

(vii) the efforts made to de-escalate the situation and the less restrictive alternatives attempted before the restraint; and

(viii) the minor's condition after the restraint was discontinued;

(B) within 24 hours after the use of the restraint, written documentation regarding the use of the restraint and the RN assessment conducted immediately after the use of the restraint is included in a minor's medical record;

(C) documentation of nursing director and administrator oral and written notifications as described in subparagraphs (E) and (I) of this paragraph, including nursing director and administrator signatures acknowledging receipt of notifications must be included in the minor's medical record;

(D) documentation of parent oral and written notifications as described in subparagraphs (F) and (J) of this paragraph, including a parent signature acknowledging receipt of notifications must be included in the minor's medical record;

(E) immediately after the restraint is used, the administrator and director of nursing are notified orally that the restraint occurred;

(F) on the day the restraint is used, the minor's parent is notified orally that the restraint occurred;

(G) on the day the restraint is used, the center's staff responsible for psychosocial treatment and services is notified orally that the restraint occurred;

(H) immediately after the RN assessment is conducted in accordance with paragraph (6)(E) of this subsection, if the assessment determines a change in the minor's condition or a negative reaction to the restraint has occurred, the minor's physician is notified of the restraint and the minor's condition, including:

(i) the minor's medical condition;

(ii) the minor's reaction to the restraint; and

(iii) the minor's psychosocial condition;

(I) within one hour after the use of the restraint, the administrator and director of nursing are notified in writing of the restraint, including the information in subparagraph (A) of this paragraph; and

(J) within one day after the use of the restraint, the minor's parent is notified in writing, in a language and format the parent understands, of the restraint, including the information in subparagraph (A) of this paragraph;

(8) The IDT must review, on an annual basis or more frequently as needed, all behavioral emergencies that occurred at the center during the time period being reviewed to determine the appropriateness of the center's response and to identify strategies for reducing behavioral emergencies at the center.

(9) A center must maintain documentation of compliance with this section.

 

§15.208 Equipment, Devices, and Supplies

 

(a) A center, with input from the medical director, must determine the quantity and types including age and developmentally appropriate equipment, devices, and supplies that the center must keep on the premises to meet the needs of minors and for emergency purposes.

(b) The center must coordinate with a minor, a minor's parent, and a minor's prescribing physician and other basic service providers, as applicable, to ensure that equipment, devices, and supplies used by a minor are available to a minor at the center.

(c) The center must ensure the provision of necessary consumable supplies and resources, including diapers, if the center determines, after the minor's arrival at the center, that the minor's parent failed to provide an adequate amount of necessary consumable supplies and resources for the minor.

(d) The center must adopt and enforce written preventive maintenance policies and procedures to ensure the center's equipment, devices, and supplies are inspected for safety purposes and maintained at least annually or more frequently if recommended by the manufacturer. Equipment, devices, and supplies must be maintained free of defects that could pose a potential hazard to a minor or an individual at the center. The staff may perform preventive maintenance if the staff are trained and experienced in maintaining the specific equipment.

(e) The center must adopt and enforce written policies and procedures to ensure equipment used by a minor is cleaned and sanitized after each use.

(f) A center must have clean storage areas for equipment, devices, and supplies.

 

§15.209 Emergency Preparedness Planning and Implementation

 

(a) A center must have a written emergency preparedness and response plan that comprehensively describes its approach to an emergency situation, including a public health disaster that could affect the need for its services or its ability to provide those services.

(b) Administration. A center must:

(1) develop and implement a written plan as described in subsection (c) of this section;

(2) maintain a current written copy of the plan in a central location that is accessible to all staff at all times and at a work station of each staff who has responsibilities under the plan;

(3) evaluate the plan to determine if information in the plan must change:

(A) no later than 30 days after an emergency situation;

(B) as soon as possible after the remodeling or construction of an addition to the center; and

(C) at least annually;

(4) revise the plan no later than 30 days after information in the plan changes; and

(5) maintain documentation of compliance with this section.

(c) Emergency Preparedness and Response Plan. A center's plan must:

(1) include a risk assessment of all potential external and internal emergency situations that pose a risk for harm to minors or property and are relevant to the provision of services at a center and the center's geographical area, such as fire, earthquake, hurricane, tornado, flood, extreme snow and ice conditions for the area, wildfire, terrorism, hazardous materials accident, thunderstorm, wind storm, wave action, oil spill or other water contamination, epidemic, air contamination, infestation, explosion, riot, hostile military or paramilitary action, energy emergency, water outage, failure of heating and cooling systems, power outage, bomb threat, and explosion;

(2) include a description of minors served at the center;

(3) include a description of the services and assistance needed by minors served at the center in an emergency situation;

(4) include a section for each core function of emergency management, as described in subsection (d) of this section, that is based on the center's decision to either temporarily shelter-in-place or evacuate during an emergency situation; and

(5) include a section for a fire safety plan that complies with §15.205 of this division (relating to Safety Provisions).

(d) Plan Requirements Regarding Eight Core Functions of Emergency Management.

(1) Direction and control. A center's plan must contain a section for direction and control that:

(A) designates by name or title the emergency preparedness coordinator (EPC) who is the staff person with the authority to manage the center's response to an emergency situation in accordance with the plan, and includes the EPC's current phone number;

(B) designates by name or title the alternate EPC who is the staff person with the authority to act as the EPC if the EPC is unable to serve in that capacity, and includes the alternate EPC's current phone number;

(C) documents the name and contact information for the local emergency management coordinator (EMC) for the area where the center is located, as identified by the office of the local mayor or county judge;

(D)includes procedures for notifying the local EMC of the execution of the plan;

(E)includes a plan for coordinating a staffing response to an emergency situation; and

(F) includes a plan for relocating minors to a safe location that is based on the type of emergency situation occurring and a center's decision to either temporarily shelter-in-place or evacuate during an emergency situation.

(2) Warning. A center's plan must contain a section for warning that:

(A) describes how the EPC will be notified of an emergency situation;

(B) identifies who the EPC will notify of an emergency situation and when the notification will occur, including during off hours, weekends, and holidays; and

(C) addresses monitoring local news and weather reports regarding a disaster or potential disaster, taking into consideration factors such as geographic-specific natural disasters, whether a disaster is likely to be addressed or forecast in the reports, and the conditions, natural or otherwise, that would cause staff to monitor news and weather reports for a disaster.

(3) Communication. A center's plan must contain a section for communication that:

(A) identifies the center's primary mode of communication to be used during an emergency situation and the center's alternate mode of communication to be used in the event of power failure or the loss of the center's primary mode of communication in an emergency situation;

(B) requires posting of the emergency contact number for the local fire department, ambulance, and police at or near each telephone at the center in communities where a 911 emergency management system is unavailable;

(C) includes procedures for maintaining a current list of telephone numbers for:

(i) minors' parents;

(ii) safe locations; and

(iii) center staff;

(D) identifies the location of the lists described in subparagraph (C) of this paragraph;

(E) includes procedures to notify:

(i) center staff about an emergency situation;

(ii) a contact person at a safe location about an impending or actual evacuation of minors; and

(iii) a minor's parent about an impending or actual evacuation;

(F) provides a method for staff to obtain a minor's emergency information during an emergency situation;

(G) includes procedures for the center to maintain communication with:

(i) center staff during an emergency situation;

(ii) a contact person at a safe location; and

(iii) the authorized driver of a vehicle transporting minors, medication, medical records, food, water, equipment, or supplies during an evacuation; and

(H) includes procedures for reporting to DADS an emergency situation that caused the death or serious injury of a minor as follows:

(i) by telephone at 1-800-458-9858 or by using the DADS website, no later than 24 hours after the death or serious injury of a minor; and

(ii) in writing on the DADS Provider Investigation Report Form no later than five days after the center makes the report.

(4) Shelter-in-place. A center's plan must contain a section that includes procedures to temporarily shelter minors in place during an emergency situation.

(5) Evacuation. A center's plan must contain a section for evacuation that:

(A) requires posting center evacuation routes conspicuously throughout the center;

(B) identifies evacuation destinations and routes for an authorized driver, and includes a map that shows the destinations and routes;

(C) includes procedures for implementing a decision to evacuate minors to a safe location;

(D) includes a current copy of an agreement with a pre-arranged safe location, outlining arrangements for receiving minors in the event of an evacuation, if the evacuation destination identified in accordance with subparagraph (B) of this paragraph is a prearranged safe location that is not owned by the same entity as the evacuating center;

(E) includes procedures for:

(i) ensuring that staff accompany evacuating minors;

(ii) ensuring that minors and staff present at the center have been evacuated;

(iii) ensuring that visitors, including parents and service providers, evacuate the center;

(iv) accounting for minors and staff after they have been evacuated;

(v) accounting for minors absent from the center at the time of the evacuation;

(vi) releasing minor information in an emergency situation to promote continuity of a minor's care, in accordance with state law;

(vii) includes procedures for notifying the local EMC regarding an evacuation of the center, if required by the local EMC guidelines;

(viii) contacting the local EMC, if required by the local EMC guidelines, to find out if it is safe to return to the geographical area after an evacuation; and

(ix) determining if it is safe to re-enter and occupy the center after an evacuation;

(x) includes procedures for notifying DADS by telephone, at 1-800-458-9858, no later than 24 hours after an evacuation that minors have been evacuated; and

(xi) includes procedures for notifying DADS Regulatory Services by telephone immediately after the EPC makes a decision to evacuate all minors from the center.

 

(6) Transportation. A center's plan must contain a section for transportation that:

 

(A) arranges for a sufficient number of vehicles to safely evacuate all minors;

(B) identifies staff or contractors designated to drive a center owned, leased, or rented vehicle during an evacuation;

(C) includes procedures for safely transporting minors and staff involved in an evacuation; and

(D) includes procedures for safely transporting and having timely access to oxygen, medications, medical records, food, water, equipment, and supplies needed during an evacuation.

(7) Health and Medical Needs. A center's plan must contain a section for health and special needs that:

(A) identifies the types of services and medical equipment used by minors, including oxygen, respirator care, or hospice services; and

(B) ensures that a minor's needs identified in subparagraph (A) of this paragraph are met during an emergency situation.

(8) Resource Management. A center's plan must contain a section for resource management that:

(A) includes a plan for identifying medications, medical records, food, water, equipment, and supplies needed during an emergency situation;

(B)identifies staff who are assigned to locate the items in subparagraph (A) of this paragraph and who must ensure the transportation of the items during an emergency situation; and

(C) includes procedures to ensure that medications are secure and maintained at the proper temperature during an emergency situation.

 

(e) Training. A center must:

(1) train staff on their responsibilities under the plan no later than 30 days from their hire date;

(2) train staff on the staff responsibilities under the plan at least annually and when the staff member's responsibilities under the plan change; and

(3) conduct one unannounced annual drill with staff for severe weather and other emergency situations identified by a center as likely to occur, based on the results of the risk assessment required by subsection (c) of this section.

(f) Fire Emergency Response Plan.

(1) The center must have a comprehensive written fire emergency response plan. Copies of the plan must be available to all staff. The center must periodically instruct and inform staff about the duties of their positions under the plan. The written fire emergency response plan must provide for the following:

(A) use of alarms;

(B) transmission of an alarm to a fire department;

(C) response to alarms;

(D) isolation of fire;

(E) evacuation of the immediate area;

(F) preparation of floors and building for evacuation; and

(G) fire extinguishment;

(2) The fire emergency response plan must include procedures to contact DADS by telephone, at 1-800-458-9858, no later than 24 hours after activation of its Fire Emergency Response Plan.

(3) The staff must conduct emergency egress and relocation drills as follows:

(A) perform a monthly fire drill with all occupants of the building at expected and unexpected times and under varying conditions;

(B) relocate, during the monthly drill, all occupants of the building to a predetermined location where occupants must remain until a recall or dismissal is given; and

(C) complete the DADS Fire Drill Report Form for each required drill.

(4) The EPC or a designee must conduct fire prevention inspections on a monthly basis and prepare a report of the inspection results. The center must maintain copies of the fire prevention inspection report prepared by the center within the last 12 months. The center must post a copy of the most recent fire prevention inspection report in a conspicuous place at the center.

 

 

§15.210 Sanitation, Housekeeping, and Linens

 

(a) A center must ensure a sanitary environment by following accepted standards of practice and maintain a safe physical environment free of hazards for minors, staff, and visitors.

(b) A center must ensure that the following conditions are met.

(1) Wastewater and sewage must be discharged into a state-approved municipal sewage system. An on-site sewage facility must be approved by the Texas Commission on Environmental Quality (TCEQ) or authorized agent.

(2) The water supply must be from a system approved by the Public Drinking Water Section of the TCEQ, or from a system regulated by an entity responsible for water quality in the jurisdiction where the center is located as approved by the Public Drinking Water Section of the TCEQ.

(3) Waste, trash, and garbage must be disposed of from the premises at regular intervals in accordance with state and local practices. Excessive accumulations are not permitted. Outside containers must have tight-fitting lids left in closed position. Containers must be maintained in a clean and serviceable condition.

(4) Center grounds must be well kept and the exterior of the building, including sidewalks, steps, porches, ramps, and fences, must be in good repair.

(5) The interior of the center's buildings including walls, ceilings, floors, windows, window coverings, doors, plumbing and electrical fixtures must be in good repair.

(6) Pest control must be provided by a licensed structural pest control applicator with a license category for pests. The center must maintain documented evidence of routine efforts to remove rodents and insects.

(7) The center must be kept free of offensive odors, accumulations of dirt, rubbish, dust, and hazards. Storage areas, attics, and cellars must be free of refuse and extraneous materials.

(c) A center must adopt and enforce a written work plan for housekeeping operations, with categorization of cleaning assignments as daily, weekly, monthly, or annually within each area of the center.

(d) A center must ensure the provision of housekeeping and maintenance of the interior, exterior and grounds of the center in a safe, clean, orderly and attractive manner. The center must provide housekeeping and maintenance staff with equipment and supplies if needed. A center must designate staff to be responsible for overseeing the housekeeping services.

(e) A center must develop procedures for the selection, use, and disposal of housekeeping and cleaning products and equipment. The center must ensure:

(1) the use of EPA approved cleaning products appropriate for the application and materials to be sanitized;

(2) the following of manufacturer instructions for use and disposal of cleaning products;

(3) all bleaches, detergents, disinfectants, insecticides, and other poisonous substances are kept in a safe place accessible only to staff; and

(4) all products are labeled.

(f) A center must ensure a sufficient supply of clean linens is available to meet the needs of minors. Clean laundry must be provided in-house by the center, through a contract with another health care center, or with an outside commercial laundry service.

(g) A center must ensure:

(1) linens are handled, stored, and processed so as to control the spread of infection;

(2) linens are maintained in good repair;

(3) linens are washed, dried, stored, and transported in a manner which will produce hygienically clean linen;

(4) the washing process has a mechanism for removing soil and killing bacteria;

(5) clean linens are stored in a clean linen area easily accessible to the staff;

(6) soiled linens and clothing are stored separately from clean linen and clothing;

(7) soiled linens and clothing are stored in well ventilated areas, and are not permitted to accumulate at the center;

(8) soiled linens and clothing are transported in accordance with procedures consistent with universal precautions;

(9) soiled linens are not sorted, laundered, rinsed, or stored in bathrooms, corridors, food preparation area, or food storage areas;

(10) a minor's clothing stored at the center is cleaned after each use; and

(11) staff wash their hands both after handling soiled linen and before handling clean linen.

 

 

§15.211 Infection Prevention and Control Program and Vaccinations Requirements

 

(a) A center must establish and maintain an infection prevention and control program (IPCP) designed to provide a safe, sanitary, and comfortable environment by preventing the development and transmission of disease and infection. Under the IPCP, the center must:

(1) investigate, prevent, and control infections at the center;

(2) decide what procedures, such as isolation, should be applied to an individual minor;

(3) address vaccine preventable diseases in accordance with THSC, Chapter 224;

(4) address hepatitis B vaccinations in accordance with Occupational Safety and Health Administration;

(5) address tuberculosis requirements; and

(6) maintain a record of incidents and corrective actions relating to infections.

(b) A center must provide IPCP information to employees, contractors, volunteers, parents, health care providers, other service providers, and visitors.

(c) A center's IPCP must include written policies and procedures for admissions and attendance of minors who are at risk for infections or present a significant risk to other minors. The policy must include that a minor is accepted only:

(1) as authorized by a minor's prescribing physician:

(2) as determined by the center's medical director's assessment of the risk;

(3) as determined by the medical and nursing director review, on a case-by-case basis, to determine appropriateness of admission to or attendance at the center; and

(4) in accordance with Centers for Disease Control (CDC) guidelines.

(d) The center's IPCP must include written policies and procedures for preventing the spread of infection.

(1) If the center determines, in accordance with its IPCP, that a minor must be isolated to prevent the spread of infection, the center must isolate a minor.

(A) The center must maintain an isolation room with a glass window for observation of a minor. The isolation room must be equipped with emergency outlets and equipment as necessary to provide care to a minor. The isolation room must have a dedicated bathroom not accessible to the center's other rooms if appropriate to control the spread of infectious disease.

(B) The center must ensure that all equipment is thoroughly cleaned and disinfected before being placed in the isolation room and before being removed from the room.

(C) The center's procedures must address:

(i) notification to a minor's parent of the minor's condition and the center's recommendation of isolation or removal based on the minor's risk assessment;

(ii) the arrangement of transportation if the minor must be removed from the center; and

(iii) the return of a minor to the center, as determined by a reassessment conducted by a nurse that the minor no longer poses a risk to other minors.

(2) The center must prohibit employees, volunteers, and contractors with an infectious disease or infected skin lesions from direct contact with minors or food, if direct contact will transmit the disease.

(3) The center's infection control policy must provide that staff, volunteers, and contractors wash their hands between each treatment and care interaction with a minor.

(4) The center must immediately report the name of any minor with a reportable disease as specified in 25 TAC Chapter 97, Subchapter A (relating to Control of Communicable Diseases) to the city health officer, county health officer, or health unit director having jurisdiction, and implement appropriate infection control procedures as directed by the local health authority or the Department of State Health Services.

(e) The center must assign a crib, bed, or sleep mat for a minor's exclusive use each day. A center must label cribs, beds, and sleep mats with the minor's name.

(f) A center must place liquid soap, disposable paper towels, and trash containers at each sink.

(g) The center must adopt and enforce written policies and procedures for the control of communicable diseases for employees, contractors, volunteers, parents, health care providers, other service providers, and visitors and must maintain evidence of compliance.

(h) The center must adopt and enforce written policies and procedures for the control of an identified public health disaster.

(1) If a center determines or suspects that an employee, volunteer, or contractor providing services has been exposed to, or has a positive screening for, a communicable disease, the center must respond according to current CDC guidelines and keep documentation of the action taken.

(2) If the center determines that an employee, volunteer or contractor providing services has been exposed to a communicable disease, the center must conduct and document a reassessment of the risk classification. The center must conduct and document subsequent screenings based upon the reassessed risk classification.

(3) If the center determines that an employee, volunteer, or a contractor providing services at the center is suspected of having a communicable disease, the individual must not return to the center until the individual no longer poses a risk of transmission as documented by a written physician's statement.

(i) The center must conduct and document an annual review that assesses the center's current risk classification according to the current CDC Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health Care Settings and 25 TAC Chapter 97, Subchapter A.

(1) The center must have a system in place to screen all individuals providing services at the center.

(2) The center must require employees, volunteers, and contractors providing services to provide evidence of current tuberculosis screening before providing services at the center. The center must maintain evidence of compliance.

(3) Any employee, volunteer, or contractor providing services at a center with positive results must be referred to the person's personal physician, and if active tuberculosis is suspected or diagnosed, the person must be excluded from work until the physician provides written approval to return to work.

(j) A center must adopt and enforce written policies and procedures to protect a minor from vaccine preventable diseases, in accordance with THSC, Chapter 224.

(1) The policy must:

(A) require an employee, volunteer, or contractor providing direct care to receive vaccines for the vaccine preventable diseases specified by the center based on the level of risk the employee, volunteer, or contractor, presents to minors by the employee's, volunteer's, or contractor's routine and direct exposure to minors;

(B) specify the vaccines an employee, volunteer, or contractor who provides direct care is required to receive in accordance with subsection (i) of this section;

(C) include procedures for the center to verify that an employee, volunteer, or contractor who provides direct care has complied with the policy;

(D) include procedures for the center to exempt an employee, volunteer, or contractor who provides direct care from the required vaccines for the medical conditions identified as contraindications or precautions by the CDC;

(E) include procedures, including using protective equipment such as gloves and masks, to protect minors from exposure to vaccine preventable diseases, based on the level of risk the employee, volunteer, or contractor presents to minors by the employee's, volunteer's, or contractor's routine and direct exposure to minors;

(F) prohibit discrimination or retaliatory action against an employee, volunteer, or contractor who provides direct care and 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, such as gloves and masks, will not be considered retaliatory action;

(G) require the center to maintain a written or electronic record of each employee's, volunteer's or contractor's compliance with or exemption from the policy; and

(H) include disciplinary actions the center may take against an employee, volunteer, or contractor providing direct care who fails to comply with the policy.

(2) The center must have a written policy describing whether it will exempt an employee, volunteer, or contractor providing direct care:

(A) from the required vaccines based on reasons of conscience, including a religious belief; and

(B) prohibit an employee, volunteer, or contractor providing direct care who is exempt from the required vaccines from having contact with minors during a public health disaster.

(k) The center must adopt and enforce written policies and procedures to identify employees, volunteers, or contractors at risk of directly contacting blood or potentially infectious materials in accordance with Occupational Safety and Health Administration (OSHA), 29 Code of Federal Regulations Part 1910.1030 and Appendix A relating to Bloodborne Pathogens.

(l) A center must ensure that its employees, volunteers, and contractors comply with:

(1) the center's IPCP;

(2) the Communicable Disease Prevention and Control Act, THSC Chapter 81; and

(3) THSC Chapter 85, Subchapter I, concerning the prevention of the transmission of human immunodeficiency virus and hepatitis B virus.

 

Division 2, Administration and Management

 

§15.301 License Holder's Responsibilities

 

(a) The license holder is responsible for the conduct of the center and for the adoption, implementation, and enforcement of the written policies required throughout this chapter. The license holder is also responsible for ensuring that these policies comply with THSC Chapter 248A and the applicable provisions of this chapter and are administered to provide safe, professional, and quality health care.

(b) The persons described in §15.101(f) of this chapter (relating to Criteria and Eligibility for a License) must not have been convicted of an offense described in §99.2 of this title (relating to Convictions Barring Licensure), during the time frames described in that chapter.

(c) The license holder must ensure that all documents submitted to DADS or maintained by the center as required by this chapter are accurate and do not misrepresent or conceal a material fact.

(d) The license holder must comply with an order of the DADS commissioner or other enforcement orders that may be imposed on the center in accordance with THSC Chapter 248A and this chapter.

(e) The license holder of the center must have full legal authority and responsibility for the operation of the center.

(f) A license holder must designate in writing an individual who meets the qualifications and conditions set out in §15.303 of this subchapter (relating to Administrator and Alternate Administrator Qualifications and Conditions) to serve as the administrator of the center.

(g) A license holder must designate in writing an alternate administrator who meets the qualifications and conditions of an administrator set out in §15.303 of this subchapter to act in the absence of the administrator or when the administrator is unavailable to the staff during the center's operating hours.

(h) A license holder must ensure the position and designation of an administrator or alternate administrator is filled with a qualified staff.

(i) A license holder must ensure maintenance of documentation of efforts to ensure a vacancy in the position of an administrator or alternate administrator does not last more than 30 days.

(j) A license holder must ensure all written notices to DADS required by this chapter, unless specified, are submitted as described in the instructions provided on the DADS website.

 

§15.302 Organizational Structure and Lines of Authority

 

(a) A center must prepare and maintain a current written description of the center's organizational structure. The document may be either in the form of a chart or a narrative.

(b) The description must include:

(1) all services provided by the center;

(2) if applicable to the center's organization structure and lines of authority, the governing body, board of directors, the administrator, alternate administrator, the medical director, the nursing director, the alternate nursing director, advisory committee, IDT, and staff, as appropriate, based on services provided by the center; and

(3) the lines of authority and the delegation of responsibility down to and including the direct care level.

 

 

§15.303 Administrator and Alternate Administrator Qualifications and Conditions

 

(a) The administrator and alternate administrator of a center must have two years of experience in supervision and management in a pediatric health care setting and meet one of the following criteria:

(1) be a physician licensed in Texas to practice medicine in accordance with Texas Occupations Code, Chapter 155;

(2) be an RN with a master's or baccalaureate degree in nursing and be licensed under the Nursing Practice Act, Texas Occupations Code, Chapter 301, with no disciplinary actions;

(3) be a college graduate with a bachelor's degree with one additional year of supervision or management experience in a health care setting;

(4) have an associate's degree in health care or administration with two additional years of supervision or management experience in a health care setting; or

(5) have an associate's degree in nursing and currently licensed under the Nursing Practice Act, Texas Occupations Code, Chapter 301, with no disciplinary action with two additional years of supervision or management experience in a health care setting.

(b) The administrator and the alternate administrator of a center must be at least 25 years of age.

(c) An administrator and alternate administrator of a center must meet the initial training requirements specified in §15.305 of this division (relating to Initial Training in Administration) and the continuing training requirements specified in §15.306 of this division (relating to Continuing Training in Administration).

(d) A person is not eligible to be the administrator or alternate administrator of a center if the person was the administrator of a center cited with a violation that resulted in DADS taking enforcement action against the center while the person was the administrator of the cited center.

(1) This subsection applies for 12 months after the date of the enforcement action.

(2) For purposes of this subsection, enforcement action means license suspension, licensure revocation, emergency suspension of a license, denial of an application for a license, or the issuance of an injunction. Enforcement action does not include administrative or civil penalties.

(e) An administrator or alternate administrator must not be convicted of an offense described in §99.2 of this title (relating to Convictions Barring Licensure) during the time frames described in that chapter.

(f) The designated administrator and alternate administrator of a center must be full-time employees of the center.

(g) The designated administrator or alternate administrator may serve as the nursing director or alternate nursing director if the administrator or alternate administrator meets the nursing director qualifications as described in §15.309 of this division (relating to Nursing Director and Alternate Nursing Director Qualifications and Conditions).

(h) The designated administrator or alternate administrator may be included in the center's staffing ratio if:

(1) the administrator or alternate administrator is a licensed nurse or meets the qualifications in §15.409 of this subchapter (relating to Direct Care Staff Qualifications); and

(2) the center's actual census is less than four minors.

(i) The designated administrator or alternate administrator must not be included in the center's staffing ratios when functioning as the nursing director or alternate nursing director.

(j) The designated administrator must manage only one center.

 

§15.304 Administrator Responsibilities

 

(a) An administrator of a center must be responsible for implementing and supervising the administrative policies and operations of the center and for administratively supervising the provision of all services to minors on a day-to-day basis.

(b) A center's administrator must:

(1) ensure that the center complies with applicable federal, state, and local laws, rules, and regulations;

(2) manage the daily operations of the center;

(3) organize and direct the center's ongoing functions;

(4) ensure the availability of qualified staff and ancillary services to ensure the health, safety, and proper care of each minor;

(5) ensure criminal history checks, employee misconduct, and nurse aide registry checks are conducted for required staff before employment;

(6) ensure the implementation of the center's training program policies and procedures;

(7) familiarize staff with regulatory issues, as well as the center's policies and procedures;

(8) ensure that the documentation of services provided is accurate and timely;

(9) manage census records, including daily, actual, and total, in accordance with §15.803 of this chapter (relating to Census);

(10) ensure that the center immediately notifies a minor's parent of any and all accidents or unusual incidents involving their minor or that had the potential to cause injury or harm to a minor;

(11) ensure that the center provides written notice to the parent of accidents or unusual incidents involving their minor on the day of occurrence;

(12) maintain a record of accidents or unusual incidents involving a minor or staff member that caused, or had the potential to cause, injury or harm to a person or property at the center;

(13) maintain a copy of current contractor agreements with third party providers contracted by the center;

(14) maintain a copy of current written agreements with each contractor;

(15) ensure adequate staff education and evaluations according to requirements in §15.415 of this subchapter (relating to Staffing Policies for Orientation, Development, and Training);

(16) maintain documented development programs for all staff;

(17) ensure the accuracy of public information materials and activities made available and presented on behalf of the center;

(18) ensure implementation of an effective budgeting and accounting system consistent with good business practice that promotes the health and safety of the center's minors; and

(19) supervise the annual distribution and evaluation of the responses to the parent-satisfaction surveys on all minors served.

 

 

§15.305 Initial Training in Administration

 

(a) This section applies to an administrator and alternate administrator designated as an administrator or alternate administrator of a center.

(b) Before designation, an administrator or alternate administrator must complete the DADS pre-licensing program training titled Overview of Prescribed Pediatric Extended Care Center Licensing Standards in Texas.

(c) An administrator and alternate administrator of a center must complete a total of 12 clock hours of training in the administration of a center before the end of the first 12 months after designation to the position.

(d) The initial 12 clock hours of training must address:

(1) information on state and federal laws applicable to a center, including:

(A) the Americans with Disabilities Act;

(B) the Civil Rights Act of 1991;

(C) the Rehabilitation Act of 1973;

(D) the Family and Medical Leave Act of 1993;

(E) Public Law 111-148 Patient Protection and Affordable Care Act; and

(F) Occupational Safety and Health Administration requirements.

(2) information regarding the prevention, detection and reporting of fraud, waste, and abuse;

(3) legal issues regarding advance directives;

(4) infection control;

(5) communicable disease reporting;

(6) nutrition;

(7) principles of person-centered direction and guidance; and

(8) provision of services to a minor.

(e) The 12-clock-hour training requirement described in subsection (d) of this section must be met through structured, formalized classes, correspondence courses, competency-based computer courses, training videos, distance learning programs, or off-site training courses. Subject matter that deals with the internal affairs of a center does not qualify for clock hours.

(1) The training must be provided or produced by:

(A) an academic institution;

(B) a recognized state or national organization or association;

(C) a consultant;

(D) an accredited pediatric hospital; or

(E) DADS or other state agency.

(2) If a consultant provides or produces the training, the training must be approved by a recognized state or national organization or association. The center must maintain documentation of this approval or recognition for review by DADS inspectors.

(3) An administrator and alternate administrator may apply joint training provided by DADS toward the 12 clock hours of training required by this section if the joint training meets the training requirements described in subsection (d) of this section.

(f) Documentation of administrator and alternate administrator training must:

(1) be on file at the center; and

(2) contain:

(A) the name of the class or workshop;

(B) course content, including the curriculum;

(C) hours and dates of the training; and

(D) name and contact information of the entity and trainer who provided the training.

 

(g) An administrator and alternate administrator must not apply the pre-licensing program training as part of the 12 clock hours of training required in this section.

(h) After completing 12 clock hours of initial training during the first 12 months after designation as an administrator and alternate administrator, an administrator and alternate administrator must complete the continuing training requirements as specified in §15.306 of this division (relating to Continuing Training in Administration) in each subsequent 12-month period after designation.

 

§15.306 Continuing Training in Administration

 

(a) An administrator and alternate administrator must complete 12 clock hours of continuing training within each subsequent 12-month period beginning with the date of designation. The 12 clock hours of continuing training must include at least two of the following topics and may include other topics relating to the duties of an administrator:

(1) any one of the training topics listed in §15.305(d) of this division (relating to Initial Training in Administration);

(2) development and interpretation of the center policies;

(3) basic principles of management in a licensed health care setting;

(4) ethics;

(5) quality improvement;

(6) risk assessment and management;

(7) financial management;

(8) skills for working with minors, a minor's parent, and other professional service providers;

(9) community resources;

(10) communicable disease reporting; or

(11) marketing.

(b) In addition to the 12 clock hours of training required in this section, an administrator or alternate administrator must complete the Overview of Prescribed Pediatric Extended Care Center Licensing Standards in Texas provided by DADS every three years from the date of designation to the position.

(c) The center must keep documentation of administrator and alternate administrator continuing training on file at the center and maintain:

(1) the name of the class or workshop;

(2) course content, including the curriculum;

(3) hours and dates of the training; and

(4) name and contact information of the entity and trainer who provided the training.

(d) An administrator or alternate administrator must not apply the pre-licensing program training toward the continuing training requirements in this section.

 

§15.307 Medical Director Qualifications and Conditions

 

(a) A center must designate a medical director who:

(1) has a valid, unrestricted license to practice medicine or osteopathy in Texas in accordance with Texas Occupations Code Chapter 155; and

(2) is board-certified in a pediatric specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association.

(b) The medical director must be available in person or by phone for consultation or collaboration with prescribing physicians and the center's staff during the center's operating hours.

(c) The medical director must not be included in the center's staffing ratios.

 

§15.308 Medical Director Responsibilities

 

The medical director must:

(1) review the services provided at the center to ensure a high quality of services;

(2) maintain a liaison role with the medical community in the location of the center's place of business;

(3) participate in the development and implementation of appropriate performance improvement and safety initiatives as directed by the Quality Assessment and Performance Improvement (QAPI) program;

(4) participate in the development of new programs and modifications of existing programs at the center;

(5) designate a physician as defined in §15.5 of this chapter (relating to Definitions) to provide medical consultation in the event the medical director is unavailable to the center's staff;

(6) serve on committees as defined and required by this chapter and the center's polices;

(7) consult with the center's administrator and nursing director on the health status of the center's staff as it relates to the center's IPCP and on a minor's health and safety or as threats to infection control arise;

(8) review reports of accidents and unusual incidents occurring at the center and identify to the center's administrator hazards to health and safety as directed by the QAPI program;

(9) participate in the development and implementation of policies and procedures for the delivery of emergency services for minors;

(10) participate in the development and implementation of policies and procedures for the use of restraints; and

(11) participate in the development and implementation of policies and procedures for the delivery of physician's services when a minor's prescribing physician or designated alternate is not available.

 

§15.309 Nursing Director and Alternate Nursing Director Qualifications and Conditions

 

(a) A center must designate a nursing director and alternate nursing director who meet the qualifications and conditions set out in this section and who have completed the DADS pre-licensing program training titled "Overview of Prescribed Pediatric Extended Care Center Licensing Standards in Texas."

(b) The nursing director and alternate nursing director must have the following qualifications:

(1) a baccalaureate degree in nursing;

(2) a valid RN license under Texas Occupations Code, Chapter 301, with no disciplinary action;

(3) a valid certification in Cardio Pulmonary Resuscitation or Basic Cardiac Life Support; and

(4) a minimum of two years of supervision and management in employment in a pediatric setting caring for a medically or technologically dependent minor or at least two years of supervision in one of the following specialty settings:

(A) pediatric intensive care;

(B) neonatal intensive care;

(C) pediatric emergency care;

(D) center;

(E) home health or hospice agency specializing in pediatric care;

(F) ambulatory surgical center specializing in pediatric care; or

(G) have comparable pediatric unit experience in a hospital for two consecutive years before the person applies for the position of nursing director.

 

(c) The nursing director and alternate nursing director must meet the requirements of this subsection.

(1) The nursing director must be a full time employee of the center.

(2) The nursing director or alternate nursing director may serve as the administrator or alternate administrator of the center if the nursing director or alternate nursing director meets the administrator qualifications as described in §15.303 of this division (relating to Administrator and Alternate Administrator Qualifications and Conditions).

(3) A center must designate an alternate nursing director who meets the qualifications as specified in this section who will assume the responsibilities of the nursing director when the nursing director is unavailable during the center's operating hours.

(4) The nursing director must not be included in the center's staffing ratio when the center's actual census is four or more minors.

(5) The nursing director must not be included in the center's staffing ratio when the center's actual census is less than four minors and the nursing director is also functioning as the administrator.

(6) The designated alternate nursing director must not be included in the center's staffing ratio when functioning as the nursing director, administrator or alternate administrator.

 

 

§15.310 Nursing Director Responsibilities and Supervision Responsibilities

 

The center's nursing director's responsibilities must include, but are not limited to:

(1) supervising all aspects of a minor's plan of care to ensure the minor's plan of care is implemented as ordered;

(2) supervising all activities of the center's professional nursing staff and direct care staff to ensure compliance with current standards of accepted nursing practice;

(3) ensuring compliance with all federal and state laws, rules, and regulations in this chapter;

(4) supervising the daily clinical operations of the center;

(5) ensuring the documentation of the center's actual, daily, and total census in accordance with §15.803 of this subchapter (relating to Census) and §15.410 of this subchapter (relating to Nursing Services Staffing Ratio);

(6) ensuring the documentation of the center's staffing ratios in accordance with §15.410 of this subchapter;

(7) supervising the implementation of staffing policies to ensure that only qualified staff are hired by the center, including verification of licensure and certification before employment and annually thereafter;

(8) ensuring the maintenance of records to support competency of the center's nursing and direct care staff;

(9) ensuring the implementation of the center's policies and procedures that establish and support quality care to a minor;

(10) providing orientation and in-service training to employees and providers of basic services to promote effective basic services and safety to a minor;

(11) performing timely annual performance evaluations for the center's nursing and direct care staff;

(12) ensuring participation in regularly scheduled continuing training for the center's nursing and direct care staff; and

(13) ensuring that the care at the center promotes effective services and the safety of a minor.

 

§15.311 Prohibition of Solicitation

 

(a) A center must adopt and enforce a written policy to ensure compliance of the center and its employees, volunteers and contractors with Texas Occupations Code, Chapter 102.

(b) DADS may take enforcement action against a center in accordance with Subchapter G of this chapter (relating to Enforcement) if the center violates Texas Occupations Code, §102.001 or §102.006.

 

Division 3, Nursing and Staffing Requirements

 

§15.401 Nursing Staff

 

If nursing services are provided at a center, the center must ensure there are sufficient RNs and LVNs to ensure that the services provided to each minor are in accordance with the minor's plan of care.

 

 

§15.402 Registered Nurse Qualifications

 

(a) A RN providing services on behalf of a center must have at least the following qualifications and experience:

(1) a valid RN license under Texas Occupations Code, Chapter 301, with no disciplinary action;

(2) valid certifications in Cardio Pulmonary Resuscitation and Basic First Aid; and

(3) one of the following:

(A) one year of pediatric specialty experience with emphasis on medically and technologically dependent minors, obtained within the previous five years; or

(B) sufficient skills to meet the competency and training requirements described in subsection (b) of this section.

 

(b) A center must adopt and enforce a written policy regarding an RN who qualifies to provide services at the center under subsection (a)(3)(B) of this section. The policy must:

(1) require an RN qualified under subsection (a)(3)(B) of this section to complete a training program that is determined appropriate by the Director of Nursing and conducted by an RN on the RN responsibilities described in §15.403 of this division (relating to Registered Nurse Responsibilities) and that includes hands-on training;

(2) require, before performing the RN responsibilities described in §15.403 of this division, an RN qualified under subsection (a)(3)(B) of this section to demonstrate competency in performing the responsibilities described in §15.403 of this division, as determined by an RN;

(3) describe procedures for increased supervision of an RN qualified under subsection (a)(3)(B) of this section during the training program, competency evaluation, and for three months after completion of the competency evaluation to ensure the health and safety of minors; and

(4) prohibit an RN qualified under subsection (a)(3)(B) of this section from performing the responsibilities in §15.403 of this division or being included in the nursing services staffing ratio as an RN, as described in §15.410 of this division (relating to Nursing Services Staffing Ratio), until the RN completes the training program described in paragraph (1) of this subsection and demonstrates competency as described in paragraph (2) of this subsection.

(c) An RN qualified under subsection (a)(3)(B) of this section must meet the requirements in §15.415 of this division (relating to Staffing Policies for Staff Orientation, Development, and Training) and §15.416 of this division (relating to Staff Development Program).

 

§15.403 Registered Nurse Responsibilities

 

An RN providing services on behalf of a center must be responsible for the following:

(1) maintaining compliance with the standards of nursing practice and delegation;

(2) developing a minor's plan of care;

(3) providing nursing interventions that includes parental training, information, and education to increase a parent's confidence and competence in caring for a minor;

(4) coordinating services with other service providers;

(5) monitoring the ongoing physical and developmental growth of a minor;

(6) having knowledge of access to available community resources;

(7) participating on the IDT and in the IDT meetings regarding a minor's plan of care and progress;

(8) administering medication, intravenous infusions, parenteral feeding, and other specialized treatments; monitoring and documenting the effect of medications, therapies, and progress in accordance with accepted standards of professional practice;

(9) communicating findings to a minor's prescribing physician and the center's nursing director; and

(10) supervising the center's direct care staff.

 

§15.404 Licensed Vocational Nurse Qualifications

 

(a) An LVN providing services on behalf of a center must have at least the following qualifications and experience:

(1) a valid LVN licensed under Texas Occupations Code, Chapter 301, with no disciplinary action;

(2) valid certifications in Cardio Pulmonary Resuscitation and Basic First Aid; and

(3) one of the following:

(A) one year of pediatric specialty experience with emphasis on medically and technologically dependent minors obtained within the last consecutive five years; or

(B) sufficient skills to meet the competency and training requirements described in subsection (b) of this section;

 

(b) A center must adopt and enforce a written policy regarding an LVN who qualifies to provide services at the center under subsection (a)(3)(B) of this section. The policy must:

(1) require an LVN qualified under subsection (a)(3)(B) of this section to complete a training program that is determined appropriate by the Director of Nursing and conducted by an RN on the LVN responsibilities described in §15.405 of this division (relating to Licensed Vocational Nurse Responsibilities) and that includes hands-on training;

(2) require, before performing the LVN responsibilities described in §15.405 of this division, an LVN qualified under subsection (a)(3)(B) of this section to demonstrate competency in performing the responsibilities described in §15.405 of this division, as determined by an RN;

(3) describe procedures for increased supervision of an LVN qualified under subsection (a)(3)(B) of this section during the training program, competency evaluation, and for three months after completion of the competency evaluation to ensure the health and safety of minors; and

(4) prohibit an LVN qualified under subsection (a)(3)(B) of this section from performing the responsibilities in §15.405 of this division or being included in the nursing services staffing ratio as an LVN, as described in §15.410 of this division (relating to Nursing Services Staffing Ratio), until the LVN completes the training program described in paragraph (1) of this subsection and demonstrates competency as described in paragraph (2) of this subsection.

(c)

An LVN must meet the requirements in §15.415 of this division (relating to Staffing Policies for Staff Orientation, Development, and Training) and §15.416 of this division (relating to Staff Development Program).

 

§15.405 Licensed Vocational Nurse Responsibilities

 

(a) An LVN providing services on behalf of a center must work under the supervision of an RN and is responsible to provide, within the LVN's level of competence and scope of practice, nursing care to the center's minors as ordered in the plan of care.

(b) An LVN must be responsible for the following:

(1) maintaining compliance with the standards of nursing practice;

(2) providing nursing interventions that includes parental training, information, and education to increase a parent's confidence and competence in caring for a minor;

(3) having knowledge of the availability of community resources;

(4) participating on the IDT and in the IDT meetings regarding a minor's plan of care and progress;

(5) communicating findings to a minor's prescribing physician and an RN; and

(6) administering medication, intravenous infusions, parenteral feeding, and other specialized treatments; monitoring and documenting the effect of medications, therapies, and progress in accordance with accepted standards of professional practice.

 

 

§15.406 Student Nurses

 

(a) If a center has an agreement with an accredited school of nursing to use the center for a portion of a student nurse's clinical experience, the student nurse may provide care under the following conditions:

(1) the agreement ensures that criminal history checks are conducted for a student nurse in accordance with §15.418 of this division (relating to Criminal History Checks, Nurse Aide Registry (NAR), and Employee Misconduct Registry (EMR) Requirements) before a student nurse provides direct care;

(2) a student nurse is not counted in the staffing ratio required in this chapter; and

(3) one of the following:

(A) an instructor from the school is onsite, provides class supervision, and assumes responsibility for all student nursing activities at the center; or

(B) the center:

(i) assumes responsibility for supervision of all student nurses and for all student nursing activities at the center; and

(ii) meets the requirements described in subsection (b) of this section.

(b) The center must adopt and enforce written policy and procedures describing whether the center will assume responsibility for supervision of all student nurses and for all student nursing activities at the center. If a center assumes responsibility for student nurse activity, the center must:

(1) determine the appropriate level of student nurse interaction with a minor, based on the qualifications and experience of the student nurse;

(2) assign an RN to supervise a student nurse;

(3) limit RN supervision to no more than three student nurses at one time; and

(4) based on the outcomes of paragraph (1) of this subsection, determine if it is appropriate to exclude from the staffing ratio the RN assigned to supervise the student nurse activities to ensure the health and safety of minors.

 

§15.407 Nursing Education, Licensure, and Practice

 

A center must adopt and enforce a written policy to ensure compliance with the rules of the Texas Board of Nursing adopted at 22 TAC Chapters 211, 213-217, and 219-226.

 

§15.408 Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel and Tasks Not Requiring Delegation

 

A center must adopt and enforce a written policy to ensure compliance with rules adopted by the Texas Board of Nursing as specified in 22 TAC Chapter 224 (relating to Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel for Clients with Acute Conditions or in Acute Care Environments).

 

§15.409 Direct Care Staff Qualifications

 

(a) Direct care staff providing services on behalf of a center, must have the following qualifications:

(1) be 18 years of age or older;

(2) a high school diploma or a general equivalency degree;

(3) one of the following:

(A) one year of experience employed in a health care setting providing direct care to minors who are medically or technologically dependent;

(B) two years of experience employed in a health care, childcare, or school setting providing direct care to minors who are medically or technologically dependent;

(C) two years of experience employed in a health care setting providing direct care to adults; or

(D) sufficient skills to meet the competency and training requirements described in subsection (b) of this section; and

(4) maintain current certification in Pediatric Cardio Pulmonary Resuscitation and basic First Aid.

(b) The center must adopt and enforce written policy and procedures describing whether direct care staff who qualify to provide services under subsection (a)(3)(D) of this section. The policy must:

(1) require direct care staff who qualify under subsection (a)(3)(D) of this section to complete a training program regarding the provision of direct care to minors that:

(A) is determined appropriate by the nursing director;

(B) is conducted by an RN or LVN; and

(C) includes hands-on training;

(2) require, before providing services to a minor, direct care staff who qualify under subsection (a)(3)(D) of this section to demonstrate competency in the provision of direct care to minors as determined by an RN;

(3) describe procedures for increased supervision of direct care staff who qualify under subsection (a)(3)(D) of this section during the training program and the competency evaluation, and for six months after completion of the competency evaluation, to ensure the health and safety of minors; and

(4) prohibit direct care staff who qualify under subsection (a)(3)(D) of this section from being assigned to a minor or being included in the nursing services staffing ratio as described in §15.410 of this division (relating to Nursing Services Staffing Ratio) until the direct care staff completes the training program described in paragraph (1) of this subsection and demonstrates competency as described in paragraph (2) of this subsection.

(c) Direct care staff must meet the requirements in §15.415 of this division (relating to Staffing Policies for Staff Orientation, Development, and Training) and §15.416 of this division (relating to Staff Development Program).

 

§15.410 Nursing Services Staffing Ratio

 

(a) A center's total staffing for nursing services must be maintained, at a minimum, in the following ratios but at no time must there be less than one staff member on duty per three minors receiving nursing services from a center. If only one staff member is on duty, that member must be an RN.

(b) The staffing ratio is based on the number of minors on the center's actual census that are receiving nursing services from the center.

(c) A center must not include direct care staff who qualify under subsection (b) of §15.409 of this division (relating to Direct Care Staff Qualifications) in the staffing ratio until the staff complete the training program and demonstrate competency as described in subsection (b)(3) of §15.409 of this division.

(d) A center must maintain documentation to support compliance with this section and §15.803 of this chapter (relating to Census). Documentation must include:

(1) each change in the number of minors on the center's actual census that are receiving nursing services from the center; and

(2) the increase or decrease in the number of RNs, LVNs, and direct care staff in accordance with this section as changes in the number of minors on the center's actual census that are receiving nursing services from the center occurs.
 

Minors Total Staff RN RN or LVN RN, LVN or Direct Care staff
1 1 1    
2-6 2 1   1
7-9 3 1 1 1
10-12 4 1 1 2
13-15 5 2 1 2
16-18 6 2 1 3
19-21 7 2 2 3
22-24 8 2 2 4
25-27 9 3 2 4
28-30 10 3 2 5
31-33 11 3 3 5
34-36 12 3 3 6
37-39 13 4 3 6
40-42 14 4 3 7
43-45 15 4 4 7
46-48 16 4 4 8
49-51 17 5 4 8
52-54 18 5 4 9
55-57 19 5 5 9
58-60 20 5 5 10

 

 

 

§15.411 Rehabilitative and Ancillary Professional Staff and Qualifications

 

(a) If the following staff will be providing services on behalf of a center or supervising services at a center, the staff must have one year of experience of pediatric care in a health care setting. The staff may be:

(1) an audiologist with a valid license under Texas Occupations Code, Chapter 401;

(2) an occupational therapist with a valid license under Texas Occupations Code, Chapter 454;

(3) an occupational therapist assistant with a valid license under Texas Occupations Code, Chapter 454;

(4) a physical therapist with a valid license under Texas Occupations Code, Chapter 453;

(5) a physical therapist assistant with a valid license under Texas Occupations Code, Chapter 453;

(6) a respiratory therapist with a valid license under Texas Occupations Code, Chapter 604;

(7) a speech-language pathologist with a valid license under Texas Occupations Code, Chapter 401;

(8) a licensed assistant in speech-language pathology with a valid license under Texas Occupations Code, Chapter 401; or

(9) a social worker with a valid license under Texas Occupation Code, Chapter 505.

(b) A center must employ or contract with a qualified dietitian who has a valid license under the laws of the State of Texas to use the title of licensed dietitian or provisional licensed dietitian, or who is a registered dietitian with one year of supervisory experience in dietetic service.

(c) If a center has a qualified pharmacist on a full-time, part-time, or consultant basis, the pharmacist must have a valid license under Texas Occupations Code, Chapter 558.

(d) A rehabilitative professional providing services on behalf of a center or supervising services at a center must be supervised by a center's qualified licensed person who practices under the center's policies and procedures.

(e) A center must not include rehabilitative professionals in the staffing ratios.

 

§15.412 Peer Review

 

A center must adopt and enforce written policies and procedures to ensure that all professional disciplines providing services on behalf of the center comply with their respective professional practice acts or title acts relating to reporting and peer review.

 

§15.413 Contractors

 

(a) If a center uses contractors, the center must enter into a contract with each contractor. The contract must be enforced by the center and clearly designate:

(1) that minors are accepted for care only by the center;

(2) the services to be provided by the contractor and how they will be provided, including per visit or per hour;

(3) the necessity of the contractor to conform to all applicable center policies, including staff qualifications;

(4) the contractor's responsibility for participating in developing the plan of care;

(5) the manner in which services will be coordinated and evaluated by the center in accordance with §15.802 of this subchapter (relating to Coordination of Services); and

(6) the procedures for:

(A) submitting information and documentation by the contractor in accordance with the center's record policies;

(B) scheduling of visits by the contractor or the center; and

(C) periodic evaluation of the minor by the contractor.

(b) A center must establish and maintain a contract management record system to ensure that services provided to each minor by a contractor at the center are completely and accurately documented, readily accessible and systematically organized to facilitate the compilation, retrieval and review of the information.

(c) The center is not required to maintain a personnel record for contractors. Upon request by DADS, a center must provide documentation at the site of a survey no later than eight working hours of the request to demonstrate:

(1) that contractors meet the center's written job qualifications for the position and duties performed; and

(2) the center is in compliance with §15.418 of this division (relating to Criminal History Checks, Nurse Aide Registry (NAR) and Employee Misconduct Registry (EMR) Requirements).

 

§15.414 Volunteers

 

(a) If a center uses volunteers, the center must use volunteers in defined roles under the supervision of a designated center staff.

(b) A volunteer must meet the same qualifications, requirements and standards in this chapter that apply to center staff performing the same activities on behalf of the center.

(c) A center must not include the volunteer in the center's staffing ratios.

 

§15.415 Staffing Policies for Staff Orientation, Development, and Training

 

(a) A center must adopt and enforce a written staffing policies and procedures that govern all staff providing services on behalf of the center, including employees, volunteers, and contractors.

(b) A center's written staffing policies must include:

(1) requirements for orientation to the policies, procedures, and objectives of the center;

(2) requirements and procedures for processing criminal history checks;

(3) requirements that staff are current on immunizations;

(4) requirements that an applicant for employment provide written documentation to rule out communicable diseases, including but not limited to tuberculosis;

(5) requirements for direct care staff to demonstrate the necessary skills and competency to meet the direct care needs of a minor to which he or she is assigned and as described in their job description;

(6) requirements for staff to participate in appropriate employee development programs quarterly;

(7) requirements for participation by all staff in job-specific training;

(8) staff training policies that ensure:

(A) staff are properly oriented to tasks performed;

(B) demonstration of competency for tasks when competency cannot be determined through education, license, certification, or experience;

(C) quarterly continuing systemic training for all staff who provide services, including training on infection prevention and control;

(D) staff are informed of changes in techniques, philosophies, organization, minor's rights, ethics and confidentiality, medical record requirements, information relating to minor's development, goals, and products relating to a minor's care;

(E) staff are properly oriented and trained in the proper use of person-centered direction and guidance as outlined in center policy and in accordance with §15.206 of this subchapter (relating to Person-Centered Direction and Guidance);

(F) staff are properly oriented and trained in the proper use and application of protective devices; and

(G) staff are properly oriented and trained in the proper use and application of restraints in accordance with the following requirements:

(i) all center staff whose job responsibilities include the use of restraint during a behavioral emergency must be trained before assuming direct care responsibilities for a minor;

(ii) all center staff must receive training and demonstrate competency in the following areas:

(I) using any restraint techniques or procedures that are expected or anticipated to be employed;

(II) identifying the underlying causes or functions of threatening behaviors;

(III) understanding how the behavior of staff members affects the behavior of minors;

(IV) using de-escalation, mediation, self-protection, and other techniques, such as quiet time, to prevent or reduce the use of restraint;

(V) applying principles of trauma informed care; and

(VI) recognizing and responding to signs of distress in a minor who is being restrained; and

(iii) all center staff must complete training and demonstrate competence in the use of restraint in a behavioral emergency at least every 12 months following initial training; and

(H) job-specific training is documented with the following information:

(i) the name and qualifications of the trainer;

(ii) the training topics and length; and

(iii) a list of staff who completed the training and demonstrated competence;

(9) a requirement to have a written job description that is a statement of the functions and responsibilities, and job qualifications, including the specific education and training requirements for each position at the center;

(10) procedures for searching the nurse aide registry and the employee misconduct registry for staff in accordance with §15.418 of this division (relating to Criminal History Checks, Nurse Aid Registry (NAR) and Employee Misconduct Registry (EMR) Requirements);

(11) a requirement to have annual evaluation of employee and volunteer performance;

(12) a description of employee and volunteer disciplinary action and procedures;

(13) a policy regarding the use of volunteers that is in compliance with §15.414 of this division (relating to Volunteers); and

(14) a requirement that all staff providing services on behalf of a center sign a statement that the staff have read, understand, and will comply with all applicable center policies.

(c) A center must adopt and enforce written policies and procedures for parent orientation and training programs in accordance with §15.509 of this subchapter (relating to Parent Training). The policy must:

(1) require orientation be provided to each parent of each minor admitted to the center; and

(2) ensure that orientation includes:

(A) the philosophy of the center;

(B) the basic services as defined in this chapter;

(C) on-going parent training needs as determined by the individual needs of the minor;

(D) a minor's parent agreement and disclosure form;

(E) the center attendance policy for minors; and

(F) information about a minor's rights while receiving services at the center.

 

§15.416 Staff Development Program

 

(a) A center's staff development programs must:

(1) facilitate the ability of the staff to function as a member of an IDT that includes health professionals, an adult minor, and a minor's parent;

(2) improve communication skills to:

(A) facilitate a collaborative relationship between an adult minor, a minor's parent, and the staff;

(B) focus on person-centered thinking;

(C) facilitate positive behavior support; and

(D) incorporate person-first language;

(3) increase the understanding of childhood illness and the effects it has on a minor's development, a minor's parent, and a minor's family;

(4) provide mechanisms and skills for coping with the effects of childhood illness;

(5) develop case management skills to assist an adult minor and a minor's parent in setting priorities, planning, and implementing a minor's care at home;

(6) facilitate staff implementation of life-sustaining and assistive technology, provided by the center or by durable medical equipment contractors, used in the care of a minor;

(7) facilitate the ability of staff to develop an individualized comprehensive plan of care; and

(8) prepare staff for the response to and management of emergency medical situations in a center.

(b) A center must:

(1) conduct quarterly staff development programs appropriate to the staff providing services to minors to maintain high quality care; and

(2) ensure that all center staff providing basic services to minors maintain basic life support certification.

(c) A center must document all staff development programs to include:

(1) the title and a short summary of the training program;

(2) date and time;

(3) name of the trainer; and

(4) certificate of completion.

(d) A center must maintain the quarterly staff development training program documentation for a period of two years. If the staff development training is specific to services provided to a specific minor, reference to the training must be maintained as part of a minor's medical record.

 

§15.417 Personnel Records

 

(a) A center must maintain a personnel record for an employee and volunteer. A personnel record may be maintained electronically if it meets the same requirements as a paper record. All information must be kept current. A personnel record must include the following:

(1) a signed job description and qualifications for each position accepted or a signed statement that the person read the job description and qualifications for each position accepted;

(2) an application for employment or volunteer agreement;

(3) a record of the immunizations requirements and evaluation of the tuberculosis results;

(4) verification of references, job experience, and educational requirements as conducted by the center to verify qualifications for each position accepted;

(5) verification of licenses, permits, and certifications before employment and annually;

(6) annual performance evaluations and disciplinary actions;

(7) the signed statement about compliance with center policies required by §15.415 of this division (relating to Staffing Policies for Staff Orientation, Development, and Training); and

(8) for an employee and volunteer:

(A) a printed copy of the results of the initial and annual searches of the nurse aide registry and employee misconduct registry obtained from the DADS Internet website; and

(B) documentation that the employee, volunteer, or contractor in accordance with §15.418 of this division (relating to Criminal History Checks, Nurse Aide Registry (NAR) and Employee Misconduct Registry (EMR) Requirements) received written information about the EMR.

(b) A center must keep a complete and accurate personnel record for an employee and volunteer at its licensed location.

 

§15.418 Criminal History Checks, Nurse Aide Registry (NAR), and Employee Misconduct Registry (EMR) Requirements

 

(a) The following words and terms, when used in this section, have the following meanings, unless the context clearly indicates otherwise.

(1) Applicant means any individual applying for a position in a center.

(2) Employee means an individual directly employed by a center, a volunteer, or a contractor.

(b) The provisions in this subsection apply to an applicant and an employee.

(1) A center must conduct a criminal history check authorized by, and in compliance with, THSC Chapter 250 for an applicant for employment and an employee.

(2) A center must not employ an applicant whose criminal history check includes a conviction listed in THSC §250.006 that bars employment or a conviction the center has determined is a contraindication to employment. If an applicant's or employee's criminal history check includes a conviction of an offense that is not listed in THSC §250.006, the center must document its review of the conviction and its determination of whether the conviction is a contraindication to employment.

(3) The center must immediately discharge an employee when the center becomes aware that the employee's criminal history check reveals conviction of a crime that bars employment or that the center has determined is a contraindication to employment.

(c) The provisions in this subsection apply to an applicant and an employee.

(1) Before a center hires an applicant, the center must search the Nurse Aid Registry (NAR) and the Employee Misconduct Registry (EMR) using the DADS website to determine if an applicant or employee is listed in either registry as unemployable. The center must not employ an applicant who is listed as unemployable in either registry.

(2) The center must provide information about the EMR to an employee no later than five business days after hiring an employee. The information must:

(A) be in writing;

(B) state that a person listed in the EMR is not employable by the center; and

(C) include a reference to Chapter 93 of this title (relating to Employee Misconduct Registry (EMR)) and THSC Chapter 253.

(3) In addition to the initial verification of employability, the center must search the NAR and the EMR to determine if the employee is listed as unemployable in either registry at least every 12 months.

(4) The center must immediately discharge an employee when the center becomes aware:

(A) that the employee is designated in the NAR or the EMR as unemployable; or

(B) that the employee's criminal history check reveals conviction of a crime that bars employment or that the center has determined is a contraindication to employment.

(d) Upon request by DADS, a center must provide documentation to demonstrate compliance with subsections (b) and (c) of this section.

 

§15.419 Drug Testing Policy

 

(a) A center must adopt and enforce a written policy describing whether it will conduct drug testing of its staff, volunteers, and contractors.

(b) If a center conducts drug testing, the written policy must describe the method by which drug testing is conducted.

(c) If a center does not practice drug testing, the written policy must state that the center does not conduct drug testing.

(d) A center must provide a copy of the policy to anyone applying for services from the center and any person who requests a copy of the policy.

 

Division 4, General Services

 

§15.501 Basic Services

 

(a) A center must ensure the provision of all basic services based on the needs of a minor and a minor's family in accordance with the plan of care.

(b) A minor's parent is not required to accompany the minor when the minor receives services in the center, including therapeutic services provided in the center but billed separately.

 

§15.502 Medical Services

 

(a) A center must ensure the provision of medical services based on the needs of a minor, in accordance with a minor's plan of care and as ordered by a minor's prescribing physician.

(b) A center must ensure that a minor's prescribing physician maintains responsibility for the overall medical therapeutic plan of a minor and consults and collaborates with the staff providing services in a center.

(c) A center's nursing director or designee must communicate with each minor's prescribing physician at least every 90 days or more frequently when there is a health status or physical status change in a minor's condition.

(d) A center must adopt and enforce a written policy requiring that therapists who provide services to a minor at the center consult with a minor's prescribing physician directly or coordinate with the clinical staff at least every 180 days or more frequently when there is a health status or physical status change in a minor's condition.

 

§15.503 Nursing Services

 

(a) A center must ensure nursing services are provided based on the needs of a minor, in accordance with a minor's plan of care and as ordered by a minor's prescribing physician.

(b) A center's nursing director or designee must participate in pre-admission planning along with other appropriate nursing staff.

(c) The center's nursing director is responsible for:

(1) ensuring the implementation of the nursing care plan;

(2) monitoring and documenting the care and treatment according to a minor's plan of care;

(3) ensuring that nurses providing services at the center participate in interdisciplinary team meetings regarding a minor's progress towards goals;

(4) ensuring the maintenance of a minor's medical record in accordance with the center's policies and procedures; and

(5) ensuring a minor's parent is instructed on how to provide the necessary care and treatment in the home.

 

§15.504 Psychosocial Treatment and Services

 

(a) A center must ensure the provision of psychosocial treatment based on the needs of a minor, in accordance with a minor's plan of care and as ordered by a minor's physician.

(b) If psychosocial treatment and services are provided at the center, the center must ensure that the provision of psychosocial treatment and services complies with the requirements of this section, §15.206 of this subchapter (relating to Person-Centered Direction and Guidance) and §15.207 of this subchapter (relating to Restraints) as applicable to a minor's plan of care and physician's order.

(c) The center must ensure psychosocial treatments and services provided at a center are overseen by a physician, RN or psychologist.

(d) If psychosocial treatments and services are provided in a center, the center must adopt and enforce written policies and procedures relating to the provision of psychosocial treatments to a minor, including:

(1) ensuring the development of interventions to foster normal development;

(2) ensuring the development of interventions to foster psychosocial adaptations;

(3) using person-centered direction and guidance in accordance with §15.206 of this chapter; and

(4) using restraints in accordance with §15.207 of this subchapter.

(e) If psychosocial treatments are provided in a center, the center must ensure the initial health assessment of a minor receiving psychosocial treatments includes:

(1) mental status including psychological and behavioral status;

(2) sensory and motor function;

(3) cranial nerve function;

(4) language function; and

(5) any other criteria established by a center's policy.

(f) The center must ensure that an individual providing psychosocial treatment and services in a center:

(1) actively participates in the coordination of a minor's care, in accordance with accepted standards of practice;

(2) participates in ongoing interdisciplinary comprehensive assessments and developing and evaluating the plan of care;

(3) participate as a committee member in the continuous review of the center's person-centered direction and guidance program in accordance with §15.206 of this subchapter;

(4) provides assistance to a minor's family with the effects of chronic illness and supporting effective relationships within a family; and

(5) develops interventions to foster normal development and psychosocial adaptation.

 

§15.505 Social Services

 

(a) A center must ensure the provision of social services based on the needs of a minor, in accordance with a minor's plan of care and as ordered by a minor's prescribing physician.

(b) If social services are provided in a center, the services must be overseen by a social worker or RN.

(c) The center must ensure that an individual providing social services in a center:

(1) actively participates in the coordination of a minor's care, in accordance with accepted standards of practice; and

(2) participates in ongoing interdisciplinary comprehensive assessments, developing and evaluating the plan of care.

(d) The center must ensure that a minor's parent receives assistance in finding referrals to appropriate local community resources and is provided assistance to enhance coping skills in the parent's care of a minor.

 

§15.506 Rehabilitative Services

 

(a) A center must ensure the provision of rehabilitative services based on the needs of a minor, in accordance with a plan of care and as ordered by a minor's prescribing physician.

(b) The center must ensure rehabilitative services provided at a center are overseen by a licensed or certified qualified professional staff as specified in §15.411 of this subchapter (relating to Rehabilitative and Ancillary Professional Staff and Qualifications).

(c) The center must ensure that an individual providing rehabilitative services in a center:

(1) actively participates in the coordination of a minor's care, in accordance with accepted standards of practice; and

(2) participates in ongoing interdisciplinary comprehensive assessments, developing and evaluating the plan of care.

 

§15.507 Functional Developmental Services

 

(a) A center must ensure the provision of functional developmental services based on the needs of a minor, in accordance with the minor's plan of care and as ordered by a minor's prescribing physician.

(b) A center must refer a minor to Early Childhood Intervention, within seven days after identification of a developmental delay or risk of developmental delay in accordance with Code of Federal Regulations, Title 34, §303.303 (relating to Referral Procedures).

(c) A center must ensure that each minor has a functional assessment incorporated into the comprehensive assessment to include developmentally appropriate areas.

(d) A minor's functional assessment must include:

(1) measurable goals that enhance independent functioning in daily activities and to promote socialization;

(2) a description of a minor's strengths and present performance level with respect to each goal;

(3) skills areas in priority order; and

(4) planning for specific areas identified as needing development.

 

§15.508 Educational Developmental Services

 

(a) The center must adopt and enforce written policies and procedures to facilitate each minor's access to available early intervention and educational services and programs delivered by an education provider, including a local education agency, as defined in United States Code, Title 20, §1401(15), (LEA), early childhood intervention agency, or private school, in the least restrictive environment in the community where a minor resides and where the center is located. The center's educational policy must:

(1) be person-centered and parent driven;

(2) be collaborative with the education provider;

(3) ensure that the center does not act as the primary education provider for a minor or accept a delegation of responsibility for the provision of a minor’s education from an education provider; and

(4) support a minor's education program as agreed to by a parent and education provider.

(b) The center must not coerce or provide an incentive to an individual or education provider that would result in a minor's removal from a less restrictive educational environment.

(c) The center must not be the primary location for the education provider to deliver services to a minor unless it is determined by the education provider, including the LEA's Admission, Review, and Dismissal (ARD) committee or committee required by Section 504 of the Rehabilitation Act of 1973, in collaboration with a minor's parent and a minor's prescribing physician that the center is the least restrictive environment for a minor to receive educational services.

(d) For a minor who is not receiving services from an education provider, the center must provide a minor and a minor's parent contact information for the LEA where a minor resides.

(e) For a minor receiving services from an education provider, the center must:

(1) not duplicate or provide services that conflict with a minor's education program;

(2) for a minor receiving services from an LEA, not interfere with the compulsory attendance requirements of Texas Education Code §25.085 and §25.086;

(3) when requested by a parent, make available a minor's records to support the minor's education program;

(4) request copies of a minor's education program records to support center care planning activities;

(5) if requested by a parent, participate in planning activities for a minor conducted by the education provider, including an LEA's ARD committee or committee required by Section 504 of the Rehabilitation Act of 1973;

(6) request that a minor's teacher, or other education provider representative, participate as part of the IDT to ensure coordination of a minor's services with the scheduled education component of activities; and

(7) support a minor's education program activities at the center, if needed, by:

(A) providing a well-lighted room, private space or other adequate workspace;

(B) providing functional assistance to a minor;

(C) coordinating with a minor and a minor's parent to ensure special and general supplies and equipment available for a minor if needed; and

(D) providing an area to post education program calendars and information bulletins provided to the center for minors and parents to view.

 

§15.509 Parent Training

 

(a) A center must develop parent training for each minor's parent and family as identified in a minor's plan of care.

(b) A center must identify the minimum frequency for parent training appropriate to a minor's plan of care to maintain high quality care at home and at the center.

(c) A center must ensure that parent training includes the importance of basic life support certification and first aid training.

(d) A center must document parent training in a minor's medical record, to include:

(1) the title and a short summary of the training;

(2) the date and time the training was conducted;

(3) the name and title of the staff who provided the training; and

(4) a copy of the training sign-in sheet or other attendance record.

(e) A center's parent training program must:

(1) facilitate the ability of a parent to be an active participant of an IDT in the development of an individualized comprehensive plan of care;

(2) facilitate the ability of a parent to be an active participant in the development of a minor's emergency medical plan;

(3) improve communication skills to facilitate a collaborative relationship between a minor's parent and providers of basic services;

(4) increase the understanding of childhood illness and the effects it has on a minor's development and a minor's family;

(5) provide mechanisms and skills for coping with the effects of childhood illness;

(6) provide information on the importance of meeting a child's needs through a well-balanced and nutritional diet;

(7) provide training regarding appropriate person-centered direction and guidance for effectively promoting successful behavioral and coping skills for a minor relating to a minor's medical conditions and treatment;

(8) develop skills to determine and set priorities, and plan and implement a minor's care at home; and

(9) provide training regarding the use, importance, and function of new technology used to provide care to a minor.

 

§15.510 Nutritional Counseling

 

(a) A center must ensure the provision of nutritional counseling as defined in §15.5 of this chapter (relating to Definitions) based on the minor's needs and in accordance with the minor's plan of care.

(b) Nutritional counseling must be overseen by a qualified individual including a dietitian, nutritionist, or RN.

 

§15.511 Dietary Services

 

(a) A center must adopt and enforce written policy and procedures to ensure that a minor, while at the center, receives:

(1) a nourishing, well-balanced diet as recommended by the American Academy of Pediatrics or Food and Nutrition Board of the National Research Council, National Academy of Sciences; or

(2) a diet ordered by a minor's prescribing physician.

(b) If a minor's meals and snacks are supplied by an adult minor or a minor's parent, the center's written policy and procedures must:

(1) include a written signed agreement between the center and the adult minor or minor's parent that includes:

(A) a statement that the adult minor or minor's parent is responsible for providing the appropriate meals and snacks for the minor in accordance with this section;

(B) the responsibilities of the center and the responsibilities of the adult minor or minor's parent concerning the provision of meals and snacks; and

(C) actions that may be taken by the center if the adult minor or minor's parent fails to provide meals and snacks for the minor as agreed;

(2) describe the actions that will occur if an adult minor or minor's parent fails to provide the minor's meals and snacks or fails to provide meals and snacks in accordance with the minor's prescribed diet, which must include that the center ensures that the minor receives the meals and snacks as required in this section while at the center; and

(3) ensure an adult minor or minor's parent receives nutritional counseling as described in §15.5101 of this division (relating to Nutritional Counseling).

(c) If the center provides meals and snacks directly or under contract, the center must employ or contract with a dietitian as described in §15.411(b) of this subchapter (relating to Rehabilitative and Ancillary Professional Staff and Qualifications).

(1) The dietitian is responsible for the overall operation of the dietary service.

(2) The dietitian must participate in regular conferences with the administrator and nursing director to provide information about approaches to identified nutritional problems.

(3) The dietitian must participate in the development of dietary support staff policies.

(4) The center must employ sufficient dietary support staff who meet the qualifications to carry out the functions of the dietary service.

(5) The dietitian must ensure that a minor has a diet:

(A) that meets the daily nutritional and special dietary needs of a minor, based upon the acuity and clinical needs of a minor; or

(B) as prescribed by a minor's prescribing physician.

(6) The dietitian is required to review a minor's plan of care for any known food allergy and special diet ordered by a minor's prescribing physician as often as necessary for changes to a minor's dietary needs.

(d) If a center provides meals and snacks directly or under contract:

(1) a dietitian must develop a menu that:

(A) is prepared at least one week in advance;

(B) is written for each type of diet; and

(C) varies from week to week, taking the general age-group of minors into consideration;

(2) the center must post the current week's menu in a conspicuous location so an adult minor and a minor's parent may see it; and

(3) the center must retain menus for 30 days.

(e) If a center provides meals and snacks directly, the center must retain records of menus served and food purchased for 30 days. The center must keep a list of minors receiving special diets and a record of the diets in the minors' medical records for at least 30 days.

(f) The center must:

(1) provide tables that allow minors to eat together when possible;

(2) provide assistance to minors, as needed;

(3) serve food on appropriate tableware; and

(4) ensure clean napkins, bibs, dishes, and utensils are available for each use.

(g) A center must coordinate with an adult minor or a minor's parent to ensure special eating equipment and utensils are available for a minor at the center if needed.

(h) An identification system, such as tray cards, must be available to ensure that all food is served in accordance with a minor's diet.

(i) A center must monitor and record food intake of all minors as follows.

(1) Deviations from normal food and fluid intake must be recorded in a minor's medical record.

(2) In-between meal snacks, and supplementary feedings, either as a part of the overall plan of care or as ordered by a minor's prescribing physician, including special diets, must be documented using professional practice standards.

(j) The center must serve a minor meals and snacks as specified in this section and as outlined in a minor's plan of care.

(1) If breakfast is served, a morning snack is not required.

(2) Notwithstanding the provisions of this section, a minor must not go more than three hours without a meal or snack being offered, unless a minor is sleeping.

(3) The center must offer at least one snack to a minor who is served at the center for less than four hours.

(4) The center must offer one meal, or one meal and one snack, equal to one third of a minor's daily food needs to a minor who is served at the center for four to seven hours.

(5) The center must offer two meals and one snack, or two snacks and one meal, equal to one half of a minor's daily food needs to a minor who is served at the center for more than seven hours.

(6) The center must ensure that a supply of drinking water is always available to each minor and is served at every snack, mealtime, and after active play.

(k) The center must:

(1) purchase food from sources approved or considered satisfactory by federal, state, and local authorities;

(2) store, prepare, and serve food under sanitary conditions, as required by the Department of State Health Services food service sanitation requirements; and

(3) dispose of garbage and refuse properly.

(l) The center must provide safe and proper storage and service of a minor's meals and snacks provided by an adult minor and minor's parent.

(m) Dietary service staff must be in good health and practice hygienic food-handling techniques. Staff with symptoms of communicable diseases or open, infected wounds may not work at the center until the center receives written documentation from a health care professional that the staff member is released to return to work or, the signs and symptoms which relate to the communicable disease are no longer evident.

(n) Dietary service staff must wear clean, washable garments, wear hair coverings or clean caps, and have clean hands and fingernails.

(o) Routine health examinations must meet all local, state, and federal codes for food service staff.

 

Division 5, Admission Criteria, Conference, Assessment, Interdisciplinary Plan of Care, and Discharge or Transfer

 

§15.601 Admission Criteria

 

(a) A center may admit a minor if:

(1) the minor's prescribing physician, in consultation with the minor's parent and the minor, recommends admission to a center, taking into consideration the medical, nursing, psychosocial, therapeutic, nutritional, dietary, functional, education and development needs of the minor in addition to the emotional, psychosocial, and environmental factors;

(2) the minor's prescribing physician issues a prescription ordering care at a center;

(3) the minor is stable for outpatient medical services and requires ongoing nursing care and other basic services;

(4) the adult minor or the minor's parent signs a written agreement and disclosure form consenting to the minor's admission to a center; and

(5) the admission is voluntary.

(b) The center must ensure that its admission criteria are in accordance with §15.211 of this subchapter (relating to Infection Prevention and Control Program and Vaccinations Requirements).

 

§15.602 Pre-admission Conference

 

(a) If a minor meets the criteria for admission into a center as described in §15.601 of this division (relating to Admission Criteria), the medical or nursing director must contact the minor's prescribing physician to schedule a pre-admission conference before the minor receives services at the center.

(b) If a minor is hospitalized at the time of referral to a center, the pre-admission conference must include the minor's parent, the minor, the minor's prescribing physician, center staff, relevant hospital staff, including medical, nursing, social services, and developmental staff, and any other individuals requested by the adult minor or the minor's parent, to begin developing the plan of care.

(c) If a minor is not hospitalized at the time of referral to a center, the pre-admission conference must include the minor's parent, the minor, the minor's prescribing physician, center staff, and any other individuals requested by the adult minor or the minor's parent to begin developing the plan of care.

(d) A center must schedule a pre-admission conference no later than three days after receipt of the referral. The pre-admission conference must address a minor's:

(1) medical history;

(2) diagnosis;

(3) mental and developmental status;

(4) nutritional status;

(5) dietary requirements;

(6) functional abilities and limitations;

(7) activities permitted and prohibited;

(8) use of assistive devices;

(9) treatment procedures;

(10) use of restraints, if applicable;

(11) medication;

(12) safety measures to protect against injury;

(13) education level and participation in an education program, if applicable;

(14) immunization record;

(15) receipt of services from other service providers; and

(16) other appropriate information.

 

§15.603 Agreement and Disclosure

 

(a) A center must review a written agreement and disclosure form with a minor's parent or with the adult minor before services are provided at the center.

(b) The agreement and disclosure form must include evidence or attestation that the parent has the legal authority to consent to a minor's medical care.

(c) The agreement and disclosure form must document that a center obtained a minor's parent's or an adult minor's written informed consent specifying the services that may be provided on behalf of a center to a minor.

(d) The agreement and disclosure form must document that the center provided the following information orally and in writing to the minor's parent or the minor, in a language or format he or she understands:

(1) the notice of rights and responsibilities described in §15.901 of this subchapter (relating to Rights and Responsibilities);

(2) information on the Advance Directives Act, THSC, Chapter 166;

(3) the extent to which payment for services provided on behalf of the center may be expected from any third-party payment source known to a center, the charges for services not covered by a third-party payment source and charges that a minor's parent or adult minor may have to pay;

(4) a list of the staff who will provide services on behalf of the center;

(5) a list of expected outcomes and any specific limitations or barriers to reaching the outcomes;

(6) the method of supervision and oversight by a center of the services to be provided at the center;

(7) DADS toll-free telephone number and its purpose;

(8) the process for directing a grievance to the administrator about services provided at the center and the time frame in which the center must review and resolve a grievance;

(9) an adult minor's and a parent's responsibilities;

(10) an emergency plan for a minor; and

(11) notice of the center's policies regarding:

(A) attendance requirements;

(B) implementing an advance directive in accordance with §15.902 of this subchapter (relating to Advance Directives);

(C) disclosure of the minor's medical record;

(D) person-centered direction and guidance;

(E) restraints;

(F) reporting abuse, neglect, or exploitation of a minor by an employee, volunteer, or contractor;

(G) drug testing of employees in direct contact with a minor in accordance with §15.419 of this subchapter (relating to Drug Testing Policy); and

(H) management and disposal of medications in the center.

(e) The agreement and disclosure form must be signed by a minor's parent or an adult minor.

(f) A center must provide a signed copy of the agreement and disclosure form to the minor's parent or the adult minor.

(g) The center must keep the signed written agreement and disclosure form in the minor's medical record.

(h) The center must update the agreement and disclosure form if information in the form changes.

(i) The center must comply with the terms of the agreement.

 

§15.604 Admission Procedures

 

(a) A center's administrator, nursing director, or designee must conduct an interview with a minor's parent or an adult minor before or at a minor's admission to the center that addresses the following:

(1) the adult minor's and parent's rights and responsibilities;

(2) the center's policies and procedures;

(3) basic services;

(4) the center's dietary services;

(5) the center's transportation services;

(6) the center's operating hours and contact information;

(7) the center's infection prevention and control program;

(8) the center's emergency preparedness plan;

(9) the center's attendance policy;

(10) services the minor is receiving at the center, but not provided by the center;

(11) development of the minor's plan of care;

(12) the minor's emergency plan and needs; and

(13) the minor's transfer and discharge planning.

(b) A center must request and keep a copy of a minor's medical history and documentation of a physical examination performed by a minor's prescribing physician within 30 days before or after the date of the minor's admission to the center.

(c) A center must have a signed order from the minor's prescribing physician on the day of the minor's admission, as described in §15.701 of this subchapter (relating to Physician Orders).

 

§15.605 Initial and Updated Comprehensive Assessment

 

(a) A center's RN must conduct and document a specific initial comprehensive assessment that identifies the minor's medical, nursing, psychosocial, therapeutic, nutritional, dietary, functional abilities, educational, and developmental needs and the adult minor's or minor's parent's training needs.

(b) The initial comprehensive assessment must include the minor's discharge planning, including transition support, self-advocacy guidance, and coordination of services required by the minor and the minor's parent.

(c) The initial comprehensive assessment must be conducted in consultation with a minor's parent and the minor, if the minor is an adult minor.

(d) An RN must complete an initial comprehensive assessment no earlier than three business days before the minor is admitted to the center.

(e) An RN must conduct, in consultation with a minor's parent or the adult minor, a comprehensive assessment of the minor at least once every 180 days after admitting the minor into the center. An RN must conduct a new comprehensive assessment on the minor when the minor has a change of condition or the minor's needs change.

(f) The updated comprehensive assessment described in subsection (e) of this section must:

(1) identify a minor's ongoing medical, nursing, psychosocial, therapeutic, nutritional, dietary, functional, educational, and developmental needs and the adult minor's and a minor's parent's training needs; and

(2) include a minor's discharge planning, detailing transition support, if needed, self-advocacy guidance, and coordination with the minor's parent or the adult minor.

 

§15.606 Interdisciplinary Team

 

(a) A center must designate an IDT.

(b) The IDT must monitor the services provided to the minor at the center.

(c) A center must designate an RN to be a member of the IDT to:

(1) provide coordination of care for the minor;

(2) ensure continuous assessment of the minor's and the minor's parent's needs; and

(3) implement the minor's interdisciplinary plan of care.

(d) The IDT must prepare a written plan of care for the minor as described in §15.607 of this division (relating to Initial and Updated Plan of Care).

(e) The IDT must include:

(1) the minor's prescribing physician;

(2) the center's nursing director or an RN designated by the nursing director;

(3) the minor;

(4) the minor's parent;

(5) a social worker, if the minor is receiving social services at the center; and

(6) another individual providing basic services to a minor if the minor is receiving basic services other than nursing services at the center.

(f) The IDT must participate in the development of a plan of care with goals and objectives for a minor that includes discharge planning when goals and objectives are met.

 

§15.607 Initial and Updated Plan of Care

 

(a) A center must develop an individualized written plan of care for a minor. The plan of care must include:

(1) the minor's and the minor's parent's goals and interventions based on the issues identified in the pre-admission conference and the initial and updated comprehensive assessments; and

(2) measurable goals with interventions based on the minor's care needs and means of achieving each goal and must address, as appropriate, rehabilitative and restorative measures, preventive intervention and training, and teaching of personal care by the minor's parent.

(b) An RN must address in the written interdisciplinary plan of care:

(1) the services needed to address the medical, nursing, psychosocial, therapeutic, dietary, functional, educational, and developmental needs of the minor and the training needs of the minor's parent;

(2) the minor's functional assessment;

(3) the specific goals of care;

(4) the time frame for achieving the goals and the schedule for evaluation of progress;

(5) the orders for treatment, services, medications, medical equipment, diet, and restraints, if applicable;

(6) specific criteria for transitioning from or discontinuing participation at the center; and

(7) the minor's scheduled days of attendance.

(c) In collaboration with the interdisciplinary team, an RN, a minor's parent, the minor, and an individual requested by the adult minor or the minor's parent must develop a plan of care based on the comprehensive assessment.

(d) The RN, a minor's parent and the minor, if the minor is an adult minor, must sign the plan of care within five days after initiation of the plan.

(e) A minor's prescribing physician must review and sign the plan of care within 30 days after initiation of the plan.

(f) The center must incorporate the plan of care into a minor's medical record no later than 10 days after receiving the signed plan from a minor's prescribing physician.

(g) Copies of the plan of care must be given, in a language and format the recipient understands, to a minor's parent, an adult minor, the minor's prescribing physician, the center's staff and other health care providers and providers of basic services as appropriate.

(h) The center's IDT and an RN must review and update a minor's plan of care at least every 180 days, or more often, if there is a change in a minor's medical condition or changes in a minor's needs.

(i) A minor's parent and the minor, if the minor is an adult minor, must review and sign the updated plan of care within five days before changes to the plan of care are implemented.

(j) A minor's prescribing physician must review and sign the updated plan of care within 30 days after initiation of the updated plan.

(k) The center must incorporate the updated plan of care into a minor's medical record no later than 10 days after receiving the signed plan from a minor's prescribing physician.

(l) The center must adopt and enforce written policies and procedures regarding the communication and coordination of a minor's care with a minor's prescribing physician in accordance with the plan of care.

(m) The policy described in subsection (l) of this section must ensure the communication between the center's staff and the minor's prescribing physician is conveyed to the minor's parent and the minor in a language and format that an adult minor and minor's parent understand.

(n) The center's nursing director or designee must:

(1) document communication with the minor's prescribing physician;

(2) maintain the documentation in the minor's medical record; and

(3) ensure that the communication is conveyed to the minor's parent and the adult minor in a language and format the adult minor and minor's parent understand.

(o) The center staff must ensure the provision of services and treatments in accordance with the plan of care and as ordered by the minor's prescribing physician.

 

§15.608 Discharge or Transfer Notification

 

(a) A center intending to transfer or discharge a minor must provide both oral and written notification to a minor's parent and adult minor no later than 15 days before the date the minor will be transferred or discharged, if the notification is provided in person.

(b) If the center does not provide the notice of transfer or discharge in person, the center must provide oral notification to a minor's parent and adult minor by telephone no later than 15 days before the date of transfer or discharge and mail the written notification no later than 15 days before the date of transfer or discharge.

(c) A center that intends to transfer or discharge a minor must also notify the minor's prescribing physician no later than 15 days before the date the minor will be transferred or discharged.

(d) A center may transfer or discharge a minor without providing the oral and written notification described in subsections (a) and (b) of this section:

(1) if the minor's parent or adult minor requests the transfer or discharge;

(2) if the minor's medical needs require transfer, including a medical emergency;

(3) if the minor's health and safety is at risk due to an emergency and a transfer is made in accordance with §15.209 of this subchapter (relating to Emergency Preparedness Planning and Implementation);

(4) for the protection of staff or a minor attending the center after the center makes a documented, reasonable effort to notify the minor's parent, the minor's prescribing physician, and appropriate state or local authorities of the center's concerns for the safety of staff or the minor, and in accordance with center policy;

(5) according to the minor's prescribing physician's orders; or

(6) if the minor's parent or an adult minor fails to pay for services, except as prohibited by state law.

(e) A center must keep in a minor's medical record:

(1) a copy of the written notification provided in accordance with subsection (a) or (b) of this section to the minor's parent or adult minor;

(2) documentation of the personal contact with the minor's parent or adult minor in accordance with subsection (b) of this section; and

(3) documentation that the minor's prescribing physician was notified of the date of transfer or discharge in accordance with subsection (c) of this section.

 

Division 6, Physician, Pharmacy, Medication, and Laboratory Services

 

§15.701 Physician Orders

 

(a) A center must ensure that a minor admitted to the center is admitted under an order of the minor's prescribing physician and remains under the care of the prescribing physician for the duration of the minor's stay at the center. The minor's medical record must contain the written prescribing physician order used for admission as well as all subsequent prescribing physician orders.

(b) The prescribing physician orders must include:

(1) approval of a minor's admission to a center;

(2) nursing services;

(3) medication administration, if applicable;

(4) dietary needs, if applicable;

(5) permitted activities, if applicable;

(6) therapies treatments, if applicable;

(7) transportation authorization, if applicable; and

(8) other services, if applicable.

 

§15.702 Receiving Physician Orders

 

(a) A center must adopt and enforce a written policy describing protocols and procedures the center must follow when receiving physician orders. A center's written policy must comply with this section. The center's written policy must ensure the center's compliance with THSC Chapter 248A, applicable rules in this chapter, and applicable state and federal regulations relating to receiving physician orders. If there is a conflict between this chapter and other applicable state and federal laws and regulations, a center must comply with the more stringent requirement.

(b) A center's written policy describing protocols and procedures for receiving physician orders must address:

(1) receipt of a physician order before providing basic services;

(2) the licensed staff authorized to accept physician verbal orders;

(3) the recording and signing of verbal physician orders by licensed staff;

(4) the time frame for a physician to sign and date verbal orders; and

(5) whether the center accepts an electronically signed physician order or a physician order submitted via a facsimile machine.

(c) A center may accept signed facsimile copies of physician orders. A center must be able to obtain an original signature to verify a signature on a facsimile copy. If signed physician orders are accepted by this method, the written policy must describe:

(1) safeguards to ensure that transmitted information is sent to the appropriate individual; and

(2) the procedure to be followed in the case of misdirected transmission.

(d) A center may accept electronically signed physician orders submitted electronically. If signed physician orders are accepted by this method, the written policy must describe the center's method for verifying that the system and software product the physician uses provides protection against:

(1) modification of the physician order, including the physician's signature and date of signature; and

(2) the unauthorized use of the physician's electronic signature.

 

§15.703 Pharmacist Services

 

(a) If a center administers or stores medication, the center must have a pharmacist or a qualified RN with education and training in drug management and on a full-time, part-time, or on a consultant basis to provide consultation to the medical director, administrator, nursing director, and other center staff.

(b) A center must consult with a pharmacist or qualified RN as needed on the following:

(1) establishing written policies and procedures for the storage and administration of medications as described in §15.704 of this division (relating to Storage of Medication) and §15.705 of this division (relating to Administration of Medication);

(2) reviewing medical records to ensure that the medication records are accurate, updated and reflect that medications are administered in accordance with the orders of a minor's prescribing physician;

(3) providing in-service training to staff on the storage and administration of medications; and

(4) ensuring pharmaceutical compliance.

 

§15.704 Storage of Medication

 

(a) A center must adopt and enforce a written policy for the storage and administration of medication at the center. The policy must include protocols and procedures for:

(1) labeling;

(2) storage;

(3) integrity;

(4) control; and

(5) accountability of all medications stored by a center;

(b) A center must store over-the-counter (OTC) stock medications separately from medication brought to the center by an adult minor or a minor's parent. The OTC medication must include a medication label that includes:

(1) the medication name;

(2) strength;

(3) manufacturer's name;

(4) lot number;

(5) expiration date;

(6) recommended dosage for safe use; and

(7) applicable cautionary or accessory labeling.

(c) A center must only receive prescription medication from an adult minor or a minor's parent and in the original and labeled container issued by a pharmacy.

(d) A center must store medication in a locked cabinet, located in or convenient to a nurse's station or other central location.

(e) A center must keep Schedule II substances in separately locked, securely fixed boxes or drawers in the locked medication cabinet and under two locks.

(f) A center must keep medications requiring refrigeration in a separate locked box in a separate refrigerator from the refrigerator the center uses to store food.

 

§15.705 Administration of Medication

 

(a) A center must adopt and enforce written policies and procedures for the administration of medication to a minor. The policies and procedures must address:

(1) removing an individual dose from a previously dispensed, properly labeled container;

(2) verifying the medication with the prescriber's orders;

(3) verifying the order with the correct minor;

(4) giving the correct medication dose to a minor;

(5) giving the medication by the correct route;

(6) observing that the medication is taken;

(7) recording the required information, including the method of administration; and

(8) documenting any medication not administered and the reason.

(b) A center's written policy must ensure compliance with:

(1) THSC Chapter 248A;

(2) this chapter;

(3) state law authorizing a person licensed under the Texas Occupations Code to administer medications;

(4) rules adopted by the Texas Board of Nursing 22 TAC Chapter 224 (relating to Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel for Clients with Acute Conditions or in Acute Care Environments) governing when an RN may delegate the administration of medication to an unlicensed person; and

(5) any other applicable state and federal regulations relating to the administration of medication to a minor.

(c) If there is a direct conflict between this chapter and other applicable state and federal laws and regulations, a center must comply with the more stringent requirements.

(d) The administration of medication by center staff must be included in a minor's plan of care.

(e) A center must adopt and enforce written policies and procedures for maintaining a current medication list and a current medication administration record.

(f) A center's written policy must require center staff who supervise, assign, or delegate the administration of medication or administer medication to a minor to maintain a current medication list in the minor's medical record.

(g) A center may incorporate a current medication list and medication administration record into one document.

(h) An RN must review the medication list initially after a minor is admitted and update the list when necessary but at least every 90 days.

(i) An RN must report significant findings from a review of the medication list to the minor's prescribing physician.

(j) Review of the medication list includes evaluation of prescription and over-the-counter drugs, medication orders, and the medication list for:

(1) known allergies;

(2) rational drug therapy-contraindication;

(3) reasonable dose and route of administration;

(4) reasonable directions for use;

(5) duplication of drug therapy;

(6) drug-drug interaction;

(7) drug-food interaction;

(8) drug-disease interaction;

(9) adverse drug reaction; and

(10) proper use, including overuse or under use.

(k) A center must adopt and enforce written policies and procedures on medication errors. The policy must ensure that the nursing director, a minor's prescribing physician and the minor's parent are notified immediately after the discovery of a medication error or an adverse reaction.

 

§15.706 Laboratory Services

 

If a center provides laboratory services, then the center must adopt and enforce a written policy to ensure that the center meets the Clinical Laboratory Improvement Act, 42 United States Code Annotated, §263a (CLIA 1988).

 

§15.707 Disposal of Special or Medical Waste

 

(a) A center must adopt and enforce a written policy for the safe handling and disposal of special or medical waste and materials, including bio-hazardous waste and materials.

(b) A center that generates special or medical waste while providing services must dispose of the waste according to the requirements issued by the Department of State Health Services in 25 TAC Chapter 1, Subchapter K (relating to Definition, Treatment, and Disposition of Special Waste From Health Care-Related Facilities).

 

§15.708 Disposal and Destruction of Pharmaceuticals

 

A center must adopt and enforce a written policy for the safe and legal disposal and destruction of pharmaceuticals in accordance with all state, federal, and local laws.

 

Division 7, Care Policies, Coordination of Services, and Census

 

§15.801 Care Policies

 

A center must adopt and enforce written policies and procedures that specify the center's care practices. The written care policies and procedures must address the following topics, as applicable:

(1) initial and updated comprehensive assessment;

(2) pre-admission, admission, placing a minor on hold, transfer, and discharge;

(3) attendance requirements;

(4) active play of a minor;

(5) intravenous services;

(6) safety of center staff;

(7) safety of a minor;

(8) the prevention, detection, and reporting of abuse, neglect, or exploitation;

(9) nursing procedures relating to the care of a minor;

(10) psychiatric nursing procedures;

(11) person-centered direction and guidance;

(12) restraints;

(13) parent teaching;

(14) care planning;

(15) palliative care and management of a terminal illness;

(16) performing waived laboratory testing;

(17) medication administration;

(18) emergency plans of care; and

(19) any other care policies relating to the services provided on behalf of a center.

 

§15.802 Coordination of Services

 

(a) A center must adopt and enforce written policies and procedures regarding coordination of services to ensure the effective exchange of information, reporting, and coordination of a minor's services:

(1) among all staff providing services on behalf of a center; and

(2) between the center and a provider of services to the minor that is not providing services on behalf of the center, if known by the center.

(b) Documentation in a minor's medical records must demonstrate coordination of services as described in subsection (a) of this section.

(c) For a minor receiving services from a provider that is not providing services on behalf of a center, the center must:

(1) not duplicate or provide services that conflict with a minor's care plan or service plan with the provider;

(2) when requested by an adult minor or parent, make available a minor's records to support the coordination of services between the center and the provider;

(3) request copies of a minor's records with the provider to support center care planning activities;

(4) if requested by an adult minor or parent, participate in planning activities for a minor conducted by the provider;

(5) request that a minor's provider participate as part of the center's interdisciplinary team and QAPI committee, as applicable; and

(6) support the coordination of a minor's services by allowing a minor's provider to serve a minor at the center, if:

(A) the center, a minor's parent, a minor, if the minor is an adult minor and the provider agree that the provision of services to a minor by the provider at the center would be appropriate for the minor; and

(B) the center and the provider establish a written agreement for the provision of services at the center. The written agreement must include the provider's compliance with center policies and this chapter.

 

§15.803 Census

 

(a) A center must adopt and enforce written policies and procedures for the development of the center's actual, daily, and total census lists.

(b) A center's written policies and procedures must address:

(1) developing and maintaining the census lists;

(2) the staff responsible for maintaining the census lists; and

(3) the retrieval of the census lists when requested by DADS.

(c) A center must maintain the following lists of minors receiving services:

(1) actual census, which must be updated each time the number of minors at the center changes;

(2) daily census; and

(3) total census.

(d) The actual and daily census must include:

(1) a minor's name;

(2) the services provided to a minor and the provider responsible for the delivery of each service; and

(3) the time a minor entered and left the center.

(e) The total census must include:

(1) a minor's name;

(2) a minor's diagnosis; and

(3) the name and contact information of a minor's prescribing physician.

 

Division 8, Rights and Responsibilities, Advance Directives, Abuse, Neglect, and Exploitation, Investigations, Death Reporting, and Inspection Results

 

§15.901 Rights and Responsibilities

 

(a) A center must adopt and enforce written policies to ensure a minor's legal rights are observed and protected and to ensure compliance with this section. The policies must comply with relevant law and ensure that the center considers a minor's age and legal status, including whether a guardian has been appointed or the disabilities of minority have been removed, to determine a minor's or other individual's authority to make decisions for the minor.

(b) Before providing services to a minor, a center must provide an adult minor and a minor's parent with oral and written notification of the requirements of this section in a language and format that the minor and parent understand. The center must obtain the signature of the adult minor and minor's parent to confirm that the individual received the notice.

(c) A center must:

(1) ensure that a minor is free from abuse, neglect, and exploitation at the center, as described in §15.903 of this division (relating to Abuse, Neglect, or Exploitation Reportable to DADS);

(2) inform a minor and a minor's parent of the center's policy for reporting abuse, neglect, or exploitation of a minor;

(3) ensure that a minor and the minor's property is treated with respect;

(4) at the time of admission, inform an adult minor and a minor's parent, orally and in a written statement, that a complaint or question about the center may be directed to the Department of Aging and Disability Services, DADS Consumer Rights and Services Division, P.O. Box 149030, Austin, Texas 78714-9030, toll free 1-800-458-9858;

(5) at the time of admission, inform an adult minor and a minor's parent, orally and in a written statement, that:

(A) states that complaints about services at the center may be directed to the administrator who will address them promptly;

(B) provides the time frame in which a center must review and resolve the complaint as described in §15.904 of this division (relating to Investigations of a Complaint and Grievance); and

(C) does not include a statement that a complaint must be made to the center administrator before directing a complaint to DADS;

(6) ensure that a minor is not subjected to unlawful discrimination or retaliation;

(7) ensure that a minor is treated appropriate to his or her age and developmental status;

(8) ensure that a minor is allowed to interact with other minors, including through planned and spontaneous active play, respective to a minor's condition and physician orders;

(9) ensure that an adult minor and a minor's parent are informed in advance about the services to be provided, including:

(A) staff who will provide the services and the proposed frequency of each service;

(B) any change in the plan of care before the change is made, except when a delay based on notification would compromise the health and safety of a minor;

(10) ensure that an adult minor and a minor's parent are informed of the expected outcomes of services and any specific limitations or barriers to services;

(11) ensure that an adult minor and a minor's parent are allowed and encouraged to participate in planning services and in planning changes to services and that the adult minor and the minor's parent consented to the changes before the changes are made, except when a delay based on participation in planning or obtaining consent would compromise the immediate health and safety of a minor;

(12) ensure that an adult minor and a minor's parent are informed of the center's policies on implementing an advance directive in accordance with §15.902 of this division (relating to Advance Directives) and to receive information about executing an advance directive;

(13) ensure that an adult minor and a minor's parent are allowed to refuse services;

(14) ensure that minor's medical record is kept confidential and an adult minor and a minor's parent are informed of the center's policies and procedures regarding disclosure of medical records;

(15) ensure that an adult minor and a minor's parent are informed, before care is provided, of the:

(A) extent to which payment for the center's services may be expected from Medicaid, or any other federally funded or aided program known to the center, or any other third-party payment source;

(B) charges for services not covered by a third-party payment source; and

(C) charges that the adult minor or minor's parent may have to pay;

(16) inform an adult minor and a minor's parent of any changes in the information provided in accordance with paragraph (15) of this subsection as soon as possible after changes occur, but no later than 30 days after the date the center becomes aware of the change;

(17) inform an adult minor and a minor's parent of the availability of other programs, including day care, early intervention programs, or school; and

(18) ensure that an adult minor and a minor's parent are allowed to convene or participate in a council or support group for individuals receiving services at the center.

 

§15.902 Advance Directives

 

(a) A center must adopt and enforce a written policy regarding implementation of advance directives. The policy must be in compliance with the Advance Directives Act, THSC, Chapter 166. The policy must include a clear and precise statement of any procedure the center is unwilling or unable to provide or withhold in accordance with an advance directive.

(b) A center must provide written notice to a minor's parent and the adult minor of the written policy required by subsection (a) of this section. The notice must be provided at the earlier of:

(1) the time a minor is admitted to receive services at the center; or

(2) the time service provision begins for a minor.

(c) DADS assesses an administrative penalty of $500 against a center that violates this section.

 

§15.903 Abuse, Neglect, or Exploitation Reportable to DADS

 

(a) The following words and terms, when used in this section, have the following meanings, unless the context clearly indicates otherwise.

(1) Abuse, neglect, and exploitation of a minor have the meanings assigned in THSC Chapter 260A; and

(2) Employee means an individual directly employed by a center, a contractor, or a volunteer.

(b) DADS investigates a complaint or an incident of abuse, neglect, or exploitation when the act occurs at a center, a center employee is responsible for the care of a minor at the time the act occurs, or the alleged perpetrator is associated with the center. A complaint of abuse, neglect, or exploitation that does not meet these criteria must be referred to the Department of Family and Protective Services.

(c) A center must adopt and enforce a written policy relating to the center's procedures for preventing, detecting, and reporting alleged acts of abuse, neglect, and exploitation of a minor.

(d) A center's employee who has cause to believe that the physical or mental health or welfare of a minor has been or may be adversely affected by abuse, neglect, or exploitation must report the information immediately:

(1) to DADS Consumer Rights and Services section at 1-800-458-9858 or via the DADS website;

(2) to one of the following law enforcement agencies in accordance with THSC Chapter 260A:

(A) a municipal law enforcement agency, if the center is located in the territorial boundaries of a municipality; or

(B) the sheriff's department of the county in which the center is located if a center is not located in the territorial boundaries of a municipality; and

(3) in accordance with Texas Family Code, §261.101.

(e) The following information must be reported to DADS:

(1) name, age, and address of the alleged victim;

(2) name and address of the person responsible for the care of the alleged victim;

(3) nature of the alleged act;

(4) nature and extent of the alleged victim's condition;

(5) identity of the alleged perpetrator; and

(6) any other relevant information.

(f) A center must investigate allegations of abuse, neglect, or exploitation immediately and send a written report of the investigation using DADS Provider Investigation Report form to the DADS Complaint Intake Unit no later than five days after the initial report.

(g) A center must complete DADS Provider Investigation Report form and include the following information:

(1) incident date;

(2) the alleged victim;

(3) the alleged perpetrator;

(4) any witnesses;

(5) the allegation;

(6) any injury or adverse effect;

(7) any assessments made;

(8) any treatment required;

(9) the investigation summary; and

(10) any action taken.

(h) A center must require an employee, as a condition of employment with a center, to sign a statement indicating that the employee may be criminally liable for the failure to report abuse, neglect, or exploitation.

(i) A center must prominently and conspicuously post a readable sign for display in a public area accessible to minors, minors' parents, employees and visitors that reads: "Cases of Suspected Abuse, Neglect, or Exploitation Shall be Reported to the Department of Aging and Disability Services by calling 1-800-458-9858."

 

§15.904 Investigations of a Complaint and Grievance

 

(a) DADS investigates a complaint of non-compliance with THSC Chapter 248A or this chapter regarding:

(1) treatment or care that was furnished at a center;

(2) treatment or care that a center failed to furnish; or

(3) a lack of respect for a minor's property by anyone furnishing services at the center.

(b) A center must adopt and enforce a written policy relating to the center's procedures for prompt investigation of complaints, grievances, and reports of abuse, neglect, and exploitation.

(c) A center must:

(1) acknowledge receipt of a complaint or grievance;

(2) document receipt of a complaint or grievance;

(3) initiate an investigation no later than 10 days after a center receives a complaint or grievance; and

(4) document all components of an investigation.

(d) A center must retain all investigation documentation for a minimum of three years from the date a complaint or grievance was received.

(e) A center must not retaliate against a person for filing a complaint, presenting a grievance, or providing in good faith information relating to services provided by a center.

(1) A center may not retaliate against a minor or a minor's parent for filing a complaint, presenting a grievance, or providing, in good faith, information relating to services provided at the center.

(2) A center is not prohibited from terminating an employee for a reason other than retaliation.

(f) A center must not discharge or otherwise retaliate against a minor or a minor's parent for presenting a complaint or grievance against a center.

 

§15.905 Reporting of a Minor's Death

 

(a) A center must report to DADS the death of a minor at the center and those minors transferred from the center to a hospital who expire within 24 hours after the transfer.

(b) A center must submit to the DADS Consumer Rights and Services section a DADS Provider Investigation Incident Report form no later than 10 days after the date a minor dies. A center must complete the DADS Provider Investigation Incident Report form and include the following information:

(1) name of a deceased minor;

(2) social security number of a deceased minor;

(3) date, time, place of death; and

(4) name and address of a center.

 

§15.906 Examination of Inspection Results

 

(a) A center must make available to any person on request a copy of each DADS written notification of the inspection results pertaining to the center.

(b) Before making the inspection results available under this subsection, the center must redact from the report any information that is confidential under other state or federal law.

 

Division 9, Medical Records, Quality Assessment and Performance Improvement, Dissolution and Retention of Records

 

§15.1001 Medical Records

 

(a) In accordance with accepted principles of practice, a center must establish and maintain a medical record system to ensure that the services provided to a minor are completely and accurately documented, readily accessible, and systematically organized to facilitate the compilation and retrieval of information.

(b) A center must establish a record for a minor and must maintain the record in accordance with and contain the information described in subsection (g) of this section.

(c) A center must keep a single file for services provided to a minor and a minor's parent.

(d) A center must adopt and enforce written procedures regarding the use and removal of records, the release of information, and when applicable, the incorporation of clinical, progress, or other notes into the medical record.

(e) A center may not release any portion of a minor's medical record to anyone other than an adult minor and a minor's parent, except as allowed by law.

(f) A center must establish a secure area for original active medical record storage at the center's place of business.

(1) A center must ensure that a minor's medical record is treated as confidential, safeguarded against loss and unofficial use, and maintained according to professional standards of practice.

(2) A center must keep a minor's medical record in original form, as a microfilmed copy, on an electronic system, or as a certified copy.

(3) A medical record in its original form is a signed paper record or an electronically signed computer record.

(4) A center must ensure that computerized medical records meet the requirements of paper records, including protection from unofficial use as specified in subsection (g) of this section and retention for the period specified in §15.1004 of this division (relating to Retention of Records).

(5) A center must ensure that an entry to a medical record regarding the delivery of services is not altered without evidence and explanation of the alteration.

(6) A center must ensure that an entry to a minor's medical record is current, accurate, legible, clear, complete, and appropriately authenticated and dated with the date of entry by the individual making the entry. The record must document all services provided on behalf of the center. The center must not use correction fluid or tape in the record. The center must make corrections by striking through the error with a single line and including the date the correction was made and the initials of the person making the correction.

(7) A center must store the record of an inactive minor's medical record on paper, microfilm, or electronically. The center must secure the medical record and ensure that it is readily retrievable by the center staff.

(g) Each medical record must include the following information as applicable to the services provided on behalf of a center:

(1) a minor's referral and application for services including, but not limited to:

(A) a minor's full name;

(B) sex and date of birth;

(C) the name, address and telephone number of a minor's parent, or others as identified by a minor's parent;

(D) a minor's prescribing physician's name and telephone numbers, and an emergency contact number; and

(E) a minor's prescribing physician's initial order for services;

(2) comprehensive assessments, pertinent medical history including allergies and special precautions and subsequent assessments;

(3) plans of care, nursing care plans and other plans as applicable;

(4) verbal orders of a physician reduced to writing and signed by the physician in accordance with the center's policy as required by §15.702 of this subchapter (relating to Receiving Physician Orders);

(5) documentation of nutritional counseling and special diets, as appropriate;

(6) clinical and progress notes from all professionals providing services to a minor;

(7) documentation of all known services and significant events;

(8) current medication list;

(9) medication administration record, if medication is administered by center staff;

(10) current immunization record;

(11) written acknowledgment of an adult minor's and a minor's parent's receipt of written notification of the requirements of §15.901 of this subchapter (relating to Rights and Responsibilities);

(12) written acknowledgment of an adult minor's and a minor's parent's receipt of a center's policy relating to the reporting of abuse, neglect, or exploitation of a minor;

(13) written acknowledgement of an adult minor's and a minor's parent's receipt of the notice of advance directives;

(14) written acknowledgement of an adult minor's and a minor's parent's receipt of the center's policies relating to discipline and guidance;

(15) documentation demonstrating that an adult minor and a minor's parent have been informed of how to register a complaint in accordance with §15.901 of this subchapter;

(16) discharge summary, including the reason for discharge or transfer and a center's documented notice to an adult minor, a minor's parent, a minor's prescribing physician, and other individuals as required in §15.608 of this subchapter (relating to Discharge or Transfer Notification);

(17) services provided to a minor's parent; and

(18) all consent and election forms, as applicable.

(h) The center must ensure that clinical and progress notes are written the day service is rendered and incorporated into the medical record no later than two business days after the services are rendered.

 

§15.1002 Quality Assessment and Performance Improvement

 

(a) A center must develop, implement, and maintain a written quality assessment and performance improvement (QAPI) program.

(b) A center must designate in writing the group or individuals, by title, responsible for ensuring that a center's written QAPI program is developed, implemented, and maintained in accordance with this section.

(c) The center must implement the QAPI program using a QAPI Committee. The QAPI committee must be composed of the following persons based on the services provided at the center during the time period under review by the QAPI:

(1) the administrator;

(2) the medical director;

(3) the nursing director;

(4) a therapist from each therapy that provided services during the review period (i.e., if physical therapy was provided during the quarter being reviewed, a PT must be on the QAPI committee);

(5) a social worker that provided services during the review period; and

(6) a supervisor of the direct care staff.

(d) The QAPI program must evaluate all services including:

(1) monitoring activities that have an impact on health and safety of minors;

(2) monitoring and evaluating the quality of services;

(3) improving measurable outcomes for minors, if applicable;

(4) resolving problems identified by a center and raised by parents and adult minors; and

(5) ensuring a center's compliance with THSC Chapter 248A and this chapter.

(e) The QAPI program must be ongoing. Ongoing means there is a continuous and periodic collection and assessment of measurable care provided to minors and administrative quality data.

(f) The written QAPI program must include the frequency and detail of data collection.

(g) A center must collect quality data at least quarterly for all services provided to a minor.

(h) The QAPI program must include a system that measures the quality, effectiveness, and safety of services provided to minors and identifies opportunities and priorities for performance improvement.

(i) The system of measures must allow the QAPI Committee to collect and analyze services provided to minors and administrative quality data. The measures must include a review and analysis of the following, as applicable to the services provided at the center and the problems a center identifies:

(1) a representative sample of active and closed medical records;

(2) negative care outcomes to minors or adverse events;

(3) complaints and grievances;

(4) self-reported incidents alleging abuse, neglect, or exploitation by the center employees, volunteers, or contractors;

(5) minor's parent satisfaction surveys;

(6) infection control activities;

(7) incident reports, including reports of medication errors and unprofessional conduct by licensed staff;

(8) the accuracy and completeness of center personnel records;

(9) the implementation and effectiveness of center policies;

(10) the effectiveness and safety of all services provided, including:

(A) competency and qualifications of staff;

(B) the promptness, safety, and quality of services provided to minors;

(C) the center's response to complaints and reports of abuse, neglect, or exploitation; and

(D) a determination that services are provided as outlined in each minor's plan of care; and

(11) an annual review and evaluation of a center's total operation.

(j) The QAPI Committee must meet quarterly or more often if needed to analyze the data collected and to use the data to improve services. A center must immediately correct identified problems that directly or potentially threaten health and safety of minors. The QAPI Committee must:

(1) plan and document actions taken to correct identified problems, and if necessary, to revise center policies;

(2) measure and document the outcome of the corrective action taken; and

(3) monitor and document the level of improvement over time to ensure sustained improvements.

(k) The QAPI Committee must review and update or revise the written QAPI program at least annually, or more often if needed.

(l) The center must document the ongoing implementation and annual review of the written QAPI program.

(m) The center must keep QAPI documents confidential and make the documents readily available to DADS upon request.

 

§15.1003 Dissolution

 

(a) A center must adopt and enforce a written policy that describes the center's written contingency plan for dissolution.

(b) A center must implement the dissolution plan in the event of dissolution to ensure continuity of a minor's care.

(c) The plan must include procedures for a center to:

(1) notify minors actively receiving services and a minor's parent of a center's dissolution; and

(2) transfer or discharge minors actively receiving services consistent with §15.608 of this subchapter (relating to Discharge or Transfer Notification).

 

§15.1004 Retention of Records

 

A center, including a center that permanently closes must adopt and enforce a written policy relating to the retention of records in accordance with this section.

(1) A center must retain original medical records for a minor until a minor's twenty-fourth birthday or five years from the date of service, whichever is later.

(2) The center may not destroy medical records that relate to any matter that is involved in litigation if a center knows the litigation has not been finally resolved.

LSPPECC, Subchapter D, Transportation

Revision 16-1

 

§15.1101 Transportation Services

 

(a) A center must ensure transportation services are provided for a minor, as authorized by an adult minor, the minor's parent, and the minor's prescribing physician:

(1) from the minor's home to the center;

(2) from the center to the minor's home; and

(3) to and from the center for services coordinated by the center.

(b) A minor’s parent is not required to accompany the minor when the center transports or provides for the transport of the minor.

(c) A center must ensure that vehicles are accessible for a minor with disabilities and equipped to meet the needs of a minor during transport.

(d) A minor's parent may decline a center's transportation services.

(e) A center must adopt and enforce written policies and procedures describing the staff and equipment that will accompany a minor during transportation. The staff must include a driver and a nurse.

(f) A center must ensure that:

(1) a person transporting a minor on behalf of a center has a valid and appropriate Texas driver's license, a copy of which the center must keep on file;

(2) a vehicle used to transport a minor has a current Texas safety inspection sticker and vehicle registration decal properly affixed to a vehicle;

(3) the center maintains commercial insurance for the operation of a center's vehicles, including coverage for minors and staff in a center's vehicle in the event of accident or injury;

(4) documentation of the insurance is maintained and includes:

(A) the name of the insurance company;

(B) the insurance policy number;

(C) the period of coverage; and

(D) an explanation of the coverage;

(5) the center provides a driver and the center's nurse with an up-to-date master transportation list that includes a minor's name, pick up and drop off locations, and authorized persons to whom a minor may be released;

(6) the master transportation list is on file at the center;

(7) the driver and the center's nurse riding in the vehicle maintain a daily attendance record for each trip that includes the driver's name, the date, names of all passengers in the vehicle, the name of the person to whom a minor was released, and the time of release; and

(8) the number of people in a vehicle used to transport minors does not exceed the manufacturer's recommended capacity for the vehicle.

 

§15.1102 Transportation Safety Provisions

 

(a) A center must adopt and enforce written policies and procedures to ensure the care and safety of minors during transport.

(b) A center must appropriately train staff on the needs of a minor being transported.

(c) A center must properly restrain or secure a minor when the minor is transported by the center in a motor vehicle, in accordance with applicable federal motor vehicle safety standards, state law, THSC Chapter 248A, and this chapter.

(d) A center must ensure that:

(1) a minor boards and leaves the vehicle from the curbside of the street and is safely accompanied to the minor's destination;

(2) there is a first aid kit with unexpired supplies, including oxygen, a pulse oximeter, and suction equipment, in each center vehicle;

(3) the center prohibits the use of tobacco in any form, electronic cigarettes, alcohol and possession of illegal substances or unauthorized potentially toxic substances, firearms, pellet or BB guns, including loaded or unloaded BB guns, in any vehicle;

(4) the driver does not use a hand-held wireless communication device while operating a center vehicle;

(5) a center's nurse accompanies all minors during transport;

(6) at least one direct care staff member, or more depending on the acuity of the minors, accompanies every seven minors;

(7) the driver or center's nurse does not leave a minor unattended in the vehicle at any time;

(8) the driver or the center's nurse riding in the vehicle inspects the vehicle at the completion of each trip to ensure that no minor is left in the vehicle; and

(9) the center maintains documentation that includes the signature of the individual conducting the inspection described in paragraph (8) of this subsection and the time of inspection.

(e) A center must post near the emergency exit of each vehicle that transports a minor the following information in an easily readable font:

(1) the name of the administrator;

(2) the center's name;

(3) the center's telephone number; and

(4) the center's address.

(f) The center must adopt and enforce a policy on emergencies while transporting a minor. The policy must include:

(1) procedures for mechanical break downs;

(2) procedures for vehicle accidents; and

(3) procedures for a minor's emergency.

(g) If a center conducts a field trip, the center must ensure that the driver or center's nurse riding in the vehicle must inspect the vehicle and account for each minor upon arrival and departure from each destination to ensure that no minor is left in the vehicle after reaching the vehicle's final destination.

(1) A center must ensure that the driver or center's nurse riding in the vehicle maintains a field trip record for each trip. The record must include the driver's name, the nurse's name, the time and date, the vehicle's destinations, and names of all passengers in the vehicle.

(2) A center must maintain documentation that includes the signature of the person conducting the inspection and the time of each inspection during the field trip.

(3) Appropriate staff must be present when a minor is delivered to the center.

 

LSPPECC, Subchapter E, Building Requirements

Revision 14-0

 

§15.1201 General Requirements

 

The standards in this subchapter apply to:

(1) a newly constructed center;

(2) alterations, additions, or renovations to an existing center;

(3) an existing building renovated to create a center; and

(4) a center's maintenance.

 

§15.1202 Plan Reviews

 

(a) Plans for new buildings, additions, conversions of buildings not licensed by DADS, and the remodeling of existing licensed facilities must be submitted to DADS for review. No later than 30 days after receipt of the plans, DADS informs an applicant in writing of the results of the review.

(b) If the submitted plans comply with DADS architectural requirements, DADS may not subsequently change the architectural requirement that applies to the project unless the change is required by federal law or an applicant fails to complete the project no later than two years after submitting the plans to DADS.

(c) DADS may grant a waiver of the two-year period for delays due to unusual circumstances.

(d) DADS may impose a deadline for completing a project using requirements that are revised after the project was reviewed.

(e) Submittal of plans.

(1) One copy of contract documents must be submitted to DADS before construction begins. The documents must:

(A) include working drawing and specifications;

(B) have sufficient detail for DADS to interpret compliance with this chapter and for a general contractor or builder to ensure proper construction; and

(C) be prepared according to accepted architectural practice and include general construction, special conditions, and schedules.

(2) Final copies of plans must be submitted to DADS and include:

(A) a title block that shows the name of the center;

(B) the person or organization preparing the sheet;

(C) sheet numbers;

(D) the center's address; and

(E) the drawing date.

(3) Sheets and sections covering structural, electrical, mechanical, and sanitary engineering final plans, designs, and specifications must bear the seal of a professional engineer licensed by the Texas Board of Professional Engineers.

(4) An architect licensed by the Texas Board of Architectural Examiners must prepare contract documents for additions, remodeling, and construction of a new center. Drawings must bear the seal of the architect.

(5) A final plan for a major addition to a center must be submitted to DADS and include a basic layout to scale of the entire building into which the addition will connect. North direction must be shown. The entire basic layout must be scaled to fit on a single 8 1/2-inch by 11-inch sheet.

(6) Final plans and specifications for conversions or remodeling must be submitted to DADS and include all parts and features involved.

(7) Qualified staff must be employed to prepare the contract documents for construction. If the contract documents have errors or omissions to the extent that compliance with this chapter cannot be reasonably ensured or determined, DADS may request a revised set of documents for review.

(8) DADS review of the plans and specifications is based on general utility and compliance with this chapter and the Life Safety Code. DADS review is not an all-inclusive review of the structural, electrical, or mechanical components of a center. DADS review does not include a review of building plans for compliance with the Texas Accessibility Standards as administered and enforced by the Texas Department of Licensing and Regulation.

(9) Plan review fees must be submitted in accordance with §15.113 of this chapter (relating to Plan Review Fees).

(f) Contract documents.

(1) Site plan documents must be submitted to DADS and include:

(A) grade contours;

(B) streets with names;

(C) north arrow;

(D) fire hydrants;

(E) fire lanes;

(F) public or private utilities;

(G) fences; and

(H) unusual site conditions, including:

(i) ditches;

(ii) low water levels;

(iii) other buildings on-site; and

(iv) indications of buildings five feet or less beyond site property lines.

(2) Foundation plan documents must be submitted to DADS and include general foundation design and details.

(3) Floor plan documents must be submitted to DADS and include:

(A) room names, numbers, and usages;

(B) numbered doors, including swing;

(C) windows;

(D) legend or clarification of wall types that include:

(i) dimensions;

(ii) fixed equipment;

(iii) plumbing fixtures;

(iv) basic layout of the food preparation area; and

(v) identification of all smoke barrier walls from outside wall to outside wall or fire walls.

(4) For both new construction and additions or remodeling to existing buildings, an overall plan of the entire building drawn or reduced to fit on a single 8 1/2-inch by 11-inch sheet must be submitted to DADS.

(5) Schedules must be submitted to DADS and include:

(A) door materials, widths, and types;

(B) window materials, sizes, and types;

(C) room finishes; and

(D) special hardware.

(6) Elevations and roof plans must be submitted to DADS. Plans must include exterior elevations, including:

(A) material note indications;

(B) rooftop equipment;

(C) roof slopes;

(D) drains;

(E) gas piping; and

(F) interior elevations where needed for special conditions.

(7) Contract document details must be submitted to DADS and include:

(A) wall sections as needed, especially for special conditions;

(B) cabinet and built-in work, basic design only;

(C) cross sections through buildings as needed; and

(D) miscellaneous details and enlargements as needed.

(8) Building structure documents must be submitted to DADS and include:

(A) structural framing layout and details used primarily for column, beam, joist, and structural building;

(B) roof framing layout if it cannot be adequately shown on a cross section; and

(C) cross sections in quantity and detail to show sufficient structural design and structural details as necessary to ensure adequate structural design and calculated design loads.

(9) Electrical documents must be submitted to DADS and include:

(A) electrical layout, including lights, convenience outlets, equipment outlets, switches, and other electrical outlets and devices;

(B) service, circuiting, distribution, and panel diagrams;

(C) exit light systems with exit signs and emergency egress lighting;

(D) emergency electrical provisions, including generators and panels;

(E) staff communication systems;

(F) fire alarm and similar systems, including control panel, devices, and alarms; and

(G) sizes and details sufficient to ensure safe and properly operating systems.

(10) Plumbing documents must be submitted to DADS and include:

(A) plumbing layout with pipe sizes and details sufficient to ensure safe and properly operating systems;

(B) water systems;

(C) sanitary systems;

(D) gas systems; and

(E) other systems normally considered under the scope of plumbing, fixtures, and provisions for combustion air supply.

(11) Heating, ventilating, and air-conditioning systems (HVAC) documents must be submitted to DADS and include:

(A) sufficient details of HVAC systems and components to ensure a safe and properly operating installation, including heating, ventilating, and air-conditioning layout, ducts, protection of duct inlets and outlets, combustion air, piping, exhausts, and duct smoke and fire dampers; and

(B) equipment types, sizes, and locations.

(12) Sprinkler system documents must be submitted to DADS and include:

(A) plans and details of National Fire Protection Association (NFPA) designed systems to meet the requirements of NFPA 13, Standard for the Installation of Sprinklers;

(B) plans and details of partial systems provided only for hazardous areas; and

(C) electrical devices interconnected to the alarm system.

(13) Specifications must be submitted to DADS that include:

(A) installation techniques;

(B) quality standards and manufacturers;

(C) references to specific codes and standards;

(D) design criteria;

(E) special equipment;

(F) hardware;

(G) finishes; and

(H) other specifications as needed to amplify drawings and notes.

(14) Other layouts, plans or details must be submitted to DADS as necessary for DADS to obtain a clear understanding of the design and scope of the project. Plans covering private water or sewer systems that have been reviewed by the health or wastewater authority having appropriate jurisdiction must be submitted to DADS.

(g) Construction phase.

(1) DADS Architectural Unit must be notified in writing before beginning construction of a new center or the remodeling of an existing center.

(2) DADS requires additional drawings if construction of the center is not performed in accordance with the completed plans and specifications as submitted to DADS for review or as modified in accordance with DADS review requirements, if the change is significant.

(h) Initial inspection of completed construction.

(1) After completion of construction, including grounds and basic equipment and furnishings, DADS performs an initial architectural inspection of the center before the center admits a minor. DADS schedules an initial architectural inspection after DADS receives a licensure application, required fees, fire marshal approval, approval of local building authority, and a letter from an architect or engineer stating that, to the best of the architect or engineer's knowledge, the center meets the building requirements for licensure.

(2) If DADS Life Safety Code staff inspect the completed construction and find it in compliance with this chapter, the DADS Architectural Unit forwards the information to the DADS Licensing and Credentialing Unit as part of an applicant's license application. For additions to or remodeling of an existing center, DADS may require an applicant to submit a revision or modification to an existing license. The building, including basic furnishings and operational needs, grades, drives, and parking, must be 100 percent complete at the time of DADS initial architectural inspection. A center may admit at least one but no more than three minors after it receives initial approval from DADS but before a license is issued.

(3) An applicant must make the following documents related to the completed building available to DADS architectural inspection surveyor at the time of the inspection:

(A) written approval of the local authorities as required in paragraph (1) of this subsection;

(B) for fire detection and alarm systems:

(i) record drawings of the fire detection and alarm system as installed, signed by an alarm planning superintendent licensed by the State Fire Marshal's Office or sealed by a licensed professional engineer;

(ii) a sequence of operation, the owner's manuals and the manufacturer's published instructions covering all system equipment;

(iii) a signed copy of the State Fire Marshal's Office Fire Alarm Installation Certificate; and

(iv) for software-based systems, a record copy of the site-specific software, excluding the system executive software or external programmer software in non-volatile, non-erasable, non-rewritable memory;

(C) documentation of materials used in the building that are required to have a specific limited fire or flame spread rating, including special wall finishes or floor coverings, flame retardant rated ceilings and curtains, including cubicle curtains.

(D) for carpeting that is required to have a specific limited fire or flame spread rating, a signed letter from the installer verifying that the carpeting installed is named in the laboratory test document;

(E) for fire sprinkler systems:

(i) record drawings of the fire sprinkler system as installed, signed by a responsible managing employee, licensed by the State Fire Marshal's Office or sealed by a licensed professional engineer;

(ii) the hydraulic calculations;

(iii) the alarm configuration;

(iv) above ground and underground Contractor's Material and Test Certificate;

(v) the literature and instructions provided by the manufacturer describing the proper operation and maintenance of all equipment and devices in accordance with NFPA 25, Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems;

(vi) service contracts for maintenance and testing of alarm systems and sprinkler systems;

(vii) a copy of gas test results of the center's gas lines from the meter;

(viii) a written statement from an architect or engineer stating, to the best of the architect or engineer's knowledge, the building was constructed in substantial compliance with the construction documents, the Life Safety Code, this chapter, and local codes; and

(ix) any other such documentation as needed.

(i) Non-approval of new construction.

(1) If, during the initial on-site architectural inspection of completed construction, the DADS Life Safety Code surveyor finds certain basic requirements are not met, the surveyor may recommend that the center not be licensed or approved for occupancy. Items that may result in this recommendation include:

(A) substntial changes made during construction that were not submitted to DADS for review and that may require revised "as-built" drawings to include the changes, including. architectural, structural, mechanical, and electrical items as specified in this section;

(B) construction that does not meet minimum code or licensure standards, including corridors that are less than the required width, ceilings installed at less than the minimum seven-foot, six-inch height, and other features that would disrupt or otherwise adversely affect minors and staff if corrected after occupancy;

(C) lack of written approval by appropriate local authorities;

(D) fire protection systems, including fire alarm systems, emergency power and lighting, and sprinkler systems, that are not completely installed or functioning properly;

(E) required exits that not all usable according to NFPA 101 requirements;

(F) telephones that are not installed or not working properly;

(G) sufficient basic furnishings, essential appliances, and equipment that are not installed or functioning; and

(H) other basic operational or safety feature that would preclude safe and normal occupancy by a minor on that day.

(2) An applicant must submit copies of reduced-size floor plans on an 8 1/2-inch by 11-inch sheet, in duplicate, to DADS for records and for the center's use for an evacuation plan, or fire alarm zone identification. The plan must contain basic legible information including scale, room usage names, actual bedroom numbers, doors, windows, and any other pertinent information.

 

§15.1203 Design Criteria

 

(a) A center must be designed in accordance with:

(1) the Health Care Occupancy chapter of the 2000 edition of the National Fire Protection Association (NFPA)101 Life Safety Code for newly constructed centers or centers converting an existing unlicensed building to a center; and

(2) the requirements of Limited Care, as defined by NFPA 101.

(b) An applicant for a center license must submit to DADS site approval by the local building department and fire marshal having appropriate jurisdiction.

(c) An applicant for a center license must meet applicable local, state, or national codes and ordinances as determined by the authority having appropriate jurisdiction for those codes and ordinances and by DADS.

(d) A center must meet the requirements of the International Plumbing Code or Uniform Plumbing Code, as adopted by the local municipality.

(e) If conflicting codes apply to the construction of the center, the more stringent codes apply.

(f) A center may not be built in an area designated as a floodplain of 100 years or less.

(g) A center must comply with the accessibility requirements for individuals with disabilities as referenced in the revised regulations for Title II and III (2010 ADA Standards for Accessible Design) of the Americans with Disabilities Act of 1990 at Title 42, United States Code, Chapter 126; federal regulations at Title 28, Code of Federal Regulations, Part 35 and Part 36; Texas Accessibility Standards at Texas Government Code, Chapter 469; and Texas Department of Licensing and Regulation rules at 16 TAC Chapter 68 (relating to Elimination of Architectural Barriers).

 

§15.1204 Fire Safety

 

(a) A center's construction type is limited to the building construction shown in the minimum construction requirements in the Life Safety Code chapter for New Health Care Occupancies.

(b)A center must have a National Fire Protection Association (NFPA) 72 fire alarm system with initiation, notification, emergency forces notification, annunciation, emergency control and detection in accordance with the Life Safety Code. The center must have a written contract with a fire alarm firm that has been issued an Alarm Certificate of Registration number from the Texas State Fire Marshal's Office to inspect, test and maintain a fire alarm system to meet NFPA 72 requirements, semiannually. Inspections required in the contract must be performed. The person performing the semiannual service must have an individual fire alarm license from the Texas State Fire Marshal's Office.

(c) A center must be protected throughout by an approved, supervised automatic sprinkler system installed in accordance with NFPA 13. The center must ensure that the sprinkler system is inspected, tested, and maintained in accordance with NFPA 25. The center must have a written contract with a fire protection sprinkler firm that has been issued a Sprinkler Certificate of Registration number from the Texas State Fire Marshal's Office to perform the required services, semiannually. The center must document and show to DADS that all the requirements of NFPA 25 are met including the annual inspection, test, and maintenance performed by the registered fire sprinkler firm. The center must retain one set of the fire sprinkler system plans and hydraulic calculations on the property.

(d) A center must distribute portable fire extinguishers throughout the center of size and type in accordance with NFPA 10.

(e) A center must provide emergency power for emergency lighting, exit signs, and the fire alarm by a generator.

(f) A center must ensure that the design, installation, and maintenance of emergency motor generators are in accordance with NFPA 37, NFPA 99, and NFPA 110.

(g) A center must ensure that the generator is of sufficient size to maintain Life Safety Code requirements, medical equipment, and HVAC to operate in designated core areas of the center in the event of power failure.

(h) The center must ensure that emergency powered receptacles are used:

(1) for a patient care-related electrical appliance, including a biological refrigerator;

(2) at a nurse station; and

(3) in a medication room.

(i) The center must store and administer oxygen in accordance with NFPA 99.

 

§15.1205 Distinct Part Facilities and Physical and Programmatic Separation

 

(a) A center must be physically and programmatically distinct from any business to which it is attached or of which it is a part.

(b) If more than one business occupies the same building or physical location, the center must have its own entrance.

(c) A center must be separated from other occupancies with construction having a fire resistance rating of not less than 2 hours.

(d) A center's separate entrance must not be accessed solely through another business or health care provider.

(e) A center's separate entrance must have appropriate signage and be clearly identified as belonging to the center.

(f) A licensed center's space must be contiguous.

(g) If a center has more than one building, the center must provide protection from inclement weather to minors, staff, contractors, volunteers and visitors who travel between the buildings.

 

§15.1206 Exterior Spaces

 

(a) A center must have separate entrances for guests and minors.

(b) A center must have a covered entry with a covered drop-off for family, emergency medical services (EMS), and the center's vehicles.

(c) A center's roof overhang or canopy must extend as far as practicable to the face of the driveway or curb of the passenger access door of a passenger vehicle.

(d) A center's roof overhang or cover must be of sufficient height to allow entry or departure from EMS vehicles.

(e) A center must provide for an outdoor play space with a direct exit from the center into the outdoor play space. The outdoor play space should at least be 400 square feet in area with at least 20 percent of that area shaded.

(f) A center's play yard must meet the requirements of the Texas Accessibility Standards.

(g) A center must ensure that its structures and the grounds of the center that are used by minors are maintained in good repair and are free from hazards to health and safety.

(h) A center must fence or ensure natural barriers are present to protect a minor from areas determined to be unsafe by DADS, including steep grades, cliffs, open pits, swimming pools, high voltage boosters, high voltage equipment, and high speed roads.

(i) A center must keep fences in good repair.

(j) A center must store garbage, rubbish, and trash securely in outdoor, covered containers.

(k) A center must keep trash collection receptacles and incinerators separated from outdoor recreational spaces and locate the receptacles and incinerators in a place to avoid being a nuisance.

 

§15.1207 Interior Spaces

 

(a) A center must consist of a building suitable for the purpose intended, and have a minimum of 50 square feet of space per minor exclusive of kitchen, toilet facilities, storage areas, hallways, stairways, basements, and attics.

(b) If a center uses a room exclusively for dining or sleeping, the center must not count that space as part of the licensed capacity.

(c) A center must have sufficient rooms to accommodate and segregate the different age groups of minors being served at the center.

(d) A center must provide staff area and staff toilets.

(e) A center must provide a reception area.

(f) A center must provide an administrative office.

(g) A center must provide quiet rooms based on the needs of minors.

(h) A center's quiet room must contain a minimum of 100 square feet.

(i) A center must provide indoor recreational exercise play area.

(j) A center must provide a treatment room with a medication preparation area. The medication preparation area must contain a work counter, refrigerator, sink with hot and cold water, and locked storage for biologicals and drugs.

(k) A center must develop isolation procedures to prevent cross-infection and provide an isolation room with at least one large glass area for observation of a minor in accordance with §15.211 of this chapter (relating to Infection Prevention and Control Program and Vaccination Requirements). The isolation room must contain a minimum of 100 square feet.

(l) The center must make privacy accommodations available to attend to the personal care needs of a minor.

 

§15.1208 Food Preparation

 

A center must have a food preparation area designated for the preparation of meals, snacks, or prescribed nourishments. The meals, snacks and nourishments must be maintained in accordance with state and local sanitation and safe food handling standards, including the Texas Food Establishment Rules. The center must be in compliance with Department of State Health Services rules in 25 TAC §§229.161-229.171 and §§229.173-229.175 and local health ordinances or requirements in the storage, preparation, and distribution of food; sanitation of dishes, equipment, and work area; and in the storage and disposal of waste.

 

§15.1209 Toileting Facilities

 

(a) A center must provide toileting facilities appropriately accessible to persons with disabilities and age appropriate in design with hand-washing stations.

(b) A center must have separate toilet facilities for minors, staff, and visitors.

(c) A center must install a hand-washing station in each play area, classroom, and therapy room or area.

 

§15.1210 Minor's Personal Belongings

 

(a) A center must have a secure, individually labeled space available for each minor's personal belongings.

(b) A center must provide locked storage for a minor's personal possessions as needed.

 

§15.1211 Linen Storage

 

(a) A center must have a mechanical forced air exhaust system to the outside for soiled linen areas in accordance with §15.210 of this chapter (relating to Sanitation, Housekeeping, and Linens).

(b) A center must have separate storage areas for clean and soiled linen in accordance with §15.210 of this chapter.

 

§15.1212 Janitorial Supplies

 

(a) A center must have a secure room for the safe storage of janitorial supplies and equipment, poisonous materials, and toxic materials.

(b) A center must label and identify poisonous and toxic substances and place them in locked cabinets that are used for no other purpose.

(c) A center must provide a janitor's closet with mechanical forced air exhaust to the outside.

(d) A center must install child proof latches onto closet and cabinet doors that are accessible to a minor.

 

§15.1213 Locked Areas

 

A center must secure and lock any area the center determines is unsafe for a minor or minor's family. The center's door locking arrangement must meet Life Safety Code egress requirements from inside the room. An unsafe area includes high voltage areas and equipment rooms.

 

§15.1214 File Storage

 

A center must have an area for the safe and secure maintenance and storage of medical records and other center files, records, and manuals. If these areas are deemed hazardous storage in accordance with the Life Safety Code, the center must have rated doors with closers.

 

§15.1215 Garbage

 

(a) A center must store garbage, rubbish, and trash in an area separate from the areas used for the preparation and storage of food. A center must remove garbage, trash, and rubbish from the premises and sanitize the containers regularly.

(b) A center must meet the sanitation requirements in §15.210 of this chapter (relating to Sanitation, Housekeeping, and Linens).

 

§15.1216 Furnishings and Equipment

 

(a) A center must secure clean storage areas for equipment, devices, and supplies including equipment supplied by the center for a minor's needs, including a wheelchair, a bed, and a mattress.

(b) A center must maintain an age appropriate and developmentally appropriate environment in each of the areas where services are provided to a minor.

 

§15.1217 Laundry

 

(a) A center must have a supply of clean linen sufficient to meet the needs of a minor. Clean laundry must be provided by:

(1) an in-house laundry service;

(2) contract with another health care center; or

(3) an outside commercial laundry service.

(b) A center must handle, store, process, and transport laundry in a manner to prevent the spread of infection in accordance with §15.210 of this chapter (relating to Sanitation, Housekeeping, and Linens).

 

§15.1218 Housekeeping

 

(a) A center must:

(1) maintain a clean and safe environment;

(2) be free of unpleasant odors; and

(3) eliminate odors at the center at their source by prompt and thorough cleaning of commodes, urinals, bedpans, and other sources.

(b) A center must meet the housekeeping requirements in §15.210 of this chapter (relating to Sanitation, Housekeeping, and Linens).

 

§15.1219 Maintenance

 

(a) A center must:

(1) ensure that the grounds and the exterior of the building, including the sidewalks, steps, porches, ramps, and fences are in good repair;

(2) keep equipment supplied by the center for a minor's needs in good repair, including wheelchairs, cribs, and mattresses;

(3) keep the interior of the building including walls, ceilings, floors, windows, window coverings, doors, plumbing, and electrical fixtures in good repair; and

(4) use pest control services provided by a licensed structural pest control applicator with a license category for pests.

(b) A center must meet the requirements in §15.210 of this chapter (relating to Sanitation, Housekeeping, and Linens).

 

§15.1220 Heating, Ventilation, Air Conditioning (HVAC)

 

(a) A center must use a safe HVAC system that meets the requirements of the National Fire Protection Association (NFPA) 90A and is sufficient to maintain a comfortable temperature, with a minimum of 65 degrees and a maximum of 80 degrees Fahrenheit, in all public and private areas year round.

(b) A center must ensure that during warm weather conditions, the temperature within the center does not exceed 80 degrees Fahrenheit. The center must ensure that the HVAC operates in designated core areas of the center in the event of power failure.

(c) A center must maintain the HVAC system in good repair.

(d) A center must inspect gas-fired heating equipment before the cold weather season to ensure that the equipment operates properly and safely. The center must ensure that gas-fired heating equipment is inspected by a person licensed or approved by the State of Texas to inspect the equipment.

(e) The center must maintain a record of the inspection conducted in accordance with subsection (d) of this section.

(f) A center must correct any unsatisfactory condition or evacuate or relocate the minors.

(g) A center must ensure that a gas heating unit and water heater are vented in accordance with NFPA 54 to carry the products of combustion to the outside atmosphere. The center must ensure that a vent is constructed and maintained to provide a continuous draft to the outside atmosphere in accordance with NFPA 54. The center must ensure that a heating unit is provided with a sufficient supply of outside combustion air in accordance with NFPA 54. A center must not use a portable heater within the center.

 

§15.1221 Water Supply

 

(a) A center must maintain an adequate supply of water, under pressure at all times. When a public water system is available, the center must ensure it is connected to the public water system. If the center uses water from a source other than a public water supply, the center must ensure that the water supply meets the rules issued by the Texas Commission on Environmental Quality.

(b) A center must have a plan and policy for an alternative water supply in the event of interruption of water supply and the temporary loss of water to the center.

 

§15.1222 Sewage

 

A center must ensure that sewage is disposed of by a public system or an approved sewage disposal system constructed and operated to conform with the standards established for systems by the Texas Commission on Environmental Quality and in accordance with sanitation requirements in §15.210 of this chapter (relating to Sanitation, Housekeeping, and Linens).

 

§15.1223 Signage

 

A center's address and name must be displayed so as to be easily visible from the street.

 

§15.1224 Waivers

 

(a)DADS may grant a waiver for certain provisions of the physical plant and environment requirements of DADS licensure standards, which, in DADS opinion, would be impractical for a center to meet. In granting the waiver, DADS, on a case by case basis, determines if:

(1) there are adverse effects on the health and safety of a minor if the center does not meet the licensure requirement; and

(2) the center will experience an unreasonable hardship if the requirement is not waived.

(b) DADS may require a center to offset or comply with an equivalent provision if DADS grants a waiver. A center must demonstrate an equivalent safety feature by utilizing the National Fire Protection Association 101A, Guide on Alternative Approaches to Life Safety, for waivers of the Life Safety Code.

(c) A DADS waiver is not transferable in a change of ownership and is subject to DADS review or revocation upon any change in circumstances at the center.

 

LSPPECC, Subchapter F, Inspections and Visits

Revision 16-1

 

§15.1301 Inspections and Visits

 

(a) DADS performs inspections, follow-up visits, compliance investigations, investigations of abuse, neglect and exploitation, and other contact visits at a center as deemed appropriate or as required to determine a center's compliance with this chapter.

(b) An inspection may be conducted by an inspector or by a team depending on the purpose of the inspection, size of a center, and other factors.

(c) DADS does not announce inspections or visits.

(d) DADS conducts at least one unannounced licensing inspection annually after issuance of a license.

(e) DADS may visit a center for purposes other than the reasons described in subsection (a) of this section.

(1) DADS may visit a center to consult with a center's staff to determine how a center's physical space may be expanded or upgraded or determine the progress of a center's construction or repairs, equipment installation or repairs, systems installation or repairs, or when conditions or emergencies arise, including fire, windstorm, or malfunctioning or nonfunctioning of electrical or mechanical systems.

(2) DADS may announce visits that are not for a purpose described in subsection (a) of this section.

 

§15.1302 Investigation of Complaints and Self-Reported Incidents

 

(a) DADS investigates complaints of abuse, neglect, or exploitation if:

(1) the act occurs at the center;

(2) the center is responsible for the supervision of a minor at the time the act occurs;

(3) the alleged perpetrator is associated with the center; or

(4) the alleged perpetrator is present at the center.

(b) DADS refers complaints of abuse, neglect, or exploitation not meeting the criteria in subsection (a) of this section to the Department of Family and Protective Services.

(c) DADS conducts an investigation under this section in accordance with THSC §260 A.007.

(d) A center's investigation of complaints and self-reported incidents does not preclude DADS from taking action in accordance with Subchapter G of this chapter (relating to Enforcement).

(e) DADS notifies the following individuals of the results of a DADS investigation:

(1) the individual who reported the allegation or complaint;

(2) an adult minor;

(3) a minor's parent;

(4) any person designated by an adult minor or minor's parent to receive information concerning a minor; and

(5) a center.

 

§15.1303 Cooperation with an Inspection and Visit

 

(a) By applying for and holding a license, a license holder consents to entry or inspection of the center's premises by a DADS representative to verify compliance with THSC Chapter 248A and this chapter.

(b) A center must make all of its books, records, and other documents maintained by or on behalf of a center accessible to DADS upon request.

(1) DADS is authorized to photocopy documents, photograph minors, and use any other available recording devices to preserve all relevant evidence of conditions found during an inspection or investigation that DADS reasonably believes threaten the health and safety of a minor.

(2) DADS may request, photocopy, and otherwise reproduce records and documents including admission sheets, medication records, observation notes, medical records, clinical notes, and any other of a center's documents.

(3) DADS protects the copies for privacy and confidentially purposes in accordance with recognized standards of medical records practice, applicable state laws, and DADS policy.

(c) During an inspection or investigation, a center's representative and staff must not:

(1) make a false statement that a person knows or should know is false of a material fact about a matter under investigation by DADS;

(2) willfully interfere with the work of a DADS representative;

(3) willfully interfere with a DADS representative in preserving evidence of a violation; or

(4) refuse to allow a DADS representative to inspect a book, record, or file required to be maintained by or on behalf of a center.

(d) DADS may assess an administrative penalty for a violation of provisions in this section, or may take other enforcement action to deny, revoke, or suspend a license, if a center does not cooperate with an inspection.

 

§15.1304 Staff Requirements for an Inspection

 

(a) The center's administrator, alternate administrator, nursing director, or alternate nursing director must be present in person at the entrance and exit conferences of every DADS inspection or visit and be available in person during the inspection.

(b) If a required individual is not at the center when the inspector arrives and is unavailable during the inspection, the inspector will make reasonable attempts to contact the individual.

(c) If an inspector arrives during regular business hours and the center is closed, an administrator, alternate administrator, nursing director, or alternate nursing director must provide the inspector entry to the center no later than two hours after the inspector's arrival at the center. The center must comply with the notice requirements described in §15.201 of this chapter (relating to Operating Hours).

 

§15.1305 General Provisions

 

(a) DADS determines if a center meets the requirements of the THSC Chapter 248A and this chapter.

(b) After an inspection is completed, the inspector holds an exit conference to inform a center of the preliminary findings.

(c) A center may submit additional written documentation and facts after the exit conference only if a center describes the additional documentation and facts to the inspector during the exit conference.

(1) A center must submit the additional written documentation and facts to the DADS inspector or inspection team no later than two business days after the end of the exit conference.

(2) If a center properly submits additional written documentation, the inspector may add the documentation to the record of the inspection.

(d) DADS provides a written notification of the inspection results to the center no later than 10 business days after the exit conference. The written notification includes a statement of violations and instructions for submitting an acceptable plan of correction, and provides an opportunity for an informal dispute resolution.

(e) If a center receives DADS written notification of the inspection results indicating that the center is in violation of THSC Chapter 248A or this chapter, the center must follow DADS instructions included with the notification for submitting an acceptable plan of correction.

(f) f required, a center must submit an acceptable plan of correction that includes the corrective measures and time frame in which the center will comply to ensure correction of a violation. If a center fails to correct each violation by the date on the plan of correction, DADS may take enforcement action against the center.

(g) A center must submit an acceptable plan of correction for each violation no later than 10 calendar days after receipt of DADS written notification of the inspection results. An acceptable plan of correction must address:

(1) how the center will accomplish corrective action for the minors affected by the violation;

(2) how the center will identify other minors with the potential to be affected by the same violation;

(3) the measures that the center will incorporate, or systemic changes the center made to ensure the violation will not recur;

(4) how the center will monitor its corrective actions to ensure that the violation is corrected and will not recur; and

(5) dates when the center's corrective action will be completed.

(h) A center's acceptable plan of correction does not preclude DADS from taking enforcement action against the center in accordance with Subchapter G of this chapter (relating to Enforcement).

(i) A center must submit a plan of correction in response to DADS written notification of inspection results that specifies a violation even if the center disagrees with the inspection results.

(j) If a center disagrees with the inspection results, the center may request an informal dispute resolution (IDR). The center must submit a written request and all supporting documentation DADS no later than the 10th calendar day after the center receives DADS statement of violations.

(k) A center waives its right to an IDR if the center fails to submit the required information to DADS Regulatory Services, Survey and Certification Enforcement Unit, within the required time frames.

(l) A center must make available to any person on request a copy of each DADS inspection report. Before making an inspection report available under this subsection, the center must redact from the report any information that is confidential under other law.

(m) A center must post inspection results in a conspicuous location at the center.

LSPPECC, Subchapter G, Enforcement

Revision 14-0

 

§15.1401 Denial of License Application

 

DADS may deny a license application for the reasons described in §15.115 of this chapter (relating to Criteria for Denial of a License).

 

§15.1402 License Suspension

 

(a) DADS may suspend a center's license for:

(1) a violation of THSC Chapter 248A or standard in this chapter committed by the license holder, applicant, or a person listed on the application;

(2) an intentional or negligent act by a center or an employee of a center that DADS determines significantly affects the health and safety of a minor served at a center;

(3) use of drugs or intoxicating liquors to an extent that it affects the license holder's or applicant's professional competence;

(4) a felony conviction, including a finding or verdict of guilty, an admission of guilt, or a plea of nolo contendere, in Texas or another state of any person required by this chapter to undergo a background and criminal history check;

(5) fraudulent acts, including acts relating to Medicaid fraud and obtaining or attempting to obtain a license by fraud or deception committed by any person listed on the application;

(6) license revocation, suspension, or other disciplinary action taken in Texas or another state against the license holder or any person listed in the application;

(7) criteria described in Chapter 99 of this title (relating to Denial or Refusal of License) that applies to any person required by this chapter to undergo a background and criminal history check;

(8) aiding, abetting, or permitting a violation described in paragraph (1) of this subsection about which a person listed on the application had or should have had knowledge;

(9) a license holder or applicant's failure to provide the required information, facts, or references;

(10) a license holder or applicant who knowingly:

(A) submits false or intentionally misleading statements to DADS on an application;

(B) uses subterfuge or other evasive means of filing an application;

(C) engages in subterfuge or other evasive means of filing an application on behalf of another who is unqualified for licensure; or

(D) conceals a material fact on an application; or

(11) a person listed on the application failing to pay the following fees, taxes, and assessments when due:

(A) licensing fees as described in §15.112 of this chapter (relating to Licensing Fees);

(B) plan review fees as described in §15.113 of this chapter (relating to Plan Review Fees); or

(C) franchise taxes, if applicable.

(b) DADS may suspend a license simultaneously with any other enforcement action available to DADS.

(c) DADS notifies the license holder by personal service, facsimile transmission, or registered or certified mail of DADS intent to suspend the license, including the facts or conduct alleged to warrant the suspension.

(d) The license holder has an opportunity to show compliance with all requirements of law to retain the license, as provided in §15.1407 of this subchapter (relating to Opportunity to Show Compliance). If the license holder requests an opportunity to show compliance, DADS gives the license holder a written affirmation or reversal of the proposed action.

(e) DADS notifies the license holder by personal services, facsimile transmission or by registered or certified mail of DADS suspension of the center license. The license holder has 20 days after receipt of the notice to request a hearing in accordance with Texas Government Code, Chapter 2001, and the formal hearing procedures in 1 TAC Chapter 357, Subchapter I (relating to Hearings Under the Administrative Procedure Act) and Chapter 91 of this title (relating to Hearings Under the Administrative Procedure Act). The license suspension takes effect when the deadline for an appeal of the suspension expires, unless the license holder appeals the suspension.

(f) If a license holder appeals, the license remains valid until all administrative appeals are final, unless the license expires without a timely application for renewal submitted to DADS. The license holder must continue to submit a renewal application in accordance with §15.106 of this chapter (relating to Renewal License Application Procedures and Issuance) until the action to suspend the license is completed. However, DADS does not renew the license until it determines the reason for the proposed action no longer exists.

(g) If a license holder appeals, the enforcement action takes effect when all administrative appeals are final and the proposed enforcement action is upheld. If the center wins the appeal, DADS does not take the proposed action.

(h) If DADS suspends a license, the suspension remains in effect until DADS determines that the reason for suspension no longer exists. A suspension may last no longer than the term of the license. DADS conducts an on-site investigation before making a determination. During the suspension, the license holder must return the license to DADS.

 

§15.1403 Emergency License Suspension

 

(a) DADS may issue an emergency order to suspend a license, as authorized by THSC Chapter 248A, if DADS has reasonable cause to believe that the conduct of a license holder creates an immediate danger to a minor served at the center or the public's health and safety.

(1) If DADS issues an order for emergency suspension of the center's license, DADS provides immediate notice to the controlling person, administrator, or alternate administrator of the center by personal service, facsimile transmission, or registered or certified mail. The notice includes:

(A) the action taken;

(B) legal grounds for the action;

(C) the procedure governing appeal of the action; and

(D) the effective date of the order.

(2) An order for emergency licensure suspension goes into effect immediately.

(3) On written request of a license holder, DADS conducts a hearing not earlier than the 10th day or later then the 30th day after the date DADS receives the hearing request to determine if the emergency suspension should be continued, modified, or rescinded.

(4) The hearing and any appeal are governed by DADS rules for a contested case hearing and by Chapter 2001, Texas Government Code.

(b) If DADS suspends a license, the suspension remains in effect until DADS determines that the reason for an emergency licensure suspension no longer exists. An emergency licensure suspension may last no longer than the term of the license. DADS conducts an inspection of the center before making a determination to recommend cancellation of a suspension. During the suspension, the license holder must return the license to DADS.

 

§15.1404 License Revocation

 

(a) DADS may revoke a center's license for:

(1) a violation of THSC Chapter 248A or standard in this chapter committed by the license holder, applicant, or a person listed on the application;

(2) an intentional or negligent act by a center or an employee of a center that DADS determines significantly affects the health and safety of a minor served at a center;

(3) use of drugs or intoxicating liquors to an extent that affects the license holder's or applicant's professional competence;

(4) a felony conviction, including a finding or verdict of guilty, an admission of guilt, or a plea of nolo contendere, in Texas or another state of any person required by this chapter to undergo a background and criminal history check;

(5) fraudulent acts, including acts relating to Medicaid fraud and obtaining or attempting to obtain a license by fraud or deception committed by any person listed on the application;

(6) license revocation, suspension, or other disciplinary action taken in Texas or another state against the license holder or any person listed in the application;

(7) criteria described in Chapter 99 of this title (relating to Denial or Refusal of License) that applies to any person required by this chapter to undergo a background and criminal history check;

(8) aiding, abetting, or permitting a violation described in paragraph (1) of this subsection about which a person listed on the application had or should have had knowledge;

(9) a license holder or applicant's failure to provide the required information, facts, or references;

(10) a license holder or applicant who knowingly:

(A) submits false or intentionally misleading statements to DADS on an application;

(B) uses subterfuge or other evasive means of filing an application;

(C) engages in subterfuge or other evasive means of filing an application on behalf of another who is unqualified for licensure; or

(D) conceals a material fact on an application;

(11) a person listed on the application committing fraud; or

(12) a person listed on the application failing to pay the following fees, taxes, and assessments when due:

(A) licensing fees as described in §15.112 of this chapter (relating to Licensing Fees);

(B) plan review fees as described in §15.113 of this chapter (relating to Plan Review Fees); and

(C) franchise taxes, if applicable.

(b) DADS may revoke a license simultaneously with any other enforcement action available to DADS.

(c) DADS notifies the license holder by personal service, facsimile transmission, registered or certified mail of DADS intent to revoke the license, including the facts or conduct alleged to warrant the revocation, and sends a copy to the center. The license holder has an opportunity to show compliance with all requirements of the law to retain the license, as provided in §15.1407 of this subchapter (relating to Opportunity to Show Compliance). If the license holder requests an opportunity to show compliance, DADS gives the license holder a written affirmation or reversal of the proposed action.

(d) DADS notifies a license holder by personal service, facsimile transmission, or by registered or certified mail of DADS revocation of the center license, and sends a copy to the center. The license holder has 20 days after receipt of the notice to request a hearing in accordance with the Health and Human Services Commission's formal hearing procedures in 1 TAC Chapter 357, Subchapter I (relating to Hearings Under the Administrative Procedure Act), and DADS formal hearing procedures in Chapter 91 of this title (relating to Hearings Under the Administrative Procedure Act). The revocation takes effect when the deadline for appeal of the revocation expires, unless the license holder appeals the revocation.

(e) If a license holder appeals, the license remains valid until all appeals are final, unless the license expires without a timely application for renewal submitted to DADS. The license holder must continue to submit a renewal application in accordance with §15.106 of this chapter (relating to Renewal Application Procedures and Issuance) until the action to revoke the license is completed. However, DADS does not renew the license until it determines the reason for the proposed action no longer exists.

(f) If a license holder appeals, the enforcement action takes effect when all appeals are final and the proposed enforcement action is upheld. Upon revocation, the license must be returned to DADS. If the license holder wins the appeal, DADS does not take the proposed action.

 

§15.1405 Probation

 

If DADS finds that a center is in repeated noncompliance with THSC Chapter 248A, this chapter or a plan of correction, but the noncompliance does not endanger a minor served at a center or the public health and safety, DADS may schedule the center for probation rather than suspending or revoking the center's license.

(1) DADS provides notice to the license holder of the probation and the items of noncompliance not later than the 10th day before the date the probation period begins.

(2) DADS designates a period of not less than 30 days during which the center remains on probation. During the probation period, the center must correct the items that were in noncompliance and report the corrections to DADS for approval.

(3) DADS may suspend or revoke the license of a center that does not correct items that were in noncompliance or does not comply with THSC Chapter 248A or this chapter within the applicable probation period.

 

§15.1406 Injunctive Relief or Civil Penalties

 

(a) DADS may petition a district court for a temporary restraining order against a center to restrain a continuing violation of THSC Chapter 248A or standard in this chapter if DADS finds that the violation creates an immediate threat to the health and safety of minors served at a center.

(b) A district court, on petition of DADS, and on a finding of the court that a person is violating THSC Chapter 248A or a standard in this chapter, may by injunction:

(1) prohibit the person from continuing the violation;

(2) restrain or prevent the establishment or operation of a center without a license under THSC Chapter 248A; or

(3) grant any other injunctive relief warranted by the facts.

(c) DADS may request the attorney general to institute and conduct a suit authorized by this section.

(d) DADS may recover reasonable expenses incurred in obtaining relief under this section, including court costs, reasonable attorney's fees, investigation costs, witness fees, and deposition expenses.

(e) Venue for a suit brought under this section is in the county in which the center is located or in Travis County.

(f) If DADS determines that a violation of THSC Chapter 248A or a standard in this chapter threatens the health and safety of a minor served at the center, DADS may seek, against the person who violates THSC Chapter 248A, the requirements in this chapter, or fails to comply with a corrective action plan submitted in accordance with this chapter, a civil penalty of not more than $500 for each violation.

(1) Each day a violation continues constitutes a separate violation for the purpose of this section.

(2) DADS may request the attorney general to sue to collect the penalty. DADS may recover reasonable expenses incurred in obtaining relief under this section, including court costs, reasonable attorney fees, investigation costs, witness fees, and deposition expenses.

 

§15.1407 Opportunity to Show Compliance

 

(a) Before revocation or suspension of a center's license or denial of an application for the renewal of a center's license, DADS gives the license holder:

(1) a notice by personal service, facsimile transmission, or by registered or certified mail of the facts or conduct alleged to warrant the proposed action, with a copy sent to the center; and

(2) an opportunity to show compliance with all requirements of law to retain the license by sending DADS a written request. The request must:

(A) be postmarked no later than 10 days after the date of DADS notice and be received in DADS office no later than 10 days after the date of the postmark; and

(B) contain specific documentation refuting DADS allegations.

(b) DADS limits its review to the documentation submitted by the license holder and information DADS used as the basis for its proposed action. A license holder or center representative may not attend DADS meeting to review the opportunity to show compliance documents. DADS gives a license holder a written affirmation or reversal of the proposed action.

(c) After an opportunity to show compliance, DADS sends a license holder a written notice that:

(1) informs the license holder of DADS decision; and

(2) provides the license holder with an opportunity to appeal DADS decision through a formal hearing process, if DADS affirms the proposed action.

 

§15.1408 Administrative Penalties

 

(a) Assessing penalties. DADS may assess an administrative penalty against a person who violates:

(1) THSC Chapter 248A; or

(2) a provision in this chapter for which a penalty may be assessed.

(b) Criteria for assessing penalties. DADS assesses administrative penalties in accordance with the schedule of appropriate and graduated penalties established in this section. The schedule of appropriate and graduated penalties for each violation is based on the following criteria:

(1) the seriousness of the violation, including the nature, circumstances, extent, and gravity of the violation;

(2) the threat to the health or safety caused by the violation;

(3) any previous violations;

(4) the amount necessary to deter future violations;

(5) efforts made by the violator to correct the violation; and

(6) any other matters that justice may require.

(c) Penalty calculation and assessment. The amount of the penalty may not exceed $500 for each violation. Each day a violation continues or occurs is a separate violation for purposes of imposing a penalty.

(d) Schedule of appropriate and graduated penalties.

(e) The penalty range for a Severity Level A violation is $400 - $500 per violation.

(f) A Severity Level A violation is a violation that results in serious harm to or death of a minor.

(g) DADS may assess a separate Severity Level A administrative penalty for each of the rules listed in the table in subsection (p) of this section.

(h) The penalty range for a Severity Level B violation is $300 - $400 per violation.

(i) A Severity Level B violation constitutes a serious threat to the health or safety of a minor.

(j) DADS may assess a separate Severity Level B administrative penalty for each of the rules listed in the table in subsection (p) of this section.

(k) The penalty range for a Severity Level C violation is $200 - $300 per violation.

(l) A Severity Level C violation substantially limits the center's capacity to provide care.

(m) DADS may assess a separate Severity Level C administrative penalty for each of the rules listed in the table in subsection (p) of this section.

(n) The penalty range for a Severity Level D violation is $100 - $200 per violation.

(o) A Severity Level D violation has or had minimal or no health or safety significance.

(p) DADS may assess a separate Severity Level D administrative penalty for each of the rules listed in the following table.

Rule Cite Subject Matter Severity Level
A B C D
§15.101(c) A center may not be operated on the same premises as other licensed facilities     X X
§15.101(e) Actual census must not exceed capacity authorized by DADS X X X  
§15.108(a) A license is not assignable or transferrable     X X
§15.109(a) Center capacity must not be increased without approval from DADS X X X  
§15.117 A license may not be altered     X X
§15.119 Notification procedures for reporting a change in administration and management       X
§15.120 Notification procedures for reporting a change in contact information       X
§15.121 Notification procedures for reporting a change in operating hours       X
§15.122 Notification procedures for reporting a change in business "name       X
§15.201(a)(1)-(2) separate penalties Adoption and enforcement of a policy for operating hours X X X  
§15.201(c)(1)-(2) separate penalties Providing information on how to contact the person in charge if the center is closed during operating hours   X X X
§15.202(c)(1)-(5) Requirements for when a center suspends operations for a scheduled closing   X X  
§15.202(c)(6)-(9) Documentation and notice requirements for when a center suspends operations for a scheduled closing     X X
§15.202(d)(1)-(5) separate penalties Requirements for when a center suspends operations for an unscheduled closing   X X  
§15.202(d)(6)-(9) Documentation and notice requirements for when a center suspends operations for an unscheduled closing     X X
§15.202(e) Requirements for when a center must close with less than 15 days' notice   X X  
§15.203(a) Requirement to have the financial ability to carry out center functions   X X  
§15.203(b) Requirement to make all business records available to DADS       X
§15.203(c) Requirements for maintaining and correcting business records     X X
§15.204 Adoption and enforcement of policy for billing and insurance claims     X X
§15.205(a) Obtain annual inspection from local fire marshal and maintain documentation   X X X
§15.205(b) Requirement to plan, conduct and document fire drills once a month   X X X
§15.205(c)(1)-(2), (4) separate penalties Requirement for the administrator and nursing director to review and evaluate the center's fire drill plan and maintain documentation of fire drill plan requirements   X X X
§15.205(c)(3) Requirement for the administrator and nursing director to review and correct any problems that occurred during a fire drill   X X X
§15.205(d) Requirement to have a working telephone in each building of the center     X X
§15.205(e)(1)-(2) Required emergency contact information posted near telephones     X X
§15.205(f) Adoption and enforcement of a policy for a minor's medical emergency X X X  
§15.205(f)(1)(A)-(C) separate penalties Requirements for a minor's emergency plan X X X  
§15.205(f)(2)-(4) separate penalties Training and notification procedures for a minor's medical emergency X X X  
§15.205(g) Procedures for transporting a minor to an emergency medical facility   X X  
§15.205(h) Requirements for a medical emergency transfer form X X X  
§15.205(i) Requirements to maintain a first aid kit and automated external defibrillator   X X X
§15.205(j)(1)-(2), (4) separate penalties Adoption and enforcement of policies and procedures for verification and monitoring of visitors; verification and supervision of visitors X X X  
§15.205(j)(3), (5) Documentation of verification of visitors   X X X
§15.205(k)(1)-(2) separate penalties Adoption and enforcement of policies and procedures for releasing minors X X X  
§15.205(l)(1)-(4) separate penalties Adoption and enforcement of a policy for ensuring minors are not left unattended at the center X X    
§15.205(m) Requirements for visual checks at the center     X X
§15.205(n) Requirement to meet LSC and building requirements in this chapter X X    
§15.205(o)(1) Use of alcohol-based hand rub dispensers at the center in compliance with state or local codes     X X
§15.205(o)(2), (4) separate penalties Installation of alcohol-based hand rub dispensers minimize leaks and spills and is compliance with LSC   X X  
§15.205(o)(3) Installation of alcohol-based hand rub dispensers out of reach of minors X X X  
§15.205(p)(1)-(4) separate penalties Requirements for center to be free from health and safety hazards X X    
§15.205(q)(1) Requirement to provide a copy of policy to staff, adult minors and parents of weapons-free location   X    
§15.205(q)(2) Requirements to provide a copy of policy to requestors     X X
§15.205(r) Requirement to post a notice for a weapons-free location     X X
§15.206(a)(1)-(2) separate penalties Implementation of a person-centered direction and guidance program   X X  
§15.206(a)(3) Providing daily notification to a parent of a minor's behavior     X X
§15.206(b) Requirements for strategies and techniques to encourage self-esteem, self-control and self-direction   X X  
§15.206(c) Requirements for direction and guidance used in a center   X X  
§15.206(d)(1)-(5) separate penalties Requirements for the use of timeout in a center X X    
§15.206(e)(1)-(10) separate penalties Prohibited forms of discipline in a center X X    
§15.206(f)(1)-(2) separate penalties Establishment and responsibilities of a person-centered direction and guidance committee   X X X
§15.206(g) Personnel requirements for the person-centered direction and guidance committee     X X
§15.206(h) Documentation requirements to support attempted inclusion of parent or parent committee in the person-centered direction and guidance committee     X X
§15.206(i) Adoption and enforcement of policy for the person-centered direction and guidance committee     X X
§15.206(j) Requirements to provide staff and parents with a copy of the person-centered direction and guidance policy and maintain documentation of receipt.   X X X
§15.207(a)(1)-(4) separate penalties Acceptable circumstance for use of restraint X X    
§15.207(b)(1)-(6) separate penalties Acceptable types of restraint X X    
§15.207(c) Adoption and enforcement of a policy for the use of restraints X X    
§15.207(d) Prohibition of the use of physician's orders written for the use of protective devices on an as needed basis X X    
§15.207(e)(1)-(3) separate penalties Requirements for physician's orders for restraints X X    
§15.207(f)(1)-(3) separate penalties Responsibilities of an RN for the use of restraints X X    
§15.207(g) Oral and written notification of right to discontinue use of restraints   X X  
§15.207(h) Training of staff before use of restraints X X    
§15.207(i)(1)-(4)(A)-(D), (7) separate penalties Requirements for the release of a minor for reassessment and removal and replacement of a restraint and notification to physician X X    
§15.207(j)(1)-(4) separate penalties Requirements for restraining a minor for a behavioral emergency X X    
§15.207(j)(5)(A)-(E)(i)-(ix) separate penalties Documentation requirements for restraining a minor for a behavioral emergency   X X  
§15.207(k)(1)-(6) separate penalties Prohibited types of restraint X X    
§15.207(l)(1)-(5) separate penalties Prohibited circumstances for restraint X X    
§15.207(m) Requirement to maintain documentation   X X  
§15.208(a)-(f) separate penalties Equipment, Devices and Supplies   X X X
§15.209(a)-(b)(1)-(3)(A)-(C), (b)(4)-(5), (c)(1)-(3)(A)-(H), (c)(4)-(5)(A)-(E), (c)(6)(A)-(D), (c)(7)(A)-(B), (c)(8)(A)-(C), (d)(1)-(3), (e)(1)-(4) separate penalties Emergency Preparedness and Response Planning Requirements X X X X
§15.210(a)-(b)(1)-(7) separate penalties Requirements for maintaining a sanitary environment   X X X
§15.210(c) Develop a written work plan for housekeeping operations     X X
§15.210(d)-(e)(1)-(4) separate penalties Maintain a safe and clean environment and procedures for cleaning products and equipment   X X X
§15.210(f) Maintain a sufficient supply of clean linens and laundry service     X X
§15.210(g)(1)-(11) separate penalties Requirements for handling, storage and processing of linens   X X  
§15.211(a)(1)-(6) separate penalties Establish and maintain an Infection Prevention and Control Program X X X  
§15.211(b) Provide IPCP information to certain individuals   X X  
§15.211(c)(1)-(d)(1)(A)-(B) separate penalties Policies and procedures for admissions and attendance of minors at risk for infection and risk to others and preventing the spread of infection X X X  
§15.211(d)(1)(C) Procedures for preventing the spread of infection--notifications, transportation and return of a minor X X X  
§15.211(d)(2)-(3) separate penalties Prohibition of individuals with infectious diseases from contact with minors or food and policy for individuals to wash hands X X X  
§15.211(d)(4) Requirement to report minor's with reportable diseases and implement control procedures   X X  
§15.211(e)-(g) separate penalties Labeling and assignment of sleeping equipment, supplies for hand washing, and policies and procedures for the control of communicable diseases   X X X
§15.211(h)(1)-(3) separate penalties Policies and procedures for control of a public health disaster X X X  
§15.211(i)(1)-(3) separate penalties Annual review to assess center's risk classification X X X  
§15.211(j)(1)(A)-(E) separate penalties Policies and procedures for protecting a minor against vaccine preventable diseases X X X  
§15.211(j)(1)(F)-(H) separate penalties Prohibition of discrimination, requirements for disciplinary action and documentation relating to protecting minors against vaccine preventable diseases     X X
§15.211(j)(2)(A)-(B) separate penalties Policy for exempting individuals from vaccine requirements and prohibition of exempt individuals from having contact with minors   X X X
§15.211(k) Policies and procedures to identify individuals at risk of contacting blood or infectious materials X X X  
§15.211(l)(1)-(3) separate penalties Compliance with statute, regulations and center policies related to infection prevention and control X X X  
§15.301(a)-(h) separate penalties License holder responsibilities   X X X
§15.301(i)-(j) separate penalties License holder responsibilities for documentation and notifications to DADS     X X
§15.302(a)-(b) separate penalties Organizational structure and lines of authority     X X
§15.303(a)-(j) separate penalties Administrator and alternate administrator qualifications and conditions   X X  
§15.304(a)-(b)(1)-(19) separate penalties Administrator responsibilities   X X  
§15.305(b)-(d)(1)-(8) separate penalties Initial training requirements in administration   X X  
§15.305(e)(1)-(3), (f)(1)-(2), (g) separate penalties Initial training requirements in administration--structure and provision of training, documentation of training, prohibition of applying the pre-licensing program training     X X
§15.306(a)-(b) separate penalties Continuing training requirements in administration   X X  
§15.306(c)-(d) separate penalties Continuing training requirements in administration--documentation of training and prohibition of applying the pre-licensing program training     X X
§15.307(a)-(d) separate penalties Medical director qualifications and conditions   X X  
§15.308(a)(1)-(11) separate penalties Medical director responsibilities   X X  
§15.309(a)-(c)(1)-(6) separate penalties Nursing director and alternate nursing director qualifications and conditions X X X  
§15.310(a)(1)-(13) separate penalties Nursing director responsibilities and supervision responsibilities X X X  
§15.311(a) Prohibition of solicitation     X X
§15.401 Nursing Staff X X X  
§15.402 RN qualifications X X X  
§15.403(a)(1)-(10) separate penalties RN responsibilities X X X  
§15.404 LVN qualifications X X X  
§15.405(a)-(b)(1)-(6) separate penalties LVN responsibilities X X X  
§15.406(a)(1)-(3) separate penalties Student nurses X X X  
§15.408 Delegation of nursing tasks by RN to unlicensed personnel and tasks not requiring delegation X X X  
§15.409 Direct care staff qualifications X X X  
§15.410(a) Nursing services staff ratios X X X  
§15.410(c)(1)-(2) separate penalties Documentation requirements for nursing services staff ratios     X X
§15.411(a)(1)-(9), (b)-(e) separate penalties Rehabilitative and ancillary professional staff and qualifications X X X  
§15.412 Peer Review X X X  
§15.413(a)(1)-(6)(A)-(C) separate penalties Requirements for the use of contractors X X X  
§15.413(b)-(c) separate penalties Documentation requirements for the use of contractors   X X  
§15.414(a)-(c) separate penalties Use of volunteers X X X  
§15.415(a)-(b)(1)-(7)(A)-(F), (b)(8)-(13) separate penalties Staffing policies for staff orientation, development, and training X X X  
§15.415(c)(1)-(2)(A)-(F) separate penalties Policies and procedures for parent orientation and training   X X  
§15.416(a)(1)-(8), (b)(1)-(2) separate penalties Staff development program requirements   X X X
§15.416(c)-(d) separate penalties Documentation and record retention requirements for staff development program     X X
§15.417(a)(1)-(8)(A)-(B), (b) separate penalties Personnel record requirements     X X
§15.418(b)(1)-(3), (c)(1), (3)-(4) separate penalties Criminal history checks, nurse aide registry, and employee misconduct registry requirements X X X  
§15.418(c)(2), (d) separate penalties Notification and documentation requirements for criminal history checks, nurse aide registry, and employee misconduct registry requirements       X
§15.419(a)-(d) separate penalties Drug testing policy     X X
§15.501 Basic services X X    
§15.502(a)-(d) separate penalties Medical services X X    
§15.503(a)-(c)(1)-(5) separate penalties Nursing services X X    
§15.504(a)-(d)(1)-(4), (e)(1)-(5), separate penalties Psychosocial treatment and services X X    
§15.504(f)(1)-(5) separate penalties Participation in center activities by psychosocial treatment and services providers   X X  
§15.505(a)-(c)(1)-(2), (d) separate penalties Social services     X X
§15.506(a)-(b) separate penalties Rehabilitative services X X    
§15.506(c)(1)-(2) separate penalties Participation in center activities by rehabilitative services providers   X X  
§15.507(a)-(c)(1)-(4) separate penalties Functional developmental services   X X  
§15.508(a)-(e)(1)-(5), (6)(A)-(D) separate penalties Educational developmental services     X X
§15.509(a)-(e)(1)-(9) separate penalties Parent training   X X X
§15.510(a)-(b) separate penalties Nutritional counseling   X X  
§15.511(a), (g), (h) separate penalties Requirements for the provision of meals X X X  
§15.511(b)-(f) separate penalties Dietitian requirements   X X  
§15.511(i)-(l)(1)-(4) separate penalties Dietary services menus, record retention, table settings     X X
§15.511(m)-(o)(1)-(2), (p)(1)-(6), (q)(1)-(3), (r)-(w) separate penalties Requirements and responsibilities for scheduled meal and snack provisions, monitoring of food intake and purchasing, storing, preparation, and safe handling of food   X X X
§15.601(a)(1)-(5)-(b) separate penalties Admission criteria X X X  
§15.602(a)-(d)(1)-(16) separate penalties Pre-admission conference requirements X X X  
§15.603(a)-(d)(1)-(11)(A)-(F), (i) separate penalties Agreement and disclosure requirements   X X X
§15.603(e)-(h) separate penalties Signatures, record storage and updates     X X
§15.604(a)(1)-(13) separate penalties Admission procedures – interview requirements X X X  
§15.604(b)-(c) separate penalties Admission procedures - documentation and signatures   X X X
§15.605(a)-(f)(1)-(2) separate penalties Initial and updated comprehensive assessment X X X  
§15.606(a)-(d), (f) separate penalties Interdisciplinary team requirements X X X  
§15.606(e) Interdisciplinary team members     X X
§15.607(a)(1)-(2), (b)(1)-(7), (c), (g)-(h), (l), (o) separate penalties Initial and updated plan of care requirements X X X  
§15.607(d)-(f), (i)-(k), (m)-(n) separate penalties Initial and updated plan of care requirements – signatures, documentation and communication   X X X
§15.608(a)-(e) separate penalties Transfer and discharge notification requirements   X X X
§15.701(a)-(b)(1)-(8) separate penalties Physician orders X X X  
§15.702(a)-(b)(1)-(5), (c)(1)-(2), (d)(1)-(2) separate penalties Receiving physician orders   X X X
§15.703(a)-(b)(1)-(4) separate penalties Pharmacist services X X    
§15.704(a)(1)-(5), (b)(1)-(7), (c)-(f) separate penalties Storage of medication X X    
§15.705(a)(1)-(8), (b)(1)-(5), (c)-(j)(1)-(10), (k) separate penalties Administration of medication X X    
§15.706 Laboratory services X X    
§15.707 Disposal of special or medical waste   X X  
§15.708 Disposal and destruction of pharmaceuticals   X X  
§15.801(a)(1)-(19) separate penalties Care policies X X X  
§15.802(a)(1)-(2), separate penalties Adoption and enforcement of written policies and procedures for coordination of services X X X  
§15.802(b) Documentation to demonstrate coordination   X X X
§15.802(c)(1)-(6)(A)-(B) separate penalties Responsibilities and requirements for coordination of services   X X X
§15.803(a)-(b)(1)-(3), (c)(1)-(3), (d)-(e)(1)-(3) separate penalties Census   X X X
§15.901(a)-(c)(1)-(18) separate penalties Rights and Responsibilities   X X  
§15.902(a)-(b) separate penalties Advance Directives X      
§15.903(b)-(g), (i) separate penalties Abuse, neglect and exploitation requirements X X X  
§15.903(h) Liability statement for staff related to reporting of abuse, neglect and exploitation     X X
§15.904(b)-(c)(1)-(4), (e), (f) separate penalties Requirements for investigations of complaints and grievances   X X  
§15.904(d) Requirement to maintain documentation of investigations of complaints and grievances     X X
§15.905(a)-(b) separate penalties Reporting of a minor's death     X X
§15.906(a)-(b) separate penalties Requirement to make inspection results available when requested       X
§15.1001(a)-(f)(1)-(7), (g)(1)-(18), (h) separate penalties Medical Records   X X X
§15.1002(a)-(d), (e)-(m) separate penalties Quality Assessment and Performance Improvement   X X X
§15.1003(a)-(c)(1)-(2) separate penalties Dissolution   X X X
§15.1004(a)(1)-(2) separate penalties Retention of records     X X
§15.1101(a)-(e)(1)-(18), (f)(1)-(3) separate penalties Transportation Services requirements X X X  
§15.1102(a)-(d)(1)-(9), (g)(1)-(3) separate penalties Transportation safety provisions X X X  
§15.1102(e)-(f) separate penalties Transportation safety provisions – postings near vehicle exits, policies for emergencies while on transport X X X  
§15.1204(d)-(i) separate penalties Requirements for fire safety X X    
§15.1208 Food preparation requirements X X X  
§15.1210(a)-(b) separate penalties Minor's personal belongings     X X
§15.1213 Locked areas   X X X
§15.1220(a)-(g) separate penalties Heating, ventilation, air conditioning   X X X
§15.1223 Signage       X
§15.1303(a)-(c) Cooperation with an inspection and visit       X
§15.1304(a)-(c) Staff requirements for an inspection       X

 

(q) Proposal of administrative penalties. If DADS assesses an administrative penalty, DADS provides a written notice of violation letter to a center. The notice includes:

 

(1) a brief summary of the violation;

(2) the amount of the proposed penalty; and

(3) a statement of the center's right to a formal administrative hearing on the occurrence of the violation, the amount of the penalty, or both the occurrence of the violation and the amount of the penalty.

(r) A center may accept DADS determination and recommended penalty not later than 20 days after the date on which the center receives the notice of violation letter, including the proposed penalty, or make a written request for a formal administrative hearing on the occurrence of the violation, the amount of the penalty, or both.

(1) If a center that is notified of a violation accepts DADS determination and recommended penalty or fails to respond to the notice, the DADS commissioner or designee issues an order approving the determination and ordering that the center pay the proposed penalty.

(2) If a center that is notified of a violation does not accept DADS determination, the center must submit to the Health and Human Services Commission a written request for a formal administrative hearing on the determination and must not pay the proposed penalty. Remittance of the penalty to DADS is deemed acceptance by the center of DADS determination, is final, and waives the center's right to a formal administrative hearing.

(3) If a center requests a formal administrative hearing, the hearing is held in accordance with THSC §248A.255.

 

§15.1409 Operation of a Center without a License

 

(a) If a person operates a center without a license issued in accordance with this chapter, the person is liable for a civil penalty of $500 for each day of violation.

(b) A person commits an offense if the person knowingly establishes or operates a center without the appropriate license in accordance with this chapter.

(c) An offense under this section is a Class B misdemeanor.

(d) Each day a violation continues constitutes a separate offense.

 

LSPPECC, Revisions

LSPPECC, 18-1, Revises §15.5 and §15.108, and Repeals §15.107

Effective March 21, 2018

The revised handbook sections implement new requirements for Prescribed Pediatric Extended Care Centers related to a change of ownership (CHOW).

§15.5, Definitions, adds definitions for “change of ownership,” “direct ownership interest,” “disclosable interest,” “indirect ownership interest” and “license holder,” and deletes the definition of “person with a disclosable interest.”

§15.107, Change of Ownership, is repealed and removed from the handbook.

§15.108, Change of Ownership License Application Procedures and Issuance, clarifies what constitutes a CHOW and adds language that describes situations in which HHSC may conduct a desk review when processing a CHOW instead of an on-site health inspection.

LSPPECC, 16-1, Revises §15.1, §15.5, §15.501, §15.1101, §15.1302 and adds §15.123

Effective September 28, 2016

 

The revised and new handbook sections implement new requirements for Prescribed Pediatric Extended Care Centers (PPECC).

§15.1 clarifies that an applicant for a PPECC license may not provide services until DADS issues a license.

§15.5 adds a definition of the term “license.”

§15.123 allows an applicant to obtain a temporary license to operate a PPECC while pending DADS review of the application for an initial license.

§15.501 and §15.1101 clarify that a parent is not required to accompany a minor during the provision of services or during transportation of a minor to and from the PPECC.

§15.1302 corrects a statutory reference related to the investigation of abuse, neglect, and exploitation in a PPECC.

 

LSPPECC, 14-0, New Handbook

Revision 14-0; Effective September 1, 2014

This handbook contains rules for the licensing and regulation of prescribed pediatric extended care centers (PPECCs) in Texas. A PPECC provides services to individuals younger than age 21 who are medically and technologically dependent.

The rules contained in this handbook were effective September 1, 2014, and the handbook became available online November 13, 2014.

LSPPECC, Contact

For information about the Licensing Standards for Prescribed Pediatric Extended Care Centers Handbook, email PPECC@hhsc.state.tx.us

For technical or accessibility issues with this handbook, email: handbookfeedback@hhsc.state.tx.us