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.