Texas State Nursing Home Administrator Test

What are the plan fees associated with an Alzheimer's certification?

$550 in addition to the fees specified related to other fees which are charged to Alzheimer's facilities.

In facilities licensed on or after April 2, 2018, what is required in attics for maintenance?

(1) A facility must provide attic access for building maintenance and inspection. (2) A facility must provide illumination and a safe platform in the attic at all attic access locations.

What condition must the floors, walls, and ceiling be kept in?

(1) Floors of the facility must be level, smooth, and free of any irregularities that might affect safety. (2) Walls and ceilings not specifically described elsewhere in this chapter must be cleanable, maintained attractively, and in good repair. (3) Walls and floors must be kept free of cracks. The joint between the walls and floors is to be maintained so as to be free of spaces that might harbor insects, rodents, or vermin.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the requirements for capacity in resident bedrooms?

(1) The maximum room capacity must be four residents. (2) No more than 25% of the total licensed beds may be in bedrooms with more than two beds each.

How can the facility assure accuracy in service delivery of drugs?

A facility must provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident.

What does TX DHS say about availability of resident records?

(1) upon an oral or written request to the facility, to access all records pertaining to the resident, including clinical records, within 24 hours (excluding weekends and holidays); and (2) after receipt of the resident's records for inspection, to purchase photocopies of all or any portion of the records, at a cost not to exceed the community standard, upon request and two workdays advance notice to the facility.

What other conditions may be required for a staffing waiver approval?

(A) An additional licensed vocational nurse on day-shift duty when the registered nurse is absent; (B) modification of nursing services operations; and (C) modification of the physical environment relating to nursing services.

When is consent to give a psychoactive medication valid until?

(A) Consent is withdrawn; or (B) the practitioner has discontinued the medication.

How many social workers are required for a 120 bed facility?

A facility with more than 120 beds must employ a qualified social worker on a full-time basis.

What is meant by the right to use the Telephone?

(A) The resident has the right to have reasonable access to the use of a telephone (other than a pay phone), where calls can be made without being overheard, and which can also be used for making calls to summon help in case of emergency. (B) The facility must permit residents to contract for private telephones at their own expense. The facility must not require private telephones to be connected to a central switchboard.

What is are situations where a change of ownership has NOT occurred?

(A) The substitution of the executor of a decedent's estate for a decedent is not the addition of a controlling person. (B) A conversion as described in Subchapter C of Chapter 10 of the Texas Business Organizations Code is not a change of ownership if no controlling person is added.

Comprehensive Care Plan includes?

(A) goal setting; (B) establishing priorities for management of care; (C) making decisions about specific measures to be used to resolve the resident's problems; and (D) assisting in the development of appropriate coping mechanisms.

For the building plan review, what must the HVAC documents include?

(A) sufficient details of HVAC systems and components to ensure a safe and properly operating installation, including HVAC layout; ducts; protection of duct inlets and outlets; combustion air; piping; exhausts; duct smoke detectors; and fire dampers; and (B) equipment types, sizes, and locations.

What must be on the pharmacy agreement?

(A) that the resident's pharmacy services be provided by a pharmacy on a 24-hour basis for emergency medications; and (B) that the resident's medications be delivered to the facility on a timely and reasonable basis.

Before issuing a license, DADs considers the background and qualifications of:

(A) the applicant or license holder; (B) a partner, officer, director, or managing employee of the applicant or license holder; (C) a person who owns or who controls the owner of the physical plant of a facility in which the nursing facility operates or is to operate; and (D) a controlling person with respect to the nursing facility for which a license or license renewal is requested.

In facilities licensed on or after April 2, 2018, what are the minimum dimensions for a medication preparation room?

A minimum area of 50 square feet. The minimum dimension allowed is 5'6".

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what may also be provided for in physical therapy facilities:

(A) treatment areas with space and equipment for therapies provided; (B) an exercise area; (C) storage for clean linen, supplies, and equipment used in therapy; (D) service sink located near therapy area; and (E) wheelchair and stretcher storage.

What must be maintained in the general trust fund records?

(A) valid trust fund trial balance; (B) petty cash logs; (C) bank statements for trust fund and operating accounts; (D) trust fund checkbook and register; (E) trust fund account monthly reconciliations; (F) trust fund bank account agreement form; (G) applied income ledgers; (H) applied income payment plans from DADS; (I) proof of surety bond; (J) written agreements (e.g., bed hold, private room); and (K) facility census, admission, discharge, and leave records.

When should the court order and letters of guardianship be requested on behalf of a resident?

(A) when a facility admits an individual; and (B) when the facility becomes aware a guardian is appointed after the facility admits a resident.

In facilities licensed on or after April 2, 2018, where can new facilities not be built?

A new facility may not be built in an area designated as a floodplain of 100 years or less.

What code does DHS adopt when it comes to education of pediatric residents?

19 TAC §89.1115 in accordance with the Education Code, §29.012.

Where can the disclosure of ownership requirements be found in the regulations?

42 Code of Federal Regulations, §420.206 and §455.104.

In facilities licensed on or after April 2, 2018, what are the requirements for the reading lights in the bedrooms?

A durable non-glare reading light with an opaque front panel securely anchored to the wall, integrally wired, must be provided above each resident bed. The switch for this reading light must be within reach of a resident in the bed.

What is required for Licensed nursing care of children?

A facility caring for children must have twenty-four hour a day on-site licensed nursing staff in numbers sufficient to provide safe care. For any facility with five or more children under 26 pounds, at least one nurse must be assigned solely to the care of those children.

When are surge-protectors allowed in a room?

A facility may use a listed and approved surge-protection device for equipment for which the manufacturer recommends surge protection.

What type of services are required for pediatric residents?

A facility must ensure pediatric residents receive services in accordance with the guidelines established by the Department of State Health Services' Texas Health Steps (THSteps). For Medicaid-eligible pediatric residents between the ages of six months and six years, blood screening for lead must be done in accordance with THSteps guidelines.

What policy must be established for all persons regardless of their payment source?

A facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services under the Medicaid State Plan for all individuals regardless of source of payment.

What policies on smoking should be employed by the facility?

A facility must formulate, adopt, and enforce policies regarding smoking, smoking areas, and smoking safety that also take into account non-smoking residents.

In facilities licensed on or after April 2, 2018, what facilities may be shared with a hospital? What is required?

A nursing facility may be operated together with a hospital and may share administration, food service, recreation, janitor service, and physical therapy facilities, but must have clearly identifiable physical separations, such as a separate wing or floor.

Is a facility required to offer vaccinations to residents?

A facility must offer vaccinations to residents in accordance with an immunization schedule adopted by the Advisory Committee on Immunization Practices of the CDC.

In facilities licensed on or after April 2, 2018, what are the required on each side of corridor smoke barrier doors?

A facility must provide an exit sign on each side of corridor smoke barrier doors, unless otherwise directed by HHSC.

Quality-of-care monitor

A registered nurse, pharmacist, or dietitian employed by HHSC who is trained and experienced in long-term care facility regulation, standards of practice in long-term care, and evaluation of resident care, and functions independently of HHSC Regulatory Services Division.

Quality measure report

A report that provides information derived from an MDS that provides a numeric value to quality indicators. This data is available to the public as part of the Nursing Home Quality Initiative (NHQI), and is intended to provide objective measures for consumers to make informed decisions about the quality of care in a nursing facility.

What does the Right to Form Resident Groups mean?

A resident has the right to organize and participate in resident groups in a facility.

How often should laundry staff wash their hands?

Facility staff must wash their hands both after handling soiled linen and before handling clean linen.

Disclosure interest

Five percent or more direct or indirect ownership interest in an applicant or license holder.

In facilities licensed on or after April 2, 2018, what are the requirements for grease traps?

Grease traps must be provided in compliance with local plumbing code or other nationally recognized plumbing code.

When would an application be delayed?

HHSC may pend action for up to six months on an application to give an applicant time to comply with licensure requirements imposed by HHSC; or for renewal of the license if the facility is subject to a proposed denial or pending licensure revocation action.

What is provided to citizen advocates during inspections?

HHSC provides to these organizations basic licensing information and requirements for the organizations' dissemination to their members whom they engage to attend the inspections.

When is a new clinical record required?

If the resident is a new admission or has been discharged for over 30 days.

In facilities licensed on or after April 2, 2018, what should fire extinguishers be protected from?

Impact or dislodgement.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what if there are no local building codes?

In the absence of a local building code, a nationally recognized building code must be used with regard to the construction integrity of the building. The Life Safety Code must be used for fire safety requirements.

Can the resident assessment information be released?

Information concerning a resident is confidential and a facility must not release information concerning a resident except as allowed by this chapter, including §19.407 and §19.1910(d).

NFPA 58

Liquefied Petroleum Gas Code, 2011 edition.

In facilities licensed on or after April 2, 2018, fire alarm system components must be _____.

Listed as compatible by a nationally recognized testing laboratory.

Goals

Long-term: general statements of desired outcomes. Short-term: measurable time-limited, expected results that provide the means to evaluate the resident's progress toward achieving long-term goals.

As a condition of continued licensure, a license holder must _____.

Maintain the right to possession of the facility as described in §19.204(b)(1).

In facilities licensed on or after April 2, 2018, what must be on the mechanical plans for an HVAC system?

Mechanical plans must bear a statement verifying that the systems are designed according to NFPA 90A and NFPA 99.

In facilities licensed before Sept. 11, 2003, in existing construction, can medications be maintained at auxiliary stations?

Medications and clinical records may be maintained at an auxiliary station.

How often should medications be ordered?

Medications must be ordered and reordered on a timely basis so that no resident misses a dose.

MDS

Minimum Data Set

In facilities licensed on or after April 2, 2018, what is the minimum size of the bedroom area?

Minimum bedroom area, excluding toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules, must be 100 square feet in single occupancy rooms and 80 square feet per bed in multi-bed rooms.

In facilities licensed on or after April 2, 2018, what are the minimum general lighting levels? Where are these levels measured?

Minimum illumination must be 20-foot candles in resident rooms, corridors, nurses' stations, dining rooms, lobbies, toilets, bathing facilities, laundries, stairways, and elevators. Illumination requirements for these areas apply to lighting throughout the space and are measured at approximately 30 inches above the floor anywhere in the room.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, where can the minimum lighting level guidelines be found?

Minimum lighting levels can be found in the Illuminating Engineering Society (IES) Lighting Handbook, latest edition.

In facilities licensed before Sept. 11, 2003, in existing construction, where should mirrors and dispensers be located to comply with ADA?

Mirrors and dispensers for persons with disabilities must be no higher than 40 inches above the floor.

In facilities licensed on or after April 2, 2018, what should happen to a central air supply system or a system serving a means of egress upon activation of a fire alarm?

Must automatically and immediately shut down upon activation of the fire alarm system, except when such a system is part of an engineered smoke-removal system approved by HHSC.

In facilities licensed on or after April 2, 2018 building insulation materials, unless sealed on all sides and edges in an approved manner, _____.

Must have a flame spread rating of 25 or less when tested according to ASTM E84 or UL 723.

Life Safety Code

NFPA 101

When can Schedule II drugs be prescribed verbally?

Only in an emergency.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what about outdoor recreational spaces?

Outdoor activity, recreational, and sitting spaces must be provided and appropriately designed, landscaped, and equipped. Some shaded or covered outside areas are needed. These areas must be designed to accommodate residents in wheelchairs.

In facilities licensed on or after April 2, 2018, what are the regulations on outdoor activity areas?

Outdoor activity, recreational, and sitting spaces must be provided and appropriately designed, landscaped, and equipped. Some shaded or covered outside areas are needed. These areas must be designed to accommodate residents in wheelchairs.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, where must outdoor air intakes be located?

Outdoor air intakes must be located as far as practical (but normally not less than 10 feet) from exhaust outlets or ventilating systems, combustion equipment stacks, medical vacuum systems, plumbing vent stacks, or from areas which may collect vehicular exhaust and other noxious fumes.

In facilities licensed on or after April 2, 2018, where must unsanitary areas, including janitor's closets, soiled linen areas, soiled workroom and utility areas, and soiled areas of laundry rooms, exhaust all room air?

Outdoors.

What is the purpose of an administrative policy and procedure manual?

Outlines the general operating policies and procedures of the facility.

Direct ownership interest

Ownership of equity in the capital, stock, or profits of, or a membership interest in, an applicant or license holder.

In facilities licensed on or after April 2, 2018, where should parking spots be located?

Parking spaces and drives must be at least 10' away from windows in bedrooms, dining areas, and living areas.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, where should spaces for stretchers and wheelchairs be located?

Parking spaces for stretchers and wheelchairs must be located out of the path of normal traffic.

In facilities licensed on or after April 2, 2018, what personal grooming areas are required?

Personal grooming area, such as a barber or beauty shop, must be a separate room with appropriate equipment provided for hair care and grooming needs of residents in facilities with over 60 beds.

What must the final building plans for a building conversion contain?

Plans and specifications for the conversion of a building not licensed by HHSC or rehabilitation of an existing building must be complete for all parts and features involved.

In facilities licensed on or after April 2, 2018, who is required to design the kitchen?

Plans must include a large-scale detailed kitchen layout designed by a registered or licensed dietitian or architect having knowledge in the design of food service operations.

PASRR

Preadmission Screening and Resident Review.

How should kitchen garbage and refuse be disposed of?

Properly. See also §19.318(j)-(l) for information concerning dietary physical plant.

In facilities licensed before Sept. 11, 2003, in existing construction, are residents permitted to have personal items?

Residents must be permitted and encouraged to have personal possessions in their rooms that do not interfere with their care, treatment, or well-being, or that of other residents.

What does the Statement of Resident rights say about privacy?

Right to Privacy, including privacy during visits and telephone calls.

What does the Statement of Resident rights say about visitors?

Right to Receive visitors

What does the Statement of Resident rights say about environmental conditions?

Right to Safe, decent and clean conditions

In facilities licensed before Sept. 11, 2003, in existing construction, what are the size requirements for the laundry area?

Room size, and number and type of appliances must provide efficient, sanitary, and timely laundry processing to meet the needs of the facility.

In facilities licensed on or after April 2, 2018, what type of ventilation is required for rooms with toilets?

Rooms with toilets must be provided with effective forced air exhaust ducted to the exterior to remove odors. Ducted manifold systems are recommended.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, blowers for central heating and cooling systems must be designed so that they may _____.

Run continuously.

Nursing care

Services provided by nursing personnel which include, but are not limited to, observation; promotion and maintenance of health; prevention of illness and disability; management of health care during acute and chronic phases of illness; guidance and counseling of individuals and families; and referral to physicians, other health care providers, and community resources when appropriate.

Management services

Services provided under contract between the owner of a facility and a person to provide for the operation of a facility, including administration, staffing, maintenance, or delivery of resident services. Management services do not include contracts solely for maintenance, laundry, or food service.

Care and treatment

Services required to maximize resident independence, personal choice, participation, health, self-care, psychosocial functioning and reasonable safety, all consistent with the preferences of the resident.

In facilities licensed on or after April 2, 2018, what finishes are required in food storage areas?

Shelves must be adjustable wire type. Walls and floors must have a nonabsorbent finish to provide a cleanable surface. No foods may be stored on the floor; dollies, racks, or pallets may be used to elevate foods not stored on shelving.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what is required for shower areas for residents?

Showers for wheelchair residents must not have curbs. Tub and shower bottoms must have a slip-resistant surface. Shower and tub enclosures, other than curtains, must be of tempered glass, plastic, and other safe materials.

How should soiled linen and clothing be handled and stored?

Soiled linen and clothing must be stored separately from clean linen and clothing. Soiled linen and clothing must be stored in well ventilated areas, and must not be permitted to accumulate in the facility. Soiled linen and clothing must be transported in accordance with procedures consistent with universal precautions. Bags or containers must not be reused to transport or store clean items.

Where can soiled linen NOT be kept?

Soiled linen must not be sorted, laundered, rinsed, or stored in bathrooms, resident rooms, corridors, kitchens, or food storage areas, except soiled linen and clothing which is not contaminated with blood may be rinsed in a resident's bathroom water closet.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required for soiled linen?

Soiled linen rooms must be provided.

In facilities licensed on or after April 2, 2018, what must be provided in corridor walls and resident room party walls? What is the minimum required?

Sound separation must be provided in corridor walls and resident room party walls. Provide a minimum Sound Transmission Class of 30 per ASTM E90.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, when should special provisions be made for the design of buildings?

Special provisions must be made in the design of buildings in regions where local experience shows loss of life or extensive damage to buildings resulting from hurricanes, tornadoes, earthquakes, or floods.

NFPA 96

Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations, 2011 edition.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, are steps allowed in interior ways of egress? What can be done?

Steps in interior ways of egress are prohibited. If changes of elevation are necessary within ways of egress, approved ramps with maximum slope of one unit of rise to 12 units of run must be used.

In facilities licensed on or after April 2, 2018, what storage space is required for the administrative area?

Storage and work area for office equipment and supplies must be provided and accessible to the staff using such items.

What should the conditions of the storage areas be?

Storage areas must be kept safe and free from accumulations of extraneous materials such as refuse, discarded furniture, and newspapers.

In facilities licensed on or after April 2, 2018, what must the stored fuel capacity be on generators?

Stored fuel capacity must be sufficient for not less than four hours of required generator operation.

Effective December 1, 2008, minimum standards of financial condition require the applicant or license holder to have _____.

Sufficient financial resources to satisfy obligations at the time they come due; and ensure at all times the delivery of essential care and services, such as nursing or dietary services, or utilities.

In facilities licensed on or after April 2, 2018, what code must be met for gas-fired heating equipment?

Systems using liquefied petroleum gas fuel must meet the requirements of the Railroad Commission of Texas and NFPA 58.

What must be told to residents and responsible parties upon admission about inspection reports?

That the inspection reports are available for review.

What is the responsibility of the facility for rehabilitative services covered by Medicaid?

That they are provided to a resident to evaluate or treat a function that has been impaired by illness or injury. Rehabilitative services must be provided with the expectation that the resident's functioning will improve measurably in 30 days.

APA

The Administrative Procedure Act, Texas Government Code, Chapter 2001.

ASME

The American Society of Mechanical Engineers, a developer of codes and standards associated with the art, science, and practice of mechanical engineering.

In buildings that were constructed or that received design approval or building permits before July 5, 2016, must comply with _____?

The Existing Health Care Occupancies chapter of NFPA 101. All other buildings covered by this section must comply with the New Health Care Occupancies chapter of NFPA 101.

Who should be in-charge of the Activities Programs?

The activities program must be directed by a qualified professional.

What must be included in a comprehensive care plan if the resident is under the age of 18?

The activities, supports and services that, when provided or facilitated by the facility, will enable the resident to live with a family.

What is meant by accuracy of assessments?

The assessment must accurately reflect the resident's status.

When should the Capacity Assessment for Self Care and Financial Management be completed?

The assessment will be completed when: (A) a facility determines that a guardian of the estate, or the person, or both, may be appropriate and a referral to a court for guardianship is anticipated; or (B) requested to do so by a court.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is the required staffing of the auxiliary stations, if they are needed?

The auxiliary station must be staffed by nursing personnel during all shifts.

What must the clinical record of a child resident contain?

The clinical record of a child must include a record of immunizations, blood screening for lead, and developmental assessment. The local school district's developmental assessment may be used if available. See §19.1934.

Completion date

The date an RN assessment coordinator signs an MDS assessment as complete.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, who must oversee the structural systems?

The design of structural systems must be done by or under the direction of a professional engineer who is currently licensed by the Texas State Board of Professional Engineers.

In the event that a resident is comatose or otherwise incapacitated, and the facility is unable to locate an authorized person to discuss Advance Directives, what must be done?

The facility is not required to provide written information regarding advance directives. The facility must document in the resident's clinical record its attempts to make a diligent search.

Who is in charge of enforcing the smoking policy?

The facility is responsible for informing residents, staff, visitors, and other affected parties of smoking policies through the distribution and posting of policies.

In facilities licensed on or after April 2, 2018, what must the facility comply with when it comes to ADA? Who should be notified of these plans?

The facility must comply with accessibility requirements for individuals with disabilities in the revised regulations for Title II and III of the Americans with Disabilities Act of 1990 at 28 CFR Part 35 and Part 36, also known as the 2010 ADA Standards for Accessible Design, and the TAS adopted by the Texas Department of Licensing and Regulation (TDLR) at 16 TAC Chapter 68. A facility must register plans for new construction, substantial renovations, modifications, and alterations with TDLR, Attn: Elimination of Architectural Barriers Program, and comply with the TAS.

What does TX DHS say about discrimination in care?

The facility must comply with all applicable provisions of the Human Resources Code, Title 6, Chapter 102. An individual may not be denied appropriate care on the basis of his race, religion, color, national origin, sex, age, handicap, marital status, or source of payment.

Who is qualified to maintain the sprinkler alarm system?

The facility must contract with a company that is registered by the State Fire Marshal's Office to execute the program.

What policies against staff mistreatment must be implemented?

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

What must be documented at the time of resident record destruction?

The facility must document the following for each record destroyed: (1) resident name; (2) medical record number, if used; (3) social security number, Medicare/Medicaid number, or the date of birth; and (4) date and signature of person carrying out disposal.

What must be documented in regard to Advance Directive information?

The facility must document the oral discussion and the provision of the written information in the resident's clinical record. The facility must document in the resident's clinical record whether or not the resident has executed an advance directive.

For how many hours must a qualified dietitian be employed?

The facility must employ a qualified dietitian either full-time, part-time, or on a consultant basis.

What should be done by the facility to test smoke alarm system components?

The facility must ensure smoke dampers are inspected and tested in accordance with NFPA 101.

What is required for prevention of Accidents?

The facility must ensure that: (A) the resident environment remains as free of accident hazards as possible; and (B) each resident receives adequate supervision and assistive devices to prevent accidents.

How often should emergency lighting be tested?

The facility must ensure the condition and proper operation of all emergency lighting is inspected and tested at least once every week.

What is the timeline for processing the assessments for a resident?

The facility must enter MDS data into the facility's assessment software within 7 days after completing the MDS and electronically transmit the MDS data to CMS within 14 days after completing the MDS.

In facilities licensed before Sept. 11, 2003, in existing construction, if a water shortage occurs, what is required?

The facility must establish procedures to ensure that water is available to essential areas when there is a loss of normal water supply;

What documentation is required for commingled Trust Funds?

The facility must maintain the forms and records in the same manner as the financial records of Medicaid residents.

What additional requirements are there for Medicaid-certified facilities when it comes to the maintaining of financial records?

The facility must make financial records and supporting documents available at any time within working hours and without prior notification for review by the Texas Department of Human Services, the Department of Health and Human Services, and the Texas attorney general's Medicaid Fraud Control Unit.

What are the requirements if the facility stores and transfers blood or blood products?

The facility must meet the conditions established for certification of hospitals that are contained in 42 Code of Federal Regulations, §482.27(d)(1)-(6).

Does the facility need a contract with the dietitian?

The facility must outline consultant services in a signed contract. This requirement does not apply to facilities which employ a qualified dietitian on their staff.

What type of risk assessment must be performed for construction?

The facility must perform a risk assessment in accordance with NFPA 99.

Who supervises the pharmaceutical services at a facility?

The facility must provide pharmaceutical services under the responsibility and direction of the consultant pharmacist and the director of nursing.

When must the deceased resident's funds be sent to DADs?

The facility must submit the funds to DADS within 180 days after the resident's death; and funds held by a facility may be monitored or reviewed by DADS or the Health and Human Services Commission, Office of Inspector General.

When is the form about a resident's death due at TX DHS?

The facility must submit to DHS a standard DHS form within 10 workdays after the last day of the month in which a resident death occurs.

How must the MDS data be transmitted to CMS?

The facility must transmit MDS data to CMS in the format specified by CMS and DADS.

When should a drug error or adverse drug reaction be reported? What else is required?

The facility nursing staff must report drug errors and adverse drug reactions to the resident's physician in a timely manner, as warranted by an assessment of the resident's condition, and record them in the resident's record. An incident report must be completed in accordance with §19.1923.

When does a facility ask for a new waiver for the following licensing period?

The facility requests a redetermination for a waiver from HHSC Long-Term Care Regulatory Services Division staff at the time the survey is scheduled. At other times if a request is made, HHSC staff may schedule a visit for waiver determination.

Who performs the Capacity Assessment for Self Care and Financial Management?

The facility social worker, with assistance from other professionals as requested by the social worker.

What laws about smoking must the facility comply with?

The facility's policies must comply with all applicable federal, state, and local laws and regulations.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, how should the fire alarm system be designed?

The fire alarm system must be designed so that whenever the general alarm is sounded by activation of any device (such as manual pull, smoke sensor, sprinkler, or kitchen range hood extinguisher), the following must occur automatically: (1) smoke and fire doors which are held open by approved devices must be released to close; (2) air handlers (air conditioning and/or heating distribution fans) serving three or more rooms or any means of egress must shut down immediately; (3) smoke dampers must close; and (4) the alarm-initiating-device location must be clearly indicated on the fire alarm control panel(s) and all auxiliary panels.

In facilities licensed on or after April 2, 2018, what else should be monitored by the fire alarm system?

The flow and tamper conditions of a sprinkler system.

What additional requirement must be in the transfer agreement between Medicaid-certified facilities and a hospital?

The hospitals must be approved for participation under the Medicare and Medicaid programs.

In facilities licensed on or after April 2, 2018, what installation requirements must be met for electrical systems?

The installation requirements of NFPA 70.

In facilities licensed before Sept. 11, 2003, in existing construction, what type of kitchen equipment is required?

The kitchen must have operational equipment for preparing and serving meals and for refrigerating and freezing of perishable foods, as well as equipment in, and/or adjacent to, the kitchen or dining area for producing ice.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, how should the kitchen range hood extinguisher be connected to the fire alarm system?

The kitchen range hood extinguisher must be interconnected with the fire alarm system. This interconnection may be a separate zone on the panel or combined with other initiating devices located in the same zone as the range hood is located.

In facilities licensed before Sept. 11, 2003, in existing construction, if the laundry area is located within the facility, what regulations must be followed?

The laundry, if located in the facility, must meet NFPA 101 requirements for separation and construction for hazardous areas.

What are the fees for an Initial and renewal license?

The license fee is $375 plus $15 for each unit of capacity or bed space for which a license is sought. The fee must be paid with each initial and renewal of license application.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what is important when it comes to air diffusers?

The location and design of air diffusers, registers, and return air grilles, must ensure that residents are not in harmful or excessive drafts in their normal usage of the room.

In facilities licensed on or after April 2, 2018, what is the minimum allowable dimension of a bedroom? What are the requirements?

The minimum allowable room dimension is ten feet. The room must be designed to provide at least 36 inches between beds and 24 inches between any bed and the adjacent wall.

In facilities licensed on or after April 2, 2018, what determines the minimum number of power receptacles in a bedroom?

The minimum number of power receptacles at a resident bed location shall be determined based on the risk assessment required by NFPA 99 and §19.300(i).

If AEM is being conducted in a resident's room, and another resident is moved into the room who has not yet consented to AEM, what must happen?

The monitoring must cease until the new resident, or the resident's guardian or legal representative, consents.

Texas Natural Resource Conservation Commission

The predecessor agency to TCEQ.

What may be considered in determining whether a facility has demonstrated improvement in quality of care?

The rapid response team may consider factors such as implementation of the team's recommendation or guidance.

In facilities licensed on or after April 2, 2018, in what instances are the required parking spots allowed to be reduced?

The ratio may be reduced slightly in areas convenient to public parking facilities.

When should the resident be certified for a Medicaid-Certified nursing facility?

The recipient's physician must certify the recipient's need for nursing facility care no later than 20 days after the recipient's admission to the facility.

What if the on-site laboratory chooses to refer specimens for testing to another laboratory?

The referral laboratory must be approved or licensed to test specimens in the appropriate specialties and/or subspecialties of services in accordance with 42 Code of Federal Regulations, Part 493.

Where should inspection and related reports be located within the facility for public use? How often should they be updated or kept?

The reports referenced must be maintained in a well-lighted, accessible location and must include: (A) a statement of the facility's compliance record that is updated at least bi-monthly and reflects at least one year's compliance record, in a form required by DADS; and (B) if a facility has been cited for a violation of residents' rights, a copy of the citation, which must remain in the reports until any regulatory action with respect to the violation is complete and DADS has determined that the facility is in full compliance with the applicable requirement.

All other work classified as reconstruction must meet, at a minimum _____?

The requirements for modification and renovation.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018 what codes must be followed unless otherwise specified?

The requirements of NFPA 101 and other applicable NFPA codes and standards referenced in NFPA 101 will apply unless otherwise noted or modified.

Except when required by law, what are the resident's rights in regard to release of personal and clinical records?

The resident may approve or refuse the release of personal and clinical records to any individual outside of the facility.

What right do residents have in regard to choice of pharmacy in License-only facilities?

The resident must be allowed complete freedom of choice to obtain pharmacy services from any pharmacy that is qualified to perform the services. A facility must not require residents to purchase pharmaceutical supplies or services from the facility itself or from any particular vendor. The resident has the right to be informed of prices before purchasing any pharmaceutical item or service from the facility, except in an emergency.

What rights do married couples have in the facility?

The resident must be ensured privacy for visits with his spouse. The resident has the right to share a room with his spouse when married residents live in the same facility and both spouses consent to the arrangement.

What does TX DHS say about residents rights when the resident is adjudged incompetent under the laws of the State of Texas by a court of competent jurisdiction?

The rights of the resident are exercised by the person appointed under Texas law to act on the resident's behalf.

Upon granting the Registered Nurse requirement waiver, what will the Secretary of HHS do?

The secretary provides notice of the waiver to the State and the protection and advocacy system in the state for individuals with mental illness and individuals with intellectual or developmental disabilities.

What is required if the facility provides its own laboratory services?

The services must meet the applicable conditions for coverage of the services furnished by laboratories specified in 42 Code of Federal Regulations, Part 493.

In facilities licensed before Sept. 11, 2003, in existing construction, what are important considerations when it comes to the size of each bedroom?

The width and length of bedrooms and the arrangement of furniture must assure appropriate resident circulation, especially in relation to emergency evacuation and to usual wheelchair movement.

What is the purpose of a validation team from HHSC?

They are a special team who conduct validation surveys or verify findings of previous licensure surveys.

What is required of Licensed-only facilities when it comes to dental care?

They must maintain a list of local dentists for residents who require one.

For Small House and Household Facilities, to request a waiver of a requirement, what must be submitted?

To request a waiver of a requirement, a facility must submit plans to HHSC according to §19.344 (Plan Review). The plans must include a statement from an architect identifying which requirements the facility is requesting to be waived and explaining how the waiver would contribute to the goals of resident-centered care.

In facilities licensed on or after April 2, 2018, what safety measures are required in bathrooms?

Tubs and showers must be provided with slip-proof bottoms. Lavatories and hand-washing facilities must be securely anchored to withstand an applied downward load of not less than 250 pounds on the front of the fixtures.

UL

UL LLC, formerly Underwriters' Laboratory.

What is required of licensed-only facilities in regard to managing resident financial affairs?

Upon written authorization of a resident, the facility may hold, safeguard, manage, and account for the personal funds of the resident deposited with the facility. The facility will act as a fiduciary agent if the facility holds, safeguards, and accounts for the resident's personal funds.

In facilities licensed on or after April 2, 2018, what type of ventilation is required in the kitchen?

Vapor removal from cooking equipment must be designed and installed in accordance with NFPA 101.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required for visual privacy?

Visual privacy such as cubicle curtains must be available for each resident in multi-bed rooms. Design for privacy must not restrict resident access to entry, lavatory, or toilet, nor may it restrict bed evacuation or obstruct sprinkler flow coverage.

What is the exception when it comes to confidentiality of resident records?

When release is required by: (1) transfer to another health care institution; (2) law or this chapter; (3) third party payment contract; or (4) the resident.

When can the AEM begin?

When the completed Request for Authorized Electronic Monitoring form and the Consent to Authorized Electronic Monitoring form, if applicable, have been given to the administrator or designee.

When should residents, relatives or responsible parties be notified of the closure of the facility if the closure is involuntary? What must be sent?

Whether orally or in writing, immediately on receiving notice of the closure.

When will a license will be issued or denied after a complete application has been received?

Within 30 days of the receipt of a complete application or within 30 days prior to the expiration date of the license.

When should the applicant submit requested information to DADs?

Within 30 days of the request.

Can relevant outside training be used to satisfy the in-service education requirement?

Yes

When the facility is requested to furnish the copies, can the facility charge HHSC? How much?

Yes; at the rate not to exceed the rate charged by HHSC for copies.

What does the preamble of the Statement of Resident Rights state?

You, the resident, do not give up any rights when you enter a nursing facility. The facility must encourage and assist you to fully exercise your rights. Any violation of these rights is against the law. It is against the law for any nursing facility employee to threaten, coerce, intimidate or retaliate against you for exercising your rights.

What are the required documents for new construction?

(1) Site plan documents (2) Foundation plan (3) Floor plans (4) Overall plan of the building including elevations (5) Roof plans (6) Building structure documents (7) Electrical and plumbing plans (8) Heating, cooling and ventilation (9) Fire detection, alarm and sprinkler system

What should be on Resident Financial Quarterly statements?

(1) The individual financial record must be available, through quarterly statements and on request, to the resident, legally authorized representative, representative payee, or responsible party. (2) The statement must reflect any resident's funds that the facility has deposited in an account as well as any resident's funds held by the facility in a petty cash account. (3) The statement must include at least the following--balance at the beginning of the statement period; total deposits and withdrawals; interest earned, if any; bank name and location of any account in which the resident's personal funds have been deposited; and ending balance.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what type of general safety hazard precautions must be observed in regard to windows?

(1) Windows must be designed to prevent residents from accidentally falling through the windows. (2) The proper use of safety glass must be adhered to in applicable locations and conditions.

What are considered Self-Reported Incidents when it comes to the Emergency Management and Control Plan?

(A) A facility must report a fire to DADS by calling 1-800-458-9858 immediately after the fire; and by submitting a completed DADS form titled "Fire Report for Long Term Care Facilities" within 15 calendar days after the fire. (B) A facility must report an emergency situation that caused the death or serious injury of a resident to DADS by calling 1-800-458-9858 immediately after the death or serious injury; and by submitting a completed DADS form titled "DADS Provider Investigation Report" within 5 working days after making the telephone report required by subparagraph (2)(A) of this subsection.

Restraint hold

(A) A manual method, except for physical guidance or prompting of brief duration, used to restrict free movement or normal functioning of all or a portion of a resident's body; or normal access by a resident to a portion of the resident's body. (B) Physical guidance or prompting of brief duration becomes a restraint if the resident resists the guidance or prompting.

When must nurses enter, or approve and sign, nurses' notes?

(A) At least monthly; and (B) at the time of any physical complaints, accidents, incidents, and change in condition or diagnosis, and progress. All of these situations must be promptly recorded as exceptions and included in the clinical record.

What if DADs finds something in the trust fund accounts worth further inspection?

(A) DADS may, as a result of monitoring, refer a facility to the Office of Inspector General (OIG) for an audit. (B) The facility must provide all records and other documents required to DADS upon request.

What additional training is required for facilities which have pediatric residents?

(A) Facility staff must be trained in the use of pediatric equipment and supplies, including emergency equipment and supplies. (B) Facility staff should receive annual continuing education dealing with pediatric issues, including child growth and development and pediatric assessment.

How and where are the posting about the Nursing staff required to be?

(A) In a clear and readable format; and (B) in a prominent place readily accessible to residents and visitors.

Where must the current week's menu be posted?

(A) In the dietary department, including therapeutic diet menus, so employees responsible for purchasing, preparing, and serving foods can use it; and (B) in a convenient location so the residents may see it.

Even though the death reports are confidential, what must be provided to potential residents upon request?

(A) Licensed facilities must make available historical statistics provided to them by DHS and must provide the statistics, if requested, to the applicants for admission or their representative. (B) DHS produces statistical information of official causes of death to determine patterns and trends of incidents of death among the elderly and in specific facilities and makes this information available to the public upon request.

What is included in a quality-of-care monitor assessment visit?

(A) Observation of the care and services provided to a resident; and (B) formal and informal interviews with residents, family members, facility staff, resident guests, volunteers, other regular staff, and resident representatives and advocates.

What are the overall requirements for resident beds?

(A) The facility must provide each resident with a separate bed of proper size and height for the safety and convenience of the resident; (B) a clean, comfortable mattress; (C) bedding appropriate to the weather and climate.

What falls under the category of Direction and Control in Emergency Management?

(A) The facility's plan must contain a section for direction and control that designates by name or title the emergency preparedness coordinator (EPC), who is the facility staff person with the authority to manage the facility'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 facility 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 facility 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 guiding residents to a safe location that is based on the type of emergency situation occurring and a facility's decision to either shelter-in-place or evacuate during an emergency situation.

What are the overall requirements for egress for resident rooms?

(A) They must have direct access to an exit corridor; (B) have at least one window to the outside; and (C) have a floor at or above grade level.

Who signs the respite plan of care?

(A) a licensed physician if the individual needing care requires medical care or treatment; or (B) the individual arranging the care if medical care or treatment is not required.

Where must the facility ensure the resident's right to privacy?

(A) accommodations as described in §19.1701; (B) medical treatment. The facility must provide privacy to each resident during examinations, treatment, case discussions, and consultations. Staff must treat these matters confidentially; (C) personal care; (D) access and visitation as described in §19.413; (E) governmental searches (F) the resident has the right to privacy for meetings with family and resident groups.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, besides those for illumination, which power sources must be arranged for automatic connection to the alternate power source, without delay?

(A) alarm systems including fire alarms activated by manual stations, water flow alarm devices of sprinkler systems, fire and smoke detecting systems, and alarms required for nonflammable medical gas systems if installed; (B) selected duplex receptacles including such areas as resident corridors, each bed location where patient care-related electrical appliances are utilized, nurse stations, and medication rooms including biologicals refrigerator; (C) all facility telephone equipment; and (D) paging or speaker systems if intended for communication during emergency. Radio transceivers where installed for emergency use must be capable of operating for at least one hour upon total failure of both normal and emergency power.

What must be in the HIV curriculum for staff development?

(A) modes of transmission; (B) methods of prevention; (C) behaviors related to substance abuse; (D) occupational precautions; (E) current laws and regulations concerning the rights of an acquired immune deficiency syndrome/HIV-infected individual; and (F) behaviors associated with HIV transmission which are in violation of Texas law.

For the building plan review, what must the sprinkler system documents include?

(A) plans and details of systems designed according to NFPA 13; and (B) electrical devices interconnected to the alarm system.

What must be documented about employee or contractor vaccines?

(A) require the facility to maintain a written or electronic record of each employee's, contractor's, or other individual's compliance with or exemption from the policy; and (B) include disciplinary actions the facility may take against an employee, contractor, or other individual with privileges to provide direct resident care who fails to comply with the policy.

When should the information on Advanced Directives be discussed with the resident or authorized person?

(A) within 14 days after the resident is admitted, orally review and discuss the information provided and the importance of planning for end-of-life care with the resident or with the appropriate person; and (B) annually and when there is a significant positive change or a significant deterioration in the resident's clinical condition, provide, review, and discuss the written information regarding advance directives with the resident or with the appropriate person.

What are the requirements of a clinical records supervisor?

(1) A registered health information administrator (RHIA) or registered health information technician (RHIT); or (2) An individual with experience appropriate to the scope and complexity of services performed as determined by the Texas Department of Human Services, and who receives consultation at a minimum of every 180 days from an RHIA or RHIT.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what type of storage is needed for maintenance usage? Where is it suggested to be located?

(1) A storage area for building and equipment maintenance supplies, tools, and parts must be provided. (2) A space for storage of yard maintenance equipment and supplies, including flammable liquids bulk storage, must be provided separate from the resident-occupied facility. (3) A maintenance and repair workshop of at least 120 square feet and equipment to support usual functions is recommended. (4) A suitable office or desk space for the maintenance staff is recommended, possibly located within the repair shop area, with space for catalogs, files, and records. It is suggested that these be part of a separate laundry building or area.

What are the various requirements applicable to nursing facilities?

(1) All nursing facilities must comply with division 3 of this subchapter (2) A nursing facility licensed before September 11, 2003, must comply with division 2. (3) A nursing facility licensed on or after September 11, 2003, but before April 2, 2018, must comply with division 5. (4) A nursing facility licensed on or after April 2, 2018, must comply with division 9. (5) A small house or household facility is a facility that is designed to provide a non-institutional environment to promote resident-centered care and that meets the requirements of §19.345. New construction of a small house or household facility must meet the requirements of §19.345.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what must be provided for in the occupational therapy area of the facility?

(1) An activities area with a sink or lavatory and facilities for collection of waste products prior to disposal must be provided. (2) Storage for supplies and equipment used in the therapy must be provided.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what utilities are required to be available to nursing staff?

(1) Clean utility room that must contain a work counter, sink with high-neck faucet with lever controls, and storage facilities and must be part of a system for storage and distribution of clean and sterile supply materials. (2) Soiled utility room must contain a water closet or equivalent flushing rim fixture, a sink large enough to submerge a bedpan with spray hose and high-neck faucet with lever controls, work counter, waste receptacle, and linen receptacle. These utility rooms must be part of a system for collection and cleaning or disposal of soiled utensils or materials. A separate hand-wash sink must be provided if the bedpan disinfecting sink cannot normally be used for hand-washing.

What are the required Eight Core Functions of Emergency Management?

(1) Direction and control (2) Warning (3) Communication (4) Sheltering Arrangements (5) Evacuation (6) Transportation (7) Health and Medical Needs (8) Resource Management

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, how should portable extinguishers be installed?

(1) Extinguishers must be installed on hangers or brackets supplied or mounted in approved cabinets. Recessed cabinets are required for extinguishers located in corridors. (2) Extinguishers installed under conditions where they are subject to physical damage must be protected from impact or dislodgement. (3) Extinguishers having a gross weight not exceeding 40 pounds must be installed so that the top of the extinguisher is not more than five feet above the floor. Extinguishers having a gross weight greater than 40 pounds must be installed so that the top of the extinguisher is not more than 3-1/2 feet above the floor. In no case may the clearance between the bottom of the extinguisher and the floor be less than four inches. (4) Portable extinguishers provided in hazardous rooms should be located as close as possible to the exit door opening and nearest the latch (knob) side.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what type of general safety hazard precautions must be observed to prevent tripping?

(1) Hazards such as sharp corners and edges and unexpected steps must be avoided. (2) Items such as drinking fountains, telephone booths, vending machines, and portable equipment must be located so as not to restrict corridor traffic or reduce corridor width. (3) Doors that normally stay open or are frequently used must not swing out into the corridor unless otherwise needed or required. Alcoves may be provided for doors that must swing outward toward a corridor or way of egress.

In facilities licensed on or after April 2, 2018, what are ways safety can be improved in the corridor?

(1) Hazards such as sharp corners, edges, or unexpected steps must be avoided. (2) Drinking fountains, telephone booths, vending machines, and portable equipment must not restrict corridor traffic or reduce corridor width. (3) Doors that normally stay open or are frequently used must not swing out into the corridor unless required by NFPA 101 or another provision of this subchapter. Alcoves must be provided for doors that must swing outward toward a corridor or way of egress (4) Thresholds and expansion joint covers must be flush with the floor surface to facilitate use of wheelchairs and carts.

If a resident group or family council exists, what must a facility do?

(1) Listen to and consider the views and act upon the grievances and recommendations of residents and families concerning proposed policy and operational decisions affecting resident care and life in the facility; (2) provide a resident group or family council with private space; (3) provide a designated staff person responsible for providing assistance and responding to written requests that result from resident group and family council meetings; and (4) allow staff or visitors to attend meetings at the resident group's or family council's invitation.

What does the Statement of Resident rights say about managing finances?

(1) Right to manage your own finances or to delegate that responsibility to another person; (2) Right to access money and property you have deposited with the facility and to an accounting of your money and property that are deposited with the facility and of all financial transactions made with or on behalf of you.

In facilities licensed before Sept. 11, 2003, in existing construction, what type of storage should be provided for maintenance use?

(1) The facility must provide storage for building equipment, supplies, tools, parts, and yard maintenance equipment. (2) Volatile liquids and supplies must not be kept within the main building housing residents. (3) All equipment requiring periodic maintenance, testing, and servicing must be reasonably accessible. Necessary equipment to conduct these services, such as ladders, specific tools, and keys, must be readily available on site.

What is rehabilitation work on a facility?

(1) The patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition must be classified as repair (2) The replacement in kind, strengthening, or upgrading of building elements, materials, equipment, or fixtures, that does not result in a reconfiguration of the building spaces within, must be classified as renovation (3) The reconfiguration of any space; the addition, relocation, or elimination of any door or window; the addition or elimination of load-bearing elements; the reconfiguration or extension of any system; or the installation of any additional equipment, must be classified as modification (4) The reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space; or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained, must be classified as reconstruction (5) A change in the purpose or level of activity within a facility that involves a change in application of the requirements of this subchapter must be classified as a change of use and must comply with division 9 of this subchapter. (6) A change in the use of a structure or portion of a structure must comply with division 9 of this subchapter. (7) An increase in the building area, aggregate floor area, building height, or number of stories of a structure must be classified as an addition and must comply with division 9 of this subchapter.

What must be documented after a risk assessment for construction?

(1) The risk assessment must follow and document the defined risk assessment procedure used. (2) The results of the assessment procedure must be documented and records retained. (3) A building system required by NFPA 99 shall be designed to meet the risk categories determined for each system as part of this assessment. At a minimum, any new systems or equipment must be designed to meet the requirements for Category 2 risk, as defined in NFPA 99. (4) The assessment must be reviewed and a new assessment performed, if necessary, on an annual basis and when the facility identifies changes in resident care needs that cannot be met by the currently installed systems and equipment. (5) In addition to the requirements of NFPA 99 based on the risk assessment, a facility must also meet all applicable requirements stated elsewhere.

In facilities licensed on or after April 2, 2018, what are ways safety can be improved with windows?

(1) Windows must be designed to prevent residents from accidentally falling through the windows. (2) Safety glass must be used where required by local building codes or NFPA 101.

Who is authorized to receive advance information on unannounced inspections?

(1) citizen advocates invited to attend inspections; (2) the State Ombudsman, a certified ombudsman, and an ombudsman intern who are authorized to attend and participate in inspections; (3) representatives of the United States Department of Health and Human Services whose programs relate to the Medicare/Medicaid Long Term Care Program; and (4) representatives of HHSC whose programs relate to the Medicare/Medicaid long term care program.

What other information must be conveyed to the resident upon admission and during the stay, in a language the resident understands?

(1) facility admission policies; (2) a description of the protection of personal funds as described in §19.404. (3) the Human Resources Code, Title 6, Chapter 102; or a written list of the rights and responsibilities contained in the Human Resources Code, Title 6, Chapter 102; and (4) a written description of the services available through the Ombudsman Program. This information must be made available to each facility by the ombudsman program. Facilities are responsible for reproducing this information and making it available to residents, their families, and legal representatives; and (5) a written statement to the resident, the resident's next of kin, or guardian describing the facility's policy for the drug testing of employees who have direct contact with residents; and the criminal history checks of employees and applicants for employment; and (6) HHSC rules and the facility's policies related to the use of restraint and involuntary seclusion. This information must also be given to the resident's legally authorized representative, if the resident has one.

For Small House and Household Facilities, what is the resident limit?

(1) have no more than 16 bedrooms; (2) have living, dining, social, and staffing areas exclusively within and for the house or household; and (3) have a kitchen that meets the requirements in §19.354(g)(1) (Same as Building Rehabilitation requirement) or a food service area that meets the requirements of an auxiliary serving kitchen in §19.354(g)(3), exclusively within and for the house or household.

What must be contained in the license holder's notice of a significant change in its financial condition?

(A) A description of the specific significant adverse change in financial condition; (B) how the significant adverse change in financial condition affects the license holder's ability to deliver essential care and services; and (C) the actions the license holder has taken to address the significant adverse change in financial condition.

What must be contained in the notice of the loss or imminent loss of the right to possession sent to DADS?

(A) A description of the specific situation that resulted in loss of possession of the facility; (B) be faxed to (512) 438-2730 or (512) 438-2728; and (C) be kept on file with a copy of the fax confirmation.

What may the facility do when a request for an AEM is made?

(A) A facility may require an electronic monitoring device to be installed in a manner that is safe for residents, employees, or visitors who may be moving about the room, and meets all local and state regulations; (B) require AEM to be conducted in plain view; (C) place a resident in a different room to accommodate a request for AEM.

What is a facility not allowed to do in regard to the family council itself?

(A) A facility must not terminate an existing family council; (B) prevent or interfere with the family council from receiving outside correspondence addressed to the family council or open family council mail; or (C) willfully interfere with the formation, maintenance, or operation of a family council, including interfering by denying a family council the opportunity to accept help from an outside person; discriminating or retaliating against a family council participant; or willfully scheduling events in conflict with previously scheduled family council meetings, if the facility has other scheduling options.

What must be permitted in the way of Authorized Electronic Monitoring?

(A) A facility must permit a resident or the resident's guardian or legal representative to monitor the resident's room through the use of electronic monitoring devices. (B) A facility may not refuse to admit an individual and may not discharge a resident because of a request to conduct authorized video monitoring.

What falls under the category of Communication in Emergency Management and Control?

(A) A facility's plan must contain a section for communication that identifies the facility's primary mode of communication to be used during an emergency situation and the facility's alternate mode of communication to be used in the event of power failure or the loss of the facility'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 on or near each telephone in the facility in communities where a "911" emergency management system is unavailable; (C) includes procedures for maintaining a current list of telephone numbers for residents' responsible parties; (D) includes procedures for maintaining a current list of telephone numbers for pre-arranged receiving facilities; (E) includes procedures for maintaining a current list of telephone numbers for the facility's staff; (F) identifies the location of the lists described in subparagraphs (C) through (E) of this paragraph and the contact information for the EPC; (G) includes procedures to notify: facility staff about an emergency situation; a receiving facility about an impending or actual evacuation of residents; and residents and residents' responsible parties about an impending or actual evacuation; (H) provides a method for a person to obtain resident information during an emergency situation; and (I) includes procedures for the facility to maintain communication with: facility staff involved in an emergency situation; a receiving facility; and the driver of a vehicle transporting residents, medication, records, food, water, equipment, or supplies during an evacuation.

What falls under the category of Evacuation in Emergency Management and Control?

(A) A facility's plan must contain a section for evacuation that identifies evacuation destinations and routes, and includes a map that shows the destinations and routes; (B) includes procedures for implementing a decision to evacuate residents to a receiving facility; (C) includes a current copy of an agreement with a receiving facility, outlining arrangements for receiving residents in the event of an evacuation, if the evacuation destination identified in accordance with subparagraph (B) of this paragraph is a receiving facility that is not owned by the same entity as the evacuating facility; (D) includes procedures for: ensuring facility staff accompany evacuating residents; ensuring that residents and facility staff present in the building have been evacuated; accounting for residents and facility staff after they have been evacuated; accounting for residents absent from the facility at the time of the evacuation; releasing resident information in an emergency situation to promote continuity of a resident's care; contacting the local EMC to find out if it is safe to return to the geographical area after an evacuation; determining if it is safe to re-enter and occupy the building after an evacuation; and (E) includes procedures for notifying the local EMC regarding an evacuation of the facility; (F) includes procedures for notifying DADS Regulatory Services regional office for the area in which the facility is located by telephone immediately after the EPC makes a decision to evacuate; and (G) includes procedures for notifying DADS Regulatory Services regional office for the area in which the facility is located by telephone immediately when residents have returned to the facility after an evacuation.

What falls under the category of Health and Medical Needs in Emergency Management and Control?

(A) A facility's plan must contain a section for health and medical needs that identifies the types of services used by residents, such as dialysis, oxygen, respirator care, or hospice services; and (B) ensures the resident's needs identified in subparagraph (A) of this paragraph are met during an emergency situation.

What falls under the category of Resource Management in Emergency Management and Control?

(A) A facility's plan must contain a section for resource management that includes a plan for identifying medications, records, food, water, equipment and supplies needed during an emergency situation; (B) identifies facility 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 medications are secure and maintained at the proper temperature during an emergency situation.

What falls under the category of Sheltering Arrangements in Emergency Management and Control?

(A) A facility's plan must contain a section for sheltering arrangements that includes procedures for implementing a decision to shelter-in-place that includes: having access to medications, records, food, water, equipment and supplies; and sheltering facility staff involved in responding to an emergency situation, and their family members, if necessary; (B) includes procedures for notifying DADS Regulatory Services regional office for the area in which the facility is located by telephone immediately after the EPC makes a decision to shelter-in-place: before, during, or after a hurricane or flood impacts a facility, if the risk assessment identified a hurricane or flood as a potential emergency situation; or after any other type of emergency situation that has caused property damage to a facility; (C) includes procedures for accommodating evacuated residents, if the facility serves as a receiving facility for a facility that has evacuated.

What falls under the category of Transportation in Emergency Management and Control?

(A) A facility's plan must contain a section for transportation that arranges for a sufficient number of vehicles to safely evacuate all residents; (B) identifies facility staff designated to drive a facility owned, leased or rented vehicle during an evacuation; (C) includes procedures for safely transporting residents, facility staff involved in an evacuation; and (D) includes procedures for safely transporting and having timely access to oxygen, medications, records, food, water, equipment, and supplies needed during an evacuation.

What falls under the category of Warning in Emergency Management and Control?

(A) A facility's plan must contain a section for warning that 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.

What should be included in the Emergency Preparedness and Response Plan?

(A) A facility's plan must include a risk assessment of all potential internal and external emergency situations relevant to the facility's operations and geographical area, such as a fire, failure of heating and cooling systems, a power outage, a bomb threat, an explosion, a hurricane, a tornado, a flood, extreme snow and ice conditions for the area, a wildfire, terrorism, a hazardous materials accident, or a thunderstorm with a risk for harm to persons or property; (B) include a description of the facility's resident population; (C) include a section for each core function of emergency management that is based on a facility's decision to either shelter-in-place or evacuate during an emergency situation; (D) include a section for a fire safety plan that complies with §19.326; and (E) include a section for self reporting incidents.

What is an automated external defibrillator?

(A) A heart monitor and defibrillator that has received approval from the United States Food and Drug Administration of its premarket notification filed under United States Code, Title 21, §360(k); (B) is capable of recognizing the presence or absence of ventricular fibrillation or rapid ventricular tachycardia; (C) is capable of determining, without interpretation of cardiac rhythm by an operator, whether defibrillation should be performed; and (D) after determining that defibrillation should be performed, automatically charges and requests delivery of an electrical impulse to an individual's heart

If a license holder wishes to relocate a facility, what procedures must be done?

(A) A license holder may not relocate a facility to another location without approval from the Texas DHS. The license holder must submit a complete application and the fee required under §19.216 to DHS before the relocation. (B) Residents may not be relocated until the new building has been inspected and approved as meeting the standards of the Life Safety Code as applicable to nursing facilities. (C) Following Life Safety Code approval by DHS, the license holder must notify DHS of the date residents will be relocated. If the new facility meets the standards for operation based on an on-site survey, a license will be issued.

In the review of plans, the code compliance documents must include:

(A) A life safety floor plan (B) documentation, published by a nationally recognized testing laboratory, describing any proposed fire resistance-rated assemblies (C) for projects involving building rehabilitation, provide a diagram outlining each area undergoing rehabilitation identifying the classification of the rehabilitation work according to §19.350 of this subchapter, and identifying the total floor area of each rehabilitation work area by rehabilitation classification.

What are the requirement for a reconfiguration in a facility?

(A) A newly constructed element, component, or system must comply with division 9; (B) All other work in a modification must meet, at a minimum, the requirements for a renovation according to paragraph (2) of this subsection; and (C) If the total rehabilitation work area classified as modification exceeds 50% of the total building area, the work must be classified as reconstruction according to paragraph (4) of this subsection.

If a facility is about to have its license revoked or suspended, or if a renewal license will be denied, what will DHS do?

(A) A notice by personal service or by registered or certified mail of the facts or conduct alleged to warrant the proposed action, with a copy being sent to the facility; and (B) an opportunity to show compliance with all requirements of law for the retention of the license by sending the director of Long-Term Care-Regulatory a written request. The request must: be postmarked within 10 days of the date of DHS's notice and be received in the state office of the director of Long-Term Care-Regulatory within 10 days of the date of the postmark; and contain specific documentation refuting DHS's allegations.

When using an AEM, when is the recording considered to have been viewed or listened to?

(A) A person who is conducting electronic monitoring on behalf of a resident is considered to have viewed or listened to a tape or recording made by the electronic monitoring device on or before the 14th day after the date the tape or recording is made. (B) If a resident, who has capacity to determine that the resident has been abused or neglected and who is conducting electronic monitoring, gives a tape or recording made by the electronic monitoring device to a person and directs the person to view or listen to the tape or recording to determine whether abuse or neglect has occurred, the person to whom the resident gives the tape or recording is considered to have viewed or listened to the tape or recording on or before the seventh day after the date the person receives the tape or recording.

Who must sign off on the resident assessment as being completed?

(A) A registered nurse must sign and certify that the assessment is completed. (B) Each individual who completes a portion of the assessment must sign and certify the accuracy of that portion of the assessment.

What are the requirements for a repair in a facility?

(A) A repair must meet the applicable requirements of §19.300(d); (B) A repair must be done using like materials, unless such materials are prohibited by NFPA 101; and (C) A repair must not make a building less conforming with NFPA 101 or the applicable sections of this subchapter, or with any alternative arrangements previously approved by HHSC, than it was before the repair was undertaken, unless approved by HHSC.

How are funds from the Trust Fund disbursed?

(A) A request for funds from the trust fund or trust fund petty cash box may be made, either orally or in writing, by the resident, the resident's legally authorized representative, representative payee, or responsible party to cover a resident's expenses. (B) The facility must respond to a request received during normal business hours at the time of the request. (C) The facility must respond to a request received during hours other than normal business hours immediately at the beginning of the next normal business hours.

What is the Right to Accommodation of Needs?

(A) A resident has the right to reside and receive services in the facility with reasonable accommodation of individual needs and preferences, except when the health or safety of the individual or other residents would be endangered; and (B) receive notice before the resident's room or roommate in the facility is changed.

In facilities licensed on or after April 2, 2018, if linen is to be processed on the site, what must be provided?

(A) A soiled linen receiving, holding, and sorting room with a rinse sink. This area must have a floor drain and forced exhaust to the exterior which must operate at all times there is soiled linen being held in the area. (B) A laundry processing room with equipment which can process seven days' worth of laundry within a regularly scheduled work week. (C) Hand-washing facilities must be provided.

What statement must be signed as a condition of employment at a facility?

(A) A statement that states the employee may be criminally liable for failure to report abuses; and (B) under the Texas Health and Safety Code, Title 4, §260A.14, the employee has a cause of action against a facility, its owner(s) or employee(s) if he is suspended, terminated, disciplined, or discriminated or retaliated against as a result of reporting to the employee's supervisor, the administrator, DADS, or a law enforcement agency a violation of law, including a violation of laws or regulations regarding nursing facilities; for initiating or cooperating in any investigation or proceeding of a governmental entity relating to care, services, or conditions at the nursing facility. (C) The statement above must be available for inspection by DADS.

What is the penalty for falsification of a resident assessment under Medicare and Medicaid? What is not considered a false statement?

(A) An individual who willfully and knowingly certifies a material and false statement in a resident assessment is subject to a civil money penalty of not more than $1,000 for each assessment; or causes another individual to certify a material and false statement in a resident assessment is subject to a civil money penalty of not more than $5,000 for each assessment. (B) Clinical disagreement does not constitute a material and false statement.

What are the requirements for a replacement in a facility?

(A) Any new work that is part of a renovation must comply with the applicable requirements of §19.300(d); (B) Any new interior or exterior finishes must meet the requirements of division 9 (Facilities Licensed On or After April 2, 2018); (C) A renovation must not make a building less conforming with NFPA 101 or the applicable sections of this subchapter, or with any alternative arrangements previously approved by HHSC, than it was before the renovation was undertaken, unless approved by HHSC; and (D) The reconfiguration or extension of any system, or the installation of any additional equipment, must be classified as modification according to paragraph (3) of this subsection.

To avoid a facility operating while unlicensed, when should the items be submitted to DADs?

(A) At least 30 days before the anticipated date of the sale or other transfer to the new owner. (B) DADS considers an application as submitted timely if the application is postmarked at least 30 days before the anticipated date of the sale or other transfer to the new owner and received in DADS Licensing and Credentialing Section, Regulatory Services Division within 15 days after the date of the postmark.

Who is responsible for Bank Charges on individual accounts?

(A) Bank service charges and charges for checks and deposit slips may be deducted from the individual checking accounts if it is the resident's written, individual choice to have this type of account. (B) Bank fees on individual accounts established solely for the convenience of the facility are the responsibility of the facility and may not be charged to the resident, legally authorized representative, or responsible party. (C) The facility may not charge the resident, legally authorized representative, or responsible party for the administrative handling of either type of account.

What is required of in-service training for Nurse Aides?

(A) Be sufficient to ensure the continuing competence of nurse aides, but must be no less than 12 hours per year; (B) address areas of weakness as determined in nurse aides' performance reviews and may address the special needs of residents as determined by the facility staff; and (C) for nurse aides providing services to individuals with cognitive impairments, also address the care of the cognitively impaired.

What information should be included in the staffing waiver request/notification?

(A) Beginning date when facility was/is unable to meet staffing requirements; (B) type waiver requested (24-hour licensed nurse or seven-day-per-week R.N.); (C) projected number of hours per month that staffing is reduced for 24-hour licensed nurse waiver or seven-day-per-week R.N. waiver; and (D) staffing adjustments made due to inability to meet staffing requirements.

How should the facility cooperate with the permanency planner?

(A) By allowing access to a child's records or providing other information in a timely manner as requested by the permanency planner or the Health and Human Services Commission; (B) participating in meetings to review the child's permanency plan; and (C) identifying, in coordination with the permanency planner, activities, supports and services that can be provided by the family, LAR, facility, or the permanency planner to prepare the child for an alternative living arrangement.

In the review of building plans, what contract documents must be submitted?

(A) Code compliance documents (B) Site plan documents (C) Foundation plan documents (D) Floor plan documents (E) For new construction, additions or rehabilitation of an existing building, an overall plan of the entire building (F) Schedules (G) Elevations (H) Roof plans (I) Detail documents (J) Building structure documents (K) Electrical documents (L) Plumbing documents (M) HVAC documents (N) Sprinkler system documents (O) Specification documents (P) Other layouts, plans or details as necessary

When should dental claims be filed for reimbursement?

(A) Complete and accurate claims for services must be received within 12 months from the date of service. (B) Claims for services delivered before the effective date of this section must be submitted within 12 months of the effective date of this section. (C) Adjustments to claims must be received by DHS's claims processor during the applicable 12-month period. Claims and adjustments rejected or denied during the 12-month period through no fault of the dentist may be paid upon approval by DHS.

What should the reasonable accommodations for the LAR of a child include?

(A) Conducting a meeting in person or by telephone, as mutually agreed upon by the facility and the LAR; (B) conducting a meeting at a time and, if the meeting is in person, at a location that is mutually agreed upon by the facility and the LAR; (C) if the LAR has a disability, providing reasonable accommodations in accordance with the Americans with Disabilities Act, including providing an accessible meeting location or a sign language interpreter, if appropriate; and (D) providing a language interpreter, if appropriate.

What is DADs and the OIG finds something in the trust fund audit that requires further action?

(A) DADS provides the facility with a report of the findings, which may include corrective actions that the facility must take and internal control recommendations that the facility may follow. (B) The facility may request an informal review or a formal hearing to dispute the report of findings.

What is the process for facility license renewal?

(A) DHS sends the local health authority a copy of DHS's license renewal notice specifying the expiration date of the facility's current license. (B) the local health authority may provide recommendations to DHS regarding the status of compliance with local codes, ordinances, or regs. (C) the local authority may also recommend that a state license be issued or denied; however, the final decision remains with DHS.

How should food intake be monitored and recorded?

(A) Deviations from normal food and fluid intake must be recorded in the clinical records. See also §19.1911(12)(B)(vi) for information concerning dietary intake and clinical records. (B) In-between meals and bedtime snacks, and supplementary feedings, either as a part of the overall care plan or as ordered by a physician, including caloric-restricted diets, must be documented using the point, percentage, or other system consistently facility-wide. See also §19.1911(12)(B)(vi) for information concerning dietary intake and clinical records.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the rules for drinking fountains?

(A) Drinking fountains must not extend into exit corridors. (B) Fixture controls easily operable by residents must be provided (such as lever type).

How often and when should meals be served?

(A) Each resident receives and the facility provides at least three meals daily, at regular times comparable to normal mealtimes in the community. (B) There must be not more than 14 hours between a substantial evening meal and breakfast the following day. (C) The facility must offer snacks at bedtime daily. Routine snacks that are not ordered by the physician and are not part of the plan of care do not need to be documented as accepted or rejected. (D) When a nourishing snack is provided at bedtime, up to 16 hours may elapse between a substantial evening meal and breakfast the following day, if a resident group agrees to this meal span and a nourishing snack is served.

What is the responsibility of the Medicaid-Certified nursing facility when it comes to resident certification for nursing facility services?

(A) Ensure that each certification and recertification statement states: "I hereby certify that this resident requires/continues to require nursing facility care for 180 days"; and (B) keep the physician's certification and recertification statements in the recipient's clinical record.

What is not allowed in the resident clinical record? What is the exception?

(A) Erasures are not allowed on any part of the clinical record, with the exception of the medication/treatment/diet section of the resident care plan. (B) Correction of errors will be in accordance with accepted health information management standards.

What type of facilities may have a visit from Quality-of-care monitors?

(A) Facilities with a history of resident care deficiencies; (B) that are identified as a medium risk through the early warning system; or (C) that request a visit.

How long must resident Clinical records be retained for?

(A) Five years after medical services end; or (B) for a minor, three years after a resident reaches legal age under Texas law.

What must be contained in the accident or incident reports?

(A) For incidents involving residents, the name of the resident; witnesses, if any; date, time, and description of the incident; circumstances under which it occurred; action taken including documentation of notification of the responsible party and attending physician, if appropriate; and the resident's current (post-incident) health condition, including vital signs and date and time of entry. (B) Incident reports describing incidents not involving residents must contain such information as names of individuals involved, date, time, witnesses (if witnesses were present), description of the event or occurrence, including the circumstances under which it occurred, action taken, and final disposition that indicates resolution of the event or occurrence.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what administrative space must be made available?

(A) General or individual offices for business transactions, medical and financial records, administrative and professional staff, and for private interviews relating to social service, credit, and admissions. (B) A multipurpose room for conferences, meetings, and health education purposes including facilities for showing visual aids. (C) Storage and work area for office equipment and supplies must be provided and accessible to the staff using such items.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the regulations for HVAC systems?

(A) HVAC systems must be designed and installed in accordance with the HVAC Guide of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE), except as may be modified by this section. (B) HVAC systems must meet the requirements of the Life Safety Code and the National Fire Protection Association (NFPA) 90A. The plans must have a statement verifying that the systems are designed to conform to NFPA 90A.

When a nursing facility (NF) contracts for hospice services for residents, what must the nursing facility do?

(A) Have a written contract for the provision of arranged services, which must be signed by authorized representatives of the NF and hospice. (B) provide room and board services, which include the performance of personal care services including: assistance in the activities of daily living, administration of medication, socializing activities, maintaining the cleanliness of a resident's room, and supervision and assisting in the use of durable medical equipment and prescribed therapies; (C) immediately notify the hospice of any significant changes in the hospice recipient's condition; (D) have joint procedures with the hospice provider for ordering medications that ensure the proper payor is billed and for reconciling billing between NF and hospice. (E) ensure that hospice documentation is a part of the current clinical record.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, which power sources must be arranged for delayed automatic or manual connections to the alternate power source:

(A) Heating equipment must provide heating for general resident rooms. (B) In instances when interruptions of power would result in elevators stopping between floors, throw-over facilities must be provided to allow the temporary operation of any elevator for the release of passengers.

What topics must staff be trained on as part of their orientation and then annually thereafter?

(A) Human Immunodeficiency Virus (HIV), as outlined in the educational information provided by the Texas Department of Health Model Workplace Guidelines. (B) restraint reduction and the prevention of falls through competency-based training. Facilities also may choose to train on behavior management, including prevention of aggressive behavior and de-escalation techniques.

What if a resident chooses to discontinue trust fund participation?

(A) If a resident, legally authorized representative, or responsible party requests that the facility discontinue managing the resident's personal funds the facility must return to the resident, legally authorized representative, or responsible party all of the resident's personal funds held by the facility, including any interest accrued. (B) If the request is made during normal business hours, the facility must immediately return the funds. (C) If the request is made during hours other than normal business hours, the facility must return the funds immediately during the next normal business hours.

In facilities licensed on or after April 2, 2018, what are the requirements for auxiliary serving kitchens?

(A) If a service area other than the kitchen is used to dispense food, it must be designated as a food service area and must have equipment for maintaining required food temperatures while serving. (B) Separate food service areas must have hand-washing facilities as a part of the food service area. (C) Finishes of all surfaces, except ceilings, must be the same as those required for dietary kitchens or comparable areas.

Under what circumstances would the State Ombudsman be allowed all files, records, and other information concerning a resident, even if the legally authorized representative refuses consent?

(A) If the State Ombudsman or certified ombudsman has reasonable cause to believe that the legally authorized representative is not acting in the best interest of the resident; and (B) if it is a certified ombudsman seeking access to the records, files, or other information, the certified ombudsman obtains the approval of the State Ombudsman to access the records, files, or other information without the legally authorized representative's consent; and (C) the administrative records, policies, and documents of the facility to which the residents or general public have access.

Under what circumstances would the State Ombudsman be allowed all files, records, and other information concerning a resident, including an incident report involving the resident?

(A) If the State Ombudsman or certified ombudsman has the consent of the resident or legally authorized representative; (B) the resident is unable to communicate consent to access and has no legally authorized representative; or (C) such access is necessary to investigate a complaint.

What is the time limit for a facility to take corrective action on a trust fund audit if a hearing or review is not requested after the report of findings is issued?

(A) If the facility does not request an informal review or a formal hearing and the report of findings requires corrective actions, the facility must complete corrective actions within 60 days after receiving the report of findings. (B) If the facility does not complete corrective actions required by DADS within 60 days after receiving the report of findings, DADS may impose a vendor hold on payments due to the facility under the provider agreement until the facility completes corrective actions. (C) If DADS imposes a vendor hold, the facility may request a formal hearing. If the failure to correct is upheld, DADS continues the vendor hold until the facility completes the corrective actions.

When would a person be excluded from obtaining a license?

(A) If the person has substantially failed to comply with the rules. During the period of exclusion, the excluded person is not eligible to be a license holder or a controlling person of a license holder. The period of exclusion must extend for at least 2 years, and may extend for more than 10 years if the exclusion is based on conduct that occurred before Sept. 1, 2011; or throughout the person's lifetime or existence if the exclusion is based on conduct after Sept. 1. 2011 (B) If a trustee is appointed and emergency funds are used.

When can a facility stop allowing a resident to use a "self-release seat belt"?

(A) If the resident cannot consistently demonstrate the ability to fasten and release the seat belt without assistance; (B) the use of the self-release seat belt does not comply with the resident's comprehensive care plan; or (C) the resident or the resident's legal guardian revokes in writing the authorization for the resident to use the self-release seat belt.

What happens to personal property in the event of a resident's death?

(A) If the resident dies, personal property must be transferred to the estate or the person designated by the resident. (B) If it is donated or sold to the facility by the resident or estate, the transaction must be documented. (C) If the resident dies and there is no responsible party, family, or legal guardian and no arrangements have been made for the disposition of property, the facility must dispose of property according to the Texas Property Code, Title 6, Chapter 71 and according to the Texas Probate Code, Chapter 10.

How should drugs and biologicals be stored?

(A) In accordance with state and federal laws, the facility must store all drugs and biologicals in locked compartments under proper temperature controls and permit only authorized personnel to have access to the keys. (B) The facility must provide separately locked, permanently affixed compartments for storage of controlled drugs, listed in Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of 1976, and of other drugs subject to abuse, except when the facility uses single-unit-package drug distribution systems in which the quantity stored is minimal and a missing dose can be readily detected (see §19.1509).

According to Texas Family Code 261, what does neglect mean?

(A) Includes the leaving of a child in a situation where the child would be exposed to a substantial risk of physical or mental harm, without arranging for necessary care for the child, and the demonstration of an intent not to return by a parent, guardian, or managing or possessory conservator of the child; (B) the following acts or omissions by a person: placing a child in or failing to remove a child from a situation that a reasonable person would realize requires judgment or actions beyond the child's level of maturity, physical condition, or mental abilities and that results in bodily injury or a substantial risk of immediate harm to the child; failing to seek, obtain, or follow through with medical care for a child, with the failure resulting in or presenting a substantial risk of death, disfigurement, or bodily injury or with the failure resulting in an observable and material impairment to the growth, development, or functioning of the child; the failure to provide a child with food, clothing, or shelter necessary to sustain the life or health of the child, excluding failure caused primarily by financial inability unless relief services had been offered and refused; placing a child in or failing to remove the child from a situation in which the child would be exposed to a substantial risk of sexual conduct harmful to the child; or placing a child in or failing to remove the child from a situation in which the child would be exposed to acts or omissions that constitute abuse committed against another child; (C) the failure by the person responsible for a child's care, custody, or welfare to permit the child to return to the child's home without arranging for the necessary care for the child after the child has been absent from the home for any reason, including having been in residential placement or having run away; or (D) a negligent act or omission by an employee, volunteer, or other individual working under the auspices of a facility or program, including failure to comply with an individual treatment plan, plan of care, or individualized service plan, that causes or may cause substantial emotional harm or physical injury to, or the death of, a child served by the facility or program as further described by rule or policy; and (E) does not include the refusal by a person responsible for a child's care, custody, or welfare to permit the child to remain in or return to the child's home resulting in the placement of the child in the conservatorship of the department if: the child has a severe emotional disturbance; the person's refusal is based solely on the person's inability to obtain mental health services necessary to protect the safety and well-being of the child; and the person has exhausted all reasonable means available to the person to obtain the mental health services.

What type of individuals are not allowed to be employed by the facility?

(A) Individuals who have been found guilty of abusing, neglecting, or mistreating residents by a court of law, or (B) had a finding entered into the state nurse aide registry concerning abuse, neglect, mistreatment of residents, or misappropriation of their property; or (C) been convicted of any crime contained in §250.006, Health and Safety Code; and (D) report any knowledge it has of actions by a court of law against an employee, which would indicate unfitness for service as a nurse aide or other staff to the state nurse aide registry or licensing authority.

What are the qualifications for an Activities Director?

(A) Is a qualified therapeutic recreation specialist or an activities professional who is licensed or registered, if applicable, by the state in which practicing; and eligible for certification as a therapeutic recreation specialist, therapeutic recreation assistant, or an activities professional by a recognized accrediting body, such as the National Council for Therapeutic Recreation Certification, on October 1, 1990; or (B) has two years of experience in a social or recreational program within the last five years, one of which was full-time in a patient activities program in a health care setting; or (C) is a qualified occupational therapist or occupational therapy assistant; or (D) has completed an activity director training course approved by any state. The Texas Department of Human Services (DHS) does not review or approve any courses. DHS accepts training courses approved by a recognized credentialing body, such as the National Certification Council for Activity Professionals, the National Therapeutic Recreation Society, or the Consortium for Therapeutic Recreation/Activities Certification, Inc.

What may be included in the vaccine exemption policy for employees and contractors?

(A) It may include procedures for an employee, contractor, or other individual with privileges to provide direct resident care to be exempt from the required vaccines based on reasons of conscience, including a religious beliefs; and (B) prohibit an employee, contractor, or other individual with privileges to provide direct resident care who is exempt from the required vaccines from having contact with residents during a public health disaster, as defined in Texas Health and Safety Code, §81.003.

What are the requirements of a Nursing Facility Administrator?

(A) Licensed by the Texas Board of Nursing Facility Administrators; (B) responsible for management of the facility; and (C) required to work at least 40 hours per week on administrative duties. (D) The administrator must be accountable to the governing body for overall management of the nursing facility.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the exit provisions for doors in the means of egress?

(A) Locking hardware or devices which are capable of preventing or inhibiting immediate egress must not be used in any room or area that can be occupied. (B) A latch or other fastening device on an exit door must be provided with a knob, handle, panic bar, or similar releasing device. The method of operation must be obvious in the dark, without use of a key, and operable by a well-known one-action operation that will easily operate with normal pressure applied to the door or to the device toward the exterior.

In facilities licensed on or after April 2, 2018, what are the required exit provisions for locks on doors in means of egress?

(A) Locking hardware or devices which are capable of preventing or inhibiting immediate egress must not be used in any room or area that can be occupied. (B) A latch or other fastening device on an exit door must be provided with a knob, handle, panic bar, or similar releasing device. The method of operation must be obvious in the dark, without use of a key, and operable by a well-known, one-action operation that will easily operate with normal pressure applied to the door or to the device toward the exterior. Locking hardware which prevents unauthorized entry from the outside is permissible. Self-closing devices and permanently mounted hold-open devices to expedite emergency egress and prevent accidental lock-out must be provided for exterior exit doors.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the exit provisions for exterior doors?

(A) Locking hardware which prevents unauthorized entry from the outside is permissible. Self-closing devices and permanently mounted hold-open devices to expedite emergency egress and prevent accidental lock-out must be provided for exterior exit doors. (B) No screen or storm door may swing against the direction of exit travel where main doors are required to swing out.

In facilities licensed on or after April 2, 2018, what must be provided for staff use?

(A) Lounge and toilet room must be provided for nursing staff. (B) Lockers or security compartments must be provided for the safekeeping of personal effects of staff. These must be located convenient to the duty station of personnel or in a central location.

What qualifications are there for physician delegates?

(A) Meets the applicable definition in 42 Code of Federal Regulations, §491.2 (see §19.101) or in the case of a clinical nurse specialist, is licensed as such by the state; (B) is acting within the scope of practice as defined by state law; and (C) is under the supervision of the physician.

What is required of menus?

(A) Menus must meet the nutritional needs of residents in accordance with the recommended dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences; (B) be prepared at least one week in advance; (C) be written for each type of diet ordered in the facility, in accordance with the facility's diet manual; (D) be written or completely evaluated by the facility's dietitian or consultant dietitian; (E) vary from week to week, taking the general age-group of residents into consideration; and (F) be followed. Any substitutions must be documented as required.

What are the qualifications to be a director of food service?

(A) Must be at least a qualified dietitian; (B) an associate-in-arts graduate in nutrition and food management (such as Dietetics, Home Economics, or Restaurant Management); (C) a graduate of a dietetic technician or dietetic assistant training program approved by the American Dietetic Association, or the Dietary Manager's Association, whether conducted by correspondence or in a classroom; (D) a person who has completed a state-agency-approved 90-hour course in food service supervision; or (E) a person who has training and experience in food service supervision and management in a military service equivalent in content to the programs listed above and has had their training credentials evaluated and approved by the nutrition program specialist of the Texas Department of Human Services' Long Term Care-Regulatory.

In facilities licensed on or after April 2, 2018, what are the required exit provisions for doors in means of egress?

(A) No screen or storm door may swing against the direction of exit travel when main doors are required to swing out. (B) To aid in control of wandering residents, buzzers or other sounding devices may be used to announce the unauthorized use of an exit door. Other methods include approved emergency exit door locks or fencing with a gate outside of exit doors which enclose a space large enough to allow the space to be an exterior area of egress and refuge away from the building. (C) Inactive leaves of double doors may have easily accessible and easily operable bolts if the active leaf is 44" wide, where permitted by NFPA 101. Center mullions are prohibited. (D) Folding doors must not be used in exit corridors or other means of egress. Sliding doors, when permitted by NFPA 101, may be used as secondary doors from residents' bedrooms to grade or to a balcony, or in certain other areas, when permitted by NFPA 101. Corridor doors to rooms must swing into the room or be recessed so as not to extend into the corridor when open; however, doors ordinarily kept closed may be excepted. (E) Horizontal exits, if provided, must be according to NFPA 101.

Before a facility transfers or discharges a resident, the facility must_____.

(A) Notify the resident and, if known, a responsible party or family or legal representative of the resident about the transfer or discharge and the reasons for the move in writing and in a language the resident understands; (B) record the reasons in the resident's clinical record; (C) include in the notice the required items; and (D) comply with §19.2310 when the facility voluntarily withdraws from Medicaid or Medicare or is terminated from Medicaid or Medicare participation by HHSC or the secretary.

What kind of restraints are prohibited?

(A) One that obstructs the resident's airway, including a procedure that places anything in, on, or over the resident's mouth or nose; (B) impairs the resident's breathing by putting pressure on the resident's torso; (C) interferes with the resident's ability to communicate; or (D) places the resident in a prone or supine hold.

What drug administration procedures must be established by the facility?

(A) Ones that ensure that drugs to be administered are checked against the physician's orders; (B) the resident is identified before the administration of a drug; (C) each resident has an individual medication record, where the dose of drug administered is properly recorded by the person who administered the drug; (D) drugs and biologicals are prepared and administered by the same person, except under unit-of-use package distribution systems and as outlined in §19.418; and (E) drugs prescribed for one resident must not be administered to any other person.

What should be in the statement notifying a resident granted permanent medical necessity under the Medicaid program?

(A) PMN status continues after discharge, unless the resident is discharged to home; (B) PMN status expires 30 consecutive days after the resident is discharged to home; and (C) a new medical necessity determination is required if the resident applies to be admitted to a nursing facility under the Medicaid program more than 30 consecutive days after the resident moves home from a nursing facility; and (D) a post-discharge plan of care, developed with the participation of the resident, and a family representative, responsible party or legal guardian, that will, after discharge, assist the resident to adjust to his new living environment.

What should a facility do to cooperate with a rapid response team to improve the quality-of-care provided at the facility?

(A) Provide immediate access to all the parts of the building; (B) provide immediate access to residents, staff, contractors and reasonable access to volunteers; (C) provide access to all documents maintained by or on behalf of the facility upon request from the rapid response team; (D) allow the rapid response team to copy documents, photograph residents, and use any other available recording devices in accordance with §19.2002(h); and (E) not interfere with the work of the rapid response team during a visit.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required for physical therapy facilities?

(A) Provision for privacy at each individual treatment area. (B) Hand-washing facilities and one lavatory or sink may serve more than one cubicle. (C) Facilities for the collection of soiled linen and other material that may be used in the therapy. (D) Residents' dressing areas, showers, lockers, and toilet rooms, if the therapy is such that these would be needed at the area.

In facilities licensed on or after April 2, 2018, what are the required exit provisions for areas outside of exterior exit or discharge doors?

(A) Provision must be made to facilitate continuation of emergency egress away from a building for a reasonable distance beyond the outside exit door, especially for movement of non-ambulatory residents in wheelchairs and beds. Any condition which may retard or halt free movement and progress outside the exit doors will not be allowed. Ramps must be used outside the exit doors in lieu of steps whenever possible. (B) The landing outside of each exit door must be essentially the same elevation as the interior floor and level for a distance equal to the door width plus at least four feet. Generally, the difference in floor elevation at an exterior door must not be over 1/2" with the outside slope not to exceed 1/4" per foot sloping away from the door for drainage on the exterior. In locations north of the +20 F Isothermal Line as defined in the ASHRAE Handbook of Fundamentals, the landing outside of all exit doors must be protected from ice build-up which would prohibit the door from opening or would be a slip hazard.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the regulations governing ventilation and exhaust?

(A) Provisions for natural ventilation using windows or louvers must be incorporated into the building design where possible and practical. These windows or louvers must have insect screens. (B) All air-supply and air-exhaust systems must be mechanically-operated. The ventilation rates must be considered as minimum acceptable rates and must not be construed as precluding the use of higher ventilation rates.

What are the requirements for The Texas Department of Human Services (DHS) to reimburse nursing facilities the cost of emergency dental services provided to eligible Medicaid residents residing in Medicaid-contracted facilities?

(A) Recipients must be 21 years of age or older. (B) Dental care for recipients under the age of 21 is covered under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. (C) Services reimbursed are subject to the limitations specified in §19.1401(b). (D) Emergency dental services may be provided only if the attending physician orders a dental consultation. See §19.1201.

What should be done upon admission and annually thereafter for a child resident?

(A) Request from and encourage an LAR to provide the following information for a child during the annual comprehensive care plan meeting and; (B) inform the personal information provided for the LAR is not provided or is not accurate and the facility and DADS are unable to locate the LAR, DADS refers the case to the Department of Family and Protective Services.

Under the facility's vaccination policy, what must a facility do?

(A) Require an employee, contractor, or other individual with privileges providing direct care to a resident to receive vaccines for the vaccine preventable diseases specified by the facility based on the level of risk the employee, contractor, or other individual presents to residents by the employee's, contractor's, or other individual's routine and direct exposure to residents; (B) specify the vaccines an employee, contractor, or other individual with privileges to provide direct resident care is required to receive in accordance with clause (A) of this subparagraph; (C) include procedures for the facility to verify that an employee, contractor, or other individual with privileges to provide direct resident care has complied with the policy;

In general, how should resident rooms be designed and equipped?

(A) Resident rooms must be designed and equipped for adequate nursing care, comfort, and privacy of residents. (B) Be designed or equipped to ensure full visual privacy for each resident; (C) in facilities initially certified after March 31, 1992, except in private rooms, have ceiling-suspended curtains for each bed, which extend around the bed to provide total visual privacy, in combination with adjacent walls and curtain.

What written assurances must be in the transfer agreement between hospitals and the facility?

(A) Residents will be transferred from the facility to the hospital and ensured of timely admission to the hospital when transfer is medically appropriate as determined by the attending physician. (B) Medical and other information needed for care and treatment of residents, and when the transferring facility deems it appropriate, for determining whether such residents can be adequately cared for in a less expensive setting than either the facility or the hospital, will be exchanged between the institutions.

In facilities licensed on or after April 2, 2018, what parts of the therapy area may be shared?

(A) Residents' dressing areas with accessible benches, showers, lockers, and toilet rooms if the therapy is such that these would be needed at the area. (B) storage for clean linen, supplies, and equipment used in therapy; (C) service sink located near therapy area; and (D) wheelchair and stretcher storage.

In facilities licensed on or after April 2, 2018, what are the ventilation requirements for the laundry area?

(A) Soiled and clean operations must be planned to maintain sanitary flow of functions as well as air flow. If carts containing soiled linens from resident rooms are not taken directly to the laundry area, intermediate holding rooms must be provided and located convenient to resident bedroom areas. (B) Laundry areas must have adequate air supply and ventilation for staff comfort without having to rely on opening a door that is part of the fire wall separation. (C) Provisions must be made to exhaust heat from dryers and to separate dryer make-up air from the habitable work areas of the laundry.

What must be provided to residents to accommodate their dining needs?

(A) Table service for all who can and will eat at the table, including wheelchair residents; (B) firm supports, such as over-bed tables, for serving trays to bedfast residents; (C) sturdy tray stands of proper height for residents able to be out of bed for their meals; (D) special eating equipment and utensils for residents who need them; and (E) prompt assistance for residents who need help eating.

What must be in the policies for the pronouncement of death by a RN or PA?

(A) The apparent death of a resident must be reported immediately to the attending physician, relatives, and any guardian or legal representatives. (B) The body of a deceased resident must not be removed from the facility without a physician's or registered nurse's authorization. Telephone authorization is acceptable, if not in conflict with local regulations. Authorization by a justice of the peace, acting as a coroner, is sufficient when the attending or consulting physician or registered nurse is not available. (C) A death that involves trauma, or unusual or suspicious circumstances, must be reported immediately, in accordance with local regulations, and to DADS, in accordance with §19.602(e)(2). Deaths must also be reported to DADS monthly, in accordance with §19.606.

In facilities licensed on or after April 2, 2018, what are the requirements for auxiliary nurses' stations?

(A) The auxiliary station must be staffed by nursing personnel during all shifts. (B) More than one auxiliary station may be assigned to a designated nurses' station, regardless of the distance between stations. (C) The nurse call system for resident corridors monitored by the auxiliary station must report to the auxiliary station. (D) Each auxiliary station must meet the emergency electrical requirements for a nurse's station, including electrical receptacles and emergency lighting. (E) If a required auxiliary station does not already exist and the facility must establish a new auxiliary station, all applicable standards, particularly those pertaining to the physical plant and NFPA 101, must be observed.

In facilities licensed before Sept. 11, 2003, in existing construction, what criteria must the closed-circuit television monitors meet?

(A) The camera must be placed to view the entire corridor length, without any "blind spots." (B) The camera must be capable of providing recognizable images, in minimum and maximum light levels, for the complete viewing area. (C) The monitor must be installed and be clearly visible to persons in the nurses' station or auxiliary station who are assigned to the area monitored by the camera. (D) The system must be supplied with emergency power that enables the system to function during electrical service failures. (E) Each camera must have its own separate monitor. (F) If the system performs the minimum basic functions, television monitoring systems installed before March 1984 may remain in service until the equipment is replaced or the system is expanded. Replacement systems or new component equipment must satisfy all requirements.

What are the exceptions to the usual requirements of care that pertain to those under respite care?

(A) The clinical record of each respite care resident must contain general identifying information necessary to care for the individual and maintain his clinical record; resident assessment and care plan according to facility policy; progress notes and/or flow sheets which document care and services; reports of diagnostic or lab studies; physician's orders; and discharge and readmission information as required by facility policy for respite care services. (B) Resident assessment requirements of §19.801 of this title apply to respite care services only on the 14th day of care. (C) The clinical records requirement found at §19.1912(e) does not apply.

When is consent to give a prescription of psychoactive medication to a resident valid?

(A) The consent is given voluntarily and without coercive or undue influence; (B) the person who prescribes the medication, or that person's designee, provides the resident and, if applicable, the person authorized by law to consent on behalf of the resident, with the following information in a single document identified as being for the purpose of consent to treatment with psychoactive medication: the specific condition to be treated; the beneficial effects on that condition expected from the medication; the probable clinically significant side effects and risks associated with the medication, as reported in widely available pharmacy databases or the manufacturer's package insert; and the proposed course of the medication. (C) the resident and, if appropriate, the person authorized by law to consent on behalf of the resident, are informed in writing that consent may be revoked; and (D) the consent is evidenced in the resident's clinical record by a signed form prescribed by the facility, or by a statement of the person who prescribes the medication or that person's designee, that documents consent was given by the appropriate person and the circumstances under which the consent was obtained.

In Medicaid-certified facilities, who is responsible for paying special nurses or sitters requested by the family?

(A) The facility is not responsible for payment for a special nurse (registered nurse or licensed vocational nurse) or sitter requested by the resident's physician or family. (B) The special nurse or sitter must be hired as a separate agreement between the nurse or sitter and resident, or the resident's family or legal representative, and paid directly by them.

Who can work as a paid feeding assistant?

(A) The facility may use a paid feeding assistant, if the paid feeding assistant has successfully completed a state-approved training course that meets the requirements of §19.1115 before feeding residents. (B) The facility must not use any individual working in the facility as a paid feeding assistant unless that individual has successfully completed the state-approved training course for paid feeding assistants.

What is a facility's responsibility when it comes to dental care?

(A) The facility must assist residents in obtaining routine and 24-hour emergency dental care. (B) The facility must make all reasonable efforts to arrange for a dental examination for each resident who desires one. (C) The facility is not liable for the cost of the resident's dental care.

What should be the Respiratory staffing level for a facility that cares for six or more ventilator dependent children?

(A) The facility must designate a respiratory therapy supervisor, either on staff or contracted who must be credentialed by the National Board for Respiratory Care (either CRT or RRT). (B) provide and document that all respiratory therapy staff is trained in the care of children who are ventilator dependent. This training must be reviewed annually. (C) assure that appropriate care, maintenance, and disinfection of all ventilator equipment and accessories occurs.

What must be documented about incident and accidents?

(A) The facility must detail in the medical record every accident or incident, including allegations of mistreatment of residents by facility staff, medication errors, and drug reactions. (B) Accidents, whether or not resulting in injury, and any unusual incidents or abnormal events including allegations of mistreatment of residents by staff or personnel or visitors, must be described in a separate administrative record and reported by the facility in accordance with the licensure Act and this section.

What are the general qualifications of facility staff?

(A) The facility must employ on a full-time, part-time, or consultant basis those professionals necessary to carry out the provisions of these requirements of participation. (B) Professional staff must be licensed, certified or registered in accordance with applicable state laws.

What is the responsibility of the facility in regard to Advance Directives?

(A) The facility must ensure compliance with the requirements of Texas law, whether statutory or as recognized by the courts of Texas, respecting advance directives. (B) The facility must provide, individually or with others, education for staff and the community on issues concerning advance directives. For the community, this may include newsletters, newspaper articles, local news reports, or commercials. For educating staff, this may include in-service programs. (C) The facility must provide the attending physician, emergency medical technician, and hospital personnel with any information relating to a resident's known existing advance directive and assist with coordinating physicians' orders with the resident's known existing advance directive.

Which residents are paid feeding assistants allowed to assist? How are these residents selected?

(A) The facility must ensure that a paid feeding assistant only feed residents who have no complicated feeding problems, which include difficulty swallowing, recurrent lung aspirations, and tube or parenteral/IV feedings. (B) The facility must base resident selection on the charge nurse's assessment and the resident's latest assessment and plan of care.

What must be done in the way of resident assessments for Social Services?

(A) The facility must ensure that psychosocial assessment and care planning are completed and reviewed or updated as provided in §19.801 and §19.802. (B) If indicated by the Resident Assessment Instrument (RAI) and/or the resident's need, an in-depth psycho-social assessment is required. The social service needs of each resident must be identified and addressed by the direct provision of services or by arranging access to services.

After an abuse allegation has been filed, what must the facility do then?

(A) The facility must have evidence that all alleged violations are thoroughly investigated and must prevent further potential abuse while the investigation is in progress. (B) The results of all investigations must be reported to the administrator or his designated representative and to other officials in accordance with Texas law (including to the state survey and certification agency) within five workdays of the incident, and if the alleged violation is verified, appropriate corrective action must be taken.

What must be done under the infection control program?

(A) The facility must investigate, control, and prevent infections in the facility; (B) decide what procedures, such as isolation, should be applied to an individual resident; and (C) maintain a record of incidents and corrective actions related to infections.

What is the responsibility of the facility in regard to the AEM?

(A) The facility must meet residents' requests to have a video camera obstructed to protect their dignity. (B) The facility must make reasonable physical accommodation for AEM, which includes providing: a reasonably secure place to mount the video surveillance camera or other electronic monitoring device; and access to power sources for the video surveillance camera or other electronic monitoring device.

When would a person be allowed to access resident clinical records?

(A) The facility must not allow access to a resident's clinical record unless a physician's order exists for supplies, equipment, or services provided by the entity seeking access to the record. (B) The facility must allow access and/or release confidential medical information under court order or by written authorization of the resident or his or her legal representative (see §19.407).

What must be provided to residents in the way of environment?

(A) The facility must provide a safe, clean, comfortable, and homelike environment, allowing the resident to use his personal belongings to the extent possible; (B) housekeeping and maintenance services necessary to maintain a sanitary, orderly and comfortable interior; (C) clean bed and bath linen that are in good condition; (D) private closet space in each resident room; (E) adequate and comfortable lighting levels in all areas (see §19.1721); (F) comfortable and safe temperature levels. Facilities initially licensed or certified after October 1, 1990, must maintain temperature ranges of 71 - 81° F; and (G) for the maintenance of comfortable sound levels.

How should food be prepared and served in the facility?

(A) The facility must provide food prepared in accordance with established professional food preparation practices and by methods that conserve nutritive value, flavor, and appearance; (B) adequate amounts of food that is palatable, attractive, and at the proper temperature; (C) food prepared in a form designed to meet individual needs; (D) substitutes of similar nutritive value to residents who refuse food served, and (E) food that is prepared and served on schedule.

What must be done by the facility in regard to laboratory services?

(A) The facility must provide or obtain laboratory services only when ordered by the attending physician; (B) promptly notify the attending physician of the findings; (C) assist the resident in making transportation arrangements to and from the source of service, if the resident needs assistance; and (D) file in the resident's clinical record laboratory reports that are dated and contain the name and address of the issuing laboratory.

What training must be done on the Emergency Management and Control Plan?

(A) The facility must train a facility staff member on the staff member's responsibilities under the plan within 30 days after assuming job duties; (B) train a facility staff member on the staff member's responsibilities under the plan at least annually and when the staff member's responsibilities under the plan change; and (C) conduct one unannounced annual drill with facility staff for severe weather and other emergency situations identified by the facility as likely to occur, based on the results of the risk assessment required by subsection (c)(1) of this section.

What are the requirements for Registered nursing staff?

(A) The facility must use the services of a registered nurse for at least eight consecutive hours a day, seven days a week, except when waived. (B) The facility must designate a registered nurse to serve as the director of nursing on a full-time basis, 40 hours per week, except when waived. (C) The director of nursing may serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents.

What are some examples of significant adverse changes in financial condition that must be reported?

(A) The facility receives notice that a judgment or tax lien of at least $50,000 has been filed, recorded or levied against the facility or any of the assets of the facility or the license holder and the judgment or tax lien is not satisfied, or an appropriate extension has not been obtained, within three working days after receipt of the notice. (B) A financial institution refuses to honor facility-operation-related checks or other financial instruments issued by the facility and the cumulative amounts of the checks or financial instruments are $50,000 or more; and the checks or financial instruments are not honored or replaced to the satisfaction of the holders of the instruments within five working days after the holders have notified the facility of the dishonored items. (C) The facility fails to maintain the facility's utilities or a sufficient quantity of supplies, including nursing, dietary, pharmaceutical or other care and service supplies, to meet the needs of the residents. (D) The facility fails to make timely payments of any facility-related tax of at least $10,000 and fails to satisfy such tax within five working days after the date the tax becomes due. (E) The facility files a voluntary bankruptcy petition, or a creditor files an involuntary bankruptcy petition against the license holder or controlling person, under the United States Code or any other laws of the United States. (F) A court appoints a bankruptcy trustee for the facility. (G) A person seeking appointment of a receiver for the facility files a petition in any jurisdiction. (H) The facility is unable to meet conditions of a facility-operation-related loan or debt covenant unless the loan or debt covenant has been waived, and that inability leads to the imposition of a fine or penalty; restructuring; a change in terms or conditions of the loan or debt covenant; or a recall by the issuing entity. (I) The facility is delinquent on more than $50,000 of facility-related contractual obligations or vendor contracts and has not cured the delinquency within five working days after receipt of notice from the creditor or creditors to pay the debt.

What must be included on the form sent to TX DHS regarding a resident's death?

(A) The form must include name of deceased; (B) social security number of the deceased; (C) date of death; and (D) name and address of the institution.

What happens to a license during a Change of Ownership?

(A) The license may not transfer as part of a Change of Ownership. In a change of ownership, the license becomes invalid on date of change. The new owner must obtain a change of ownership license. (B) DADs must be notified of a change of ownership.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the requirements in the use of mirrors for resident monitoring?

(A) The mounting height of the mirror must be no less than six feet and eight inches from the floor to the bottom of the mirror. (B) The mirror must not extend more than 3-1/2 inches from the face of the corridor wall, unless the bottom of the mirror is more than seven feet and six inches above the floor. (C) The mirror image must be clear enough that individuals can be recognized, in minimum and maximum light levels, throughout the viewing area.

In facilities licensed on or after April 2, 2018, under what conditions does the need for emergency heat not apply?

(A) The outside design temperature is higher than 20° F (-6.7° C); (B) The outside design temperature is lower than 20° F (-6.7° C) and, when selected rooms are provided for the needs of all residents, then only such rooms need be heated. (C) The facility is served by a dual source of normal power.

What do Quality-of-care monitors assess?

(A) The overall quality of life in the facility; and (B) specific conditions in the facility directly related to resident care, including conditions identified through the facility's quality measure reports based on MDS assessments.

What documentation must the physician do on residents?

(A) The physician must review and/or revise and sign orders relating to the resident's total program of care, including medications and treatments, according to the visit schedule required by §19.1203(2); (B) write, sign, and date progress notes at each visit; (C) sign and date all orders; (D) write, sign, and date a physician's discharge summary within 20 workdays of being notified by the facility of the discharge, except when specified in §19.1912(e), if the resident has been temporarily discharged for 30 days or less, and readmitted to the same facility; and (E) provide documentation in the clinical record as specified in §§19.1911 and 19.1912.

When should the Emergency plan be evaluated or changed?

(A) The plan should be evaluate to determine if information in the plan needs to change within 30 days after an emergency situation; due to remodeling or making an addition to the facility; and at least annually (B) revise the plan within 30 days after information in the plan changes

What if a medical condition prevents an employee or contractor from being vaccinated?

(A) The policy should include procedures for the facility to exempt an employee, contractor, or other individual with privileges to provide direct resident care from the required vaccines for the medical conditions identified as contraindications or precautions by the CDC; (B) for an employee, contractor, or other individual with privileges to provide direct resident care who is exempt from the required vaccines, include procedures the employee, contractor, or other individual must follow to protect residents from exposure to vaccine preventable diseases, such as the use of protective equipment, such as gloves and masks, based on the level of risk the employee, contractor, or other individual presents to residents by the employee's, contractor's, or other individual's routine and direct exposure to residents; (C) prohibit discrimination or retaliatory action against an employee, contractor, or other individual with privileges to provide direct resident care 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, may not be considered retaliatory action;

What is the Right to Self-determination?

(A) The resident has the right to choose activities, schedules, and health care consistent with the resident's interests, assessments, and plans of care; (B) interact with members of the community both inside and outside of the facility; and (C) make choices about aspects of the resident's life in the facility that are significant to the resident.

What does TX DHS say about residents exercising their rights?

(A) The resident has the right to exercise his rights as a resident at the facility and as a citizen or resident of the United States. (B) The resident has the right to be free of interference, coercion, discrimination, or reprisal from the facility in exercising his rights.

How often must physician visit a resident in a Medicaid-certified and Medicare skilled nursing facilities?

(A) The resident must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter. (B) A physician visit is considered timely if it occurs not later than 10 days after the date the visit was required. (C) Except when allowed, all required visits must be made by the physician personally.

If a resident is discharged for 30 days or less and readmitted to the same facility, what must be done upon readmission, to update the clinical record?

(A) The staff must obtain current, signed physician's orders; (B) record a descriptive nurse note, giving a complete assessment of the resident's condition; (C) include any changes in diagnoses, etc.; (D) obtain signed copies of the hospital or transferring facility history and physical and discharge summary. A transfer summary, containing this information is acceptable; (E) complete a new RAI and update the comprehensive care plan if evaluation of the resident indicates a significant change which appears to be permanent. If no such change has occurred, then update only the resident comprehensive care plan; and (F) comply with §19.805 (regarding Permanency Planning for Pediatric Residents).

What is the licensed capacity when a facility provides respite care?

(A) The total number of individuals receiving services in the facility must not exceed the number of licensed beds; and (B) any required nurse-to-resident ratio must include any individual receiving respite care services regardless of the number of hours that the individual spends in the facility.

What must a facility do to ensure that rehabilitative services are provided to a resident eligible for Medicaid?

(A) They are ordered by the resident's attending physician; and (B) except as provided in subsection (c)(1) of this section, pre-certified by DADS.

What are some covered emergency dental procedures?

(A) They include, but are not limited to alleviation of extreme pain in oral cavity associated with serious infection or swelling; (B) repair of damage from loss of tooth due to trauma (acute care only, no restoration); (C) open or closed reduction of fracture of the maxilla or mandible; (D) repair of laceration in or around oral cavity; (E) excision of neoplasms, including benign, malignant and premalignant lesions, tumors and cysts; (F) incision and drainage of cellulitis; (G) root canal therapy. Payment is subject to dental necessity review and pre- and post-operative x-rays are required; and (H) extractions: single tooth, permanent; single tooth, primary; supernumerary teeth; soft tissue impaction; partial bony impaction; complete bony impaction; surgical extraction of erupted tooth or residual root tip.

What are the overall requirements for occupation of bedrooms?

(A) They must accommodate no more than four residents for a facility that receives approval of construction or reconstruction plans by state and local authorities or are newly certified before November 28, 2016; (B) accommodate no more than two residents for a facility that receives approval of construction or reconstruction plans by state and local authorities or are newly certified on or after November 28, 2016;

What sanitary conditions must be met by the dietary service personnel?

(A) They must be in good health and practice hygienic food-handling techniques. Persons with symptoms of communicable diseases or open, infected wounds may not work. (B) Dietary service personnel must wear clean, washable garments, wear hair coverings or clean caps, and have clean hands and fingernails. (C) Routine health examinations must meet all local, state, and federal codes for food service personnel.

What are the duties of the governing body?

(A) They must designate a person to exercise the administrator's authority when the facility does not have an administrator. The facility must secure a licensed nursing home administrator within 30 days; and (B) ensure that a person designated as being in authority notifies the Texas Department of Human Services immediately when the facility does not have an administrator.

What is the responsibility of the Facility when it comes to the emergency plan?

(A) They must develop and implement a written plan; (B) maintain a current printed copy of the plan in a central location that is accessible to all staff at all times and at a work station of each personnel supervisor who has responsibilities under the plan; (C) maintain documentation of compliance.

What is required for the Respiratory care of children?

(A) To facilitate the care of ventilator-dependent children or children with tracheostomies, a facility must group those children in rooms contiguous or in close proximity to each other. An exception to this rule is children who are able to be schooled off-site. (B) Facilities must assure that alarms on ventilators, apnea monitors, and any other such equipment uniquely identify the child or the child's room. (C) A facility caring for children with tracheostomies requiring daily care (including ventilator-dependent children with tracheostomies) must have twenty-four hour a day on-site respiratory therapy staff in numbers sufficient to provide a safe ratio of respiratory therapist per these residents.

If a family council exists, what must a facility do?

(A) Upon written request, allow the family council to meet in a common meeting room of the facility at least once a month during hours mutually agreed upon by the family council and the facility; (B) provide the family council with adequate space on a prominent bulletin board to post notices and other information; (C) designate a staff person to act as the family council's liaison to the facility; (D) respond in writing to written requests by the family council within five working days; (E) include information about the existence of the family council in a mailing that occurs at least semiannually; and (F) permit a representative of the family council to discuss concerns with an individual conducting an inspection or survey of the facility.

Under what circumstances should a local or state law enforcement agency be notified of reports of abuse?

(A) When a resident's health or safety is in imminent danger; (B) a resident has recently died because of conduct alleged in the report of abuse or neglect or other complaint; (C) a resident has been hospitalized or treated in an emergency room because of conduct alleged in the report of abuse or neglect or other complaint; (D) a resident has been a victim of any act or attempted act described in the Penal Code, §§21.02, 21.11, 22.011, or 22.021; or (E) a resident has suffered bodily injury, as that term is defined in the Penal Code, §1.07, because of conduct alleged in the report of abuse or neglect or other complaint.

When can psychoactive medications be administered to a resident who does not consent?

(A) When the resident is having a medication-related emergency; or (B) the person authorized by law to consent on behalf of the resident has consented to the prescription.

When does the resident's right to refuse release of personal and clinical records not apply?

(A) When the resident is transferred to another health care institution; (B) record release is required by law; or (C) during surveys.

The life safety floor plan for the document review must include:

(A) a building layout, depicted at an identified drawing scale; (B) the location of any changes in construction type; (C) occupant loads, according to NFPA 101; (D) egress capacity, according to NFPA 101; (E) egress routes from spaces in the building to the public way, including travel distances; (F) areas in buildings which use provisions for suites, per NFPA 101; (G) provisions for the protection of vertical openings; (H) the locations of doors that use special locking arrangements; (I) the relationship of the subject building to any adjacent buildings on the same property, including dimensions between buildings; (J) the size and location of smoke compartments, and the tested fire resistance-rated assemblies proposed for the construction of smoke barriers defining the compartments; (K) the location of any fire barriers or fire walls, and the tested fire resistance-rated assemblies proposed for the construction of those barriers or walls; and (L) the location of egress signage.

What must the prospective new owner submit to DADS?

(A) a complete application for a change of ownership license or an incomplete application with a letter explaining the circumstances that prevented the inclusion of the missing information; (B) the application fee; and (C) signed, written notice from the facility's existing license holder of his intent to transfer operation of the facility to the applicant beginning on a date specified by the applicant.

What must be provided to Texas DHS for a Change of Ownership?

(A) a copy of a letter notifying the local health authority of the request for a change of ownership. (B) the local health authority may provide recommendations to DHS regarding the status of compliance with local codes, ordinances or regulations.

DADS will deny a license to an applicant to operate a facility if the applicant has on the date of the application?

(A) a debarment or exclusion from the Medicare or Medicaid programs by the federal government or a state; or (B) a court injunction prohibiting the applicant or manager from operating a facility

What should be contained in each resident's clinical record?

(A) a face sheet that contains the attending physician's current mailing address and telephone numbers; (B) sufficient information to identify and care for the resident (C) a record of the resident's assessments, including 15 months of MDS records; (D) the comprehensive, interdisciplinary plan of care and services provided; (E) a permanency plan, for residents younger than 22 years of age; (F) the results of any PASARR; (G) signed and dated clinical documentation from all health care practitioners involved in the resident's care, with each page identifying the name of the resident for whom the clinical care is intended; (H) any directives or medical powers of attorney; (I) discharge information and a physician discharge summary, to include, at least, dates of admission and discharge, admitting and discharge diagnoses, condition on discharge, and prognosis, if applicable; (J) at admission or within 14 days after admission, documentation of an initial medical evaluation, including history, physical examination, diagnoses and an estimate of discharge potential and rehabilitation potential, and documentation of a previous annual medical examination; (K) authentication of a hospital diagnosis, which may be in the form of a signed hospital discharge summary, a signed report from the resident's hospital or attending physician, or a transfer form signed by the physician; (L) the physician's signed and dated orders, including medication, treatment, diet, restorative and special medical procedures, and routine care to maintain or improve the resident's functional abilities (required for the safety and well-being of the resident), which must not be changed either on a handwritten or computerized physician's order sheet after the orders have been signed by the physician unless space allows for additional orders below the physician's signature, including space for the physician to sign and date again; (M) arrangements for the emergency care of the resident; (N) observations made by nursing personnel; (O) items as specified on the MDS assessment; (P) current information, including PRN medications and results; treatments and any notable results; (Q) physical complaints, changes in clinical signs and behavior, mental and behavioral status, and all incidents or accidents; flow sheets, which may include bathing, restraint observation or release documentation, elimination, fluid intake, vital signs, ambulation status, positioning, continence status and care, and weight; a record of dietary intake, including deviations from normal diet, rejection of substitutions, and physician's ordered snacks or supplemental feedings; a record of the date and hour a drug or treatment is administered; documentation of a special procedure performed for the safety and well-being of the resident, and (R) a copy of the most recent court order and letters of guardianship appointing a guardian of the resident or the resident's estate received by the facility.

In facilities licensed on or after April 2, 2018, what is required in the laundry washer area?

(A) a floor drain; (B) storage for laundry supplies; (C) a clean linen inspection and mending room or area and a folding area; (D) a clean linen storage, issuing, or holding room or area; (E) a janitors' closet containing a floor receptor or service sink and storage space for housekeeping equipment and supplies; and (F) sanitizing and washing facilities and a storage area for carts.

In a Limited Partnership, a change of ownership occurs if:

(A) a general partner of a limited partnership that is licensed to operate the facility is added or substituted; (B) ownership of the limited partnership that is licensed to operate the facility changes by 50% or more and one or more controlling person is added; (C) the partnership that is licensed to operate the facility is sold or otherwise transferred to an entity that is not licensed to operate the facility; (D) the entity that is licensed to operate the facility sells or otherwise transfers its business of operating the facility to an entity that is not licensed to operate the facility; (E) for any reason other than correction of an error, the federal taxpayer identification number changes; or (F) the entity that is licensed to operate the facility is terminated and fails or is ineligible to be reinstated, and the facility continues to operate.

According to Texas Family Code 261, what does person responsible for a child's care, custody or welfare mean?

(A) a parent, guardian, managing or possessory conservator, or foster parent of the child; (B) a member of the child's family or household; (C) a person with whom the child's parent cohabits; (D) school personnel or a volunteer at the child's school; (E) personnel or a volunteer at a public or private child-care facility that provides services for the child or at a public or private residential institution or facility where the child resides; or (F) an employee, volunteer, or other person working under the supervision of a licensed or unlicensed child-care facility, including a family home, residential child-care facility, employer-based day-care facility, or shelter day-care facility.

In a General Partnership, a change of ownership occurs if:

(A) a partner of a general partnership that is licensed to operate the facility is added or substituted; (B) the partnership that is licensed to operate the facility is sold or otherwise transferred to an entity that is not licensed to operate the facility; (C) the entity that is licensed to operate the facility sells or otherwise transfers its business of operating the facility to an entity that is not licensed to operate the facility; (D) for any reason other than correction of an error, the federal taxpayer identification number changes; or (E) the entity that is licensed to operate the facility is terminated and fails or is ineligible to be reinstated, and the facility continues to operate.

When is a receipt not required for a purchase?

(A) a purchase is made with funds withdrawn; (B) a purchase is made by the resident, a legally authorized representative, a responsible party, or an individual (other than facility personnel) authorized in writing by the resident; or (C) the item purchased costs one dollar or less.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, if linen is laundered off-site, what must be provided on premises?

(A) a soiled linen holding room provided with adequate forced exhaust ducted to the exterior; (B) clean linen receiving, holding, inspection, sorting or folding, and storage rooms; and (C) sanitizing facilities and storage area for carts.

In facilities licensed on or after April 2, 2018, for off-site linen processing, what must be provided on the premises?

(A) a soiled linen holding room with adequate forced exhaust ducted to the exterior; (B) clean linen receiving, holding, inspection, sorting or folding, and storage rooms; and (C) sanitizing facilities and storage area for carts.

In facilities licensed on or after April 2, 2018, in addition to systems and devices required for the type of EES installed, where must systems and devices be connected according to NFPA 99 to provide for things other than illumination?

(A) alarm systems, including fire alarms and alarms required for nonflammable medical gas systems, if installed; (B) selected duplex receptacles including receptacles in such areas in resident corridors, at each resident bed location, in nurses' stations, and in medication rooms, including biologicals refrigerator; (C) nurse call systems; (D) all facility telephone equipment; (E) paging or speaker systems, if intended for communication during an emergency. Radio transceivers installed for emergency use must be capable of operating for at least one hour upon total failure of both normal and emergency power.

What must a facility, in accordance with the Older American Act, §712(b)(1)(B) and 45 CFR §1324.11(e)(2), allow the State Ombudsman and a certified ombudsman immediate access to?

(A) all files, records, and other information concerning a resident, including an incident report involving the resident. (B) the administrative records, policies, and documents of the facility to which the residents or general public have access.

In regard to an Increase in Capacity, what is the process for approval?

(A) an application for increase in capacity from DHS. (B) DHS notifies the local fire marshal and the local health authority of the request. (C) inspection of the facility by the local fire marshal. (D) notification of the local health authority and DHS in writing if the facility meets local code requirements. (E) DHS approves the application (F) approval to occupy the increased capacity may be granted by DHS prior to issuance of the license after the inspection if standards are met.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the mattress requirements for each resident?

A clean, comfortable mattress with a moisture-proof cover, and a comfortable pillow

What else must be provided for public inspection besides the inspection reports and administrative manual?

A copy of the Texas Health and Safety Code, Chapters 242 and 260A.

Who should have access to the administrative policy and procedure manual?

A copy of this manual must be made available for review upon request to each physician, staff member, resident, and resident's next of kin or guardian and to the public.

What should be done by the facility to inspect, test, and maintain sprinkler alarm systems?

A facility must have a program to inspect, test and maintain the sprinkler system and must execute the program at least once every three months.

Are extension cords allowed in the facility?

A facility must not use electrical extension cords or multi-receptacle plug-in adaptors as a substitute for approved wiring methods in the facility.

Who must assess a child's functional status?

A licensed health professional must assess a child's functional status in relation to pediatric developmental levels, rather than adult developmental levels.

In facilities licensed on or after April 2, 2018, what makes up a nurse call system?

A nurse call system consists of power units, annunciator control units, corridor dome stations, emergency call stations, bedside call stations, and activating devices.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the call light requirements for auxiliary stations?

A nurse call system for resident corridors monitored by an auxiliary station must register calls at the auxiliary station.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, if a two-way voice communication system is used as a call switch, what must be activated?

A nurse call system that provides two-way voice communication must be equipped with an indicating light at each call station which lights and remains lighted as long as the voice circuit is operating.

Who licenses nursing facilities?

A nursing facility (NF) must be licensed by the Texas Department of Human Services (DHS) as described in §19.201.

What must be submitted to DADs by the license holder to get an expedited license?

A nursing facility license holder appearing on the list must submit an affidavit that demonstrates the license holder continues to meet the criteria established for being listed on the expedited change of ownership list, and continues to meet the requirements in §19.201.

In facilities licensed on or after April 2, 2018, if a facility has different levels of care, what is required?

A nursing facility with different levels of care will require identifiable physical separations. Combined attendant or nurses' stations and medication room areas will require some separating construction features.

When is a person who is viewing or listening to an AEM required to report abuse or neglect?

A person is required to report abuse based on the person's viewing of or listening to a tape or recording only if the incident of abuse is acquired on the tape or recording. A person is required to report neglect based on the person's viewing of or listening to a tape or recording only if it is clear from viewing or listening to the tape or recording that neglect has occurred.

Responsible Managing Employee

A person licensed by the State Fire Marshal's Office who is designated by a registered fire sprinkler firm to ensure that any fire protection sprinkler system, as planned, installed, maintained, or serviced, meets the standards provided by law. The type of RME license issued determines the type of fire sprinkler services the fire sprinkler firm may perform.

Advanced practice registered nurse

A person licensed by the Texas Board of Nursing as an advanced practice registered nurse.

Who can serve as a physical therapy assistant?

A physical therapist assistant licensed by the Texas State Board of Physical Therapy Examiners

Dietitian

A qualified dietitian is one who is qualified based upon either: (A) registration by the Commission on Dietetic Registration of the Academy of Nutrition and Dietetics; or (B) licensure, or provisional licensure, as a dietitian under Texas Occupations Code, Chapter 701 and one year of supervisory experience in dietetic service of a health care facility.

What happens if a resident is denied pre-certification by DADS for Medicaid rehabilitation services?

A resident whose request for pre-certification of Medicaid rehabilitative services is denied may request fair hearing in accordance with 1 TAC Chapter 357, Subchapter A.

In facilities licensed on or after April 2, 2018, what provisions must be made for clean linens?

A separate closets or room for clean linens.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, are beauty shop facilities required? What must be provided?

A separate room with appropriate equipment must be provided for hair care and grooming needs of residents in facilities with over 60 beds.

In regard to resident rights, what must be uploaded to the DADS website (http://fives.dads.state.tx.us/choose.asp?

A statement of all facility requirements involving resident rights and responsibilities that are not described in §19.401(b). The facility must promptly upload a revised statement if the facility changes its requirements.

What are the plan fees associated with new construction?

A. single-story facilities — $20 per bed, $2,000 minimum; and B. multiple-story facilities — $24 per bed, $2,500 minimum.

How many hours of Continuing Education are required for Activity Directors? Who can give these?

Activity directors must complete eight hours of approved continuing education or equivalent continuing education units each year. Approval bodies include organizations or associations recognized as such by certified therapeutic recreation specialists or certified activity professionals or registered occupational therapists.

In facilities licensed on or after April 2, 2018, what additional receptacles must be provided for resident use above the minimums?

Additional receptacles must be provided to ensure the electrical needs of all residents living in the bedroom are met, including power for TV, radio, razors, hairdryers, clocks, or as required by NFPA 99 and NFPA 70.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, in the installation of the sprinkler system, what must be paid close attention to?

Adequate, safe, and reasonable freeze protection for all piping. The design of freeze protection should minimize the need for dependence on staff action or intervention to provide protection.

Long-term Care Ombudsman

Advocates for resident rights. They help protect the quality of life and quality of care of anybody who lives in a nursing home or an assisted living facility. They listen to residents and family members when they have concerns or issues; telling residents about their rights; protecting resident health, safety, welfare and rights; helping families learn about nursing homes and how to pay for them; ombudsmen work to solve problems and make sure state regulations and laws protect residents.

What procedures must be followed by citizen advocates during inspections?

Advocates participating in the inspections must follow all protocols of HHSC. Advocates provide their own transportation. The schedule of inspections in this category are arranged confidentially in advance with the organizations. Participation by the advocates is not a condition precedent to conducting the inspection.

When might the specific provisions of the Life Safety from Fire regulations be waived?

After consideration of the findings of HHSC, CMS may waive specific provisions of NFPA 101 which, if rigidly applied, would result in unreasonable hardship on the facility, but only if the waiver does not adversely affect the health and safety of residents or personnel.

In facilities licensed on or after April 2, 2018, what are the requirements for bedroom door alcoves?

Alcoves must meet applicable accessibility standards for a front approach to the door, and handrails must be provided in the alcove.

What are the licensing requirements for new construction?

All construction must be done in accordance to the minimum licensing requirements.

During an inspection what must the facility make available upon request to the survey team?

All of its books, records, and other documents maintained by or on behalf of a facility.

What is not required when a child is staying less than 14 days?

All other requirements except the facility must notify DADS, the CRCG, ECI, and the local school district as required.

In facilities licensed on or after April 2, 2018, what codes must the plumbing adhere to?

All plumbing systems must be designed and installed according to the requirements of the locally adopted plumbing code.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what spaces must have lighting?

All spaces occupied by people, machinery, equipment, approaches to buildings, and parking lots must have lighting.

What happens if the facility fails to provide written policies to the resident upon admission about Advance Directives?

An administrative penalty of $500.

What happens if the disclosure statement for Alzheimer's is not submitted?

An administrative penalty.

In regard to Disaster and Emergency Preparedness, what is an emergency situation?

An impending or actual situation that: (A) interferes with normal activities of a facility and its residents; (B) may cause injury or death to a resident or staff member of the facility; or cause damage to facility property; (C) requires the facility to respond immediately to mitigate or avoid the injury, death, damage or interference; and (D) does not include a situation that arises from the medical condition of a resident, such as cardiac arrest, obstructed airway, or cerebrovascular accident;

What are the qualifications for an audiologist?

An individual who: (A) is an audiologist licensed by the Texas Department of Licensing and Regulation; or (B) meets the educational requirements and has accumulated, or is in the process of accumulating, the supervised professional experience required to be licensed as an audiologist;

For license holders that have multiple-level ownership structures, a change of ownership also occurs if:

Any action occurs at any level of the license holder's entire ownership structure.

Complaint

Any allegation received by HHSC other than an incident reported by the facility. Such allegations include, but are not limited to, abuse, neglect, exploitation, or violation of state or federal standards.

In facilities licensed on or after April 2, 2018, what may be grounds for disapproval of a site by HHSC?

Any conditions considered to be a fire, safety, or health hazard.

In facilities licensed on or after April 2, 2018, what are the ventilation rates for all areas of the facility?

As required by NFPA 99. These rates are the minimum acceptable rates, but do not preclude the use of higher ventilation rates.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what is the minimum ratio of fixtures to residents?

As required in §19.334(c).

When is a survey validation team used?

At HHSC's discretion, based on record review, random sample, or any other determination, HHSC may assign a team to conduct a validation survey. HHSC may use the information to verify previous determinations or identify training needs to assure consistency in deficiencies cited and in punitive actions recommended throughout the state.

Where should a record of consultant pharmacist services, consultations, and recommendations for pharmacy procedure be kept?

At the facility.

Supervision (intermittent)

Authoritative procedural guidance by a qualified person for the accomplishment of a function or activity within his sphere of competence, with initial direction and periodic inspection of the actual act of accomplishing the function or activity. The person being supervised must have access to the qualified person providing the supervision.

Supervision (direct)

Authoritative procedural guidance by a qualified person for the accomplishment of a function or activity within his sphere of competence. If the person being supervised does not meet assistant-level qualifications specified in this chapter and in federal regulations, the supervisor must be on the premises and directly supervising.

Supervision (general)

Authoritative procedural guidance by a qualified person for the accomplishment of a function or activity within his sphere of competence. The person being supervised must have access to the qualified person providing the supervision.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, if auxiliary buildings are used, what is the requirement?

Auxiliary buildings located within 20 feet of the main building must meet the applicable NFPA 101 requirements for separation and construction. Other buildings on the site must meet the appropriate occupancy section or separation requirements of NFPA 101.

In facilities licensed before Sept. 11, 2003, in existing construction, can auxiliary heating devices be used?

Auxiliary heating devices permanently installed, such as heat strips in ducts, electric ceiling-mounted heating units, and electric baseboards, may be used to augment a central heating system as approved by the Texas Department of Human Services (DHS). See §19.705.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required for auxiliary serving kitchens, if they exist?

Auxiliary serving kitchens not contiguous to food preparation or serving area must be as follows: (A) Where service areas other than the kitchen are used to dispense foods, these must be designated as food service areas and must have equipment for maintaining required food temperatures while serving. (B) Separate food service areas must have hand-washing facilities as a part of the food service area. (C) Finishes of all surfaces, except ceilings, must be the same as those required for dietary kitchens or comparable areas.

In facilities licensed before Sept. 11, 2003, in existing construction, how should auxiliary stations be staffed?

Auxiliary stations must be staffed by nursing personnel during all shifts.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the regulations for backflow systems?

Backflow preventers or vacuum breakers must be installed with any water supply fixture where the outlet or attachments may be submerged.

In facilities licensed on or after April 2, 2018, what is the point of having barriers on the outside of a building?

Barriers must be provided for resident safety from traffic or other site hazards by the use of appropriate methods such as fences, hedges, retaining walls, railings, or other landscaping. These barriers must not inhibit emergency egress to a safe distance away from the building.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, how should barriers be used?

Barriers must be provided for resident safety from traffic or other site hazards by the use of appropriate methods such as fences, hedges, retaining walls, railings, or other landscaping. These barriers must not inhibit the free emergency egress to a safe distance away from the building.

How is the base necessity for and type of incontinent briefs assessed?

Based on an assessment of the resident's medical and psychosocial condition and resulting determination.

In facilities licensed on or after April 2, 2018, where is a laundry room suggested to be?

Because of the high incidence of fires in laundries, it is highly recommended that the laundry be in a separate building 20 feet or more from the main building.

What registries must be checked before a Nurse Aide is allowed to work?

Before allowing an individual to serve as a nurse aide, a facility must seek information from every state registry, established under §1819(e)(2)(A) or §1919(e)(2)(A) of the Social Security Act, that the facility believes will include information about the individual.

What should be included in the building structure documents for new construction?

Building structure documents must include structural framing layout and details, primarily for column, beam, joist, and structural frames; roof framing layout, when this cannot be adequately shown on cross section; cross sections in quantity and detail to show sufficient structural design; and structural details as necessary to ensure adequate structural design.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what type of general safety hazard precautions must be observed in regard to ceiling fans?

Ceiling fan blades must be at least 7' above the floor and be located so as not to interfere with the operation of any ceiling-mounted smoke detectors.

In facilities licensed on or after April 2, 2018, what are the regulations for ceiling fans?

Ceiling fan blades must be at least seven feet above the floor and be located so as not to interfere with the operation of any ceiling-mounted smoke detectors.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the requirements for clean linen storage?

Clean linen storage must be provided, conveniently located to resident bedroom areas.

How many towels and washcloths must be provided?

Clean towels and washcloths must be provided to each resident as needed or desired. Towels and washcloths must be stored in a sanitary manner between uses by the resident and must not be used by more than one resident between launderings.

CFR

Code of Federal Regulations.

What rights do residents have in regard to Advance Directives?

Competent adults may issue advance directives in accordance with applicable laws. An advance directive has the meaning as defined in Texas Health and Safety Code, §166.002.

What standards must the facility be compliant with?

Compliance with federal, state, and local laws and professional standards. The facility must operate and provide services in compliance with all applicable federal, state, and local laws, regulations, and codes, and with accepted professional standards and principles that apply to professionals providing services in such a facility.

NFPA 55

Compressed Gases and Cryogenic Fluids Code, 2010 edition.

In facilities licensed on or after April 2, 2018, what finishes cannot be used on the floor?

Concrete floors, whether finished by sealant, or similar product, must not be used as the finished floor unless specifically approved in writing by HHSC. An exception is mechanical equipment rooms and maintenance or similar areas.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what may not be used as a type of flooring?

Concrete floors, whether finished by sealant, or similar product, must not be used as the finished floor unless specifically approved in writing by the Texas Department of Human Services. An exception is mechanical equipment rooms and maintenance or similar areas.

What must be available to the facility staff if there are pediatric residents?

Consultative pediatric nursing services.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the regulations for cooking equipment?

Cooking equipment must be protected according to NFPA 101.

In facilities licensed on or after April 2, 2018, what are the requirements for storage rooms?

Corridors must not be used for folding or cart storage. Storage rooms must be located and distributed in the building for efficient access to bedrooms. An equipment storage room must be provided for equipment such as intravenous stands, inhalators, air mattresses, and walkers.

If an applicant for a new license owns multiple facilities, what will DADS consider for the new license?

DADS examines the overall record of compliance in all of the applicant's facilities.

How does DADs monitor trust fund accounts?

DADS may periodically monitor all trust fund accounts to assure compliance. DADS notifies a facility of monitoring plans and gives a report of the findings to the facility.

Where can the criteria for an expedited change of ownership be found in the regs?

DADS uses the criteria found in §19.2322(e). A nursing facility license holder meeting these criteria appears on the list and is eligible to be issued, on an expedited basis, a change of ownership license to operate another existing institution in Texas.

If an applicant for a new license owns multiple facilities and the new license is denied, what will happen to the other facilities?

Denial of an application for a new license will not preclude the renewal of licenses for the applicant's other facilities with satisfactory records.

Under what conditions would a staffing waiver be denied or withdrawn?

Denial or withdrawal of a waiver may be made at any time if any of the following conditions exist: (A) requirements for a waiver are not met on a continuing basis; (B) the quality of resident care is not acceptable; or (C) justified complaints are found in areas affecting resident care.

In facilities licensed on or after April 2, 2018, what are the requirements for drinking fountains?

Drinking fountains must not extend into exit corridors. A facility must provide fixture controls easily operable by residents, such as lever-type controls.

In facilities licensed before Sept. 11, 2003, in existing construction, what standard should be met in regard to water fountains to comply with ADA?

Drinking fountains or coolers must meet American National Standards Institute (ANSI) A117.1 (that is, up front spout and controls no more than 36 inches from floor maximum). Fountains existing at the time of this publication do not have to be altered.

In facilities licensed before Sept. 11, 2003, in existing construction, what kind of ventilation system is required for the dry food storage area?

Dry food storage must have a venting system to provide for reliable positive air circulation.

In facilities licensed on or after April 2, 2018, what is required of the dry food storage in the way of ventilation?

Dry food storage must have an effective venting system to provide for positive air circulation.

In facilities licensed on or after April 2, 2018, what are ducts to be composed of in HVAC systems?

Ducts must be of metal or other approved noncombustible material. Cooling ducts must be insulated against condensation.

When does DHS inspect a facility's respite care services and records?

During licensing or certification inspections, or at other times DHS determines necessary, DHS inspects a facility's records of respite care services, physical accommodations for respite care, and the plan of care records to ensure that the respite care services comply with the certification requirements.

In facilities licensed on or after April 2, 2018, how is each building classified?

Each building must be classified as to building construction type for fire resistance rating purposes according to NFPA 220 and NFPA 101.

What is meant by the Right to Quality of Care?

Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, as defined by and in accordance with the comprehensive assessment and plan of care. If children are admitted to the facility, care and services must be provided to meet their unique medical and developmental needs.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what about bedroom exit doors?

Each room must open onto an exit corridor and must be arranged for convenient resident access to dining, living, and bathing areas.

In facilities licensed on or after April 2, 2018, what are the requirements for bedroom doors?

Each room must open onto an exit corridor and must be arranged for convenient resident access to dining, living, and bathing areas. To ensure a direct view from nurses' stations, resident room doors must not be recessed into the corridor wall more than four feet.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the requirements for the tub or shower rooms?

Each tub or shower must be in an individual room or enclosure which provides space for the private use of the bathing fixture, for drying and dressing, and for a wheelchair and an attendant. Each general-use bathing room must be provided with at least one water closet, in a stall, room, or area for privacy, and one lavatory. A bathing room must be located conveniently to the bedroom area it serves and must not be more than 100 feet from the farthest bedroom.

What should be included in the electrical plan documents for new construction?

Electrical documents must include electrical layout, including lights, convenience outlets, equipment outlets, switches, and other electrical outlets and devices; service, circuiting, distribution, and panel diagrams; exit signs and emergency egress lighting; emergency electrical provisions, such as generators and panelboards; fire alarms and similar systems, such as control panels, devices, and alarms; staff communication systems, including a nurse call system; and sizes and details sufficient to ensure safe and properly operating systems.

In facilities licensed on or after April 2, 2018, what type of fire protection should be in the elevators?

Elevator call buttons, controls, and door safety stops must be of a type that will not be activated by heat or smoke. Door openings must meet the requirements of the NFPA 101 for protection of vertical openings.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what regulations cover enclosed exterior spaces?

Enclosed exterior spaces, such as fenced areas, that are in a means of egress to a public way must meet the requirements of §19.2208(a)(6).

What should be encouraged between the child and the community?

Encourage regular contact between the child and LAR and, if desired by the child and LAR, between the child and advocates and friends in the community to continue supportive and nurturing relationships.

What should the facility do if the resident is leaving the facility on a furlough?

Enough prescription drugs to last throughout the furlough must be released. The facility must inventory Schedule II, III, and IV drugs in and out. Non-schedule drugs should be listed by name. The pharmacist must handle any division of the prescription, and all information on the original prescription label must appear on the furlough medication supply.

What kind of access to clinical records should outside vendors have?

Except for those members of the comprehensive assessment team, the facility allows outside resources access to the clinical records of only those residents who have orders for the service(s) to be provided.

If the resident is being relocated to another room within the facility, what is required?

Except in an emergency, the facility must notify the resident and either the responsible party or the family or legal representative at least five days before relocation of the resident to another room within the facility. The facility must prepare a written notice which contains: (A) the reasons for the relocation; (B) the effective date of the relocation; and (C) the room to which the facility is relocating the resident.

When must a discharge or transfer notice be sent timing wise?

Except when specified elsewhere, or in §19.2310, the notice of transfer or discharge required must be made by the facility at least 30 days before the resident is transferred or discharged.

In facilities licensed on or after April 2, 2018, what must exhaust ducting be made of?

Exhaust duct material must be metal.

In facilities licensed on or after April 2, 2018, what are the required provisions for exit doors?

Exit doors and ways of egress must be maintained clear and free for use at all times, except as permitted by NFPA 101. Furnishings, equipment, carts, and other obstacles must not be left to block egress at any time, except as permitted by NFPA 101.

In facilities licensed on or after April 2, 2018, where should exit doors not open directly to?

Exit doors from the building must not open directly onto a drive for vehicular traffic.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what should be installed on high heat generating lamps? Why?

Exposed incandescent light bulbs or other high heat generating lamps in closets or other similar spaces must be provided with basket wire guards or other suitable shield to prevent contact of combustible materials with the hot bulb and to help prevent breakage.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what is not permitted in regard to lighting? Why? How is this prevented?

Exposed incandescent or fluorescent bulbs will not be permitted in food service or other areas where glass fragments from breakage may get into food, medications, linens, or utensils. All fluorescent bulbs will be protected with a shield or catcher to prevent bulb drop-out.

In facilities licensed on or after April 2, 2018, what type of receptacles are required on the exterior of the facility?

Exterior receptacles must be an approved waterproof type.

In facilities licensed on or after April 2, 2018, what are the requirements for extinguishers in the resident corridors?

Extinguishers in resident corridors must be located so the travel distance from any point to an extinguisher does not exceed 75 feet. Water-type extinguishers must have a capacity of at least 2 1/2 gallons. Dry chemical-type extinguishers must be at least 5 pound ABC extinguishers.

Where must the license holder's notice of a significant change in its financial condition be sent?

Fax the notice to (512) 438-2730 or (512) 438-2728, and the notice must be kept on file with a copy of the fax confirmation.

In facilities licensed before Sept. 11, 2003, in existing construction, what finishes are required in auxiliary serving areas?

Finishes of all surfaces except ceilings must be the same as those required for dietary kitchens.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what types of heating are not allowed?

Floor furnaces, unvented space heaters, and portable heating units must not be used. Heating devices or appliances must not be a burn hazard (to touch) to residents.

What should be included in the floor plan documents for new construction?

Floor plan documents must include room names, numbers, and usages; resident care areas; numbered doors, including swing; windows; a legend or clarification of wall types; dimensions; fixed equipment; plumbing fixtures; kitchen basic layout; and identification of all smoke barrier walls and fire walls, outside wall to outside wall.

In facilities licensed before Sept. 11, 2003, in existing construction, what finishes are required for the laundry area?

Floors, walls, and ceilings must be non-absorbing and easily cleanable.

In facilities licensed on or after April 2, 2018, what type of finishes are required for bathroom facilities?

Floors, walls, and ceilings must have nonabsorbent surfaces, be smooth, and be easily cleanable.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what type of finish is required for bathroom areas?

Floors, walls, and ceilings must have nonabsorbent surfaces, be smooth, and easily cleanable.

In facilities licensed on or after April 2, 2018, how large should the food storage area be?

Food storage areas must provide for storage of a seven-day minimum supply of nonperishable foods at all times.

In facilities licensed before Sept. 11, 2003, in existing construction, can food be stored on the floor? What is the alternative?

Foods must not be stored on the floor. Dunnage carts or pallets may be used to elevate foods not stored on shelving.

How long must the accident or incident reports be retained?

For at least two years following the occurrence.

How often does HHSC inspection and survey personnel perform inspections and surveys, follow-up visits, complaint investigations, investigations of abuse or neglect, and other contact visits?

From time to time as they deem appropriate or as required for carrying out the responsibilities of licensing.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what type of general safety hazard precautions must be observed in bathrooms? What are the requirements?

Grab bars must be provided at all residents' toilets, showers, tubs, and sitz baths. The bars must be 1-1/4 to 1-1/2 inches in diameter and must have 1-1/2 inch clearance to walls. Bars must have sufficient strength and anchorage to sustain a concentrated load of 250 pounds. Grab bar standards must comply with standards adopted under the Americans with Disabilities Act of 1990.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what type of grease traps are required in the kitchen?

Grease traps must be provided in compliance with local plumbing code or other nationally recognized plumbing code.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what type of receptacles should be installed in wet areas?

Ground fault interruption protection must be provided at appropriate locations such as at whirlpools and other wet areas according to the NFPA 70.

Under what circumstances will HHSC grant a waiver of the two-year project completion timeline?

HHSC may grant a waiver of this two-year period for delays due to unusual circumstances. There is no time limit to complete a project, only a time limit for completing a project using requirements that have been revised after the project was reviewed.

If the results of the plan review show the plan is in compliance with HHSC's architectural requirements, what happens?

HHSC may not subsequently change the architectural requirement applicable to the project unless the change is required by federal law or the applicant fails to complete the project within two years.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what is required for hand-washing for staff use?

Hand-washing sinks for staff use are required in many areas throughout the facility in accordance with §19.334. Lavatories are required to be provided adjacent to water closets in each area.

In facilities licensed on or after April 2, 2018, what are the requirements for hand-washing sinks for staff use?

Hand-washing sinks for staff use must be according to §19.354 of this division. A facility must provide lavatories adjacent to all water closets.

In facilities licensed on or after April 2, 2018, what are the requirements for the handrails used in the corridors?

Handrails must be provided on both sides of corridors used by residents, and must meet the following: (A) A clear distance of 1-1/2" must be provided between the handrail and the wall; (B) Handrails must be securely mounted to withstand downward forces of 250 pounds; (C) Handrails may be omitted on wall segments less than 18" in length; (D) A window must be considered part of the wall segment in which it is installed and must not interrupt the continuity of the handrail; (E) Handrails must be mounted 33"- 36" above the floor, and must comply with standards adopted under the Americans with Disabilities Act and with TAS. (F) Where fixed furniture is provided in corridors, as permitted by NFPA 101 and §19.326(n), the handrail may be omitted, provided the handrail terminates no more than 18" from the fixed furniture. (G) Ends of handrails and grab bars must be constructed with return ends to walls to prevent snagging the clothes of residents.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what type of general safety hazard precautions must be observed in the corridors? What are the requirements?

Handrails must be provided on both sides of corridors used by residents. A clear distance of 1-1/2 inches must be provided between the handrail and the wall. Handrails must be securely mounted to withstand downward forces of 250 pounds. Handrails may be omitted on wall segments less than 18 inches. Handrails must be mounted 33 inches to 36 inches above the floor, and must comply with standards adopted under the Americans with Disabilities Act and the Texas Accessibility Standards. Ends of handrails and grab bars must be constructed to prevent snagging the clothes of residents (that is, return ends to wall).

In facilities licensed before Sept. 11, 2003, in existing construction, what air filters should be used?

Heating and air conditioning systems must be provided with clean and effective air filters.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the exit provisions for horizontal exits?

Horizontal exits, if provided, must be according to NFPA 101.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what is the range for water usage in the kitchen and laundry?

Hot water for laundry and kitchen use must be normally 140° F except that dish sanitizing, if done by hot water, must be 180° F.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the regulations for hot water systems not for resident use?

Hot water for other usages must be provided at the temperatures required for the appliance or fixture or for the operation involved, such as dishwashing and laundry.

In facilities licensed on or after April 2, 2018, what is the required temperature for the water in the kitchen? Where is this measured?

Hot water for sanitizing purposes must be 180° F or the manufacturer's suggested temperature for chemical sanitizers. For mechanical dishwashers, the temperature measurement is at the manifold.

What if DADS determines that false statements have been made by the facility on assessments (besides penalties)?

If DADS determines, under a certification survey or otherwise, that there has been a knowing and willful certification of false statements, DADS may require (for a period specified by DADS) individuals who are independent of the facility and who are approved by DADS to conduct and certify the resident assessments under this section.

When would retraining be required for Nurse Aides?

If, since an individual's most recent completion of a training and competency evaluation program, there has been a continuous period of 24 consecutive months during none of which the individual provided nursing or nursing-related services for monetary compensation, the individual must complete a new training and competency evaluation program or a new competency evaluation program.

When may a physician not delegate a task in a Medicare SNF?

In a Medicare SNF, a physician may not delegate a task when the regulations specify that the physician must perform it personally, or when the delegation is prohibited under state law or by the facility's own policies.

Where should Self-administered medications be kept?

In a locked cabinet in the resident's room. When medications are self-administered, the facility remains responsible for medication security, accurate information, and medication compliance.

How are Building rehabilitation on existing buildings classified?

In accordance with NFPA 101 and shall comply with NFPA 101 and §19.350.

How must AEM be conducted?

In accordance with any limitation placed on the monitoring as a condition of the consent given by or on behalf of another resident in the room. The resident's roommate, their guardian, or legal representative assumes responsibility for assuring AEM is conducted according to the designated limitations.

Where should the Statement of Resident Rights must be posted?

In accordance with §19.1921.

If a chance for cross-contamination exists in the facility, what must be done?

In operations where there is a chance of cross-contamination, clean and soiled operations must be separated to lessen the chance of cross-contamination by facility employees, residents, and others. This separation must be in relation to traffic flow, air currents, air exhaust, water flow, vapors, and other conditions.

How will hearings required by 42 Code of Federal Regulations §488.335 be conducted (pertaining to abuse, neglect or exploitation)?

In person or by telephone for the purpose of determining whether sufficient grounds exist for a referral of an individual to the appropriate licensure authority and the facility administrator.

In facilities licensed before Sept. 11, 2003, what codes must be followed for existing construction if the city does not have stated building and plumbing codes?

In the absence of municipal codes, nationally recognized codes must be used. To ensure continuity, all nationally recognized codes, when used, must be publications of the same group or organization

What process must be implemented when it comes to the QAA policy?

(A) analysis of the risk of injury to both residents and nurses posed by the resident handling needs of the resident populations served by the nursing facility and the physical environment in which resident handling and moving occurs; (B) annual in-service education of nurses in the identification, assessment, and control of risk of injury to residents and nurses during resident handling; (C) evaluation of alternative ways to reduce risks associated with resident handling, including evaluation of equipment and the environment; (D) restriction, to the extent feasible with existing equipment and aids, of manual resident handling or moving of all or most of a resident's weight to emergency, life-threatening, or otherwise exceptional circumstances; (E) collaboration with and an annual report to the nurse staffing committee; (F) specific procedures for nurses to refuse to perform or be involved in resident handling or moving that the nurse believes in good faith will expose a resident or a nurse to an unacceptable risk of injury; (G) submission of an annual report by the nursing staff to the Quality Assessment and Assurance Committee on activities related to the identification, assessment, and development of strategies to control risk of injury to residents and nurses associated with the lifting, transferring, repositioning, or moving of a resident; and (H) in developing architectural plans for constructing or remodeling a nursing facility or a unit of a nursing facility in which resident handling and moving occurs, consideration of the feasibility of incorporating resident handling equipment or the physical space and construction design needed to incorporate that equipment at a later date.

What terms are included in the category of psychoactive medications?

(A) anti-psychotics or neuroleptics; (B) antidepressants; (C) agents for control of mania or depression; (D) anti-anxiety agents; (E) sedatives, hypnotics, or other sleep-promoting drugs; and (F) psychomotor stimulants.

For the building plan review, what must the roof plan documents include?

(A) any roof top equipment; (B) roof slopes; (C) drain locations; and (D) gas pipes.

A facility must ensure that rehabilitative services _____.

(A) are provided to a resident under a comprehensive care plan based on a physician's diagnosis and orders; and (B) are documented in the resident's clinical record.

In facilities licensed on or after April 2, 2018, when door locks are permitted on bedrooms, what are the guidelines?

(A) bedroom door locks must be of the type which the occupant can unlock at will from inside the room; (B) all bedroom door locks must be of the type which can be unlocked from the corridor side; (C) attendants must carry keys which will permit ready access to the locked bedrooms when entrance becomes necessary; and (D) locking of bedroom doors by residents for privacy or security will not be permitted except when specifically included in the attending physician's written orders or authorized by the nursing facility administrator.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the guidelines for having locks on bedroom doors?

(A) bedroom door locks must be of the type which the occupant can unlock at will from inside the room; (B) all bedroom door locks must be of the type which can be unlocked from the corridor side; (C) attendants must carry keys which will permit ready accessibility to the locked bedrooms when entrance becomes necessary; and (D) locking of bedroom doors by residents for privacy or security will not be permitted except when specifically included in the attending physician's written orders or authorized by the nursing facility administrator.

What must be provided to the LEA about school-aged children?

(A) birth certificate or other document as proof of a child's identity; (B) medical history and medical records, including current immunization records; (C) social history; (D) vision and hearing screening and/or evaluation; (E) assessment reports, including psychological, educational, related service, and vocational assessments; (F) the facility's care plan; (G) educational history (at least previous educational placement to facilitate the LEA's efforts to obtain educational records from the previous LEA); and (H) any court order which authorizes the placement in the facility.

In addition to the initial search of the EMR and NAR, what else must a facility do?

(A) conduct a search of the NAR and EMR to determine if an employee of the facility is listed as unemployable in either registry as follows for an employee most recently hired before September 1, 2009, by August 31, 2011, and at least every twelve months thereafter; and for an employee most recently hired on or after September 1, 2009, at least every twelve months; and (B) keep a copy of the results of the initial and annual searches of the NAR and EMR in the employee's personnel file.

How will anonymous complaints of abuse or neglect be treated?

In the same manner as acknowledged reports unless the anonymous report accuses a specific individual of abuse or neglect, which report need not be investigated.

How should each resident's drugs be stored?

In their original containers.

What rights does the resident have when served with a discharge or transfer notice?

Individuals who receive a discharge notice from a facility have 90 days to appeal. If the recipient appeals before the discharge date, the facility must allow the resident to remain in the facility, except in the circumstances of non-payment or safety, until the hearing officer makes a final determination.

When during the year should an influenza vaccine be given? When would it not be given?

Influenza vaccinations for all residents and employees in contact with residents must be completed by November 30 of each year. Employees hired or residents admitted after this date and during the influenza season (through March of each year) must receive influenza vaccinations, unless medically contraindicated by a physician or the employee, the resident, or the resident's legal representative refuses the vaccination.

In facilities licensed on or after April 2, 2018, what must be furnished to the facility about the elevators?

Inspections and tests must be made and the facility must be furnished written certification that the installation meets the requirements set forth in this section and all applicable safety regulations and codes.

In facilities licensed on or after April 2, 2018, if an extinguisher has a gross weight not exceeding 40 pounds, where must it be installed?

Installed so the top of the extinguisher is located no more than five feet above the floor. In no case may the clearance between the bottom of an extinguisher and the floor be less than four inches.

What could prevent a new construction for getting a license after the survey?

(A) construction that does not meet minimum code or licensure standards for basic requirements such as corridor widths being less than 8' clear width, ceilings installed at less than the minimum 7'6" height, resident bedroom dimensions less than required minimum dimensions, and other similar features which would disrupt or otherwise adversely affect the residents and staff if corrected after occupancy; (B) absence of written approval by local authorities; (C) fire protection systems that are not completely installed or not functioning properly including fire alarm systems, emergency power and lighting, and sprinkler systems; (D) required exits are not all usable according to NFPA 101 requirements; (E) telephones that are not installed or not properly working; (F) sufficient basic furnishings, essential appliances and equipment that are not installed or are not functioning; and (G) any other basic operational or safety feature that the surveyor, as the authority having jurisdiction, encounters that in his judgment would preclude safe and normal occupancy by residents on that day.

If a facility if offering hospice services, how do they coordinate with the hospice in regard to medications?

(A) contacting the hospice prior to filling a new prescription; and (B) ensuring that drugs unrelated to the terminal illness are ordered through the Vendor Drug program.

In regard to a New Facility, what must be provided to the Texas DHS for Building approval?

(A) copy of a dated, written notice to the local health authority that construction or modification has been or will be completed by a specific date (B) the local health authority may provide recommendations to DHS regarding the status of compliance with local codes, ordinances or regs. (C) also provide a copy of a dated, written notice of the approval for occupancy by the local building code authority.

When thinning of active clinical records is required, what must always be maintained in the active clinical record (not thinned)?

(A) current history and physical, (B) current physician's orders and progress notes, (C) current resident assessment instrument (RAI) and subsequent quarterly reviews; in Medicaid-certified facilities, all RAIs and Quarterly Reviews for the prior 15-month period, (D) current care plan, (E) most recent hospital discharge summary or transfer form (F) current nursing and therapy notes, (G) current medication and treatment records, (H) current lab and x-ray reports, and (I) the admission record; and (J) the current permanency plan.

What should be kept in the resident's trust fund ledger?

(A) description of each transaction; (B) the date and amount of each deposit and withdrawal; (C) the name of the person who accepted any withdrawn funds; (D) the balance after each transaction; and (E) amount of interest earned, posted at least quarterly;

What is included in the overall professional management of hospice care?

(A) designation of a hospice registered nurse to coordinate the implementation of the plan of care; (B) provision of substantially all core services (physician, nursing, medical social work, and counseling services) that must be routinely provided directly by the hospice employees, and cannot be delegated to the NF, as outlined under 42 Code of Federal Regulations §418.80; (C) provision of drugs and medical supplies as needed for palliation and management of the terminal illness and related conditions; and (D) involvement of NF personnel in assisting with the administration of prescribed therapies in the plan of care only to the extent that the hospice would routinely use the services of a hospice patient's family or caregiver in the home setting.

What must be kept in the resident's clinical record in regard to court orders and letters of guardianship?

(A) documentation of the results of the request for the court order and letters of guardianship; and (B) a copy of the most recent court order appointing a guardian of a resident or a resident's estate and letters of guardianship that the facility received.

What must be kept in a separate section at the front of each child's records?

(A) documentation regarding the notifications required; (B) a copy of all PASARR documents; and (C) a copy of the current permanency plan.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, where can gas-fired equipment not be located?

It must not be located in attic spaces, except under the following conditions: (1) the area around the units must be constructed to be one-hour fire rated; (2) the enclosure must have sprinkler protection; and (3) combustion and venting air must be ducted from the exterior in properly sized metal ducts.

For the building plan review, what must the schedules documents include?

(A) door materials, sizes, and types; (B) window materials, sizes, and types; (C) room finishes; and (D) special hardware.

What should be documented in the comprehensive care plan regarding the education of pediatric residents?

(A) efforts to resolve differences between the IEP and the comprehensive care plan; (B) educational objectives (such as behavior therapy or speech therapy), services, and approaches; (C) the resident's adjustment to the educational program; (D) changes and modifications to the plan; and (E) discipline(s) in the facility responsible for follow-through on each educational objective.

For the building plan review, what must the electrical documents include?

(A) electrical layout, including lights, convenience outlets, equipment outlets, switches, and other electrical outlets and devices; (B) service, circuiting, distribution, and panel diagrams; (C) exit signs and emergency egress lighting; (D) emergency electrical provisions, such as generators and panelboards; (E) staff communication systems, including a nurse call system; (F) fire alarm and similar systems, such as control panels, devices, and alarms; and (G) sizes and details sufficient to ensure safe and properly operating systems.

For the building plan review, what must the elevations documents include?

(A) exterior elevations with material note; and (B) interior elevations, where needed for special conditions.

What must the fire resistance assemblies plan for the building plan review contain?

(A) fire resistance-rated wall assemblies; (B) fire resistance-rated floor-ceiling assemblies; (C) fire resistance-rated roof-ceiling assemblies; (D) fire resistance-rated joint systems; (E) fire resistance-rated systems for protection of penetrations into or through other fire resistance-rated construction and assemblies; and (F) fire resistance-rated assemblies for protection of structural columns and beams.

What General Information must be contained in the application for a facility license?

(A) for initial and change of ownership, evidence of the right to possession of the facility at the time the application is granted; (B) certificate of good standing by the Comptroller of Public Accounts; and (C) certificate of incorporation issued by the secretary of state for a corporation or a copy of the partnership agreement for partnership; and (D) for Alzheimer's disease, a disclosure statement describing the nature of its care and treatment for Alzheimer's.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, the normal wiring circuits for the emergency system must be _____?

Kept entirely independent of all other wiring and must not enter the same race-ways, boxes, or cabinets in accordance with NFPA 70.

What must be in the written cooperative agreement between a pediatric facility and the local independent school district?

(A) general responsibilities of the facility and the school district in delivering appropriate and mutually supportive services to eligible school-age residents; (B) a provision allowing the school district staff to access, with appropriate consent of the eligible resident or guardian, the facility's resident record and assessment information to avoid unnecessary duplication of services; (C) a provision allowing the school district staff an opportunity to participate in or provide information for the facility's admission, programmatic, and discharge-planning meetings when the educational needs of an eligible resident are being considered; and (D) a provision allowing the NF staff to participate in or provide information to the school district's admission, review, and dismissal (ARD) committee during its deliberations about each eligible school-age resident

For the building plan review, what must the site plan documents include?

(A) grade contours; (B) streets (with names); (C) a north arrow; (D) fire hydrant locations; (E) fire lanes; (F) utilities, public or private; (G) fences; and (H) unusual site conditions, such as ditches; low water levels; other buildings on-site; and indications of buildings five feet or less beyond site property lines.

What must be addressed in the acceptable plan of correction?

(A) how corrective action will be accomplished for those residents affected by the violations; (B) how the facility will identify other residents with the potential to be affected by the same violations; (C) what measures will be put into place or systemic changes made to ensure the violations will not recur; (D) how the facility will monitor its corrective actions to ensure that the violations are being corrected and will not recur; and (E) when corrective action will be completed.

When should the facility notify each resident that receives Medicaid benefits about their personal funds?

(A) if the amount in the resident's account reaches $200 less than SSI resource limit for one person, specified in §1611(a)(3)(B) of the Social Security Act; and (B) that, if the amount in the account, in addition to the value of the resident's other nonexempt resources, reaches the SSI resource limit for one person, the resident may lose eligibility for Medicaid or SSI.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, which power sources must be arranged for automatic connection to the alternate power source, without delay for illumination?

(A) illumination for means of egress, nurses' stations, medication rooms, dining and living rooms, group bathing rooms not directly connected to resident bedrooms, and areas immediately outside of exit doors; (B) exit signs and exit directional signs as required by NFPA 101; (C) task illumination and selected receptacles at the generator set location; (D) nurse call systems; (E) resident room night lights; (F) a light and receptacle in an electrical room or a boiler room; (G) elevator cab lighting, control, and communication systems

If an immediate involuntary transfer or discharge is contemplated, unless the discharge is to a hospital, the facility must ______.

(A) immediately call the staff of the state office Consumer Rights and Services section of HHSC to report its intention to discharge; and (B) submit to HHSC the required physician documentation regarding the discharge.

When it comes to Automated External Defibrillators what does onsite mean?

(A) in a single story building; (B) on each floor of a multiple story building; or (C) in each small house of a multiple small house model.

For the building plan review, what must the specifications documents include?

(A) installation techniques; (B) quality standards; (C) manufacturers; (D) references to specific codes and standards; (E) design criteria; (F) special equipment; (G) hardware; (H) finishes; and (I) any other information as needed to amplify drawings and notes.

What happens if an incident appears to be of a serious nature?

(A) it must be investigated by or under the direction of the director of nurses, the facility administrator, or a committee charged with this responsibility. (B) If the incident involves a resident and is serious or requires special reporting to HHSC, the resident's responsible party and attending physician must be immediately notified.

In denying a license, what fees, taxes and assessments which the licensee has failed to pay is considered?

(A) licensing fees as described in §19.216; (B) reimbursement of emergency assistance funds within one year after the date on which the funds were received by the trustee in accordance with the provisions of §19.2116(e) and (f); or (C) franchise taxes.

In facilities licensed on or after April 2, 2018, what are some situations where bedroom door locks would be permitted?

(A) married couples whose rights of privacy could be infringed upon unless bedroom door locks are permitted; and (B) residents for whom the attending physician wants bedroom door locks to enhance the residents' sense of security.

In facilities licensed on or after April 2, 2018, in addition to systems and devices required for the type of EES installed, where must systems and devices be connected according to NFPA 99 to provide for illumination?

(A) means of egress, including areas immediately outside of exit doors; (B) nurses' stations; (C) medication rooms; (D) dining, living, and recreation rooms, including activity rooms; (E) bathing rooms not directly connected to resident bedrooms; (F) exit signs and exit directional signs as required by NFPA 101; (G) task illumination and selected receptacles at the generator set location; (H) a light and receptacle in an electrical room or a boiler room; (I) elevator cab lighting, control, and communication systems; (J) resident room night lights;

The services provided or arranged by the facility must _____.

(A) meet professional standards of quality; and (B) be provided by qualified persons in accordance with each resident's written plan of care.

What are the duties of the Quality Assessment and Assurance Committee?

(A) meets at least quarterly to identify issues with respect to which quality assessment and assurance activities are necessary; and (B) develops and implements appropriate plans of action to correct identified quality deficiencies.

In the event of closure of a facility, change of ownership or change of administrative authority, the new management must _____.

Maintain documented proof of the medical information required for the continuity of care of all residents. This documentation may be in the form of copies of the resident's clinical record or the original clinical record. In a change of ownership, the two parties will agree and designate in writing who will be responsible for the retention and protection of the inactive and closed clinical records.

In facilities licensed on or after April 2, 2018, a duct with a smoke damper must have _____?

Maintenance panels for inspection. A maintenance panel must be removable without tools. A facility must provide access in the ceiling or side wall to facilitate smoke damper inspection.

What accommodations should be made for the LAR and the facility in regard to a child?

Make reasonable accommodations to promote the participation of the LAR in all planning and decision-making regarding the child's care, including participating in: (A) the initial development and annual review of the child's comprehensive care plan; (B) decision-making regarding the child's medical care; (C) routine interdisciplinary team meetings; and (D) decision-making and other activities involving the child's health and safety.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the space requirements per resident in bedrooms?

Measure at least 80 square feet per resident in multiple resident bedrooms and at least 100 square feet in single resident rooms.

Title XIX

Medicaid provisions of the Social Security Act.

Title XVIII

Medicare provisions of the Social Security Act.

According to Texas Family Code 261, what does abuse mean?

(A) mental or emotional injury to a child that results in an observable and material impairment in the child's growth, development, or psychological functioning; (B) causing or permitting the child to be in a situation in which the child sustains a mental or emotional injury that results in an observable and material impairment in the child's growth, development, or psychological functioning; (C) physical injury that results in substantial harm to the child, or the genuine threat of substantial harm from physical injury to the child, including an injury that is at variance with the history or explanation given and excluding an accident or reasonable discipline by a parent, guardian, or managing or possessory conservator that does not expose the child to a substantial risk of harm; (D) failure to make a reasonable effort to prevent an action by another person that results in physical injury that results in substantial harm to the child; (E) sexual conduct harmful to a child's mental, emotional, or physical welfare, including conduct that constitutes the offense of continuous sexual abuse of young child or children, indecency with a child, sexual assault, or aggravated sexual assault; (F) failure to make a reasonable effort to prevent sexual conduct harmful to a child; (G) compelling or encouraging the child to engage in sexual conduct, including compelling or encouraging the child in a manner that constitutes an offense of trafficking of persons, prostitution, or compelling prostitution; (H) causing, permitting, encouraging, engaging in, or allowing the photographing, filming, or depicting of the child if the person knew or should have known that the resulting photograph, film, or depiction of the child is obscene, or pornographic; (I) the current use by a person of a controlled substance, in a manner or to the extent that the use results in physical, mental, or emotional injury to a child; (J) causing, expressly permitting, or encouraging a child to use a controlled substance; (K) causing, permitting, encouraging, engaging in, or allowing a sexual performance by a child; (L) knowingly causing, permitting, encouraging, engaging in, or allowing a child to be trafficked in a manner punishable as an offense, or the failure to make a reasonable effort to prevent a child from being trafficked in a manner punishable as an offense under any of those sections; or (M) forcing or coercing a child to enter into a marriage.

What must the facility do in regard to the enrolling of school aged children in a TEA approved program?

(A) notify the local education agency (LEA), in writing, within three days of the admittance of an individual between the ages of birth and 22; and (B) provide the LEA information or records available to the facility within 14 working days of a school-age child's admission to the facility. (C) maintain, as a separate document in the school-age resident's record, a copy of the original Individual Education Plan (IEP) developed by the school district, and any subsequent changes; (D) document, in the comprehensive care plan; (E) provide to the local ARD committee a description of available space should a child need to be educated at the facility.

What items or services are included in Medicare or Medicaid payment that may not be billed to the resident's personal funds?

(A) nursing services as required in §19.1001; (B) dietary services as required in §19.1101; (C) an activities program as required in §19.702; (D) room and bed maintenance services; (E) routine personal hygiene items and services as required to meet the needs of the resident (F) medically-related social services as required in §19.703.

What actions committed by the licensee would keep them from obtaining a license?

(A) operation of a facility that has been decertified or had its contract canceled under the Medicare or Medicaid program in any state or both; (B) federal or state nursing facility sanctions or penalties, including, but not limited to, monetary penalties, downgrading the status of a facility license, proposals to decertify, directed plans of correction or the denial of payment for new Medicaid admissions; (C) unsatisfied final judgments; (D) eviction involving any property or space used as a facility in any state; (E) suspension or revocation of a license to operate a health care facility, long-term care facility, assisted living facility, or similar facility in any state; (F) surrender of a license in lieu of revocation or while a revocation hearing is pending; (G) or expiration of a license while a revocation action is pending and the license is surrendered without an appeal of the revocation or an appeal is withdrawn

In facilities licensed before Sept. 11, 2003, in existing construction, how many auxiliary stations may be assigned to a nurse's station?

More than one auxiliary station may be assigned to a designated nurses' station, regardless of the distance between stations. More than one corridor may be observed by mechanical means from a designated nurses' station or auxiliary station.

For a For-profit corporation or limited liability company, a change of ownership occurs if:

(A) ownership of the business entity that is licensed to operate the facility changes by 50% or more and one or more controlling person is added; (B) the business entity that is licensed to operate the facility is sold or otherwise transferred to an entity that is not licensed to operate the facility; (C) the entity that is licensed to operate the facility sells or otherwise transfers its business of operating the facility to an entity that is not licensed to operate the facility; (D) for any reason other than correction of an error, the federal taxpayer identification number changes; or (E) the entity that is licensed to operate the facility is terminated and fails or is ineligible to be reinstated, and the facility continues to operate.

In facilities licensed on or after April 2, 2018, where should a extinguisher be located in a hazardous room?

Must be located as close as possible to the exit door opening and on the latch side.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what regulations are required to be followed for systems using liquefied petroleum gas fuel?

Must meet the requirements of the Railroad Commission of Texas and NFPA 58 Liquefied Petroleum Gases.

In facilities licensed on or after April 2, 2018, what are vacant rooms not allow to be?

Must not be used for hazardous activities or hazardous storage, unless specifically approved by HHSC in writing.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, emergency electrical connection service must be provided to the distribution systems as required by ____?

NFPA 101 and NFPA 99.

When are governmental searches allowed?

(A) permitted only if there exists probable cause to believe an illegal substance or activity is being concealed. (B) Administrative searches by the appropriate entity, such as the fire inspector, are allowed only for limited purposes, but such searches would not ordinarily extend to the resident's personal belongings. The Texas Department of Human Services (DHS) and the nursing facility must provide for and allow residents their individual freedoms.

Abuse

Negligent or willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical or emotional harm or pain to a resident; or sexual abuse, including involuntary or nonconsensual sexual conduct that would constitute an offense under Penal Code §21.08 (indecent exposure) or Penal Code Chapter 22 (assaultive offenses), sexual harassment, sexual coercion, or sexual assault.

For the building plan review, what must the plumbing documents include?

(A) plumbing layout with pipe sizes and details sufficient to ensure safe and properly operating systems; (B) water systems; (C) sanitary systems; (D) gas systems; and (E) other systems normally considered under the scope of plumbing, fixtures, and provisions for combustion air supply.

What may be the conditions on approval of an AEM by a roommate?

(A) pointing the camera away from the consenting resident, when the proposed electronic monitoring is a video surveillance camera; and (B) limiting or prohibiting the use of an audio electronic monitoring device.

In addition, to ensure continuity of care, the transfer agreement should _____.

(A) provide for prompt diagnostic and other medical services; (B) ensure accountability for a resident's personal effects at the time of transfer; (C) specify the steps needed to transfer a resident in a prompt, safe and efficient manner; and (D) provide for supplying, at the time of transfer, a summary of administrative, social, medical, and nursing information to the facility to which the resident is transferred.

If rehabilitative services are required in a resident's comprehensive care plan, the facility must _____.

(A) provide the required services; or (B) obtain the required services from an outside resource, in accordance with §19.1906.

When it comes to educating pediatric residents, if the ARD committee decides that the facility is the appropriate educational placement and the space is adequate, what must the facility do?

(A) provide the space as described, free of any costs, including those incurred for the operation and maintenance of the space; and (B) if the space will no longer be available or must be reduced, notify the LEA 30 days in advance with regard to one student and 90 days in advance regarding more than one student.

What must the physician document in order to assure preservation of rights for an incapacitated resident?

(A) resident's comatose state, incapacity, or other mental or physical inability to communicate; (B) proposed medical treatment or decision; (C) periodic assurance that there has been no essential change in the resident's mental function; and (D) reevaluation whenever a significant change in resident status occurs or for orders that impact on resident rights (such as "No CPR").

Are Medicaid-certified facilities required to provide routine dental services?

No

In facilities licensed before Sept. 11, 2003, in existing construction, what is the maximum number of residents allotted per room?

No more than four residents.

What is the timeline for follow-up comprehensive assessments?

Not less often than once every 12 months.

In facilities licensed on or after April 2, 2018, what is required for cooling systems in areas of high heat, such as kitchens? Where is this measured?

Occupied areas generating high heat, such as kitchens, must be provided with a sufficient cool air supply to maintain a temperature not exceeding 85° F at the five-foot level. Supply air volume must be approximately equal to the air volume exhausted to the exterior for these areas.

OBRA

Omnibus Budget Reconciliation Act of 1987, which includes provisions relating to nursing home reform, as amended.

In facilities licensed on or after April 2, 2018, where must siphon breakers or back-flow preventers be installed?

On any water supply fixture if the outlet or attachments may be submerged.

When does a change of ownership license expire?

On the 90th day after its effective date.

In facilities licensed before Sept. 11, 2003, in existing construction, what must be employed to control the entry of insects into the facility?

Operable outside windows must be provided with insect screens. Outside doors must be self-closing to control entry of insects. All exterior doors must be effectively weather stripped.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, if a window exists in the kitchen, what must be installed?

Operable windows must have insect screens provided.

In facilities licensed on or after April 2, 2018, what is required for operational windows in the kitchen?

Operable windows must have insect screens provided.

DADS may deny a license to an applicant to operate a new facility if the applicant has a history of any of the following actions at any time preceding the date of the application?

(A) revocation of a license to operate a health care facility, long-term care facility, assisted living facility, or similar facility in any state; (B) surrender of a license in lieu of revocation or while a revocation hearing is pending; (C) expiration of a license while a revocation action is pending and the license is surrendered without an appeal of the revocation or an appeal is withdrawn; (D) debarment or exclusion from the Medicare or Medicaid programs by the federal government or a state; or (E) a court injunction prohibiting the applicant or manager from operating a facility.

For the building plan review, what must the floor plan documents include?

(A) room names, numbers, and usages; (B) numbered doors, including swing; (C) windows; (D) legend or clarification of wall types; (E) dimensions; (F) fixed equipment; (G) plumbing fixtures; (H) kitchen basic layout; and (I) identification of all smoke barrier walls and fire walls, outside wall to outside wall.

For the building plan review, what must the building structure include?

(A) structural framing layouts and details; (B) roof framing layout, when this cannot be adequately shown on cross section; (C) cross sections in quantity and detail to show adequate structural design; and (D) structural details as necessary to assure adequate structural design.

In facilities licensed on or after April 2, 2018, if other buildings are located on site, but do not follow under the within 20 feet limit, what are their requirements?

Other buildings on the site must meet the appropriate occupancy section or separation requirements in NFPA 101.

What kind of outside doors should be used to protect against pest infestation?

Outside doors must be self-closing to control entry of pests.

What must be included in the request for an informal review disputing a trust fund audit?

(A) submit a concise statement of the specific findings it disputes; (B) specify the procedures or rules that were not followed; (C) identify the affected cases; (D) describe the reason the findings are being disputed; and (E) include supporting information and documentation that directly demonstrates that each disputed finding is not correct.

If, within one year of the date DADS receives the notification that DADS is unable to locate the LAR, DADS will refer the case to?

(A) the Child Protective Services Division of the Department of Family and Protective Services if the child is under 18 years of age; or (B) the Adult Protective Services Division of the Department of Family and Protective Services if the child is 18-22 years of age.

What personal information should be provided by the LAR for a child upon admission?

(A) the LAR's name; address; telephone number; driver license number and state of issuance or personal identification card number issued by the Department of Public Safety; and place of employment and the employer's address and telephone number; (B) the name, address, and telephone number of a relative of the child or other person whom DADS or the facility may contact in an emergency situation, a statement indicating the relation between that person and the child, and at the LAR's option that person's driver license number and state of issuance or personal identification card number issued by the Department of Public Safety; and the name, address, and telephone number of that person's employer; and (C) a signed acknowledgement of responsibility stating that the LAR agrees to notify the facility of any changes to the contact information submitted; and make reasonable efforts to participate in the child's life and in planning activities for the child.

In accordance with the Older American Act, §712(b)(1)(A) and 45 CFR §1324.11(e)(2), a facility must allow_____.

(A) the State Ombudsman, a certified ombudsman, and an ombudsman intern to have immediate, private, and unimpeded access to enter the facility at any time during the facility's regular business hours or regular visiting hours; immediate, private, and unimpeded access to a resident; and immediate and unimpeded access to the name and contact information of a responsible party if the State Ombudsman, a certified ombudsman, or an ombudsman intern determines the information is needed to perform a function of the Ombudsman Program; and (B) the State Ombudsman and a certified ombudsman to have immediate, private, and unimpeded access to enter the facility at a time other than regular business hours or visiting hours, if the State Ombudsman or a certified ombudsman determines access may be required by the circumstances to be investigated.

In facilities licensed on or after April 2, 2018, where should stretchers and wheelchairs be located?

Parking spaces for stretchers and wheelchairs must be located out of the path of normal traffic.

What dental services are not part of the Texas Medicaid Program? How may these be paid for?

Payment for services provided on the teeth, gums, alveolar ridges, and supporting structures are not a benefit of the Texas Medicaid Program; however, recipients with applied income may use incurred medical expenses to pay for routine dental services and appliances.

What method of payment can be used to pay fees?

Payment of fees must be by check or money order made payable to the Texas Department of Human Services. All fees are nonrefundable except as provided by the Government Code, Chapter 2005.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, are physical therapy facilities required?

Physical therapy facilities must be provided if required by the treatment program. The facilities may be planned and arranged for shared use by occupational therapy residents and staff if the treatment program reflects this sharing concept.

What must be contained in each incident or complaint report?

(A) the address or phone number of the person making the report so that DADS can contact the person for any additional information, except for an anonymous report; (B) the name and address of the resident; (C) the name and address of the person responsible for the care of the resident, if available; (D) information required by DADS guidelines, when the report is an incident; and (E) any other relevant information. Relevant information includes the reporter's or complainant's basis or cause for reporting and his or her belief that a resident's physical or mental health or welfare has been or may be adversely affected by abuse or neglect caused by another person or persons, and any other information DADS considers relevant for the report.

An applicant for a license must affirmatively show that ____.

(A) the applicant or license holder has the ability to comply with minimum standards of medical care, nursing care and financial conditions; and any other applicable state or federal standard; (B) the facility meets the standards of the Life Safety Code; (C) the facility meets the construction standards in Subchapter D; and (D) the facility meets the standards for operation based upon an on-site survey

Who must be on the Quality Assessment and Assurance Committee?

(A) the director of nursing services; (B) a physician designated by the facility; and (C) at least three other members of the facility's staff.

What should be included in the plumbing plan documents for new construction?

Plumbing documents must include plumbing layout with pipe sizes and details sufficient to assure safe and properly operating systems, water systems, sanitary systems, gas systems, other systems normally considered under the scope of plumbing, fixtures, and provisions for combustion air supply.

In facilities licensed on or after April 2, 2018, what are the required finishes for plumbing fixtures for residents?

Plumbing fixtures for residents must be vitreous china or porcelain finished cast iron or steel unless otherwise approved by HHSC. Fiberglass bathing units are acceptable if they have a Class B flame spread rating when tested according to ASTM E84.

Barrier precautions

Precautions including the use of gloves, masks, gowns, resuscitation equipment, eye protectors, aprons, face shields, and protective clothing for purposes of infection control.

Investigations of reports do not _____.

Preclude actions under the provisions of Subchapter V.

For a trust, living trust, estate or any other entity type not included in paragraphs (1)-(6) of this subsection. A change of ownership occurs if:

(A) the entity that is licensed to operate the facility is sold or otherwise transferred to an entity that is not licensed to operate the facility; (B) the entity that is licensed to operate the facility sells or otherwise transfers its business of operating the facility to an entity that is not licensed to operate the facility; (C) for any reason other than correction of an error, the federal taxpayer identification number changes; or (D) the entity that is licensed to operate the facility is terminated and the facility continues to operate.

What procedure must be followed for Controlled Drugs?

Procedures governing the use of drugs covered by the Controlled Substances Act: (A) a separate record must be maintained for each drug covered by Schedules II, III, and IV of the Controlled Substances Act, Health and Safety Code, Chapter 481; (B) the record for each drug must contain the prescription number, name, and strength of drug, date received by the facility, date and time administered, name of resident, dose, physician's name, signature of person administering dose, and original amount dispensed with the balance verifiable by drug inventory at every shift change; and (C) Schedule V drugs are exempt from the above requirements.

What additional requirements are there for Medicaid-certified facilities in regard to establishing Medicaid eligibility?

Provide a written description of the requirements and procedures for establishing eligibility for Medicaid, including the right to request an assessment under §1924(c) of the Social Security Act which: (A) is used to determine the extent of a couple's nonexempt resources at the time of institutionalization; and (B) attributes to the community spouse an equitable share of resources which cannot be considered available for payment toward the cost of the institutionalized spouse's medical care in the process of spending down to Medicaid eligibility levels

If systems or equipment whose failure is likely to cause major injury or death to a resident are used, the facility must _____.

Provide emergency electrical power with an emergency generator defined in NFPA 99 located on the premises.

In general, what space must be provided to residents?

Provide sufficient space and equipment in dining, health services, recreation, living, and program areas to enable staff to provide residents with needed services as required by these standards and as identified in each resident's plan of care.

In the event that a resident is deemed an incompetent or otherwise incapacitated and was unable to receive information regarding advance directives, including written policies regarding the implementation of advance directives, later becomes able to receive the information, the facility must _____?

Provide, review, and discuss the written information at the time the resident becomes able to receive the information.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what must be provided at lavatories for resident use?

Provision must be made for sanitary hand drying and toothbrush storage at lavatories. There must be paper towel dispensers or separate towel racks and separate toothbrush holders. Mirrors must be arranged for convenient use by residents in wheelchairs as well as by residents in a standing position, and the minimum size must be 15 inches in width by 30 inches in height, or tilt type.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required for clean linen storage?

Provision must be made for separate closets or room for clean linens. Corridors must not be used for folding or cart storage. Storage rooms must be located and distributed in the building for efficient access to bedrooms.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the exit provisions for areas outside of exterior exit doors?

Provision must be made to accommodate and facilitate continuation of emergency egress away from a building for a reasonable distance beyond the outside exit door, especially for movement of non-ambulatory residents in wheelchairs and beds. Any condition which may retard or halt free movement and progress outside the exit doors will not be allowed. Ramps must be used outside the exit doors in lieu of steps whenever possible.

In facilities licensed before Sept. 11, 2003, in existing construction, if public telephones are provided, where should they be located to comply with ADA?

Public telephones, if provided, must meet ANSI A117.1. Mounting height must not exceed 48 inches to coin slot.

What if the facility gets notification of an inspection?

Releasing advance information of an unannounced inspection is a third degree felony, as provided in §242.045 of the Health and Safety Code.

Where should allegations of abuse be reported?

Reports must be made to DADS at 1-800-458-9858 and written reports must be sent to: DADS Consumer Rights and Services, P.O. Box 14930, Austin, Texas 78714-9030.

In facilities licensed on or after April 2, 2018, what requirements must be met for utilities; heating, ventilating, and air-conditioning systems; vertical conveyors; and chutes?

Requirements of NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

For Small House and Household Facilities, what are the requirements for the door between the resident bedroom and bathroom?

Resident bathing and toilet facility requirements in §19.354(c) must be met, except the door between a bathroom and a resident bedroom: (A) is not required to be a side-hinged swinging door; (B) may be an externally mounted by-pass door; (C) must have substantial hardware; (D) must not be equipped with a bottom door track that is a tripping hazard; and (E) if it swings open into the bedroom, must not interfere with the swing of any other door that opens into the bedroom.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, for design calculation purposes, what is the maximum temperature allowed at resident-use hot water fixtures?

Resident-use hot water must not exceed 110° F at the fixture. For purposes of conforming to licensure requirements, an operating system providing water from 100° F to 115° F is acceptable.

In facilities licensed on or after April 2, 2018, what is the maximum temperature for resident hot water use?

Resident-use hot water must not exceed 110° F at the fixture. For purposes of conforming to licensure requirements, an operating system providing water from 100° F to 115° F is acceptable.

RUG

Resource Utilization Group. A categorization method, consisting of 34 categories based on the MDS, that is used to determine a recipient's service and care requirements and to determine the daily rate HHSC pays a nursing facility for services provided to the recipient.

What does the Statement of Resident rights say about restraints?

Right to be free from any physical or chemical restraints imposed for the purposes of discipline or convenience and not required to treat your medical symptoms;

What does the Statement of Resident rights say about discharging yourself?

Right to discharge yourself from the facility unless you have been adjudicated mentally incompetent

What does the Statement of Resident rights say about being discharged from the facility?

Right to not be discharged from the facility, except as provided in the nursing facility regulations;

What does the Statement of Resident rights say about activities outside the facility?

Right to participate in activities inside and outside the facility

What does the Statement of Resident rights say about electronic monitoring?

Right to place an electronic monitoring device in your room that is owned and operated by you or provided by your guardian or legal representative.

What does the Statement of Resident rights say about psychoactive medications?

Right to receive information about prescribed psychoactive medication from the person who prescribes the medication or that person's designee, to have any psychoactive medications prescribed and administered in a responsible manner, as mandated by the Health and Safety Code, §242.505, and to refuse to consent to the prescription of psychoactive medications

What does the Statement of Resident rights say about mail service?

Right to receive unopened mail and to receive assistance in reading or writing correspondence

What does the Statement of Resident rights say about clothing?

Right to wear your own clothes

In facilities licensed before Sept. 11, 2003, in existing construction, where must room signs to located to comply with ADA?

Room identification signs or letters must be installed 4'6" to 5' above finished floor and located on the corridor walls adjacent to the latch side of the door jamb. Letters or numbers on signs must be raised or recessed at least 1/32" minimum. Characters must be at least 5/8" in height and no higher than 2".

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what type of ventilation must be installed in toilet rooms?

Rooms with toilets must be provided with effective forced air exhaust ducted to the exterior to help remove odors. Ducted manifold systems are recommended for some multiple-type installations.

What are not considered emergencies and are therefore not included?

Routine restorative procedures are not considered emergency procedures. Dental services not covered include, but are not limited to (A) cleaning; (B) filling teeth with amalgam composite, glass ionomer, or any other restorative material; (C) cast or preformed crowns (capping); (D) restoration of carious or non-carious permanent or primary teeth, including those requiring root canal therapy; (E) replacement or repositioning of teeth; (F) services to the alveolar ridges or periodontium of the maxilla and the mandible, except for procedures covered under subparagraph (A) of this paragraph; and (G) complete or partial dentures.

In facilities licensed before Sept. 11, 2003, in existing construction, what type of containers are permissible for opened dry food packages?

Sealed containers must be provided for storing dry foods after the package seal has been broken.

In facilities licensed on or after April 2, 2018, what is the requirement for seat height in water closets?

Seat height 17 inches to 19 inches from the floor for persons with disabilities.

In facilities licensed before Sept. 11, 2003, in existing construction, what should the finishes on the food storage area be?

Shelves and pallets must be moveable wire, metal, or sealed lumber, and walls must be finished with a nonabsorbent finish to provide a cleanable surface.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what type of finishes are required in the food storage area?

Shelves must be adjustable wire type. Walls and floors must have a nonabsorbent finish to provide a cleanable surface.

In facilities licensed on or after April 2, 2018, what are the requirements for showers and tubs?

Showers for wheelchair residents must not have curbs. Tub and shower bottoms must have a slip-resistant surface. Shower and tub enclosures, other than curtains, must be of tempered glass, plastic, or other safe material.

What is required of small multiple-dose containers?

Small multiple-dose drug containers which are placed into another container must be labeled in a manner so that, if the two containers become separated, the small drug container still has a strip label attached containing the name of the resident and the prescription number.

How should personnel handle, store, process, and transport linens?

So as to prevent the spread of infection and in accordance with §19.325.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, how should the soiled and clean operations of the laundry facility be set-up?

Soiled and clean operations must be planned to maintain sanitary flow of functions as well as air flow. If carts containing soiled linens from resident rooms are not taken directly to the laundry area, intermediate holding rooms must be provided and located convenient to resident bedroom areas.

In facilities licensed before Sept. 11, 2003, in existing construction, how must soiled linen be transported and stored?

Soiled linen must be stored and/or transported in closed or covered containers. Soiled linen storage or holding rooms must have a negative air pressure in relation to adjacent areas with air exhausted through ducts to the exterior.

In facilities licensed before Sept. 11, 2003, in existing construction, what personal grooming areas must be provided?

Space and equipment must be provided for the hair care and grooming needs of the residents. Hair care and grooming service will be provided in resident bedrooms or in designated areas which are not in a way of egress.

In facilities licensed on or after April 2, 2018, what is required at each nurses' station?

Space for nurses' charting, doctors' charting, and storage for administrative supplies.

In facilities licensed on or after April 2, 2018, what are some special provisions to be considered in the structural design of the building?

Special provisions must be made in the design of buildings in regions where local experience shows loss of life or extensive damage to buildings resulting from hurricanes, tornadoes, earthquakes, or floods.

What must be included in the specifications for new construction plans?

Specifications must include installation techniques, quality standards, manufacturers, references to specific codes and standards, design criteria, special equipment, hardware, finishes, and any other information needed to amplify drawings and notes.

When can administrative nurses be counted in the licensed-care ratio?

Staff, who also have administrative duties not related to nursing, may be counted in the ratio only to the degree of hours spent in nursing-related duties.

ASTM E662

Standard Test Method for Specific Optical Density of Smoke Generated by Solid Materials, 2017, published by ASTM.

ASTM E84

Standard Test Method for Surface Burning Characteristics of Building Materials, 2010, published by ASTM.

ASTM E108

Standard Test Methods for Fire Tests of Roof Coverings, published by ASTM.

UL 790

Standard Test Methods for Fire Tests of Roof Coverings.

NFPA 110

Standard for Emergency and Standby Power Systems, 2010 edition.

UL 1069

Standard for Hospital Signaling and Nurse Call Equipment.

UL 723

Standard for Test for Surface Burnings Characteristics of Building Materials.

NFPA 220

Standard on Types of Building Construction, 2012 edition.

What areas are not allowed to be searched during a governmental search?

State statutes authorize inspections of the nursing facility but do not authorize inspection of those areas in which an individual has a reasonable expectation of privacy. Any direct participation by DHS personnel in an inspection of "the contents of residents' personal drawers and possessions," is in violation of federal and state law.

In facilities licensed on or after April 2, 2018, what are the static pressure requirements of HVAC systems?

Static pressures of systems must be within limits recommended by ASHRAE and the equipment manufacturer, both upstream and downstream.

In facilities licensed on or after April 2, 2018, what are the required exit provisions for changes in elevation the facility?

Steps in interior ways of egress are prohibited. If changes of elevation are necessary within ways of egress, approved ramps with a maximum slope of one unit of rise to 12 units of run must be provided.

In facilities licensed on or after April 2, 2018, what are the requirements for the security for resident items not kept in their rooms?

Storage space with provisions for locking and security control must be provided for residents' personal effects which are not kept in their rooms.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, in the event that personal items are not kept in the residents' rooms, what type of storage should be provided?

Storage space with provisions for locking and security control should be provided for residents' personal effects which are not kept in their rooms.

Where can the requirements a facility must comply with to provide nursing facility specialized services to a designated resident be found?

Subchapter BB (PASRR), as define in §19.2703.

In facilities licensed before Sept. 11, 2003, in existing construction, what is the minimum temperature allowed in a kitchen at peak load?

Sufficient heating must be provided to maintain an average temperature of not less than 70° F (with exhausts operating) at the five-foot level.

Title XVI

Supplemental Security Income (SSI) of the Social Security Act.

In facilities licensed on or after April 2, 2018, what must the supply system do?

Supply systems must ensure adequate hot and cold water.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what is important when designing air systems?

Systems must be designed as much as possible to avoid having ducts passing through fire walls or smoke barrier walls. All openings or duct penetrations in these walls must be provided with approved automatic dampers. Smoke dampers at smoke partitions must close automatically upon activation of the fire alarm system to prevent the flow of air or smoke in either direction.

What must be conspicuously and prominently posted in the facility?

(A) the facility license; (B) a complaint sign provided by DADS giving the toll-free telephone number; (C) a notice in a form prescribed by DADS that inspection and related reports are available at the facility for public inspection; (D) a concise summary prepared by DADS of the most recent inspection report; (E) a notice of DADS toll-free telephone number to request summary reports relating to the quality of care, recent investigations, litigation or other aspects of the operation of the facility that are available to the public; (F) a notice that DADS can provide information about the nursing facility administrator; (G) if a facility has been ordered to suspend admissions, a notice of the suspension, which must be posted also on all doors providing public ingress to and egress from the facility; (H) the statement of resident rights provided in §19.401 and any additional facility requirements involving resident rights and responsibilities; (I) a notice that employees, other staff, residents, volunteers, and family members and guardians of residents are protected from discrimination or retaliation as provided by the Texas Health and Safety Code, §260A.014 and §260A.015; and that the facility has available for public inspection a copy of the Texas Health and Safety Code, Chapter 260A; (J) a prominent and conspicuous sign for display in a public area of the facility that is readily available to the residents, employees, and visitors and that includes the statement: CASES OF SUSPECTED ABUSE, NEGLECT, OR EXPLOITATION SHALL BE REPORTED TO THE DEPARTMENT OF AGING AND DISABILITY SERVICES BY CALLING 1-800-458-9858; (K) for a facility that advertises, markets, or otherwise promotes that it provides services to residents with Alzheimer's disease and related disorders, a disclosure statement describing the nature of its care or treatment of residents with Alzheimer's disease and related disorders in accordance with §19.204(b)(4); (L) at each entrance to the facility, a sign that states that a person may not enter the premises with a concealed handgun and that complies with Government Code §411.204; and (M) daily for each shift, the current number of licensed and unlicensed nursing staff directly responsible for resident care in the facility. In addition, the nursing facility must make the information required to be posted available to the public upon request.

What data must be posted daily about the Nursing staff?

(A) the facility name; (B) the current date; (C) the resident census; and (D) the specific shifts for the day

What must be included in the Alzheimer's disclosure statement?

(A) the facility's philosophy of care for Alzheimer's; (B) whether the facility is certified to care for Alzheimer's; (C) the pre-admission, admission, and discharge process; (D) resident assessment, care planning, and implementation of the care plan; (E) staffing patterns, such as resident to staff ratios and staff training; (F) the physical environment of the facility; (G) resident activities; (H) program changes; (I) systems for evaluation of the facility's program; (J) family involvement in resident care; (K) the phone number for DAD's complaint line

For a city, county, state or federal government authority, hospital district, or hospital authority, a change of ownership occurs if:

(A) the governmental entity that is licensed to operate the facility sells or otherwise transfers its business of operating the facility to an entity that is not licensed to operate the facility; or (B) the entity that is licensed to operate the facility is terminated and the facility continues to operate.

In making a determination whether to grant a nursing facility license, DADs reviews _____.

(A) the information contained in the application; (B) the criminal history information of the persons; (C) other documents DADs deems relevant, including survey and complaint investigation findings in each facility with which the applicant or any other person named has been affiliated at any time.

TAS

Texas Accessibility Standards.

Distinct part

That portion of a facility certified to participate in the Medicaid Nursing Facility program.

In a Nonprofit organization, a change of ownership occurs if:

(A) the nonprofit organization that is licensed to operate the facility is sold or otherwise transferred to an entity that is not licensed to operate the facility; (B) the entity that is licensed to operate the facility sells or otherwise transfers its business of operating the facility to an entity that is not licensed to operate the facility; (C) for any reason other than correction of an error, the federal taxpayer identification number changes; or (D) the entity that is licensed to operate the facility is terminated and fails or is ineligible to be reinstated, and the facility continues to operate.

What is a good cause for exceeding the period established for the issuing of a license?

(A) the number of applications to be processed exceeds by 15% or more the number processed in the same calendar quarter of the preceding year; (B) another public or private entity used in the application process caused the delay; or (C) other conditions existed giving good cause for exceeding the established periods.

Who is authorized to give consent for the roommate of a resident for an AEM?

(A) the other resident or residents in the room; (B) the guardian of the other resident, if the resident has been judicially declared to lack the required capacity; or (C) the legal representative of the other resident.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, when would emergency heating not be required?

(A) the outside design temperature is higher than 20° F (-6° C); (B) the outside design temperature is lower than 20° F (-6° C) and where selected rooms are provided for the needs of all confined residents, then only those rooms need to be heated; or (C) the facility is served by a dual source of normal power.

What can be done if a person prescribes psychoactive medication to a resident without the resident's consent because the resident is having a medication-related emergency?

(A) the person must document the necessity of the order in the resident's clinical record in specific medical or behavioral terms; and (B) treatment of the resident with the psychoactive medication must be provided in the manner, consistent with clinically appropriate medical care, least restrictive of the resident's personal liberty.

What is the time limits on applications for a license?

The Health and Human Services Commission (HHSC) will process only applications received within 60 days prior to the requested date of the issuance of the license.

Where can guidance on the treatment of a resident who is comatose, incapacitated or otherwise mentally or physically incapable of communication be found?

The Health and Safety Code, Chapter 313, Consent to Medical Treatment. An ethics committee also may prove helpful in such situations.

What must be in the written notice of discharge?

(A) the reason for transfer or discharge; (B) the effective date of transfer or discharge; (C) the location to which the resident is transferred or discharged; (D) a statement that the resident has the right to appeal the action as outlined in HHSC's Fair Hearings, Fraud, and Civil Rights Handbook by requesting a hearing through the Medicaid eligibility worker at the local HHSC office within 10 days; (E) the name, address, and telephone number of the managing local ombudsman, and the toll-free number of the Ombudsman Program; (F) in the case of a resident with mental illness, the address and phone number of the state mental health authority; and (G) in the case of a resident with an intellectual or developmental disability, the authority for individuals with intellectual and developmental disabilities, and the phone number of the agency responsible for the protection and advocacy of individuals with intellectual and developmental disabilities.

Who developed the resident rights statement?

The Texas Department of Human Services

What must be on receipts that the facility must obtain for the purchase of an item or service?

(A) the resident's name; (B) the date the receipt was written or created; (C) the amount of funds spent; (D) the specific item or service purchased; (E) the name of the business from which the purchase was made; and (F) the signature of the resident.

What must be included in the written contract with a hospice to provided services?

(A) the services to be provided; (B) a stipulation that hospice-related services performed by NF staff may be provided only with the express authorization of the hospice; (C) how the contracted services are to be coordinated, supervised, and evaluated by the hospice and the NF; (D) delineation of the roles of the hospice and the NF in the admission process, recipient and family assessment, and the interdisciplinary team case conferences; (E) a requirement for documentation of services furnished; and (F) the qualifications of the personnel providing the services.

In a Sole proprietorship, a change of ownership occurs if:

(A) the sole proprietor who is licensed to operate the facility sells or otherwise transfers its business of operating the facility to an entity not licensed to operate the facility; or (B) upon the death of the sole proprietor, the facility continues to operate.

In facilities licensed on or after April 2, 2018, what are optional physical therapy facilities which may be included?

(A) treatment areas with space and equipment for the therapies provided; (B) an exercise area; (C) storage for clean linen, supplies, and equipment used in therapy; (D) service sink located near therapy area; and (E) wheelchair and stretcher storage.

For the building plan review, what must the details documents include?

(A) wall sections as needed, especially for special conditions; (B) cabinets and built-in work, basic design only; (C) cross sections through buildings as needed; and (D) miscellaneous details and enlargements as needed.

What happens if DADS denies a license or refuses to issue a renewal of a license?

The applicant or license holder may request an administrative hearing.

When may the delegation of resident's rights occur?

(A) when a competent individual chooses to allow another to act for him, such as with a Durable Power of Attorney; (B) when the resident has been adjudicated to be incompetent by a court of law and a guardian has been appointed; or (C) when the physician has determined that, for medical reasons, the resident is incapable of understanding and exercising such rights. The Health and Safety Code, Chapter 313, Consent to Medical Treatment, provides guidance under certain circumstances when a resident is comatose, incapacitated, or otherwise mentally or physically incapable of communication.

In determining whether there is a history of satisfactory compliance with federal or state regulations, DADS at a minimum may consider:?

(A) whether any violation resulted in significant harm or a serious and immediate threat to the health, safety, or welfare of any resident; (B) whether the person promptly investigated the circumstances surrounding any violation and took steps to correct and prevent a recurrence of a violation; (C) the history of surveys and complaint investigation findings and any resulting enforcement actions; (D) a repeated failure to comply with regulation; (E) an inability to attain compliance with cited deficiencies within an acceptable period of time as specified in the plan of correction or credible allegation of compliance, whichever is appropriate; (F) the number of violations relative to the number of facilities the applicant or any other person named in §19.201(e) has been affiliated with at any time; and (G) any exculpatory information deemed relevant by DADS;

What documents must be provided to HHSC at the time of the survey of completed construction?

(A) written approval of local authorities; (B) record drawings of the fire detection and alarm system as installed; (C) documentation of materials used in the building that are required to have a specific limited fire resistant or flame spread rating (D) record drawings of the fire sprinkler system as installed (E) service contracts for maintenance and testing of systems, including alarm systems and sprinkler systems; (F) a copy of gas pressure test results of the facility's gas lines from the meter to gas-fired equipment and appliances; (G) a written statement from an architect or engineer certifying the building was constructed to meet NFPA 101, all locally applicable codes, and that the facility substantially conforms to the minimum licensing requirements; and (H) the contract documents specified

How often should personal clothing be laundered?

The clothing must be collected and cleaned at least weekly.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what must be included in the washer area of the laundry facilities?

(I) a floor drain; (II) storage for laundry supplies; (III) a clean linen inspection and mending room or area and a folding area; (IV) a clean linen storage, issuing, or holding room or area; (V) a janitors' closet containing a floor receptor or service sink and storage space for housekeeping equipment and supplies; and (VI) sanitizing and washing facilities and a storage area for carts.

Who reimburses the facility for emergency dental services?

The cost of emergency dental services provided to eligible Medicaid residents residing in nursing facilities will be reimbursed to facilities, provided that the services are not reimbursable by the Medicaid claims processor or the EPSDT program. DHS reimburses facilities for services properly rendered in accordance with applicable laws, regulations, and operational instructions. DHS may withhold or suspend payment for services that are not properly rendered.

In facilities licensed on or after April 2, 2018, what is the requirements for the entrance to the facility?

The entrance must be at grade level, sheltered from the weather, and able to accommodate wheelchairs. A drive-under canopy must be provided for the protection of residents or visitors entering or leaving a vehicle. The drive-under canopy may be a secondary entrance.

How many dietary support personnel are required in a facility?

The facility must employ sufficient dietary support personnel who are competent to carry out the functions of the dietary service.

What can be done if the facility does not employ a qualified professional to furnish a specific service to be provided by the facility?

The facility must have that service furnished to residents by a person or agency outside the facility under an agreement.

In facilities licensed before Sept. 11, 2003, in existing construction, what must be at each nurse's station in addition to the required normal and emergency illumination?

The facility must keep on hand and readily available to night staff no less than one working flashlight at each nurses' station.

What must be safeguarded when it comes to clinical record information?

The facility must safeguard clinical record information against loss, destruction, or unauthorized use;

What must be done at the time of a resident's admission in regard to communicable diseases?

The facility must screen all residents at admission in accordance with the attending physician's recommendations and current CDC guidelines.

If the ownership of a facility changes, what must the old and new owner do about a resident's personal funds?

The former owner must transfer the bank balances or trust funds to the new owner with a list of the residents and their balances. The former owner must get a receipt from the new owner for the transfer of these funds. The former owner must keep this receipt for monitoring or audit purposes.

Who has access to the resident's financial records?

The individual financial record must be available on request to the resident, responsible party, representative payee or legal representative.

Who will receive notice of the results of a DADS investigation of a reported case of abuse, neglect or other complaint?

The individual reporting the alleged abuse or neglect or other complaint, the resident, the resident's family, any person designated by the resident to receive information concerning the resident, and the facility.

What happens after the completed construction is surveyed and found acceptable by HHSC?

The information is conveyed to the licensing officer as part of the information needed to issue a license to the facility. Additions to or rehabilitation of existing facilities may require a revision or modification to an existing license. The building, including basic furnishings and operational needs, grades, drives, parking, and grounds must be essentially 100% complete at the time of this initial survey visit for HHSC to approve occupancy and licensing. A facility may accept up to three residents between the time it receives initial approval from HHSC and the time the license is issued.

What is a facility probationary license?

The initial license issued to a license holder who has not previously held a license. It is effective for one year. A permanent license may be issued only after DHS finds that the license holder continues to meet nursing facility requirements and submits an application requesting a permanent license with the applicable fees. The facility must be able to pass an inspection unless not required.

What form should be used to perform the Capacity Assessment for Self Care and Financial Management?

The instrument developed by the Texas Department of Mental Health and Mental Retardation.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the exhaust hood requirements for a kitchen?

The kitchen exhaust hood at cooking equipment and its attached automatic chemical extinguisher must comply with NFPA 96. HHSC may waive certain details of NFPA 96 for existing kitchen exhausts at cooking equipment provided that basic function and safety are not compromised.

What are the fees for a Probationary license?

The license fee is $125 plus $5 for each unit of capacity or bed space for which a license is sought.

Who else must give consent for AEM of a resident? How is this documented?

The other residents in the room. Using the DHS Consent to Authorized Electronic Monitoring form. When complete, the form must be given to the administrator or designee. A copy of the form must be maintained in the active portion of the resident's clinical record.

For Small House and Household Facilities, what recreational spaces are required?

The outdoor activity, recreational, and sitting spaces required in §19.352(f) must include a porch area under a roof with suitable furniture for sitting and space for wheelchairs.

How does HHSC pay a facility for rehabilitative services provided to a Medicaid eligible residents?

The payments are based on fees determined in accordance with Title 1, Texas Administrative Code (TAC) §355.313.

What does TX DHS say about advanced directives?

The right to formulate an advance directive (as specified in §19.419.

What does TX DHS say about experimental research?

The right to refuse to participate in experimental research. If the resident chooses to participate in experimental research, the resident must be fully notified of the research and possible effects of the research. The research may be carried on only with the full written consent of the resident's physician, and the resident. Experimental research must comply with FDA regulations on human research as found in 45 Code of Federal Regulations, Part 4b, Subpart A.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what is plumbing required in the soiled utility room?

The soiled utility room must be provided with a flushing device such as a water closet with bedpan lugs, a spray hose with a siphon breaker or similar device, such as a high neck faucet with lever controls and a deep sink that is large enough to submerse a bedpan. A sterilizer for sanitizing may be used in place of a deep sink.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, in regards to structural design, what is the responsibility of the sponsor?

The sponsor is responsible for employing qualified personnel in the preparation of plan designs and engineering and in the construction of the facility to assure that all structural components are adequate, safe, and meet the applicable construction requirements.

After a waiver is granted for the 24-hour licensed nurse requirement, what does the state do?

The state agency granting a waiver of these requirements provides notice of the waiver to the State Ombudsman and the protection and advocacy system in the state for individuals with mental illness or individuals with intellectual or developmental disabilities.

DADS

The term referred to the Department of Aging and Disability Services; it now refers to HHSC.

In facilities licensed before Sept. 11, 2003, in existing construction, what is the minimum space required between beds?

There must be at least 36 inches between beds and should be at least 18 inches between any bed and the adjacent parallel wall that restricts access by the resident, that is, bed sides should not have to be placed against a wall to meet other spacing requirements. Beds must not extend into the bedroom door opening, nor must any other piece of furnishing or equipment be located where it might preclude or inhibit the removal of any bed or closing and latching of the bedroom door in an emergency.

NHIC

This term referred to the National Heritage Insurance Corporation. It now refers to the state Medicaid claims administrator.

How are dietitian consultant hours counted?

To meet the consultant-hour requirement, time is accrued and counted exactly as rendered.

In facilities licensed on or after April 2, 2018, why should fresh air inlets be screened?

To prevent entry of debris, rodents, and animals. A facility must provide access to such screens for periodic inspection and cleaning to eliminate clogging or air stoppage.

In general, how should facilities be designed, constructed, equipped and maintained?

To protect the health and ensure the safety of residents, personnel, and the public.

In hospice care, the recipient has the right _____.

To refuse any services from the nursing facility and the hospice provider.

In facilities licensed on or after April 2, 2018, why must areas such as laundries, kitchens, and dishwashing areas exhaust all room air to the outdoors?

To remove excess heat and moisture and to maintain air flow in the direction of clean to soiled areas.

When planning activities for children, what is required?

Toys and recreational equipment for pediatric residents must be appropriate for the size, age, and developmental level of the residents.

What is the informal review process for a disputed trust fund audit once the request has be granted?

Upon receipt of a request for an informal review, the Trust Fund Monitoring Unit Manager coordinates the review of the information submitted. (A) Additional information may be requested by DADS (B) DADS sends its written decision to the facility by certified mail, return receipt requested.

What is required of Medicaid-certified facilities in regard to managing resident financial affairs?

Upon written authorization of a resident, the facility must hold, safeguard, manage, and account for the personal funds of the resident deposited with the facility, as described in §19.405. The facility will act as a fiduciary agent if the facility holds, safeguards, and accounts for the resident's personal funds.

Where must the use of restraints be documented?

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

In facilities licensed on or after April 2, 2018, what is the suggested way of providing for natural ventilation?

Using windows or louvers, if possible and practical. Windows or louvers must have insect screens.

In facilities licensed before Sept. 11, 2003, in existing construction, what is prohibited in vacant rooms?

Vacant bedrooms may not be used for hazardous activities or hazardous storage, unless specifically approved by HHSC in writing.

How long will vendor payments continue if a resident has requested a hearing after being served with a discharge or transfer notice?

Vendor payments and eligibility will continue until the hearing officer makes a final determination. If the recipient has left the facility, Medicaid eligibility will remain in effect until the hearing officer makes a final determination.

What kind of license is issued for a change of ownership if the new owner has never held a license in Texas?

When an applicant has not previously held a license in Texas, a probationary license is issued following the change of ownership license. The effective date of the probationary one-year license is the same date as the change of ownership license and cannot precede the date the application is received in DADS.

In facilities licensed before Sept. 11, 2003, in existing construction, when are auxiliary nurse's stations required?

When resident bedrooms are more than 150 feet from the nurses' station and the adjacent corridors are not observable from the station by direct line of sight, an auxiliary station must be established and used.

How should resident records be destroyed?

When resident records are destroyed after the retention period is complete, the facility must shred or incinerate the records in a manner which protects confidentiality.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the regulations for smoke compartmentation?

(a) Smoke compartmentation must be as described in the Life Safety Code and in this section. (b) An exit sign must be provided on each side of corridor smoke doors unless otherwise directed by the Texas Department of Human Services (DHS). (c) The metal frames for the wire glass view panels in smoke doors must be steel, unless otherwise approved by DHS. The bottom of the view panel must not be higher than 54" above the floor. Pairs of opposite (double egress) swinging smoke doors in corridors must have push/pull hardware. The door leaves must align in the closed position.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, if linen is laundered on site, what should be provided?

(i) A soiled linen receiving, holding, and sorting room with a rinse sink. This area must have a floor drain and forced exhaust to the exterior which must operate at all times there is soiled linen being held in the area. (ii) A laundry processing room with equipment which can process seven days needs within a regularly scheduled work week. Hand-washing facilities must be provided.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required of the auxiliary stations, if they are needed?

(i) More than one auxiliary station may be assigned to a designated nurses' station, regardless of the distance between stations. (ii) The nurse call system for resident corridors monitored by the auxiliary station must report to the auxiliary station. (iii) Each auxiliary station must meet the emergency electrical requirements for a nurses' station, including electrical receptacles and emergency lighting. (iv) If a required auxiliary station does not already exist and the facility must establish a new auxiliary station, all applicable standards, particularly those pertaining to the physical plant and NFPA 101, must be observed.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the guidelines for the use of locks on bedroom doors?

(i) bedroom door locks must be of the type which the occupant can unlock at will from inside the room; (ii) all bedroom door locks must be of the type which can be unlocked from the corridor side; (iii) attendants must carry keys which will permit ready access to the locked bedrooms when entrance becomes necessary; and (iv) locking of bedroom doors by residents for privacy or security will not be permitted except when specifically included in the attending physician's written orders or authorized by the nursing facility administrator.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are some situations where locks on bedroom doors would be permitted?

(i) married couples whose rights of privacy could be infringed upon unless bedroom door locks are permitted; and (ii) residents for whom the attending physician wants bedroom door locks to enhance the residents' sense of security.

In facilities licensed on or after April 2, 2018, when could the number of required elevators be reduced?

With the approval of HHSC, for those floors that provide only partial inpatient services.

What is the timeline for the initial comprehensive assessments of a resident?

Within 14 calendar days after admission, excluding readmissions in which there is no significant change in the resident's physical or mental condition. For purposes of this section, "readmission" means a return to the facility following a temporary absence for hospitalization or for therapeutic leave.

Upon acquiring an AED, what must the facility do? When?

Within 24 hours after acquiring an automated external defibrillator, a facility must notify the local emergency medical services provider of: (A) the existence of the automated external defibrillator; (B) the location of the automated external defibrillator in the facility; and (C) the type of automated external defibrillator.

When will a quality-of-care monitor conduct a follow-up visit?

Within 45 days after the date of an initial visit.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required in the lobby area of a facility?

(i) storage space for wheelchairs if more than one is kept available; (ii) a reception or information area, which may be adjacent to the lobby if location is obvious; (iii) waiting space; (iv) public toilet facilities for individuals with disabilities, which may be adjacent to lobby; (v) at least one public access telephone, installed to meet standards under the Americans with Disabilities Act; and (vi) drinking fountains. These may be provided in a common public area and at least one must be installed to meet standards under the Americans with Disabilities Act

What are the plan fees associated with Additions or remodeling of existing licensed facilities?

2% of construction cost with $500 minimum fee and a maximum not to exceed $2,000.

What is considered normal business hours?

8:00 a.m. to 5:00 p.m., Monday through Friday, excluding national holidays.

What happens if the facility fails to notify the Facility Enrollment department within 30 days of a change?

A $500 administrative penalty. If the notice is postmarked within the 30-day period, 15 days will be added to the time period to receive the notice.

What is the requirement for a SNF to be given a staffing waiver consideration?

A SNF (Medicare) must be in a rural area for waiver consideration.

Who is Exempt from the Facility Application requirements?

A bank, trust company, financial institution, title insurer, escrow company or underwriter title company to which a license is issued in a fiduciary capacity.

In facilities licensed on or after April 2, 2018, where are the bathtubs or shower facilities required to be located?

A bathing room must be located conveniently to the bedroom area it serves and must not be more than 100 feet from the farthest bedroom.

What is a behavioral emergency?

A behavioral emergency is a situation in which severely aggressive, destructive, violent, or self-injurious behavior is exhibited by a resident: (A) poses a substantial risk of imminent probable death of, or substantial bodily harm to, the resident or others; (B) has not abated in response to attempted preventive de-escalatory or redirection techniques; (C) could not reasonably have been anticipated; and (D) is not addressed in the resident's comprehensive care plan.

In a facility constructed or licensed after January 1, 2004, what kind of air conditioning system is required?

A central air conditioning system, or a substantially similar air conditioning system, that is capable of maintaining a temperature suitable for resident comfort within areas used by residents.

What type of license is issued during a change of ownership?

A change of ownership license is a 90-day temporary license issued to an applicant who proposes to become the new operator of a nursing facility that exists on the date the application is submitted.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the requirements for clean utility rooms?

A clean utility room must be provided and must contain a sink with hot and cold water. It must be part of a system for storage and distribution of clean and sterile supply materials and equipment.

What will be provided by DADS at the time the report of contact or similar document is provided to the facility?

A clear and concise summary in nontechnical language of each licensure inspection or complaint investigation.

In facilities licensed on or after April 2, 2018, what must be provided for all gas or fossil fuel operated equipment?

A combustion fresh air inlet must be provided to all gas or fossil fuel operated equipment in steel ducts or passages from outside the building according to NFPA 54. Combustion air must be provided through two permanent openings, one commencing within 12 inches of the floor and one commencing within 12 inches of the ceiling.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what must be provided on all gas or fossil fuel systems?

A combustion fresh air inlet must be provided to all gas or fossil fuel operated equipment in steel ducts or passages from outside the building in accordance with NFPA 54. Rooms must also be vented to the exterior to exhaust heated ambient air in the room. Combustion air will require one vent within 12 inches of the floor and one vent within 12 inches of the ceiling.

In facilities licensed before Sept. 11, 2003, in existing construction, what should the temperature be in bathing areas?

A comfortable temperature for residents when bathing must be provided.

What is a complaint?

A complaint is any allegation received by the Texas Department of Human Services (DHS) other than an incident reported by facility staff. These allegations include, but are not limited to, abuse, neglect, exploitation, or violation of state or federal standards.

In facilities licensed on or after April 2, 2018, what temperature must be maintained by cooling systems?

A cooling system must be able to maintain a temperature of not more than 78° F.

What must be provided to the resident or authorized representative upon admission about Advance Directives?

A copy of the advance care planning educational material provided by DADS; the resident's rights under Texas law (whether statutory or as recognized by the courts of the state) to make decisions concerning medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives; and the facility's policies respecting the implementation of these rights, including the written policies regarding the implementation of advance directives.

Medical Necessity

A determination, made by physicians and registered nurses who are employed by or contract with the state Medicaid claims administrator, that a recipient requires the services of a licensed nurse in an institutional setting to carry out a physician's planned regimen for total care. A recipient's need for custodial care in a 24-hour institutional setting does not constitute medical necessity.

Therapeutic diet

A diet ordered by a physician as part of treatment for a disease or clinical condition, in order to eliminate, decrease, or increase certain substances in the diet or to provide food which has been altered to make it easier for the resident to eat.

What should be provided to the resident at the time of discharge from the facility?

A discharge summary that includes: (A) A recapitulation of the overall course of the resident's stay; (B) a statement notifying a resident granted permanent medical necessity (PMN) under the Medicaid program.

What if an employee is listed on the Employee Misconduct Registry (EMR) or DADs nurse aide registry (NAR) and deemed unemployable?

A facility is prohibited from hiring or continuing to employ a person who is listed in the EMR or NAR as unemployable.

What happens if a covert electronic monitoring device is discovered?

A facility may not discharge a resident because covert electronic monitoring is being conducted by or on behalf of a resident. If a facility discovers a covert electronic monitoring device and it is no longer covert as defined in §242.843, Health and Safety Code, the resident must meet all the requirements for AEM before monitoring is allowed to continue.

What additionally is prohibited when it comes to resident grievances?

A facility may not discharge or otherwise retaliate against: (A) an employee, resident, or other person because the employee, resident, or other person files a complaint, presents a grievance, or otherwise provides in good faith information relating to the misuse of a restraint or involuntary seclusion at the facility; or (B) a resident because someone on behalf of the resident files a complaint, presents a grievance, or otherwise provides in good faith information relating to the misuse of a restraint or involuntary seclusion at the facility.

When may a "self-release seat belt" be used?

A facility must allow a resident to use a self-release seat belt if: (A) the resident or the resident's legal guardian requests that the resident use a self-release seat belt; (B) the resident consistently demonstrates the ability to fasten and release the self-release seat belt without assistance; (C) the use of the self-release seat belt is documented in and complies with the resident's comprehensive care plan; and (D) the facility receives written authorization, signed by the resident or the resident's legal guardian, for the resident to use the self-release seat belt.

What is a quarterly review assessment?

A facility must assess a resident using the quarterly review instrument specified by DADS and approved by CMS not less frequently than once every three months.

What must the facility do to help with Resident Groups?

A facility must assist residents who require assistance to attend resident group meetings.

What is meant by Quality of Life?

A facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life. If children are admitted to a facility, care must be provided to meet their unique medical and developmental needs.

How must the Long Term Care Medicaid Information form be summited?

A facility must complete the Long Term Care Medicaid Information form on an OBRA assessment that is submitted to the state Medicaid claims system for a Medicaid recipient or Medicaid applicant according to DADS instructions located on the Texas Medicaid Healthcare Partnership Long Term Care Portal at http://www.tmhp.com.

How often should battery-operated emergency lighting be tested?

A facility must conduct a functional test on every required battery emergency lighting system at 30-day intervals for a minimum of 30 seconds. The facility must also conduct an annual test for a minimum of 1 1/2 hours. The lighting system must be fully operational for the duration of the testing.

What if additional assessments are warranted at the time of admission?

A facility must conduct an additional assessment and document the summary information if the MDS indicates an additional assessment on a care area is required.

What is required from the facility in the way of assessments?

A facility must conduct, initially and periodically, a comprehensive, accurate, standardized, reproducible assessment of a resident's functional capacity. The facility must electronically transmit to CMS resident-entry-and-death-in-facility tracking records required by the RAI; and OBRA assessments, including admission, annual, quarterly, significant change, significant correction, and discharge assessments.

What kind of comprehensive care plan should be made once an assessment has been done?

A facility must develop a comprehensive care plan for each resident that includes measurable short-term and long-term objectives and timetables to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. If a child is admitted to the facility, the comprehensive care plan must be based on the child's individual needs. The comprehensive care plan must describe the following: (A) the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental and psychosocial well-being as required under §19.901; and (B) any services that would otherwise be required under §19.901, but are not provided due to the resident's exercise of rights, including the right to refuse treatment under §19.402(g).

What vaccination requirement went into effect September 1, 2012?

A facility must develop and implement a policy to protect a resident from vaccine preventable diseases in accordance with Texas Health and Safety Code, Chapter 224.

In facilities licensed on or after April 2, 2018, what must the facility protect a sprinkler system from?

A facility must ensure all sprinkler piping is protected against freezing.

What are the staffing requirements in the facility when it comes to Automated External Defibrillators?

A facility must ensure at least one staff person who has completed and maintains training in cardiopulmonary resuscitation (CPR) and automated external defibrillator operation in accordance with the guidelines established by the defibrillator's manufacturer and as approved by the American Heart Association, the American Red Cross, or other nationally recognized associations is onsite at all times.

When doing a pediatric resident assessment, what must the facility ensure?

A facility must ensure that a pediatric assessment is performed by a licensed health professional experienced in the care and assessment of children; includes parents or guardians in the assessment process; and includes a discussion with a parent or guardian about the potential for community transition.

How often should portable fire extinguishers by inspected by a licensed person?

A facility must ensure that a person licensed by the State Fire Marshal's office inspects and maintains portable fire extinguishers at least once every 12 months in accordance with NFPA 10.

Who should be testing the emergency fire extinguishment system in the kitchen? How often?

A facility must ensure that a person licensed by the State Fire Marshal's office inspects and services automatic fixed fire extinguishment systems mounted in kitchen range hoods at least once every six months in accordance with NFPA 96.

What should be on the release form allowing for the management of the commingled Trust Fund?

A facility must ensure that a release form includes permission for the facility to maintain trust fund records of private-pay residents in the same manner as those of Medicaid residents; is obtained from a private-pay resident upon admission or at the time of request for trust fund services; and includes a provision allowing inspection of the private-pay resident's trust fund records by the DADs, TX Attorney General, and US DHS.

What are the requirements for the presence of automated external defibrillators?

A facility must have at least one automated external defibrillator available for use onsite at all times. The facility must place the automated external defibrillator in a location that is easily accessible for staff persons who are trained to operate it.

In facilities licensed on or after April 2, 2018, where should the location of dampers be identified?

A facility must identify the location of dampers on the wall or ceiling of the occupied area below.

What does TX DHS say about information regarding changes to resident health?

A facility must immediately inform the resident; consult with the resident's physician; and if known, notify the resident's legal representative or an interested family member when there is: (A) an accident involving the resident which results in injury and has the potential for requiring physician intervention; (B) a significant change in the resident's physical, mental, or psychosocial status (that is, a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications); (C) a need to alter treatment significantly (that is, a need to discontinue an existing form of treatment due to adverse consequences, or to commence a new form of treatment); or (D) a decision to transfer or discharge the resident from the facility.

Which doors in a facility must be kept closed?

A facility must keep smoke doors, fire doors, and doors to hazardous rooms in the facility closed and not prop or wedge a door open. The facility may use only approved devices to hold open a door, such as alarm-activated electromagnetic hold-open devices, as permitted by NFPA 101.

In facilities licensed on or after April 2, 2018, what are the codes for outdoor air intakes?

A facility must locate an outdoor air intake according to NFPA 99 and as far as practical, but not less than 10 feet, from exhaust outlets or ventilating systems, combustion equipment stacks, medical vacuum systems, plumbing vent stacks, or areas which may collect vehicular exhaust and other noxious fumes.

How long must an assessment be maintained in the resident's active record?

A facility must maintain all resident assessments completed within the previous 15 months in the resident's active record and use the results of the assessments to develop, review, and revise the resident's comprehensive plan of care as specified in §19.802.

What are the maintenance and recordkeeping requirements of Automated External Defibrillators?

A facility must maintain and test the automated external defibrillator according to the manufacturer's guidelines and keep records of the maintenance and testing.

What assessment must be made at the time of admission?

A facility must make a comprehensive assessment of a resident's needs, using the current RAI process, including the MDS, Care Area Assessment process, and the Utilization Guidelines specified by DADS and approved by CMS. The current RAI process is found in the MDS 3.0 manual posted by CMS on http://www.cms.gov.

When should a follow-up request for court orders or guardianship letters be if they have not been received?

A facility must make at least one follow-up request within 30 days after the facility makes a request if the facility has not received a copy of the court order and letters of guardianship; or a response that there is no court order and letters of guardianship.

In facilities licensed on or after April 2, 2018, what are the requirements for the administration of the EES?

A facility must meet the requirements for the administration of the EES, including maintenance and testing of the EES, according to the requirements of NFPA 99 for the type of EES installed, and the requirements of §19.326(d).

Where should combustible materials be stored?

A facility must not allow storage of combustible products in facility rooms with gas-fired equipment. A facility must not allow storage of volatile or flammable liquids or materials anywhere within the facility building.

What is a facility not allowed to do in regard to the council's wish to meet with outside people?

A facility must not limit the rights of a resident, a resident's family member, or a family council member to meet with an outside person, including: (A) an employee of the facility during the employee's nonworking hours if the employee agrees; or (B) a member of a nonprofit or government organization.

Where can medical equipment NOT be stored?

A facility must not store or leave unattended medical equipment, carts, wheelchairs, tables, furniture, dispensing machines, or similar physical objects in corridors or other ways of egress, except as permitted by NFPA 101.

What competency must the Nurse Aides have before they are allowed to work?

A facility must not use any individual who has worked less than four months as a nurse aide in that facility unless the individual: (A) is a full-time employee in a state-approved training and competency evaluation program; (B) has demonstrated competence through satisfactory participation in a state-approved nurse aide training and competency evaluation program, or competency evaluation program; or (C) has been deemed or determined competent as provided in 42 Code of Federal Regulations §483.150(a) and (b).

What are the general rules for the employment of nurse aides?

A facility must not use any individual working in the facility as a nurse aide for more than four months, on a full-time basis, unless: (A) that individual is competent to provide nursing and nursing related services, and (B) that individual has completed a training and competency evaluation program, or a competency evaluation program approved by the state as meeting the requirements of 42 Code of Federal Regulations §§483.151-493.154; or has been deemed or determined competent as provided in 42 Code of Federal Regulations §483.150(a) and (b).

What is the facility not allowed to do in regard to Nurse Aides?

A facility must not use on a temporary, per diem, leased, or any basis other than a permanent employee any individual who does not meet the requirements stated for Nurse Aides.

Who must be notified that a facility offers respite care services?

A facility must notify the Texas Department of Human Services (DHS) in writing that it offers respite services.

Who should be notified of the child's admission? When?

A facility must notify the following entities of the child's admission not later than the 3rd day after a child is initially placed in the facility: (A) DADS via fax, using DADS Form 2437, Notification of Nursing Facility Admission of Individual Under Age 22; (B) the CRCG in the county where the LAR resides (see www.hhsc.state.tx.us/crcg/crcg.htm for a listing of CRCG chairpersons by county); (C) the local office of the Early Childhood Intervention (ECI) Program of the Texas Department of Assistive and Rehabilitative Services, if a child is less than three years of age (see www.dars.state.tx.us/ecis/index.shtml or call 1-800-628-5115 for a listing of ECI programs by county); and (D) the local school district, if a child is 3 to 22 years of age, with which the facility must coordinate educational opportunities (See §19.1934).

Is smoking allowed in rooms?

A facility must prohibit smoking in any room, ward, or compartment where flammable liquids, combustible gas, or oxygen are used or stored and in any other hazardous locations. These areas must be posted with "No Smoking" signs.

In facilities licensed on or after April 2, 2018, what must be provided around exposed incandescent light bulbs, or other high-heat generating lamps, in closets or other similar spaces? Why?

A facility must provide a basket wire guard or other suitable shield to prevent breakage or contact between combustible materials.

In facilities licensed on or after April 2, 2018, what must be provided on the generator?

A facility must provide a noncombustible protective cover or the protection recommended by the manufacturer when a generator is located on the exterior of the building.

Where should regular electrical receptacles be placed in the facility?

A facility must provide approved electrical receptacles in quantity and location for the normal use of appliances in the facility.

What must be provided in smoking areas?

A facility must provide ashtrays of noncombustible material and safe design in all areas where smoking is permitted. A facility must provide a metal container with a self-closing cover device into which ashtrays can be emptied in all areas where smoking is permitted.

In facilities licensed on or after April 2, 2018, how many emergency duplex receptacles are required in the corridors?

A facility must provide at least one duplex receptacle with emergency electrical service in each resident corridor.

In facilities licensed on or after April 2, 2018, how many elevators are required if 1-60 resident beds are located on any floor other than the main entrance floor?

A facility must provide at least one hospital-type elevator.

In facilities licensed on or after April 2, 2018, how many elevators are required if 201-350 resident beds are located on any floor other than the main entrance floor, or when major inpatient services are located on a floor other than those containing resident beds?

A facility must provide at least three elevators, one of which must be hospital-type.

In facilities licensed on or after April 2, 2018, how many elevators are required if 61-200 resident beds are located on any floor other than the main entrance floor or when major inpatient services are located on a floor other than those containing resident beds?

A facility must provide at least two elevators, one of which must be hospital-type.

In facilities licensed on or after April 2, 2018, where must clean-outs for waste piping lines be installed?

A facility must provide clean-outs for waste piping lines located so there is the least physical and sanitary hazard to residents. To avoid contamination, clean-outs must open to the exterior, where possible.

In facilities licensed on or after April 2, 2018, what kind of ventilation is required of all room air?

A facility must provide forced air exhaust of all room air directly to the outdoors according to NFPA 99.

In facilities licensed on or after April 2, 2018, what are the provisions for night lighting levels?

A facility must provide general illumination, with provisions for reduction of light levels at night, in a nursing unit corridor.

In facilities licensed on or after April 2, 2018, what are ways safety can be improved in the bathrooms? What are the requirements?

A facility must provide grab bars at all residents' toilets, showers, tubs, and sitz baths. The bars must be 1-1/4 to 1-1/2 inches in diameter and must have 1-1/2 inch clearance to walls. Bars must have sufficient strength and anchorage to sustain a concentrated load of 250 pounds. Grab bar standards must comply with standards adopted under the Americans with Disabilities Act.

In facilities licensed on or after April 2, 2018, what type of receptacles are required in wet areas?

A facility must provide ground fault interruption protection at appropriate locations such as at whirlpools and other wet areas according to the NFPA 70.

In facilities licensed on or after April 2, 2018, what must be provided in the way of heating and cooling systems for residents?

A facility must provide heating and cooling by a central air conditioning system, or a substantially similar air conditioning system. Air conditioning systems must be designed, installed and functioning to maintain temperatures suitable for resident comfort within all areas used by residents.

In facilities licensed on or after April 2, 2018, in addition to systems and devices required for the type of EES installed, where must systems and devices be connected according to NFPA 99 to provide for heating?

A facility must provide heating in resident bedrooms during disruption of the normal power source.

In facilities licensed on or after April 2, 2018, what are the requirements for the ceiling panels at smoke barrier walls?

A facility must provide prefabricated metal ceiling access panels, or their equivalent, that are at least 20" x 20". Ceiling access panels must be fire resistance-rated if required to maintain the fire resistance rating of a roof-ceiling or floor-ceiling assembly.

In facilities licensed on or after April 2, 2018, what are the required signs in concealed spaces of smoke barrier walls?

A facility must provide prominent signs on each side of smoke barrier walls in concealed spaces such as attics. The signs must state: "Warning: Smoke/fire barrier. Properly seal all openings."

In facilities licensed on or after April 2, 2018, what should the facility do about concealed smoke barrier walls?

A facility must provide reasonable access to concealed smoke barrier walls for maintaining smoke dampers, where provided, so that walls and dampers can periodically be visually checked for conformance by facility staff, service personnel, and inspectors. A facility must provide access to both sides of the wall, and to all parts, end-to-end and top-to-bottom.

What type of preparation is needed before the discharge or transfer?

A facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility.

In facilities licensed on or after April 2, 2018, in the event of an emergency power disruption, what must be done for elevators?

A facility must provide throw-over facilities to allow the temporary operation of any elevator for the release of passengers in instances when an interruption of power would result in elevators stopping between floors.

What does TX DHS say about resident or family councils?

A facility must provide written information to the resident's family representative, in a language the representative understands, of the right to form a family council; or inform the resident's family representative, in writing, if a family council exists, of the council's meeting time, date, location and contact person.

If a facility is no longer using old utilities, what must be done?

A facility must remove all abandoned utilities, such as electrical wiring, ducts, and pipes from the facility when no longer in use.

What are the fees for a Change of administrator?

A facility must report a change of administrator within 30 days of the effective date of the change by submitting a change of administrator notice and a $20 fee to DADS Licensing and Credentialing Section, Regulatory Services Division. If DADS Licensing and Credentialing Section, Regulatory Services Division does not receive the notice within 30 days of the effective date of the change, DADS may impose a $500 administrative penalty. If the notice is postmarked within the 30-day period, 15 days will be added to the time period to receive the notice.

What must the Facility get on every child who is a potential resident of the facility? What must be documented?

A facility must request a Preadmission Screening and Resident Review (PASARR) on every child who is a potential admission to a facility, as well as on all children currently residing in a facility who have not had a previous PASARR completed. Documentation regarding the request for or completion of a PASARR must be kept in the chart.

What must the facility request from a resident's nearest living relative or the person responsible for the resident's support in regard to guardianship?

A facility must request a copy of any current court order appointing a guardian and letters of guardianship for a resident or a resident's estate.

When must a facility submit a claim to DADS for rehabilitation services?

A facility must submit a complete and accurate claim for services that is received by DADS within 12 months after the last day services are provided in accordance with a single pre-certification by DADS.

How many social workers are required for a facility with less than 120 beds?

A facility of 120 beds or less must employ or contract with a qualified social worker (or in lieu thereof, a social worker who is licensed by the Texas State Board of Social Work Examiners as prescribed by the Human Resources Code, Chapter 50, §50.016(a)), and who meets the requirements to provide social services a sufficient amount of time to meet the needs of the residents.

In regard to Disaster and Emergency Preparedness, what is a receiving facility?

A facility or location that has agreed to receive the residents of another facility who are evacuated due to an emergency situation.

Who must report allegations of abuse?

A facility owner or employee who has cause to believe that the physical or mental health or welfare of a resident has been or may be adversely affected by abuse, neglect, or exploitation caused by another person must report the abuse, neglect, or exploitation.

In facilities licensed on or after April 2, 2018, what must be provided if rooms and services are offered on different floors of a facility?

A facility providing resident-use areas, such as bedrooms, dining rooms, or recreation areas, or resident services, such as diagnostic services or therapy services, located on other than the main entrance floor must provide at least one elevator that complies with the requirements of ASME A17.1.

In facilities licensed on or after April 2, 2018, what should the facility do about air systems in their relation to smoke barrier walls?

A facility should design air systems to avoid ducts that penetrate smoke barrier walls, thus eliminating the need for smoke dampers which are often a problem to maintain in proper working condition.

When is a facility not required to allow a resident to use a "self-release seat belt"?

A facility that advertises as a restraint-free facility is not required to allow a resident to use a self-release seat belt if the facility: (A) provides a written statement to all residents that the facility is restraint-free and is not required to allow a resident to use a self-release seat belt; and (B) makes reasonable efforts to accommodate the concerns of a resident who requests a self-release seat belt.

What is the purpose of an informal review after a trust fund audit?

A facility that disputes the report of findings may request an informal review. The purpose of an informal review is to provide for the informal and efficient resolution of the matters in dispute.

In facilities licensed on or after April 2, 2018, if a boiler is used in a facility, what requirements must be met?

A facility with a boiler must meet all applicable requirements of Texas Health and Safety Code Chapter 755.

In facilities licensed before Sept. 11, 2003 that employ boilers, what code must be followed for existing construction?

A facility with a boiler must meet all applicable requirements of Texas Health and Safety Code, Chapter 755.

What must the final building plan for a major addition contain?

A final plan for a major addition to a facility must include a basic layout to scale of the entire building onto which the addition will connect. North direction must be shown. The entire basic layout may be to scale such as 1/16 inch per foot or 1/32 inch per foot for very large buildings.

In facilities licensed on or after April 2, 2018, how should fire alarm systems be designed?

A fire alarm system must be designed so that whenever a general alarm is sounded by activation of any device, such as a manual pull, smoke detector, fire sprinkler, or kitchen range hood extinguisher, the following must occur automatically: (1) smoke and fire doors which are held open by approved devices must be released to close; (2) air conditioning or heating distribution fans serving three or more rooms, or any means of egress, must shut down immediately; (3) smoke dampers must close; and (4) the location of an alarm-initiating device must be clearly indicated on the fire alarm control panel and all auxiliary panels.

In facilities licensed on or after April 2, 2018, who should be in charge of the fire alarm system?

A fire alarm system must be installed, maintained, and repaired by an agent having a current certificate of registration from the State Fire Marshal's Office, according to state law. The agent must provide a Fire Alarm Installation Certificate to the facility as required by the State Fire Marshal's Office.

State plan

A formal plan for the medical assistance program, submitted to CMS, in which the State of Texas agrees to administer the program in accordance with the provisions of the State Plan, the requirements of Titles XVIII and XIX, and all applicable federal regulations and other official issuances of the U.S. Department of Health and Human Services.

In facilities licensed on or after April 2, 2018, what is required for washing of garbage cans or carts?

A garbage can or cart washing area with drain and hot water must be provided.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what must be provided for waste disposal in the kitchen?

A garbage can or cart washing area with drain and hot water must be provided. Floor drains must be provided in the kitchen and dishwashing areas.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required for general storage needs for the facility?

A general storage room must be provided as needed to accommodate the facility's needs. It is recommended that a general storage area provide at least two square feet per resident bed. This area would be for items such as extra beds, mattresses, appliances, and other furnishing and supplies.

In facilities licensed on or after April 2, 2018, what are the requirements for general storage?

A general storage room must be provided as needed to accommodate the facility's needs. It is recommended that a general storage area provide at least two square feet per resident bed. This area would be for items such as extra beds, mattresses, appliances, and other furnishing and supplies.

When is a graduate vocational nurse with a temporary permit allowed to work in a facility?

A graduate vocational nurse who has a temporary work permit must work under the direction of a licensed vocational nurse, registered nurse, or licensed physician who is physically present in the facility.

Quality assessment and assurance committee

A group of health care professionals in a facility who develop and implement appropriate action to identify and rectify substandard care and deficient facility practice.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what should be provided for handwashing in the kitchen?

A hand-washing lavatory in the food preparation area with hot and cold water, soap, paper towel dispenser, and waste receptacle. The dish room area must have ready access to a handwashing lavatory.

In facilities licensed on or after April 2, 2018, what temperature must be maintained by heating systems?

A heating system must be able to maintain a temperature of at least 75° F for all areas occupied by residents. For all other occupied areas, a heating system must be able to maintain a temperature of at least 72° F.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, when designing safety details for a facility, what must be kept in mind?

A high degree of safety for the occupants is needed to minimize accidents more apt to occur with the elderly and/or infirm residents in a nursing facility. Consideration must be given to the fact that many have impaired vision, hearing, spatial perception, and ambulation.

In facilities licensed on or after April 2, 2018, when designing safety related details, what must be taken into consideration?

A high degree of safety for the occupants is needed to minimize accidents more apt to occur with the residents in a nursing facility. Consideration must be given to the fact that many have impaired vision, hearing, spatial perception, and ambulation.

For Small House and Household Facilities, what are the requirements for a household model?

A household model, which is a single licensed building that contains one or more households having no more than 16 residents each; that may include a central area that provides social-diversional space, a treatment area, or an administrative area; and that must be arranged to avoid travel through the household by persons who are not residing in, visiting, or providing services for the household.

In facilities licensed before Sept. 11, 2003, in existing construction, what type of cleaning utility is required for a kitchen?

A janitor's closet with service sink must be easily and readily accessible to the kitchen.

In facilities licensed on or after April 2, 2018, what type of facilities are required for handwashing in the kitchen area?

A kitchen must be provided with a hand-washing lavatory in the food preparation area with hot and cold water, soap, paper towel dispenser, and waste receptacle. The dish room area must have ready access to a hand-washing lavatory.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the requirements for handwashing stations in a kitchen?

A kitchen must have at least one hand-washing lavatory in the food-preparation area. The dish washing area must have ready access to a hand-washing lavatory or hand sanitizing device. Hand-washing lavatories must be provided with hot and cold running water, a sanitary soap dispenser, and paper towel dispenser or hot air dryer.

In facilities licensed on or after April 2, 2018, what should be interconnected with the fire alarm system in the kitchen?

A kitchen range hood extinguisher, if required by NFPA 101. This interconnection may report as a separate zone on the fire alarm control panel or may be combined with other initiating devices located in the same zone as the range hood is located.

In facilities licensed on or after April 2, 2018, how will the kitchen be evaluated?

A kitchen will be evaluated on the basis of its performance in the sanitary and efficient preparation and serving of meals to residents. Consideration will be given to planning for the type of meals served, the overall building design, the food service equipment, the arrangement, and the work flow involved in the preparation and delivery of food.

When should DADS be notified in relation to fiscal condition?

A license holder must notify DADS of significant adverse changes in financial condition, which include changes in financial position, cash flow, results of operation or other events that could adversely affect the delivery of essential care and services, such as nursing or dietary services, or utilities.

When can a mediation be crushed?

A licensed nurse may exercise professional judgment in the crushing of a medication, providing that the medication is not a time-released or enteric coated medication. (1) If there is any question about crushing a medication for a resident, the licensed nurse must check with the treating physician, dispensing pharmacist, or consultant pharmacist. (2) The crushed medication should be administered as soon as feasible once it has been added to another substance.

Who oversees the Automated External Defibrillator program?

A licensed physician must provide medical consultation or general oversight of the staff training to ensure the facility complies with the training and staffing requirements.

What is the responsibility of license-only facilities when it comes to obtaining drugs for residents?

A licensed-only facility must assist the resident in obtaining routine drugs and biologicals and make emergency drugs readily available, or obtain them under an agreement described in §19.1906.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, can the lobby be considered in the space requirements for resident living space?

A lobby may also be use-designed to satisfy a portion of the minimum area required for resident living room space.

What is a CRCG (Community resource coordination group) for the purpose of Permanency Planning?

A local interagency group composed of public and private agencies that develops service plans for individuals whose needs can be met only through interagency coordination and cooperation. The group's role and responsibilities are described in the Memorandum of Understanding on Coordinated Services to Persons Needing Services from More Than One Agency, available on the Health and Human Services Commission website at www.hhsc.state.tx.us/crcg/crcg.htm.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, where should the master control panel be located?

A master control panel indicating the location of all alarm, trouble, and supervisory signals, by zone or device, must be visible at the main nurse station. Fire alarm system components must be laboratory-listed as compatible. Alarm and trouble zoning must be by smoke compartments and by floors in multi-story facilities.

In facilities licensed on or after April 2, 2018, what is required of the master control panel for fire alarms?

A master control panel, or a fire alarm annunciator panel providing annunciation of all fire alarm signals, that annunciates the location of all alarm, trouble, and supervisory signals, by zone or device, must be visible at the main nurses' station.

What is required of medication carts when not in use?

A medication cart must be secured in a designated area.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the requirements for medication storage?

A medication storage area must include a sufficient, lockable, enclosed medicine storage space, medicine room, or medication cart. The medication storage area must be furnished with a refrigerator. There must be sufficient space available for a medication preparation area equipped with a sink having hot and cold water. When not in use, the medication cart must be secured in a designated area. Only authorized personnel must have access to the lockable, enclosed medication storage area, medication room, or the medication cart. Medication storage areas and preparation areas must be adequately ventilated and temperature controlled.

For Small House and Household Facilities, what are the requirements for a multiple house model?

A multiple small house model, which is a single licensed group of two or more small houses located in close proximity to each other on a single contiguous property that meets the licensing requirements for architectural spaces in each house and that may include a stand-alone central building that provides social-diversional space, a treatment area, or an administrative area

In facilities licensed on or after April 2, 2018, what meeting space is required in the administrative area?

A multipurpose room must be provided for conferences, meetings, and health education purposes including facilities for showing visual aids.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what consists of a nurse call system? What must these items be compatible with?

A nurse call system consists of power units, annunciator control units, corridor dome stations, emergency call stations, bedside call stations, and activating devices. The units must be compatible and listed by a nationally recognized laboratory for the system and use intended.

When would an expedited license be issued for a change of ownership?

A nursing facility license holder may be eligible to acquire, on an expedited basis, a license to operate another existing nursing facility. A license holder that appears on the expedited change of ownership list may be granted expedited approval in obtaining a change of ownership license to operate another existing nursing facility in Texas. DADS maintains and keeps current a list of nursing facility license holders that operate an institution in Texas and that have met the criteria to qualify for an expedited change of ownership according to the information available to DADS.

What is the facility not allowed to do with Certain Medicaid-eligible individuals when it comes to extra charges above the per diem amount? Why?

A nursing facility may not impose charges for certain Medicaid-eligible individuals, for nursing facility services that exceed the per diem amount established by DADS for such services. "Certain Medicaid-eligible individuals" means an individual who is entitled to medical assistance for nursing facility services, but for whom such benefits are not being paid because, in determining the individual's income to be applied monthly to the payment for the costs of nursing facility services, the amount of such income exceeds the payment amounts established by DADS.

What is prohibited when it comes to resident grievances?

A nursing facility may not retaliate or discriminate against a resident, a family member or guardian of the resident, or a volunteer because the resident, the resident's family member or guardian, a volunteer, or any other person: (A) makes a complaint or files a grievance concerning the facility; (B) reports a violation of law, including a violation of laws or regulations regarding nursing facilities; or (C) initiates or cooperates in an investigation or proceeding of a governmental entity relating to care, services, or conditions at the nursing facility.

If a resident is eligible for Medicaid, what additional money can be charged to the resident?

A nursing facility may: (A) charge a resident who is eligible for Medicaid for items and services the resident has requested and received, and that are not specified in the State Plan as included in the term "nursing facility services" so long as the facility gives proper notice of the availability and cost of these services to residents and does not condition the resident's admission or continued stay on the request for and receipt of these additional services; and (B) solicit, accept, or receive a charitable, religious, or philanthropic contribution from an organization or from a person unrelated to a Medicaid-eligible resident or potential resident, but only to the extent that the contribution is not a condition of admission, expedited admission, or continued stay in the facility for a Medicaid-eligible resident.

When must a policy be written for when a resident exceeds the bed-hold period under the State Plan? Under what conditions will they be re-admitted?

A nursing facility must establish and follow a written policy under which a resident whose hospitalization or therapeutic leave exceeds the bed-hold period under the State Plan, is readmitted to the facility immediately upon the first availability of a bed in a semi-private room if the resident: (A) requires the services provided by the facility; and (B) is eligible for Medicaid nursing facility services.

In facilities licensed on or after April 2, 2018, what is considered a nursing service area?

A nursing service area includes a nurses' station and other areas described. It must be located in or readily available to each nursing unit.

Under whose supervision must a paid feeding assistant work? What is the scope of their duties?

A paid feeding assistant must work under the supervision of a registered nurse or a licensed vocational nurse. In an emergency, a paid feeding assistant must call a supervisory nurse for help. A paid feeding assistant can only feed residents in the dining room.

In facilities licensed on or after April 2, 2018, where are parking spots not allowed to be?

A parking space must not block or inhibit egress from the outside exit doors.

In facilities licensed on or after April 2, 2018, if a required way of exit, or a service way, is through a living or dining area, what is required in the way of space requirements?

A pathway equal to the corridor width must be deducted for calculation purposes and discounted from that area. These exit pathways must be kept clear of obstructions.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, if a required way of exit or a service way is through a living or dining area, what size pathway will be deducted for common space calculations?

A pathway equal to the corridor width will normally be deducted for calculation purposes and discounted from that area. These exit pathways must be kept clear of obstructions.

What is a Permanency planner for the purpose of Permanency Planning?

A person assigned by DADS to conduct permanency planning activities for a child who resides in a facility.

What is a LAR (legally authorized representative) for the purpose of Permanency Planning?

A person authorized by law to act on behalf of a resident with regard to a matter described in this subchapter, which may include a parent, guardian, managing conservator of a minor individual, a guardian of an adult individual or legal representative of a deceased individual.

Representative payee

A person designated by the Social Security Administration to receive and disburse benefits, act in the best interest of the beneficiary, and ensure that benefits will be used according to the beneficiary's needs.

If a resident's physician determines the resident lacks capacity to request AEM, who can request one?

A person from the following list, in order of priority, may act as the resident's legal representative for the limited purpose of requesting AEM: (A) a person named in the resident's medical power of attorney or other advance directive; (B) the resident's spouse; (C) an adult child of the resident who has the waiver and consent of all other qualified adult children of the resident to act as the sole decision-maker; (D) a majority of the resident's reasonably available adult children; (E) the resident's parents; or (F) the individual clearly identified to act for the resident by the resident before the resident became incapacitated or the resident's nearest living relative.

Medicaid recipient

A person who meets the eligibility requirements of the Title XIX Medicaid program, is eligible for nursing facility services, and resides in a Medicaid-participating facility.

If the recording(s) are sent to DHS, how must it be identified?

A person who sends more than one tape or recording to DHS must identify each tape or recording on which the person believes an incident of abuse or evidence of neglect may be found. Tapes or recordings should identify the place on the tape or recording that an incident of abuse or evidence of neglect may be found.

What is a Child for the purpose of Permanency Planning?

A person with a developmental disability who is under 22 years of age.

Manager

A person, other than a licensed nursing home administrator, having a contractual relationship to provide management services to a facility.

What is Permanency planning?

A philosophy and planning process that focuses on the outcome of family support by facilitating a permanent living arrangement, with the primary feature of an enduring and nurturing parental relationship. Family-directed planning empowers the family of a child under the age of 18 to direct the development of supports and services that meet the child's and family's personal outcomes as related to that child. Person-directed planning empowers the child who is between 18 and 22 years of age to direct the development of a plan of supports and services that meets the needs for self-determination.

Who can serve as a physical therapist?

A physical therapist licensed by the Texas Board of Physical Therapy Examiners;

Who must approve the recommendation to admit a residents to the facility?

A physician must personally approve in writing a recommendation that an individual be admitted to a facility.

Attending physician

A physician, currently licensed by the Texas Medical Board, who is designated by the resident or responsible party as having primary responsibility for the treatment and care of the resident.

What is a Licensed health professional?

A physician; physician assistant; nurse practitioner; physical, speech, or occupational therapist; physical or occupational therapy assistant; registered professional nurse; licensed practical nurse; or licensed or certified social worker.

In facilities licensed on or after April 2, 2018, what are the regulations for piped gas and vacuum systems?

A piped medical gas or medical vacuum system, including a piped oxygen system, a vacuum system, or a drive gas system such as a compressed air system, must be designed, installed, operated and managed according to the requirements of NFPA 99 for new health care facilities, and based on the risk category determined by the assessment required by §19.300(i).

Comprehensive care plan

A plan of care prepared by an interdisciplinary team that includes measurable short-term and long-term objectives and timetables to meet the resident's needs developed for each resident after admission. The plan addresses at least the following needs: medical, nursing, rehabilitative, psychosocial, dietary, activity, and resident's rights. The plan includes strategies developed by the team, consistent with the physician's prescribed plan of care, to assist the resident in eliminating, managing, or alleviating health or psychosocial problems identified through assessment.

In facilities licensed before Sept. 11, 2003, in existing construction, what should be the policy on special waste disposal?

A policy and procedure for the safe and sanitary disposal of special waste must be provided. Space and facilities must be provided for the sanitary storage and disposal of waste, not classified as special, by incineration, mechanical destruction, compaction, containerization, removal, or contract with outside resources, or by a combination of these techniques.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required for the disposal of waste?

A policy and procedure for the safe and sanitary disposal of special waste must be provided. Space and facilities must be provided for the sanitary storage of waste by incineration, mechanical destruction, compaction, containerization, removal, or by a combination of these techniques.

In facilities licensed on or after April 2, 2018, what are the requirements for disposal of waste?

A policy and procedure for the safe and sanitary disposal of special waste must be provided. Space and facilities must be provided for the sanitary storage of waste by incineration, mechanical destruction, compaction, containerization, removal, or by a combination of these techniques.

In facilities licensed on or after April 2, 2018, all design of structural systems must be done by or under the direction of _____.

A professional engineer who is currently licensed by the Texas Board of Professional Engineers.

What is a qualified dietitian?

A qualified dietitian is one who is qualified based upon either: (A) registration by the Commission on Dietetic Registration of the American Dietetic Association; or (B) licensure, or provisional licensure, by the Texas State Board of Examiners of Dietitians. These individuals must have one year of supervisory experience in dietetic service of a health care facility.

Can changes to a resident's diet be made?

A qualified dietitian may accept diet orders and changes from the physician.

Who else can serve in a rehabilitation capacity?

A qualified mental health professional - community services.

If the director of nursing services has other institutional responsibilities, what is required?

A qualified registered nurse must serve as an assistant so that there is the equivalent of a full-time director of nursing services on duty.

What is a qualified social worker?

A qualified social worker is an individual who is licensed, including a temporary or provisional license, by the Texas State Board of Social Work Examiners as prescribed by Chapter 50 of the Human Resources Code, and who has at least: (A) a bachelor's degree in social work, or a bachelor's degree in a human services field, including, but not limited to, sociology, special education, rehabilitation counseling, and psychology; and (B) one year of supervised social work experience in a health care setting working directly with individuals.

Social worker

A qualified social worker is an individual who is licensed, or provisionally licensed, by the Texas State Board of Social Work Examiners as prescribed by the Texas Occupations Code, Chapter 505, and who has at least: (A) a bachelor's degree in social work; or (B) similar professional qualifications, which include a minimum educational requirement of a bachelor's degree and one year experience met by employment providing social services in a health care setting.

In facilities licensed on or after April 2, 2018, what is required for bedroom identification?

A raised or recessed unique number placed on or near the door. Refer to TAS for information about signs.

When should the resident be recertified for a Medicaid-Certified nursing facility?

A recipient's physician must recertify the recipient's need for nursing facility care every 180 days that the recipient remains in the nursing facility after the first certification.

Who must certify and recertify a resident's need for nursing care in a Medicaid-Certified facility?

A recipient's physician.

MDS nurse reviewer

A registered nurse employed by HHSC to monitor the accuracy of the MDS assessment submitted by a Medicaid-certified nursing facility.

Who is responsible for the coordination of the resident assessments?

A registered nurse must conduct or coordinate each assessment with the appropriate participation of health professionals.

What if copying records for HHSC requires the records be removed from the facility?

A representative of the facility is expected to accompany the records and assure their order and preservation.

If a resident, or the resident's guardian or legal representative, wishes to conduct AEM what must be documented?

A request for AEM must be made by giving a completed, signed, and dated DHS Request for Authorized Electronic Monitoring form to the administrator or designee. A copy of the form must be maintained in the active portion of the resident's clinical record.

What is meant by the Right to Access and Visitation?

A resident has the right to have access to, and the facility must provide immediate access to a resident to, the following: (A) in Medicaid-certified facilities, a representative of the Secretary of Health and Human Services; (B) a representative of the State of Texas; (C) the resident's individual physician; (D) the State Ombudsman; (E) a certified ombudsman; (F) a representative of the protection and advocacy system for individuals with intellectual or developmental disabilities established under the Developmental Disabilities Assistance and Bill of Rights Act, 42 USC Chapter 144, Subchapter I, Part C; (G) a representative of the protection and advocacy system for individuals with mental illness established under the Protection and Advocacy for Mentally Ill Individuals Act, 42 USC Chapter 114, Subchapter I; (H) subject to the resident's right to deny or withdraw consent at any time, immediate family or other relatives of the resident; and (I) subject to reasonable restrictions and the resident's right to deny or withdraw consent at any time, others who are visiting with the consent of the resident.

What is the Right to Participation in other activities?

A resident has the right to participate in social, religious, and community activities that do not interfere with the rights of other residents in the facility.

What documentation requirements are there for resident's clinical records?

A resident's clinical record must meet all documentation requirements in the Texas Health and Human Services Commission rule at 1 TAC §371.214.

Will the refusal to be transferred from one area of the Medicaid-Certified Facility to another affect their Medicaid benefits?

A resident's exercise of the right to refuse transfer under this section does not affect the individual's eligibility or entitlement to Medicaid benefits.

What is the Right to Form Family Councils? What can the Council do?

A resident's family has the right to meet in the facility with the families of other residents in the facility and organize a family council. A family council may: (A) make recommendations to the facility proposing policy and operational decisions affecting resident care and quality of life; and (B) promote educational programs and projects intended to promote the health and happiness of residents.

Who judges whether a resident is capable of requesting an AEM? What must be documented?

A resident's physician makes the determination regarding the capacity to request AEM. Documentation of the determination must be made in the resident's clinical record.

In facilities licensed on or after April 2, 2018, what kind of ventilation is required for rooms with gas-fired heating equipment is located?

A room where gas-fired heating equipment is located must be vented to the exterior to exhaust heated ambient air in the room.

In facilities licensed on or after April 2, 2018, how much hot water is required for resident use?

A rule-of-thumb for hot water for resident use at 110° F is to provide 6-1/2 gallons per hour per resident.

What is the definition of a Rural Area? Who determines this?

A rural area is any area outside the boundaries of a standard metropolitan statistical area. Rural areas are defined and designated by the federal Office of Management and Budget; are determined by population, economic, and social requirements; and are subject to revisions.

What is a "self-release seat belt"? Is it considered a restraint?

A seat belt on a resident's wheelchair that the resident demonstrates the ability to fasten and release without assistance. A self-release seat belt is not a restraint.

What counts as a session for rehabilitation for Medicaid eligible residents? What is the pay rate for evaluations?

A session is one physical, occupational, or speech therapy service provided to one resident. HHSC pays for an evaluation at the same rate as a session.

Therapy week

A seven-day period beginning the first day rehabilitation therapy or restorative nursing care is given. All subsequent therapy weeks for a particular individual will begin on that day of the week.

How much food must be kept on hand at all times? Can substitutions be made?

A seven-day supply of staple foods and a two-day supply of perishable foods at all times. The facility is allowed the flexibility to use food on hand to make substitutions at any interval as long as comparable nutritional value is maintained. Any substitution of menu items must be recorded on the day of use. See also §19.1719(o)(1) for information concerning storage areas.

For Small House and Household Facilities, what are the requirements for a single house model?

A single small house model, which is a single licensed building having no more than 16 residents that meets the licensing requirements for architectural spaces provided within the same licensed building;

What is a psychoactive Medication-related emergency?

A situation in which it is immediately necessary to administer medication to a resident to prevent: (A) imminent probable death or substantial bodily harm (emotional or physical) to the resident; or (B) imminent physical or emotional harm to another because of threats, attempts, or other acts the resident overtly or continually makes or commits.

Threatened violation

A situation that, unless immediate steps are taken to correct, may cause injury or harm to a resident's health and safety.

SNF

A skilled nursing facility or distinct part of a facility that participates in the Medicare program. SNF requirements apply when a certified facility is billing Medicare for a resident's per diem rate.

For Small House and Household Facilities, how should the facility be designed?

A small house or household facility must be designed and equipped to provide a homelike environment that promotes resident-centered care.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the requirements for soiled linen rooms?

A soiled linen room must be provided as needed commensurate with the type of laundry system used. In relation to adjacent areas, a negative air pressure must be provided with air exhausted through ducts to the exterior. Air must be exhausted continually whenever there are soiled linens in the room. A soiled linen room may be combined with a soiled utility room.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the requirements for soiled utility rooms?

A soiled utility room must be provided and contain a flushing fixture and a sink with hot and cold water. It must be part of a system for collection and cleaning or disposal of soiled utensils or materials.

In facilities licensed on or after April 2, 2018, what are the requirements for soiled utility rooms?

A soiled utility room must be provided with a flushing device, such as a water closet with bedpan lugs; a spray hose with a siphon breaker or similar device, such as a high neck faucet with lever controls; and a deep sink that is large enough to submerse a bedpan. A sterilizer may be used for sanitizing in place of a deep sink.

Patient care vicinity

A space extending 6 ft. (1.8 m) horizontally in all directions around the resident bed and extending vertically to 7 ft. 6 in. (2.3 m) above the floor. If the dimension between the bed and a wall or partition is less than 6 ft. (1.8 m), the limit of the patient care vicinity is at the wall or partition.

How long can a staff person use a restraint hold in a behavioral emergency?

A staff person may use a restraint hold only for the shortest period of time necessary to ensure the protection of the resident or others in a behavioral emergency.

What are the training requirements of paid feeding assistants?

A state-approved training course for paid feeding assistants must include, at a minimum, 16 hours of training in the following: (1) feeding techniques; (2) assistance with feeding and hydration; (3) communication and interpersonal skills; (4) appropriate response to resident behavior; (5) safety and emergency procedures, including the Heimlich maneuver; (6) infection control; (7) resident rights; and (8) recognizing changes in residents that are inconsistent with their normal behavior and the importance of reporting those changes to the supervisory nurse.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what should the water temperature be in the kitchen?

A supply of hot and cold water must be provided. Hot water for sanitizing purposes must be 180° F or the manufacturer's suggested temperature for chemical sanitizers. For mechanical dishwashers the temperature measurement is at the manifold.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, in addition to dishwashing sinks, what else must be in the kitchen?

A vegetable preparation sink must be provided, and it must be separate from the pot sinks.

In facilities licensed on or after April 2, 2018, in addition to the sinks required for handwashing and dishwashing, what else is required?

A vegetable preparation sink must be provided, and it must be separate from the pot sinks.

If a rapid response team is requested by a facility, when would that visit occur?

A visit under this subsection may not occur until at least 60 days after the date of an exit interview following an inspection.

How often is the Registered nurse requirement waiver reviewed?

A waiver of the registered nurse requirement is subject to annual renewal by the secretary.

What special requirements are there for locked units?

A wing or area that is separated from the rest of the facility by locked doors, or a facility that is locked in its entirety, for the purpose of securing residents must meet the requirements of §19.2208(a)(6) and (c)(1)-(10).

When it comes to Respite Care, what does Plan of Care mean?

A written description of the medical care or the supervision and nonmedical care needed by an individual during respite care.

What will be left with the facility at the time of the exit conference?

A written list of the violations.

For a resident under 22 years of age, when should the LAR be notified of an upcoming comprehensive care plan meeting?

A written notice of a meeting to conduct an annual review of the resident's comprehensive care plan no later than 21 days before the meeting date, and a request for a response from the LAR.

What must be provided to each resident and responsible party about the management of resident financial affairs?

A written statement at the time of admission that describes the resident's rights to select how personal funds will be handled. The following alternatives must be included: (A) the resident has the right to manage his financial affairs; (B) the facility may not require residents to deposit their personal funds with the facility; (C) the facility has an obligation, upon written authorization of a resident, to hold, safeguard, manage, and account for the personal funds of the resident deposited with the facility; (D) the resident has a right to apply to the Social Security Administration to have a representative payee designated for federal or state benefits to which he may be entitled; and (E) except when subparagraph (D) of this paragraph applies, the resident has a right to designate in writing another person to manage personal funds; (F) the statement notes, when applicable, that any charge for the facility handling a Medicaid recipient's personal funds is included in the facility's basic rate; and (G) the statement advises the resident that the facility must have written permission from the resident, responsible party, or legal representative to handle his personal funds.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, static pressures of systems must be within limits recommended by _____.

ASHRAE and the equipment manufacturer (upstream and downstream).

ASTM

ASTM International, a not-for-profit, voluntary standards developing organization that develops and publishes international voluntary consensus standards for materials, products, systems, and services.

In facilities licensed before Sept. 11, 2003, in existing construction, what must the facility do about wheelchair access into the building?

Access into the building by use of ramps and curb breaks. Ramps must not slope more than 1:12 (one unit of rise to 12 units of run).

What does personal privacy include?

Accommodations, medical treatment, written and telephone communications, personal care, visits, and meetings of family and resident groups, but this does not require the facility to provide a private room for each resident.

In facilities licensed on or after April 2, 2018, what code governs the design and installation of emergency motor generators?

According to NFPA 37, NFPA 99, and NFPA 110.

In facilities licensed on or after April 2, 2018, how should the building be constructed? What if there are discrepancies?

According to the locally adopted building code. NFPA 101 must be used for fire safety requirements. Discrepancies between the codes must be called to the attention of HHSC for resolution.

What must be in the agreement between outside agencies and a facility?

Agreements pertaining to services furnished by outside resources must specify in writing that the facility assumes responsibility for: (1) obtaining services that meet professional standards and principles; and (2) the timeliness of the services.

In facilities licensed before Sept. 11, 2003, in existing construction, how should cross contamination be prevented?

Air flow must be designed to prevent cross contamination within any area where applicable, such as laundries and kitchens, as well as the system or facility as a whole. In relation to adjacent areas, a positive air pressure must be provided for clean utility rooms, clean linen rooms, and medication rooms. Conditioned supply air must be introduced into these rooms. In relation to adjacent areas, a negative air pressure must be provided for soiled utility rooms, soiled laundry rooms, bathrooms, toilets, and other odor-producing rooms. Air from these rooms must not be recirculated, but instead must be exhausted through ducts to the exterior by effective means.

In facilities licensed before Sept. 11, 2003, in existing construction, how should air flow be directed?

Air flow must be directed or adjusted so that a resident is not in direct drafts that could be harmful to the health and comfort of the resident.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, where should air from unsanitary areas be ventilated?

Air from unsanitary areas such as janitors' closets, soiled linen areas, utility areas, and soiled area of laundry rooms, must not be returned and recirculated to other areas.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what is the minimum requirement for the air system in relation to outside air?

Air systems must provide for mixing at least 10% outside air for the supply distribution.

In facilities licensed on or after April 2, 2018, what is the mix of outside to inside air required for air systems?

Air systems must provide for mixing at least 10% outside air for the supply distribution.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, how should air systems be designed in regard to smoke barrier walls?

Air systems should be designed to avoid having ducts which penetrate smoke barrier walls, thus eliminating the need for smoke dampers which are often a problem to maintain in proper working condition.

In facilities licensed on or after April 2, 2018, where can the air supply for food preparation areas not come from?

Air that has circulated through places such as resident bedrooms and baths.

In facilities licensed on or after April 2, 2018, in a zone-based fire alarm system _____.

Alarm and trouble zones must align with smoke compartments and with floors in multi-story buildings.

When are alcohol-based hand rub dispensers allowed to be installed?

Alcohol-based dispensers are allowed if they are installed in a manner that: (A) does not conflict with any state or local codes that prohibit or otherwise restrict the placement of alcohol-based hand rub dispensers in health care facilities; (B) minimizes leaks and spills that could lead to falls; (C) adequately protects against access by vulnerable populations; and (D) complies with NFPA 101; and are (E) maintained in accordance with dispenser manufacturer guidelines.

In facilities licensed on or after April 2, 2018, what are the requirements for supply and exhaust systems on HVACs?

All air-supply and air-exhaust systems must be mechanically-operated.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018 what other codes must be followed? What is there is a conflict?

All applicable local, state, or national codes and ordinances must be met as determined by the authority having jurisdiction for those codes and ordinances by HHSC. Any conflicts must be made known to HHSC for appropriate resolution.

What requirements must be met for a potential applicant for a change of ownership license on an expedited basis?

All applicable requirements that an applicant for renewal of a license must meet. Any requirement relating to inspections or to an accreditation review applies only to institutions operated by the license holder at the time the application is made for the change of ownership license.

Where should poisonous substances, such as cleaning materials, be kept?

All bleaches, detergents, disinfectants, insecticides, and other poisonous substances must be kept in a safe place accessible only to employees. They must not be kept in containers previously containing food or medicine. Containers must be labeled.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, if boilers are allowed, who must maintain them?

All boilers not exempted by the Texas Health and Safety Code §755.022 must be inspected and certified for operation by The Texas Department of Licensing and Regulation.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what must be installed in multi-level facilities? What regulation governs this?

All buildings having residents' facilities (such as bedrooms, dining rooms, or recreation areas) or resident services (such as diagnostic or therapy) located on other than the main entrance floor must have at least one electric or electrohydraulic elevator and must comply with standards adopted under the American National Standards Institute (ANSI) Code, §A17.1.

Who in the facility should have access to the comprehensive care plan?

All direct care staff.

Who can prescribe resident medications?

All drugs must be prescribed by the resident's physician or consulting physician, dentist, podiatrist, or other individual allowed by law to prescribe.

In general, what must be maintained for resident care?

All essential mechanical, electrical, and patient care equipment in safe operating condition.

In facilities licensed on or after April 2, 2018, when exhausting air outside, what are the requirements? What is not permitted?

All exhaust must be continuously ducted to the exterior. Exhausting air into attics or other spaces is not permitted.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, where should exhaust be vented to?

All exhausts must be continuously ducted to the exterior. Exhausting air into attics or other spaces is not permitted. Duct material must be metal.

In facilities licensed before Sept. 11, 2003, in existing construction, how often should gas heating systems be checked, and by whom?

All gas heating systems must be checked annually for proper operation and safety by persons who are licensed or approved by the State of Texas to inspect such equipment. A record of this service must be maintained by the facility. Any unsatisfactory condition must be corrected promptly.

What information is considered personal and private? What must be done to comply with the HIPAA rules?

All information that contains personal identification or descriptions which would uniquely identify an individual resident or a provider of health care is considered to be personal and private and will be kept confidential. Personal identifying information (except for PCN numbers) will be deleted from all records, reports, and/or minutes from formal studies which are forwarded to DHS, or anyone else. These records, reports, and/or minutes, which have been de-identified, will still be treated as confidential. All such material mailed to DHS or anyone else must be in a sealed envelope marked "Confidential."

What happens in the event of abuse or neglect caught by AEM?

All instances of abuse or neglect must be reported to DHS, as required by §19.602.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what material must be used in walls, partitions and roof structures?

All interior walls, partitions, and roof structure in buildings of fire resistive and noncombustible construction must be of noncombustible or limited combustible materials.

When should deaths be reported to TX DHS?

All licensed facilities must submit to the Texas Department of Human Services (DHS) a report of deaths of any persons residing in the facility and those persons transferred from the facility to a hospital who expire within 24 hours after transfer.

If the total rehabilitation work area classified as reconstruction exceeds 50% of the total building area, what is the requirement?

All means of egress components in the building identified in paragraph (4)(A)(i)-(iii) of this subsection must comply with division 9 of this subchapter.

If the total rehabilitation work area classified as reconstruction on any one floor exceeds 50% of the total area of the floor, what is required?

All means of egress components on that floor identified in paragraph (4)(A)(i)-(iii) of this subsection must comply with division 9 of this subchapter.

In facilities licensed before Sept. 11, 2003, in existing construction, if new construction is done, what are the line-or-site requirements?

All new construction completed after August 10, 1983, must allow direct line-of-sight observation of all resident bedroom corridors from the nurses' station or auxiliary station.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what code must be followed for all plumbing systems?

All plumbing systems must be designed and installed in accordance with the requirements of the plumbing code of the municipality. In the absence of a municipal code, a nationally recognized plumbing code must be used. Any discrepancy between an applicable code and these requirements must be called to the attention of the Texas Department of Human Services (DHS) for resolution.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what must be adequate and appropriate to the space and functions within the space in regard to lighting?

All quality, intensity, and type of lighting

In facilities licensed on or after April 2, 2018, what kind of lighting is required?

All quality, intensity, and type of lighting must be adequate and appropriate to the space and all functions within the space.

In facilities licensed on or after April 2, 2018, what types of receptacles are required in the bedrooms?

All receptacles must be listed and identified as "hospital grade";

In facilities licensed before Sept. 11, 2003, in existing construction, what are the requirements for the placement of Nurse's stations?

All resident bedroom corridors must be observable by direct line of sight or by mechanical means from a designated nurses' station or auxiliary station. There must be at least one nurses' station per floor in multi-storied buildings.

How should resident care information be recorded/corrected?

All resident care information must be recorded in ink or permanent print except for the medication/treatment diet section of the care plan. Correction of errors will be in accordance with accepted health information management standards.

Medicaid specific requirements apply to?

All residents, including, but not limited to private-pay. Medicaid applicants and recipients, VA patients, and Medicare recipients, who are admitted to and reside in a Medicaid certified facility or a Medicaid-certified distinct part of a facility. These requirements do not apply to SNFs licensed under the Health and Safety Code Chapter 241, participating only in the Medicare program

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what required safety features must be in bathrooms where residents are allowed?

All rooms containing bathtubs, sitz baths, showers, and water closets, must be equipped with swinging doors and hardware which will permit access from the outside in any emergency. Bathing areas must be provided with safe and effective auxiliary or supplementary heating. Bathing areas must be free of drafts and must have adequate exhaust ducted to the outside to minimize excess moisture retention and resulting mold and mildew problems. Tubs and showers must be provided with slip-proof bottoms. Lavatories and hand-washing facilities must be securely anchored to withstand an applied downward load of not less than 250 pounds on the front of the fixtures.

In facilities licensed on or after April 2, 2018, what are the requirements in the event of an emergency?

All rooms containing bathtubs, sitz baths, showers, and water closets, used by residents must be equipped with doors and hardware that permits access from the outside in any emergency.

In facilities licensed on or after April 2, 2018, which spaces are required to have lighting?

All spaces occupied by people, machinery, equipment, approaches to buildings, and parking lots must have lighting.

ANSI

American National Standards Institute.

Admission MDS assessment

An MDS assessment that determines a recipient's initial determination of eligibility for medical necessity for admission into the Texas Medicaid Nursing Facility Program.

Incident

An abnormal event, including accidents or injury to staff or residents, which is documented in facility reports. An occurrence in which a resident may have been subject to abuse, neglect, or exploitation must also be reported to HHSC.

When is an action final for the purposes of licensing?

An action is final when routine administrative and judicial remedies are exhausted. All actions, whether pending or final, must be disclosed.

Agent

An adult to whom authority to make health care decisions is delegated under a durable power of attorney for health care.

Stay agreement

An agreement between a license holder and the executive commissioner that sets forth all requirements necessary to lift a stay and rescind a license revocation proposed under §19.2107.

If there is a change in Alzheimer's disease related services, what must be sent out?

An amended disclosure statement required by §19.204(b)(4)(C) to a resident, responsible party, or legal guardian at least 30 days before the change in the operation of the facility reflected in the amended disclosure statement is effective.

In facilities licensed on or after April 2, 2018, what portions of the nurse call system are not required to meet UL 1069?

An ancillary or supplemental device, including a pocket pager or other portable device.

What are the fees for a Late renewal?

An applicant for license renewal that submits an application during the 45-day period ending on the date the current license expires must pay a late fee of an amount equal to one-half of the total basic renewal fee. The late fee for a two-year renewal license issued in accordance with §19.208(b)(2) is one half of the total two-year renewal fee calculated in accordance with §19.208(c).

When could an applicant receive an expedited inspection of a new construction?

An applicant may obtain a Life Safety Code inspection within 15 business days after HHSC receives a written request if the applicant submits: (A) a complete application as required in §19.201(b) and §19.204; and (B) the appropriate Life Safety Code fee listed in §19.220.

When is an application for a license considered complete?

An application is complete when all requirements for licensing have been met, including compliance with standards. If an inspection for compliance is required, the application is not complete until the inspection has occurred, reports have been reviewed, and the applicant complies with the standards. If the application is postmarked by the filing deadline and received by HHSC within 15 days of the postmark, the application is considered to be timely filed.

In facilities licensed on or after April 2, 2018, what type of ventilation is required for the medication room? What are the temperature requirements?

An appropriate air supply must be provided to maintain adequate temperature and ventilation for safe storage of medications. For purposes of storage of unrefrigerated medications, the room temperature must be maintained between 59° and 86° F.

What are the fees for an increase in bed space?

An approved increase in bed space is subject to an additional fee of $15 for each unit of capacity or bed space.

In facilities licensed on or after April 2, 2018, what services may be shared between an assisted living facility and a nursing facility? What is required?

An assisted living facility may be operated together with a nursing facility and may share food and laundry service, but must have clearly identifiable physical separations such as a separate wing, or floor, and each facility must independently meet all other requirements within their licensed areas.

In facilities licensed on or after April 2, 2018, when a nurses' station does not provide a direct view of a resident corridor, what must be provided?

An auxiliary station

How does HHSC detect conditions that could be detrimental to the health, safety and welfare of residents?

An early warning system.

What type of pest control system should be employed?

An effective, safe, and continuing pest control system against insects, rodents, and vermin must be in operation in the facility. Pest control services must be provided by nursing facility personnel or by contract with a licensed pest control company. Care must be taken to use the least toxic and least flammable effective insecticides and rodenticides. These compounds must be stored in nonfood preparation and storage areas. Poisons must be under lock.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the water cooler requirements?

An electric water cooler or water fountain must be accessible to residents. When new drinking fountains are provided, at least one must be installed to be accessible to persons in wheelchairs.

In facilities licensed before Sept. 11, 2003, what are the requirements for emergency power for existing construction?

An emergency electrical power system must supply power adequate at least for lighting all entrances and exits, equipment to maintain the fire detection, alarm, and extinguishing systems, and any systems or equipment whose failure is likely to cause major injury or death to a resident if the normal electrical supply is interrupted. Emergency electrical services by generator or battery must be provided to comply with the provisions of NFPA 70. Battery systems must be capable of sustaining power for a duration of at least one and one-half hours.

In general, what are the requirements of the emergency power system?

An emergency electrical power system must supply power adequate at least for lighting all entrances and exits; equipment to maintain the fire detection, alarm, and extinguishing systems; and any systems or equipment whose failure is likely to cause major injury or death to a resident if the normal electrical supply is interrupted.

In facilities licensed before Sept. 11, 2003, in existing construction, if an emergency motor generator is used, what are the installation requirements?

An emergency motor generator, if provided, must meet the following standards: (A) any emergency generator must be installed in accordance with NFPA 37, NFPA 110 and NFPA 99; (B) generators located on the exterior of the building must be provided with a noncombustible protective cover or be protected as per manufacturer's recommendations; and (C) motor generators fueled by public utility natural gas must have the capacity to be manually or automatically switched to an alternate fuel source, as specified in NFPA 70. (D) Wiring for the emergency system must be in accordance with NFPA 70.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what must be provided for electricity during an interruption of the normal electric supply?

An emergency source of electricity must be provided and connected to certain circuits for lighting and power.

Qualified surveyor

An employee of HHSC who has completed state and federal training on the survey process and passed a federal standardized exam.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required of the equipment storage rooms?

An equipment storage room must be provided for equipment such as intravenous stands, inhalators, air mattresses, and walkers.

Change of ownership

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

In facilities licensed on or after April 2, 2018, how should fire extinguishers be installed?

An extinguisher must be installed on a hanger or bracket supplied with the extinguisher or mounted in an approved cabinet. A recessed cabinet is required for an extinguisher located in a corridor.

Why must an identification system be used in the dining room?

An identification system, such as tray cards, must be available to ensure that all diets are served in accordance with physician's orders.

Responsible party

An individual authorized by the resident to act for him as an official delegate or agent. Responsible party is usually a family member or relative, but may be a legal guardian or other individual. Authorization may be in writing or may be given orally

When can a resident refuse a transfer in a Medicaid-Certified Facility?

An individual has the right to refuse a transfer to another room within the facility, if the purpose of the transfer is to relocate: (1) a resident of a skilled nursing facility (SNF) from the distinct part of the facility that is an SNF to a part of the facility that is not an SNF, or (2) a resident of a nursing facility from the distinct part of the facility that is a nursing facility to a distinct part of the facility that is an SNF.

What rights do residents have to self-administer drugs?

An individual may self-administer drugs if the interdisciplinary team, as defined in §19.802(b)(2), has determined that this practice is safe.

What is a Nurse aide?

An individual providing nursing or nursing-related services to residents in a facility under the supervision of a licensed nurse. This definition does not include an individual who is a licensed health professional or a registered dietitian or someone who volunteers such services without monetary compensation.

Fiduciary agent

An individual who holds in trust another's monies.

What are the qualifications for a speech-language pathologist?

An individual who: (A) is a speech-language pathologist licensed by the Texas Department of Licensing and Regulation; or (B) meets the educational requirements and has accumulated, or is in the process of accumulating, the supervised professional experience required to be licensed as a speech-language pathologist

How many people are on an inspection team?

An inspection may be conducted by an individual qualified surveyor or by a team, of which at least one member is a qualified surveyor.

Comprehensive assessment

An interdisciplinary description of a resident's needs and capabilities including daily life functions and significant impairments of functional capacity.

Who should be involved in the development of the comprehensive care plan?

An interdisciplinary team that includes the attending physician, a registered nurse with responsibility for the resident and other appropriate staff in disciplines as determined by the resident's needs, and, to the extent practicable, with the participation of the resident, the resident's family or legal representative;

Who can serve as an occupational therapist?

An occupational therapist licensed by the Texas Board of Occupational Therapy Examiners

Who can serve as an occupational therapy assistant?

An occupational therapy assistant licensed by the Texas Board of Occupational Therapy Examiners

Medically related condition

An organic, debilitating disease or health disorder that requires services provided in a nursing facility, under the supervision of licensed nurses.

What is an Emergency situation for the purpose of Permanency Planning?

An unexpected situation involving a child's health, safety or welfare, of which a person of ordinary prudence would determine that the LAR should be informed, such as: (A) a child needing emergency medical care; (B) a child being removed from his residence by law enforcement; (C) a child leaving his residence without notifying staff and not being located; and (D) a child being moved from his residence to protect the child (for example, because of a hurricane, fire or flood).

In addition to what is required for adult comprehensive care plan meetings, what else is required if the resident is under the age of 22?

Annually reviewed at a comprehensive care plan meeting between the facility and the resident's Legal Authorized Representative (LAR) as defined in §19.805(a)(5)), which includes a review of: (A) the LAR's contact information as required by §19.805(b)(5)(F); (B) the resident's comprehensive assessment; (C) the resident's educational status; and (D) the resident's permanency plan.

In facilities licensed on or after April 2, 2018, the design and installation of sprinkler systems must meet _____?

Any applicable state laws pertaining to these systems and one of the following criteria: (A) A sprinkler system must be designed by a qualified licensed professional engineer approved by the Texas Board of Professional Engineers to operate in Texas. The engineer must supervise the installation and provide written approval of the completed installation. (B) A sprinkler system must be planned and installed according to NFPA 13 by a firm with a certificate of registration issued by the State Fire Marshal's Office. The RME's license number and signature must be included on the prepared sprinkler drawings.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, is the location of the construction important?

Any conditions considered to be a fire, safety, or health hazard will be grounds for disapproval of the site by HHSC. New facilities may not be built in an area designated as a floodplain of 100 years or less.

Building Rehabilitation

Any construction activity involving repair, modernization, reconfiguration, renovation, changes in occupancy or use, or installation of new fixed equipment, including, the following: (A) the replacement of finishes, such as new flooring or wall finishes or the painting of walls and ceilings; (B) the construction, removal, or relocation of walls, partitions, floors, ceilings, doors, or windows; (C) the replacement of doors, windows, or roofing; (D) changes to the appearance of the exterior of a building, including new finish materials; (E) the repair, replacement, or extension of fire protection systems, including fire sprinkler systems, fire alarm system, and fire suppression systems at cooking operations; (F) the replacement of door hardware, plumbing fixtures, handrails in corridors, or grab rails in bathrooms and restrooms; (G) the repair, replacement, or extension of nurse call systems; (H) the repair or replacement of emergency electrical system equipment and components, including generator sets, transfer switches, distribution panel boards, receptacles, switches, and light fixtures; (I) the change of a wing or area to a secured wing or unit; (J) the change of a secured wing or unit to ordinary resident-use; (K) a change in the use of space, including the change of resident bedrooms to other uses, such as offices, storage, or living or dining spaces; and, (L) changes in locking arrangements, such as the installation of access control systems or the installation or removal of electronic locking devices, including electromagnetic locks, and other delayed-egress locking devices.

Legend drug or prescription drug

Any drug that requires a written or telephonic order of a practitioner before it may be dispensed by a pharmacist, or that may be delivered to a particular resident by a practitioner in the course of the practitioner's practice.

What must the facility provide, with reasonable access, to a resident in the way of health, social and legal services?

Any entity or individual that provides health, social, legal, or other services to the resident, subject to the resident's right to deny or withdraw consent at any time.

What does TX DHS say about residents not adjudicated incompetent by a state court?

Any legal surrogate designated in accordance with state law may exercise the resident's rights to the extent provided by state law.

Drug (also referred to as medication)

Any of the following: (A) any substance recognized as a drug in the official US Pharmacopoeia, official Homeopathic Pharmacopoeia of the US, or official National Formulary, or any supplement to any of them; (B) any substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man; (C) any substance (other than food) intended to affect the structure or any function of the body of man; and (D) any substance intended for use as a component of any substance specified in (A) - (C). It does not include devices or their components, parts, or accessories.

Indirect ownership interest

Any ownership or membership interest in a person that has a direct ownership interest in an applicant or license holder.

What are the requirements for a reconstruction in a facility?

Any reconstruction of components of the means of egress must comply with the applicable requirements of §19.300(d), except for the following components, which must comply with division 9: (i) illumination of means of egress; (ii) emergency lighting of means of egress; or (iii) marking of means of egress, including exit signs.

What tasks can a physician's delegate perform in a Medicaid nursing facility?

Any required physician task may also be satisfied when performed by a nurse practitioner, clinical nurse specialist, or physician assistant who is not an employee of the facility but who is working in collaboration with a physician. Services must be provided in the context of applicable state laws, rules, and regulations governing the practice of nurse practitioners, clinical nurse specialists, and physician assistants.

Poison

Any substance that federal or state regulations require the manufacturer to label as a poison and is to be used externally by the consumer from the original manufacturer's container. Drugs to be taken internally that contain the manufacturer's poison label, but are dispensed by a pharmacist only by or on the prescription order of a physician, are not considered a poison, unless regulations specifically require poison labeling by the pharmacist.

Palliative Plan of Care

Appropriate medical and nursing care for residents with advanced and progressive diseases for whom the focus of care is controlling pain and symptoms while maintaining optimum quality of life.

Who supervises the care of children admitted to the facility?

Appropriate pediatric consultative services must be utilized, in accordance with the comprehensive assessment and plan of care; and a pediatrician or other physician with training or expertise in the clinical care of children with complex medical needs participates in all aspects of the medical care.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what type of receptacles are required on the exterior of the building?

Approved waterproof type.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the ventilation requirements for nursing areas?

Area Designation-- Resident Room Minimum Total Air Changes Per Hour--2 Design Temperature—75/78 Area Designation—Examination & Treatment Room Minimum Total Air Changes Per Hour--4 All Air Exhausted To Outside--No Design Temperature--75/78 Area Designation—Physical Therapy Air Movement In Relation To Adjacent Area--In Minimum Total Air Changes Per Hour--4 All Air Exhausted To Outside--No Design Temperature—75/78 Area Designation—Occupational Therapy Minimum Total Air Changes Per Hour--4 All Air Exhausted To Outside--No Design Temperature—75/78 Area Designation—Soiled Work or Holding Room Air Movement In Relation To Adjacent Area--In Minimum Total Air Changes Per Hour--6 All Air Exhausted To Outside--Yes Area Designation—Clean Work or Holding Room Air Movement In Relation To Adjacent Area--Out Minimum Total Air Changes Per Hour--4 All Air Exhausted To Outside--No Area Designation—Toilet Rooms Air Movement In Relation To Adjacent Area--In Minimum Total Air Changes Per Hour--10 All Air Exhausted To Outside--Yes Area Designation—Bath & Shower Rooms Minimum Total Air Changes Per Hour--10 All Air Exhausted To Outside--No Design Temperature—75/78 Area Designation—Janitor's Closets Air Movement In Relation To Adjacent Area--In Minimum Total Air Changes Per Hour--10 All Air Exhausted To Outside--Yes

What should be the ratio of licensed nurses to residents?

At a minimum, the facility must maintain a ratio (for every 24-hour period) of one licensed nursing staff person for each 20 residents or a minimum of 0.4 licensed-care hours per resident day. To determine licensed-care hours per resident day, multiply the number of licensed nurses by the number of hours they work in a single day and divide the product by the number of residents in the facility. Three nurses working eight-hour shifts is 24 hours, divided by 60 residents, equals 0.4 licensed-care hours per resident day.

What is considered sufficient information to identify and care for the resident?

At a minimum: (A) full name of resident; (B) full home/mailing address; (C) social security number; (D) health insurance claim numbers, if applicable; (E) date of birth; and (F) clinical record number, if applicable;

When must the facility request an updated copy of the court order and letters of guardianship?

At each annual assessment and retain documentation of any change.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, where should a nurse call emergency switch be provided?

At each resident's toilet, bath, and shower. These switches must be usable by residents using the fixtures and by a collapsed resident lying on the floor.

In facilities licensed on or after April 2, 2018, where must nurse call emergency switches be located?

At each resident's toilet, bath, and shower. These switches must be usable by residents using the fixtures and by a collapsed resident lying on the floor.

In facilities licensed on or after April 2, 2018, how far should a new building or addition be set back from property lines?

At least 10 feet from the property lines except as otherwise approved by HHSC.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, how many bathrooms must be ADA compliant?

At least 50% of bathrooms and toilet rooms, fixtures, and accessories must be designed and provided to meet criteria under the Americans with Disabilities Act for individuals with disabilities unless otherwise approved by HHSC.

In facilities licensed on or after April 2, 2018, how many of the required bathrooms and toilet rooms are required to be ADA compliant?

At least 50% of bathrooms and toilet rooms, fixtures, and accessories must be designed and provided to meet criteria under the Americans with Disabilities Act for individuals with disabilities, unless otherwise approved by HHSC.

What must be done annually about dental care?

At least annually, the facility must ask each resident and/or responsible party if they desire a dental examination at the resident's expense.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the electrical receptacle requirements?

At least one duplex receptacle must be provided for each bed. Other duplex receptacles must be provided as needed or as required by NFPA 70.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, how many elevators are required in a multi-level facility that services 1-60 beds not on the main floor?

At least one hospital-type elevator must be installed where one to 60 resident beds are located on any floor other than the main entrance floor.

What training is required of each registered nurse, licensed vocational nurse, and nurse aide (nurse assistant) who provides nursing services dealing with dementia?

At least one hour of training each year in caring for people who have dementia.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what else must be included in each bedroom?

At least one noncombustible wastebasket must be provided in each bedroom.

In facilities licensed on or after April 2, 2018, what type of wastebasket must be in each room?

At least one noncombustible wastebasket must be provided in each bedroom.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, how many elevators are required in a multi-level facility that services 201-350 beds not on the main floor?

At least three (one of which must be hospital-type) elevators must be installed where 201 to 350 resident beds are located on floors other than the main entrance floor or where the major inpatient services are located on a floor other than those containing resident beds. Elevator service may be reduced for those floors which provide only partial inpatient services.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, how many elevators are required in a multi-level facility that services 61-200 beds not on the main floor?

At least two (one of which must be hospital-type) elevators must be installed where 61 to 200 resident beds are located on floors other than the main entrance floor, or where the major inpatient services are located on a floor other than those containing resident beds. Elevator service may be reduced for those floors which provide only partial inpatient services.

In facilities licensed before Sept. 11, 2003, in existing construction, what is the maximum temperature allowed in a kitchen at peak load?

At peak load, must not exceed a temperature of 85° F measured over the room at the five foot level.

When will violations be discussed with the facility?

At the conclusion of an inspection, survey, or investigation, the violations will be discussed in an exit conference with the facility's management.

Who may conduct the doctor's visits in a Medicare skilled nursing facility?

At the option of the physician, required visits in Medicare skilled nursing facilities after the initial visit may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with §19.1205.

What is required at the time of admission in regard to dental care?

At the time of admission, the facility must obtain the name of the resident's preferred dentist and record the name in the clinical record.

When must the facility provide written notice to Facility Enrollment, Long Term Care-Regulatory, Texas Department of Human Services (DHS) about the change of ownership?

At the time of change if a change occurs in: (A) persons with an ownership or control interest, as defined in 42 Code of Federal Regulations, §420.201 and §455.101; (B) the officers, directors, agents or managing employees; (C) the corporation, association, or other company responsible for the management of the facility; (D) the facility's administrator or director of nursing; or (E) the controlling person.

When will the verification that the facility appropriately made a staffing request and notification be done?

At the time of survey.

What if the child's LAR does not respond to a notice of the child's annual comprehensive care plan meeting, a request for the LAR's consent, or an emergency situation?

Attempt to locate the LAR by contacting a person identified by the LAR in the contact information

What should the facility do in an emergency situation with a child?

Attempt to notify the LAR as soon as the emergency situation allows and request a response from the LAR.

When would a second pneumococcal vaccination be given? When would the vaccine not be given?

Based on an assessment and practitioner recommendation, a second pneumococcal vaccination may be given five years after the first pneumococcal vaccination, unless medically contraindicated or the resident or the resident's legal representative refuses the second vaccination.

What is required for Nutrition?

Based on the comprehensive assessment of the resident, the facility must ensure that a resident: (A) maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless his clinical condition demonstrates that this is not possible; and (B) receives a therapeutic diet when there is a nutritional problem.

What is required for Mental and psychosocial functioning?

Based on the comprehensive assessment of the resident, the facility must ensure that: (A) a resident who displays mental or psychosocial adjustment difficulty receives appropriate treatment and services to correct the assessed problem; and (B) a resident whose assessment does not reveal a mental or psychosocial adjustment difficulty does not display a pattern of decreased social interaction and/or increased withdrawn, angry, or depressive behaviors, unless his clinical condition demonstrates that such a pattern is unavoidable.

What is required for Range of motion?

Based on the comprehensive assessment of the resident, the facility must ensure that: (A) a resident who enters the facility without a limited range of motion does not experience reduction in range of motion unless the resident's clinical condition demonstrates that a reduction in range of motion is unavoidable; and (B) a resident with a limited range of motion receives appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion.

What is required for Urinary incontinence?

Based on the comprehensive assessment of the resident, the facility must ensure that: (A) a resident who enters the facility without an indwelling catheter is not catheterized unless his clinical condition demonstrates that catheterization is necessary; and (B) a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible.

What is required for Pressure sores?

Based on the comprehensive assessment of the resident, the facility must ensure that: (A) a resident who enters the facility without pressure sores does not develop pressure sores unless his clinical condition demonstrates that they are unavoidable; and (B) a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing.

What is required for Naso-gastric tubes?

Based on the comprehensive assessment of the resident, the facility must ensure that: (A) a resident who has been able to eat enough alone or with assistance is not fed by naso-gastric tube unless his clinical condition demonstrates that use of a naso-gastric tube is unavoidable; and (B) a resident who is fed by a naso-gastric or gastrostomy tube receives the appropriate treatment and services to prevent aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers, and to restore, if possible, normal eating skills.

What is required for Activities of daily living?

Based on the comprehensive assessment of the resident, the facility must ensure that: (A) a resident's abilities in activities of daily living do not diminish unless the circumstances of the individual's clinical condition demonstrate that diminution is unavoidable. This includes the resident's abilities to bathe, dress, and groom; transfer and ambulate; toilet; eat; and use speech, language, or other functional communication systems. (B) the resident is given the appropriate treatment and services to maintain or improve his abilities specified in paragraph (1) of this section. (C) a resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene.

What is required for Antipsychotic drugs?

Based on the comprehensive assessment of the resident, the facility must ensure that: (A) residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record; and (B) residents who use antipsychotic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue use of these drugs.

Good faith attempts by the committee to identify and correct quality deficiencies may not be used as a _____.

Basis for sanctions.

In facilities licensed on or after April 2, 2018, what are the heating and ventilation requirements for bathing areas?

Bathing areas must be provided with safe and effective auxiliary or supplementary heating. Bathing areas must be free of drafts and must have adequate exhaust ducted to the outside to minimize excess moisture retention and resulting mold and mildew problems.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, how many bathtubs and showers are required?

Bathtubs or showers must be provided at the rate of one for each 20 beds which are not otherwise served by bathing facilities within residents' rooms. At least one bathing unit must be provided in each nursing unit.

In facilities licensed on or after April 2, 2018, how many bathtubs or shower facilities are required within the facility?

Bathtubs or showers must be provided at the rate of one for each 20 beds which are not otherwise served by bathing facilities within residents' rooms. At least one bathing unit must be provided in each nursing unit.

A rehabilitation to an occupied building that involves exit-ways or exit doors must _____?

Be accomplished without compromising the exits or creating a dead end situation at any time. HHSC may approve temporary exits, or the facility must relocate residents until construction blocking the exit is completed. The facility must maintain other basic safety features such as fire alarms, sprinkler systems, and emergency power.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, rehabilitation or modernization of an existing emergency power system must _____?

Be based on the assessed risk category and according to the requirements of NFPA 99 for new health care facilities.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the privacy requirements for each room?

Be designed or equipped to assure full visual privacy for each resident. A facility must take appropriate measures to protect the privacy and dignity of the residents through the use of cubicle curtains, screens, or procedures.

In facilities licensed on or after April 2, 2018, how far back must the exit doors sit? Where is this measured from? Why?

Be set back at least 6' from the edge of the drive, measured from the end of the building wall in the case of a recessed door, to prevent accidents due to lack of visual warning.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, where should laundry facilities be located?

Because of the high incidence of fires in laundries, it is highly recommended that the laundry be in a separate building 20 feet or more from the main building. If the laundry is located within the main building it must be separated by minimum one-hour fire construction to structure above, and sprinklered, and must be located in a remote area away from resident sleeping areas. Access doors must be from an interior nonresident use area, such as a service corridor, that is separated from the resident area, or from the exterior.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the bedding requirements for each resident?

Bedding appropriate to the weather and climate.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the exit provisions for bedrooms?

Bedroom space arrangement and doors and corridors must be designed for evacuation of bedfast residents by means of rolling the bed to a safe place in the building or to the outside.

In facilities licensed on or after April 2, 2018, what are the required exit provisions for bedrooms?

Bedroom space arrangement and doors and corridors must be designed for evacuation of bedfast residents by means of rolling the bed to a safe place in the building or to the outside.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the requirements for bedroom identification?

Bedrooms must be identified with a raised or recessed unique number placed on or near the door.

In facilities licensed before Sept. 11, 2003, in existing construction, how should bedrooms be identified?

Bedrooms must be identified with a raised or recessed unique number placed on or near the door. Refer to §19.319(c) and §19.301(c)(5).

In facilities licensed before Sept. 11, 2003, in existing construction, what is the minimum size of a wall in a bedroom?

Bedrooms should not be less than 10 feet in the smallest dimension.

What if a child needs to be transferred to another facility?

Before a child who is under 18 years of age, or who is 18-22 years of age and for whom an LAR has been appointed, is transferred to another facility operated by the transferring facility, attempt to obtain consent for the transfer from the LAR, unless the transfer is made because of a serious risk to the health and safety of the child or another person; and document compliance with the requirements of this paragraph in the child's records.

If a resident is being discharged to a hospital, what must the facility do about the bed the resident was occupying?

Before a nursing facility transfers a resident to a hospital or allows a resident to go on therapeutic leave, the nursing facility must provide written information to the resident and a family member or legal representative that specifies: (A) the duration of the bed-hold policy under the Medicaid State Plan (see §19.2603) if any, during which the resident is permitted to return and resume residence in the facility; and (B) the facility's policies regarding bed-hold periods, permitting a resident to return.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what material must be used for insulation of the building?

Building insulation materials, unless sealed on all sides and edges in an approved manner, must have a flame spread rating of 25 or less when tested in accordance with NFPA 255 and NFPA 258.

How does a resident approve a withdrawal from their personal funds?

By signing a document that shows the resident's approval and the date of the approval.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, elevators are required to have what dimensions?

Cars of hospital-type elevators must have inside dimensions that will accommodate a resident bed and attendants and must be at least 5' wide by 7'6" deep. The car door must have a clear opening of not less than 3'8".

In facilities licensed on or after April 2, 2018, what are the required dimensions of a hospital-type elevator?

Cars of hospital-type elevators must have inside dimensions that will accommodate a resident bed and attendants and must be at least 5'w x 7'6"d. The car door must have a clear opening of not less than 3'8".

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what is important in regard to central supply systems and fire alarms?

Central air supply systems and/or systems serving means of egress must automatically and immediately shut down upon activation of the fire alarm system. (An exception must be approved, engineered smoke-removal systems.)

Under what circumstances would an inspection be announced?

Certain visits may be announced, including, but not limited to, consultation visits to determine how a physical plant may be expanded or upgraded and visits to determine the progress of physical plant construction or repairs, equipment installation or repairs, or systems installation or repairs or conditions when certain emergencies arise, such as fire, windstorm, or malfunctioning or nonfunctioning of electrical or mechanical systems.

Act

Chapter 242 of the Texas Health and Safety Code.

Who is responsible for Banking Charges on pooled accounts?

Charges for checks, deposit slips, and services for pooled checking accounts are the responsibility of the facility and may not be charged to the resident, legally authorized representative, or responsible party.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what is required for plumbing clean-outs?

Clean-outs for waste piping lines must be provided and located so that there is the least physical and sanitary hazard to residents. Where possible, clean-outs must open to the exterior or areas which would not spread contamination during clean-out procedures.

Where should combustible-type materials be kept?

Combustibles, such as cleaning rags and compounds, must be kept in closed metal containers and labeled.

What does TX DHS say about Powers of Attorney?

Competent adults may issue directives or durable powers of attorney for health care, subject to the requirements of §19.419.

What else must be submitted to HHSC in regards to floor plans? What must be included?

Copies of reduced size floor plan on 8-1/2" x 11" sheets to HHSC for record and file use and for the facility to use in evacuation planning and fire alarm zone identification. Plans must contain basic legible information such as overall dimensions, room usage names, actual bedroom numbers, doors, windows, and any other pertinent information.

What must be included in the hospice record for residents?

Current and past: (A) Texas Medicaid Hospice Recipient Election/Cancellation form; (B) MDS assessment; (C) Physician Certification of Terminal Illness form; (D) Medicare Election Statement, if dually eligible; (E) verification that the recipient does not have Medicare Part A; (F) hospice interdisciplinary assessments; (G) hospice plan of care; and (H) current interdisciplinary notes, which include the following: nurses notes and summaries; physician orders and progress notes; and medication and treatment sheets during the hospice certification period.

What resource must be on hand if the facility has pediatric residents?

Current medication reference texts or sources, including information on pediatric medications, dosages, sites, routes, techniques of drug administration, desired effects, and possible side effects, if facilities have pediatric residents.

In facilities licensed before Sept. 11, 2003, in existing construction, what is the lighting level standard required for general lighting?

Current recommendations of the Illumination Engineering Society of North America must be followed to achieve proper illumination characteristics and lighting levels throughout the facility. Minimum illumination must be ten foot candles in resident rooms and 20 foot candles in corridors, nurses stations, dining rooms, lobbies, toilets, bathing facilities, laundries, stairways, and elevators.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the privacy curtain requirements for each room?

Curtains and screens must be rendered and maintained flame-retardant. In facilities initially certified after March 31, 1992, except in private rooms, have ceiling-suspended curtains for each bed, which extend around the bed to provide total visual privacy, in combination with adjacent walls and curtain.

Who determines if a facility meets the licensing rules, including both physical plant and facility operation requirements?

DADS

What are expedited Life Safety Code and Physical Plant Inspection Fees?

DADS charges a fee for expedited Life Safety Code and physical plant inspections for new buildings, additions, conversion of buildings not licensed by DADS, or remodeling of existing licensed facilities.

What type of inspection is done for a change of ownership?

DADS conducts an on-site inspection to verify compliance with the requirements after issuing a change of ownership license.

What will DADS do if additional violations are cited after the initial exit conference?

DADS gives the facility an additional exit conference regarding the additional violations.

When should a desk review be done in lieu of an on-site inspection or survey during a change of ownership?

DADS may allow a desk review in lieu of an on-site inspection or survey if: (A) the facility specifically requests a desk review and submits evidence during the application process that no new controlling person is added; (B) DADS determines the change does not involve a new controlling person; and (C) the facility meets the standards for operation based on the most recent on-site inspection.

What is the criteria for denying a license or renewal of a license?

DADS may deny an initial license or refuse to renew a license if any person: (1) is subject to denial or refusal as described in Chapter 99 during the time frames described in that chapter; (2) does not have a satisfactory history of compliance with state and federal nursing home regulations. (3) has committed any act described in §19.2112(a)(2)-(7); (4) violated Chapter 242 of the Texas Health and Safety Code in either a repeated or substantial manner; (5) aids, abets, or permits a substantial violation about which the person had or should have had knowledge; (6) fails to provide the required information and facts and/or references; (7) fails to pay the fees, taxes, and assessments when due; (9) fails to meet minimum standards of financial condition; or (10) fails to notify DADS of a significant adverse change in financial condition as required under §1919.25.

What is the procedure for requesting an informal review disputing the results of a trust fund audit?

DADS must receive a written request for an informal review by United States (U.S.) mail, hand delivery, special mail delivery, or fax no later than 15 days after the date on the written notification of the report of findings. If the 15th day is a Saturday, Sunday, national holiday, or state holiday, then the first day following the 15th day is the final day the written request will be accepted. A request for an informal review that is not received by the stated deadline is not granted. A facility must submit a written request for an informal review: (A) by U.S. mail to DADS Trust Fund Monitoring Unit, Attn: Manager, P.O. Box 149030, Mail Code W-340, Austin, Texas 78714-9030; (B) hand delivery or special mail delivery to 701 West 51st Street, Austin, Texas 78751-2321; or (C) by fax to (512) 438-3639.

What address should the unclaimed resident funds be sent to?

DADS, Accounts Receivable, Mail Code E-411, P.O. Box 149030, Austin Texas 78714-9030. (A) The funds must be identified as money that will escheat to the state. (B) If the facility held the funds, the facility must include the notarized affidavit.

What happens if the facility refuses the request for an AEM?

DHS may assess an administrative penalty of $500 against a facility for each instance in which the facility: (A) refuses to permit a resident, or the resident's guardian or legal representative, to conduct AEM; (B) refuses to admit an individual or discharges a resident because of a request to conduct AEM; (C) discharges a resident because covert electronic monitoring is being conducted by or on behalf of the resident; or (D) violates any other provision related to AEM.

What will DADS do once a complaint has been filed?

DHS will furnish the facility with a notification of the complaint received and a summary of the complaint, without identifying the source of the complaint.

What information is used in the DHS review when a revoked, suspended or denied renewal is being challenged by a licensee?

DHS's review will be limited to a review of documentation submitted by the license holder and information DHS used as the basis for its proposed action and will not be conducted as an adversary hearing. DHS will give the license holder a written affirmation or reversal of the proposed action.

In facilities licensed on or after April 2, 2018, what are privacy curtains not allowed to do?

Design for privacy must not restrict resident access to the entry, lavatory, or toilet, nor may it restrict bed evacuation or obstruct sprinkler flow coverage.

In facilities licensed on or after April 2, 2018, who sets the codes governing design temperatures for heating and cooling?

Design temperatures for heating and cooling must be as required by NFPA 99.

In facilities licensed on or after April 2, 2018, how should blowers for central heat and cooling systems be designed?

Designed so that they may run continuously.

When must the comprehensive care plan be made?

Developed within seven days after completion of the comprehensive assessment;

In facilities licensed on or after April 2, 2018, what is the required size for dining areas?

Dining space must be adequate for the number of residents served, but no less than ten square feet per resident bed.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, how large should the dining space be?

Dining space must be adequate for the number of residents served, but not less than 10 square feet per resident bed.

Direct care by licensed nurses

Direct care consonant with the physician's planned regimen of total resident care includes: (A) assessment of the resident's health care status; (B) planning for the resident's care; (C) assignment of duties to achieve the resident's care; (D) nursing intervention; and (E) evaluation and change of approaches as necessary.

The hospice plan of care must include _____.

Directives for managing pain and other uncomfortable symptoms, and must be revised and updated as necessary to reflect the recipient's current status.

What should be included in the medical record of residents regarding vaccines?

Documentation of receipt, refusal, or contraindication of vaccination. (A) Except as provided in clause (B) of this subparagraph, the medical record for each resident must show the date of the receipt or refusal of the annual influenza vaccination and the pneumococcal vaccination. (B) If a resident does not receive or refuses a vaccination, the resident's medical record must show the resident did not receive the annual influenza vaccination or the pneumococcal vaccination due to a medical contraindication.

How detailed must the building plans be for a review?

Documents must be in sufficient detail to demonstrate compliance with this subchapter and ensure proper construction. Documents must be prepared according to accepted architectural practice and must include general construction, special conditions, and schedules.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what must be installed in the door of the kitchen between it and the serving areas?

Doors between kitchen and dining or serving areas must have a safety glass view panel.

In facilities licensed on or after April 2, 2018, what is required in the doors to the kitchen?

Doors between kitchen and dining or serving areas must have a safety glass view panel.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the regulations for doors to hazardous areas?

Doors to hazardous areas must have closers and be kept closed unless provided with an approved hold-open device such as an alarm activated magnetic hold-open device, as permitted by NFPA 101. Doors must be single-swing type with positive latching hardware. View panels at laundry entrances must be provided and be of materials adequate to maintain the integrity of the door as allowed by NFPA 101.

In facilities licensed on or after April 2, 2018, what are the requirements for doors to hazardous areas?

Doors to hazardous areas must have closers and must be kept closed unless provided with an approved hold-open device such as an alarm activated magnetic hold-open device, as permitted by NFPA 101. Doors must be single-swing type with positive latching hardware. View panels at laundry entrances must be provided and be of materials adequate to maintain the integrity of the door as allowed by NFPA 101.

What must be included with the record drawings of the fire detection and alarm system upon final survey of new construction? Who must sign off on each part?

Drawings of the fire detection and alarm system as installed, signed by an Alarm Planning Superintendent licensed by the State Fire Marshal's Office or sealed by a licensed professional engineer, including a sequence of operation, the owner's manuals and the manufacturer's published instructions covering all system equipment, a signed copy of the State Fire Marshal's Office, Fire Alarm Installation Certificate, and, for software-based systems, a record copy of the site-specific software, excluding the system executive software or external programmer software, in a non-volatile, non-erasable, non-rewritable memory

For new construction, additions to or rehabilitation of an existing building, an overall plan of the entire building must be?

Drawn or reduced to fit on an 8-1/2" x 11" sheet.

How should drugs and biologicals be labeled?

Drugs and biologicals used in the facility must be labeled in accordance with currently accepted professional principals and in compliance with the Texas State Board of Pharmacy Laws and Regulations, §291, including the appropriate accessory and cautionary instructions and the expiration date when applicable.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what type of ventilation is required for the dry food storage area?

Dry foods storage must have an effective venting system to provide for positive air circulation.

In facilities licensed before Sept. 11, 2003, in existing construction, what can be done about duct and piping condensation?

Ducts and piping subject to surface condensation must be insulated to prevent condensation at least in areas which may affect sanitation or cause building deterioration.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what must the air ducts be made of?

Ducts must be of metal or other approved noncombustible material. Cooling ducts must be insulated against condensation drip.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, where should duplex receptacles be installed for general use in corridors?

Duplex receptacles for general use must be installed in corridors spaced not more than 50 feet apart and within 25 feet of ends of corridors. At least one duplex receptacle in each resident corridor must be provided with emergency electrical service.

Where should emergency receptacles be located?

Duplex receptacles powered through the emergency electrical system must be installed at each resident bed location where resident-care-related electrical appliances are in use, unless a facility can demonstrate that it can provide the diagnostic, therapeutic, or monitoring benefits of the resident-care-related electrical appliances through acceptable alternative means in the event of a power outage.

What is HHSC allowed to do during a visit?

During an inspection, survey, or investigation, HHSC is authorized to photocopy documents, photograph residents, and use any other available recordation devices to preserve all relevant evidence of conditions that HHSC reasonably believes threaten the health and safety of a resident.

How often is the waiver of the requirement to provide licensed nurses on a 24-hour basis reviewed?

During the annual state review.

When can an increase in capacity be filed?

During the license term, a license holder may not increase capacity without approval from DHS. The license holder must submit to DHS a complete application for increase in capacity and the fee required. Upon approval of an increase in capacity, DHS will issue a new license.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the emergency lighting requirements for auxiliary stations?

Each auxiliary station must have an emergency electrical source adequate to power lights at the station.

In facilities licensed before Sept. 11, 2003, in existing construction, what is the physical requirements for auxiliary nurse's stations?

Each auxiliary station must include a work area in which nursing personnel can document and maintain resident data, even if the facility's initial decision is to maintain clinical records at the nurses' station.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the bedroom lighting requirements?

Each bed must be provided with an appropriate, safe, durable, non-glare, permanently bed-mounted or wall-mounted reading-light fixture. The fixture must be wired in accordance with NFPA 70. These fixtures should be mounted at least 5'6" above the floor. The switch must be within reach of a resident in the bed. Each bedroom must be assured of having general lighting, either by means of appropriate combination reading light or by means of separate fixture.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the call light requirements?

Each bed must have access to a nurse call device that is part of an electrical nurse call system.

In facilities licensed before Sept. 11, 2003, what fire rating must be established for existing construction?

Each building must be classified as to building construction type for fire resistance rating purposes in accordance with NFPA 220 and NFPA 101. Building insulation materials, unless sealed on all sides and edges in an approved manner with noncombustible material, must have a flame-spread rating of 25 or less when tested in accordance with ASTM E84, UL723, or ASTM E662.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, how are buildings classified?

Each building must be classified as to building construction type for fire resistance rating purposes in accordance with the National Fire Protection Association (NFPA) 220 and the Life Safety Code.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what must be activated when a call switch is activated?

Each call entered into the system must activate a corridor dome light above the bedroom, bathroom, or toilet corridor door, a visual signal at the nurses' station which indicates the room from which the call was placed, and a continuous or intermittent continuous audible signal of sufficient amplitude to be clearly heard by nursing staff. The amplitude or pitch of the audible signal must not be such that it is irritating to residents or visitors. The system must be designed so that calls entered into the system may be canceled only at the calling station. Intercom-type systems which meet this requirement are acceptable.

In facilities licensed on or after April 2, 2018, what must the nurse call system do when activated?

Each call entered into the system must activate a corridor dome light above the bedroom, bathroom, or toilet room corridor door, a visual signal at the nurses' station which indicates the room from which the call was placed, and a continuous or intermittent continuous audible signal of sufficient amplitude to be clearly heard by nursing staff. The amplitude or pitch of the audible signal must not be such that it is irritating to residents or visitors. The system must be designed so that calls entered into the system may be canceled only at the call station. Intercom-type systems which meet this requirement are acceptable.

In facilities licensed on or after April 2, 2018, how many parking spots are required?

Each facility must have parking space to satisfy the needs of residents, employees, staff, and visitors. In the absence of a formal parking study, each facility must provide for a ratio of at least one parking space for every four beds in the facility.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, how much parking space is required?

Each facility must have parking space to satisfy the needs of residents, employees, staff, and visitors. In the absence of a formal parking study, each facility must provide for a ratio of at least one parking space for every four beds in the facility. This ratio may be reduced slightly in areas convenient to public parking facilities. Space must be provided for emergency and delivery vehicles. No parking space may block or inhibit egress from the outside exit doors. Parking spaces and drives must be at least ten feet away from windows in bedrooms, dining, and living areas.

What is required of facilities when it comes to staff development?

Each facility must implement and maintain programs of orientation, training, and continuing in-service education to develop the skills of its staff, as described in §19.1903.

What are the qualifications and procedures for license renewal?

Each license holder must, no later than the 45th day before the expiration of the current license, submit an application for renewal with DADs. DADs considers that an individual has submitted a timely and sufficient application for the renewal of a license if the license holder submits: (A) a complete application; (B) an incomplete application with an explanation; (C) a complete or incomplete application within the 45-day window with a late fee. If the application is post-marked by the deadline if it is received within 15-days of the post-mark.

In facilities licensed before Sept. 11, 2003, in existing construction, what must be at each nurse's station?

Each nurses' station must be equipped to register residents' calls through a communication system from resident areas.

In facilities licensed on or after April 2, 2018, what are the requirements in the bedrooms for nurse call systems?

Each resident bedroom must be served by at least one call station and each bed must be provided with a call switch. Two call switches serving adjacent beds may be served by one call station.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, how many call switches are required in each bedroom?

Each resident bedroom must be served by at least one call station and each bed must be provided with a call switch. Two call switches serving adjacent beds may be served by one calling station.

In facilities licensed on or after April 2, 2018, what type of bathroom access must be provided?

Each resident bedroom must have direct access to a bathroom without entering the general corridor area.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what size window is required for each resident living and dining room? How much of that can be sky-lighting?

Each resident living room and dining room must have at least one outside window. The window area must be equal to at least 8.0% of the total room floor area. Sky-lighting may be used to fulfill one-half of the 8.0% minimum area.

In facilities licensed on or after April 2, 2018, what is required for windows in common spaces?

Each resident living room and dining room must have at least one outside window. The window area must be equal to at least 8.0% of the total room floor area. Sky-lighting may be used to fulfill one-half of the 8.0% minimum area.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the requirement for bedroom furniture?

Each resident must have a bed with a comfortable mattress, a bedside stand with at least two enclosed storage spaces, a dresser, and closet or wardrobe space providing privacy for clothing and personal belongings. Clothes storage space must provide at least 22" of lineal hanging space per bed and have closable doors. Chairs and space must be provided for use by residents and visitors.

In facilities licensed on or after April 2, 2018, what is required in the way of bedroom furniture for residents?

Each resident must have a bed with a comfortable mattress, a bedside stand with at least two enclosed storage spaces, a dresser, and closet or wardrobe space providing privacy for clothing and personal belongings. Private clothes storage space must provide at least 22 inches of lineal hanging space per bed and have closable doors. Chairs and space must be provided for use by residents and visitors.

How often must physician visit a resident in a licensed-only facility?

Each resident must have a medical examination at least annually by his physician and as necessary to meet the needs of the resident. Physician orders must be reviewed and revised as necessary at least once every 60 days, unless the resident's physician specifies, in writing in the resident's clinical record, a different schedule for each review and revision.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the requirements in the way of toilet rooms?

Each resident must have access to a toilet room without entering the general corridor area. One toilet room must serve no more than two resident rooms. The toilet room must contain a water closet and a lavatory. The lavatory may be omitted from a toilet room which serves two bedrooms if each resident room contains a lavatory.

Who is required to supervise the care of a resident?

Each resident must remain under the care of a physician. The facility must ensure that: (A) the medical care and other health care of each resident is supervised by an attending physician. Any consultations must be ordered by the attending physician; (B) another physician supervises the medical care and other health care of residents when their attending physician is unavailable.

Generally, what is required for resident bathrooms?

Each resident room must be equipped with or located near toilet and bathing facilities. For a facility that receives approval of construction from state and local authorities or are newly certified on or after November, 28, 2016, each resident room must have its own bathroom equipped with at least a commode and sink.

What is required for the prevention of Unnecessary Drugs?

Each resident's drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used: (A) in excessive dose (including duplicate drug therapy); or (B) for excessive duration; or (C) without adequate monitoring; or (D) without adequate indications for its use; or (E) in the presence of adverse consequences which indicate the dose should be reduced or discontinued; or (F) any combination of the circumstances in clauses (i)-(v) of this subparagraph.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required in the way of windows?

Each room must have at least one operable outside window arranged and located so that it can be easily opened from the inside without the use of tools or keys. The maximum allowable sill height must not exceed 36 inches above the floor. All operable windows must have insect screens. The minimum area of a window in each bedroom must equal at least 16 square feet or 8.0% of the room area, whichever is larger. Operable window sections may be restricted to not more than six nor less than four inches for security or safety reasons.

In facilities licensed on or after April 2, 2018, what must be in each bedroom? What are the requirements?

Each room must have at least one operable outside window arranged and located so that it can be easily opened from the inside without the use of tools or keys. The maximum allowable sill height must not exceed 36 inches above the floor. All operable windows must have insect screens. The minimum area of window in each bedroom must equal at least 16 square feet or 8.0% of the gross floor area of the room, whichever is larger. Operable window sections may be restricted to not more than six nor less than four inches for security or safety reasons.

In facilities licensed on or after April 2, 2018, what type of lighting is required?

Each room must have general lighting, wall-mounted bed reading lights, and night lighting.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required in the way of general lighting?

Each room must have general lighting, wall-mounted bed reading lights, and night lighting. The night light must be switched just inside the entrance to each resident room with a silent type switch unless otherwise approved by HHSC. The light providing general illumination must be switchable at the door of the resident room for use of staff and residents. A durable non-glare reading light with an opaque front panel securely anchored to the wall, integrally wired, must be provided for each resident bed. The switch must be within reach of a resident in the bed.

In facilities licensed on or after April 2, 2018, where should nursing service areas be located?

Each service area may be arranged and located to serve more than one nursing unit, but at least one service area must be provided on each nursing floor. The maximum allowable distance from a resident room door to a nurses' station is 150 feet. Nurses' stations must be located to provide a direct view of resident corridors. A nurses' station has a direct view of a resident corridor if a person can see down the corridor from a point within 24 inches of the outside of the nurses' station counter or wall.

In facilities licensed on or after April 2, 2018, what are the requirements for the bathtub or shower rooms?

Each tub or shower must be in an individual room or enclosure which provides space for the private use of the bathing fixture, for drying and dressing, including an accessible dressing bench, and for a wheelchair and an attendant. Each general-use bathing room must be provided with at least one water closet in a stall, room, or area for privacy, and one lavatory.

In facilities licensed before Sept. 11, 2003, what electrical codes must be followed for existing construction?

Electrical and illumination systems must be designed and installed in accordance with NFPA 70 and the Lighting Handbook of the Illuminating Engineering Society of North America, except as may be modified in this subchapter.

Medicaid nursing facility vendor payment system

Electronic billing and payment system for reimbursement to nursing facilities for services provided to eligible Medicaid recipients.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what type of protection from fire must elevators have?

Elevator call buttons, controls, and door safety stops must be of a type that will not be activated by heat or smoke. Door openings must meet the requirements of the Life Safety Code for protection of vertical openings.

In facilities licensed on or after April 2, 2018, what are the accessibility provisions for elevators?

Elevator controls, alarm buttons, and telephones must be accessible to and usable by individuals with disabilities as required by the Americans with Disabilities Act.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the accessibility provisions for elevators?

Elevator controls, alarm buttons, and telephones, must be accessible to and usable by individuals with disabilities as required under the Americans with Disabilities Act of 1990.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what type of leveling device is required in an elevator?

Elevators must be equipped with an automatic leveling device of the two-way automatic maintaining type with an accuracy of 1/2 inch.

In facilities licensed on or after April 2, 2018, what kind of leveling device is required in the elevators?

Elevators must be equipped with an automatic leveling device of the two-way automatic maintaining type with an accuracy of 1/2 inch.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what must the elevators be equipped with?

Elevators, except freight elevators, must be equipped with a two-way special service switch to permit cars to bypass all landing button calls and be dispatched directly to any floor.

In facilities licensed on or after April 2, 2018, what must the elevators be equipped with?

Elevators, except freight elevators, must be equipped with a two-way special service switch to permit cars to bypass all landing button calls and be dispatched directly to any floor.

Who can provide emergency dental services?

Emergency dental services must be provided by a dentist licensed by the Texas State Board of Dental Examiners who, if not employed by the facility, contracts with the facility according to the specifications outlined in §19.1906.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the exit provisions for emergency egress lighting immediately outside of exit doors?

Emergency lighting is required as a part of the building emergency lighting system. Photocell devices may be used to turn lights off during daylight hours. The requirements of an emergency lighting system must be in accordance with §19.341.

What regulation states that stocks of inventoried emergency medications may be kept in facilities?

Emergency medication kits must be maintained in compliance with 22 TAC §291.121(b), with the exception of emergency medication kits in veterans homes, as defined by Natural Resources Code, §164.002. In veterans homes, a United States Department of Veterans Affairs pharmacy or another federally operated pharmacy may maintain emergency medication kits.

In facilities licensed before Sept. 11, 2003, what codes dealing with emergency power system must be followed?

Emergency power systems must meet the requirements of NFPA 99 applicable to existing facilities, for the risk category determined by the requirements of §19.300(i), and the requirements of this section. Rehabilitation or modernization of an existing emergency power system must be based on the assessed risk category and according to the requirements of NFPA 99 for new health care facilities.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what may be on delay after a service interruption?

Emergency service to receptacles and equipment may be delayed automatic or manually connected.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the structural requirements?

Every building and every portion thereof must be designed and constructed to sustain all dead and live loads in accordance with accepted engineering practices and standards.

In facilities licensed before Sept. 11, 2003, what engineering codes must be followed for existing construction?

Every building and portion of a building must be capable of sustaining all dead and live loads in accordance with accepted engineering practices and standards.

In facilities licensed on or after April 2, 2018, what are the structural requirements?

Every building and portion of a building must be capable of sustaining all dead and live loads in accordance with accepted engineering practices and standards.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the exit provisions for exit doors and ways of egress?

Exit doors and ways of egress must be maintained clear and free for use at all times, except as permitted by NFPA 101. Furnishings, equipment, carts, and other obstacles must not be left to block egress at any time.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, where should the exit doors be located?

Exit doors from the building must not open directly onto a drive for vehicular traffic, but must be set back at least 6' from the edge of the drive, measured from the end of the building wall in the case of a recessed door, to prevent accidents due to lack of visual warning.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the regulations for exit provisions?

Exit provisions, including doors, corridors, stairways, and other exit-ways, locks, and other applicable items must conform to the requirements of NFPA 101 concerning means of egress and of this section in order to ensure that residents can be rapidly and easily evacuated from the building at all times, or from one part of the building to a safe area of refuge in another part of the building.

In facilities licensed on or after April 2, 2018, what are the required exit provisions?

Exit provisions, including doors, corridors, stairways, other exit-ways, locks, and other applicable items must conform to the requirements of NFPA 101 concerning means of egress and to this section to ensure that residents can be rapidly and easily evacuated from the building at all times, or from one part of the building to a safe area of refuge in another part of the building.

What if the validation team finds additional deficiencies during their visit?

Facilities are required to correct any additional deficiencies cited by the validation team but are not subject to any new or additional punitive action.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what dishwashing facilities are required?

Facilities for washing and sanitizing dishes and cooking utensils must be provided. These facilities must be designed based on the number of meals served and the method of serving, that is, use of permanent or disposable dishes. As a minimum, the kitchen must contain a multi-compartment sink large enough to immerse pots and pans. In all facilities, a mechanical dishwasher is required for washing and sanitizing dishes. Separation of soiled and clean dish areas must be maintained, including air flow.

In facilities licensed on or after April 2, 2018, what equipment is required for the cleaning and sanitizing of dishes?

Facilities for washing and sanitizing dishes and cooking utensils must be provided. These facilities must be designed based on the number of meals served and the method of serving, that is, use of permanent or disposable dishes. The kitchen must contain a multi-compartment sink large enough to immerse pots and pans. A mechanical dishwasher is required for washing and sanitizing dishes. Separation of soiled and clean dish areas must be maintained, including air flow.

In facilities licensed before Sept. 11, 2003, in existing construction, what is required for administrative and public areas?

Facilities must have administrative areas for normal business transactions and maintenance of records.

What is required for facilities with fewer than five pediatric residents?

Facilities with fewer than five pediatric residents must assure that the children's rooms are in close proximity to the nurses' station.

How often should portable fire extinguishers be inspected by the facility?

Facility staff must visually inspect portable fire extinguishers monthly. Facility staff conducting the monthly visual inspection must ensure portable extinguishers are protected from damage, kept on their mounting brackets or in cabinets at all times, and kept in the proper condition and working order.

In facilities licensed before Sept. 11, 2003, in existing construction, what should the temperature be in the facility?

Facility temperature must be maintained for the comfort of residents.

Title II

Federal Old-Age, Survivors, and Disability Insurance Benefits of the Social Security Act.

What are the fees for the building plan review?

Fees for plan review will be required in accordance with §19.219 of this chapter

In facilities licensed on or after April 2, 2018, according to NFPA 99, all ventilation or air-conditioning systems must be equipped with _____.

Filters

In facilities licensed on or after April 2, 2018, what are the requirements for filters on ventilation and air-conditioning systems?

Filters must be of sufficient efficiency to minimize dust and lint accumulations throughout the system and building, including in supply and return plenums and ductwork. Filters must be easily accessible for routine changing or cleaning.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what must the central ventilation or air-conditioning systems be equipped with?

Filters of sufficient efficiency to minimize dust and lint accumulations throughout the system and building including supply and return plenums and ductwork. Filters with efficiency rating of 80% or greater (based on ASHRAE) are recommended. Filters for individual room units must be as recommended by the equipment manufacturer. Filters must be easily accessible for routine changing or cleaning.

What must the final copy of the building plans contain?

Final copies of plans must include a title block that shows name of facility, person, or organization preparing the sheet, sheet numbers, facility address, and drawing date. Sheets and sections covering structural, electrical, mechanical, and sanitary engineering final plans, designs, and specifications must bear the seal of a licensed professional engineer approved by the Texas Board of Professional Engineers to operate in Texas. Contract documents for additions, rehabilitation of, or construction of an entirely new facility must be prepared by an architect licensed by the Texas Board of Architectural Examiners. Drawings must bear the seal of the architect.

Alarm Planning Superintendent

Fire Alarm Planning Superintendent. A person licensed by the State Fire Marshal's Office to plan, install, certify, inspect, test, service, monitor, and maintain fire alarm or fire detection devices.

In facilities licensed on or after April 2, 2018, where should fire alarm bells and horns be located?

Fire alarm bells or horns must be located throughout the building for audible coverage. Flashing visual alarm lights must be installed to be visible in corridors and public areas, including dining rooms and living rooms, in a manner that will identify exit routes.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, who is required to installed and maintain the fire alarm system?

Fire alarm systems must be installed, maintained, and repaired by an agent having a current certificate of registration with the State Fire Marshal's office of the Texas Commission on Fire Protection, in accordance with state law. A fire alarm installation certificate must be provided as required by the Office of the State Fire Marshal.

What are the requirements for fire detection systems for new construction?

Fire detection and alarm system working plans must be designed in accordance with the applicable sections of the NFPA 72, and the NFPA 70, and signed by an Alarm Planning Superintendent licensed by the State Fire Marshal's Office or sealed by a licensed professional engineer.

In facilities licensed on or after April 2, 2018, what are the components of a fire protection system?

Fire protection systems include detection, alarm, and communication systems; fixed automatic extinguishment systems; and portable extinguishers.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what must be included in the fire protection system?

Fire protection systems include detection, alarm, and communication systems; fixed automatic extinguishment systems; and portable extinguishers. These systems must meet the requirements of the Life Safety Code, and of this section. Components must be compatible and laboratory listed for the use intended.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the requirements for the system?

Fire protection systems must meet the requirements of all applicable National Fire Protection Association (NFPA) standards, such as NFPA 72 for alarm systems, as referenced in the Life Safety Code. Wiring and circuitry for alarm systems must meet the applicable requirements of NFPA standards including the NFPA 70 for these systems.

Life safety features

Fire safety components required by NFPA 101, including building construction, fire alarm systems, smoke detection systems, interior finishes, sizes and thicknesses of doors, exits, emergency electrical systems, and sprinkler systems.

What regulations must be followed for the fire sprinkler plan for new construction?

Fire sprinkler system plans and hydraulic calculations, must be designed in accordance with the applicable sections of the NFPA 13, and signed by a Responsible Managing Employee, licensed by the State Fire Marshal's Office, or sealed by a licensed professional engineer.

In facilities licensed on or after April 2, 2018, what is required in the floor of kitchen and dishwashing areas?

Floor drains must be provided in the kitchen and dishwashing areas.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the exit provisions for secondary doors?

Folding doors must not be used in exit corridors or exit-ways. Sliding doors, where permitted by NFPA 101, may be used as secondary doors from residents' bedrooms to grade or to a balcony, or in certain other areas, where permitted by NFPA 101. Corridor doors to rooms must swing into the room or be recessed so as not to extend into the corridor when open; however, doors ordinarily kept closed may be excepted.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, where must the food storage area be located?

Food storage areas may be located apart from the food preparation area as long as there is space adjacent to the kitchen for necessary daily usage.

In facilities licensed before Sept. 11, 2003, in existing construction, where can the food storage area be located?

Food storage areas may be located apart from the food preparation area as long as there is space adjacent to the kitchen for necessary daily usage.

In facilities licensed on or after April 2, 2018, where is the food storage area allowed if not in the kitchen?

Food storage areas may be located apart from the food preparation area as long as there is space adjacent to the kitchen for necessary daily usage.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, how large should the food storage area be?

Food storage areas must provide for storage of a seven-day minimum supply of nonperishable foods at all times.

In facilities licensed before Sept. 11, 2003, in existing construction, what should the size of the food storage area be?

Food storage areas must provide for storage of a seven-day minimum supply of nonperishable staple foods and a two-day supply of perishable foods at all times.

When should a decision about an expedited change of ownership be expected?

For an expedited license, DADS approves or denies the application for a change of ownership license not later than the 15th day after the date of receipt of the complete application, fee, and written notice from the facility's existing license holder of the intent to transfer the operation of the facility to the applicant beginning on a date requested in the application. The effective date of the license is the later of the date requested in the application or the 31st day after the date DADS receives the required documents, unless waived. The effective date of the change of ownership license cannot precede the date the application is received in DADS.

Who is invited by HHSC to unannounced inspections of facilities?

For at least two unannounced inspections each licensing period, HHSC invites to the inspections at least one person as a citizen advocate from the American Association of Retired Persons, the Texas Senior Citizen Association, the Texas Retired Federal Employees, the Ombudsman Program, or any other statewide organization for the elderly.

What should be included in the overall plan documents for new construction?

For both new construction, additions to or rehabilitation of an existing building, an overall plan of the entire building must be drawn or reduced to fit on an 8-1/2" x 11" sheet. Schedules must include door materials, sizes, and types; window materials, sizes, and types; room finishes; and special hardware. Elevations must include exterior elevations with material note indications, and interior elevations, where needed for special conditions. Roof plans must include any roof top equipment, roof slopes, drain locations, and gas piping. Details must include wall sections as needed, especially for special conditions; cabinet and built-in work, basic design only; cross sections through buildings as needed; and miscellaneous details and enlargements as needed.

What must be contained in the testing log for the generator?

For each required operation of the generator under the program, the record or log must include the information necessary to verify: (A) the total time taken to transfer the load to emergency power; (B) the total time the generator operated under load; (C) the total time the facility's emergency system remained on generator power after restoration of normal utility power; and (D) the total time the generator operated (without load) after the facility's return to normal utility power.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the requirements of the doors during an emergency?

For emergency separation from fire and smoke, bedroom doors must be maintained to close completely without dragging or binding, to latch securely, and to fit reasonably tight in the frame. The gap between the floor and the bottom of the closed door must not exceed 3/4 inch.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, why should emergency receptacles be installed in the facility? How should these be identified?

For essential needs such as medication refrigerators and systems or equipment whose failure is likely to cause major injury or death to a resident. All receptacles on emergency circuits must be clearly, distinctly, and permanently identified, such as using a red faceplate or a small label that says "Emergency."

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, how many elevators are required in a multi-level facility that services more than 350 beds not on the main floor?

For facilities with more than 350 resident beds, the number of elevators must be determined from a study of the facility plan and the estimated vertical transportation requirements.

When will a facility perform a Capacity Assessment for Self Care and Financial Management?

For persons who will be referred to a court for guardianship if the person: (A) is elderly, which is defined as a person 60 years of age or older; or (B) has mental retardation or a developmental disability; or (C) is suspected of being a person with mental retardation or a developmental disability.

What must be submitted to get building plans reviewed?

For review of plans, submit one copy of contract documents before construction begins.

What is a rapid response team not deployed for?

For the purpose of helping a facility prepare for an inspection or survey.

Why must the facility investigate incidents/accidents and complaints?

For trends which may indicate resident abuse

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what kind of exhaust system must be installed in laundries, kitchens, and dishwasher areas? Why?

Forced air exhaust to remove excess heat and moisture and to maintain air flow in the direction of clean to soiled areas.

ASHRAE

Formerly American Society of Heating, Refrigerating and Air-Conditioning Engineers. A global society focusing on building systems, energy efficiency, indoor air quality, refrigeration, and sustainability.

What should be included in the foundation plan documents for new construction?

Foundation plan documents must include general foundation design and details.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, stored fuel capacity must be sufficient for not less than _____?

Four hours of required generator operation.

In facilities licensed on or after April 2, 2018, what must be located at the head of each bed, and how many?

Four of the required receptacles must be provided beside the head of each bed;

Generally, what else is required in the way of furniture for residents?

Functional furniture appropriate to the resident's needs and individual closet space in the resident's bedroom with clothes racks and shelves accessible to the resident.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the furniture requirements for each resident?

Functional furniture appropriate to the resident's needs including a comfortable chair, bedside cabinet, and individual closet space in the resident bedroom with at least 16 inches of hanging space, shelves for personal belongings accessible to the resident, and closeable door(s). Each bedroom must be provided with at least one noncombustible wastebasket.

Where should garbage and trash be stored to protect against pest infestation?

Garbage and trash must be stored in enclosed containers, protected against leakage, contact with disease carriers, and access to animals. It must be stored in areas separate from those used for the preparation and storage of food and must be removed from the premises in conformity with state and local practices. Garbage and trash containers must be maintained free of accumulations and coatings of garbage. Garbage storage areas must be kept clean and in a state of good repair.

In facilities licensed on or after April 2, 2018, where can gas-fired equipment not be located?

Gas-fired equipment must not be located in attic spaces, except under the following conditions: (1) the area around the units must have a one-hour fire resistance rating; (2) the enclosure must have sprinkler protection; and (3) combustion and venting air must be ducted from the exterior in properly sized metal ducts.

In facilities licensed before Sept. 11, 2003, in existing construction, what type of storage must be provided for the facility use?

General and specific storage areas must be provided as needed and required for safe and efficient operation of the facility. Items must not be stored in inappropriate places such as corridors or rooms which are not equipped for special hazard protection.

In facilities licensed on or after April 2, 2018, what offices are required in the administrative area?

General or individual offices must be provided for business transactions, medical and financial records, administrative and professional staff, and for private interviews relating to social service, credit, and admissions.

Will the inspections be announced or unannounced?

Generally, all inspections, surveys, complaint investigations and other visits, whether routine or non-routine, made for the purpose of determining the appropriateness of resident care and day-to-day operations of a facility will be unannounced, exceptions must be justified.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, where should emergency generators be located?

Generators must be located a minimum of 3' from a combustible exterior building finish and a minimum of 5' from a building opening, if located on the exterior of the building.

In facilities licensed on or after April 2, 2018, where must generators be located?

Generators must be located a minimum of three feet from a combustible exterior building finish and a minimum of five feet from a building opening, if located on the exterior of the building.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the requirements for grab bars to comply with ADA?

Grab bars at toilet and bathing units must be 1-1/4 inch to 1-1/2 inch in diameter.

Who approves the staffing waivers for licensed-only or certified facilities?

HHSC Regulatory Services Division staff.

Long-term care-regulatory

HHSC Regulatory Services Division, which is responsible for surveying nursing facilities to determine compliance with regulations for licensure and certification for Title XIX participation.

How often are inspections conducted?

HHSC conducts at least two unannounced inspections during each licensing period of each institution licensed under Health and Safety Code, Chapter 242.

In facilities licensed on or after April 2, 2018, if a conflict between local, state, or national codes and ordinances and by HHSC exists, conflicts should be made known to _____.

HHSC for appropriate resolution.

State survey agency

HHSC is the agency, which through contractual agreement with CMS is responsible for Title XIX (Medicaid) survey and certification of nursing facilities.

When would HHSC grant a fee waiver for new construction?

HHSC may grant a waiver for certain provisions regarding the physical plant and environment that, in the opinion of HHSC, would be impractical for the facility to meet. In granting the waiver, HHSC must determine that granting the waiver has no adverse effect on resident health and safety and the requirement, if not waived, would impose an unreasonable hardship on the facility. HHSC may require offsetting or equivalent provisions in granting a waiver.

In facilities licensed before Sept. 11, 2003, in existing construction, when would HHSC permit variations on the space and occupancy requirements?

HHSC may permit variations in requirements specified in individual cases when the facility demonstrates in writing that the variations: (A) are required by the special needs of the residents; and (B) will not adversely affect residents' health and safety.

How many sessions will HHSC pay for if they are not pre-certified by DADS? What if additional evaluations are needed?

HHSC pays for one evaluation that is not pre-certified by DADS. To have an additional evaluation pre-certified by DADS, facility must submit documentation by the attending physician that indicates the resident has a new illness or injury, or a substantive change in a pre-existing condition.

What policy is followed by HHSC in regard to HIPAA?

HHSC protects the copies for privacy and confidentiality in accordance with recognized standards of medical records practice, applicable state laws, and department policy.

UAR

HHSC's Utilization and Assessment Review Section

What should be included in the heating, ventilation and air-conditioning documents for new construction?

HVAC documents must include sufficient details of HVAC systems and components to ensure a safe and properly operating installation including, but not limited to, HVAC layout, ducts, protection of duct inlets and outlets, combustion air, piping, exhausts, duct smoke detectors; fire dampers; and equipment types, sizes, and locations.

In facilities licensed on or after April 2, 2018, what are the installation requirements for HVAC systems?

HVAC systems must be designed and installed in accordance with ASHRAE standards, except as may be modified by this section.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the regulations for heating, ventilating and air conditioning systems?

HVAC systems must comply with the provisions of applicable National Fire Prevention Association (NFPA) standards. Ducts are to be of a Class A material (noncombustible). Combustion air for gas-fired equipment must be ducted from the exterior.

What are routine personal hygiene items and services that are not to be charged to the resident's personal funds?

Hair hygiene supplies, including shampoo, comb, and brush; bath soaps, disinfecting soaps, or specialized cleansing agents when indicated to treat special skin problems or to fight infection; razor and shaving cream; toothbrush, toothpaste, and dental floss; denture adhesive and denture cleanser; moisturizing lotion; tissues, cotton balls, and cotton swabs; deodorant; incontinent care and supplies, to include, but not limited to, cloth or disposable incontinent briefs; sanitary napkins and related supplies; towels and washcloths; hospital gowns; over-the-counter drugs; hair and nail hygiene services; and personal laundry

In facilities licensed before Sept. 11, 2003, in existing construction, what are the general floor requirements?

Have a floor at or above grade level.

If the facility does not provide its own diagnostic services, it must _____.

Have an agreement to obtain these services from a provider or supplier that is approved to provide these services under Medicare.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the window requirements for each resident room?

Have at least one operable window to the outside which can readily be opened from the inside without the use of tools. The height of the window sill must not exceed 36 inches above the floor. The minimum area of windows in each bedroom must equal at least 8.0% of the room area. Operable window sections may be restricted to not more than six nor less than four inches for security or safety reasons. Each window must be provided with a flame-retardant shade, curtain, or blind.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the exit requirements for resident rooms?

Have direct access to an exit corridor.

In facilities licensed on or after April 2, 2018, an air system must be designed as much as possible to avoid _____? If this is unavoidable, what code must be followed?

Having ducts passing through fire walls or smoke barrier walls. All openings or duct penetrations in these walls must be according to NFPA 101.

Under what circumstances would the 30-day notification from the applicant or the 30-day notification from the existing license holder be waived?

If DADS determines that the applicant presented evidence showing that circumstances prevented the submission of the 30-day notice and if DADS determines that not waiving the 30-day notification would create a threat to resident welfare or health and safety. If the applicant submits a timely and sufficient application for a change of ownership license and meets all requirements for a license, DADS issues a change of ownership license effective on the date requested by the applicant.

If a vendor hold is placed by DADs after a formal hearing on a trust fund audit, what happens?

If DADS imposes a vendor hold, the facility may request a formal hearing. If the failure to correct is upheld, DADS continues the vendor hold until the facility completes the corrective action.

Under what circumstance would DHS require a facility to cease providing respite care? What happens if the facility does not stop?

If DHS determines that the respite care does not meet the requirement of this chapter and that the facility cannot comply with those requirements in the respite care it provides. DHS may suspend the license of a facility that continues to provide respite care after receiving a written order from DHS to cease.

What should be done if the facility already has an AED?

If a facility has an automated external defibrillator on the effective date of this rule, the facility must provide the notification to local EMS within seven days after the effective date.

What if the facility is unable to convey funds to the resident's estate?

If a facility is not able to convey funds, the facility must, within 30 days after the resident's death hold the funds by depositing them in a separate account or maintaining them in an existing account, designating on the account records that the resident is deceased; or submit funds to DADS.

Can a director of nursing in a multi-level facility be counted in the licensed-care ratio?

If a multi-level facility (nursing facility or Medicare SNF) has one director of nursing over the entire facility, he may not be counted in the nursing ratio. A director of nursing for a single distinct part may be counted in the ratio for the distinct part.

If a qualified dietitian is not available full-time, who can be substituted?

If a qualified dietitian is not employed full-time, the facility must designate a person to serve as the director of food service who receives frequently scheduled consultation from a qualified dietitian.

In facilities licensed before Sept. 11, 2003, in existing construction, if a new auxiliary station is established, what are the requirements?

If a required auxiliary station does not already exist and the facility must establish a new auxiliary station, all applicable standards, particularly those pertaining to the physical plant and NFPA 101, must be observed. All renovations and structural changes require prior approval from HHSC.

Who can request the AEM if the resident has been judged incompetent?

If a resident has been judicially declared to lack the capacity required to request AEM, only the guardian of the resident may request AEM.

Who can request the AEM if the resident is competent?

If a resident has capacity to request AEM and has not been judicially declared to lack the required capacity, only the resident may request AEM, notwithstanding the terms of any durable power of attorney or similar instrument.

If a resident is transferred or discharged from the facility, when must the facility return the resident's personal funds?

If a resident is transferred or discharged from a facility, the facility must, within five working days after the transfer or discharge, return to the resident, legally authorized representative, or responsible party all of the resident's personal funds held by the facility, including any interest accrued.

What happens to the resident's funds upon their death?

If a resident with personal funds managed by a facility dies, the facility must convey, within 30 days after the resident's death, the resident's funds and a final accounting of those funds to the individual or probate jurisdiction administering the resident's estate, or make a bona fide effort to locate the responsible party or heir to the estate (see also §19.416).

When are individuals who have met the requirements of Chapter 17 (relating to (PASARR)) and have mental or physical diseases, or both, that endanger other residents be admitted or retained?

If adequate rooms and care are provided to protect the other residents.

In facilities licensed before Sept. 11, 2003, in existing construction, when are auxiliary nurse's stations not required?

If all resident bedroom corridors are observable by direct line of sight from inside the nurses' station or from within 24 inches of the counter or hall of the nurses' station, no auxiliary stations are required, even if resident bedrooms are more than 150 feet from the nurses' station.

In facilities licensed on or after April 2, 2018, when is an alcove considered a corridor? What are the requirements if this happens?

If an alcove exceeds 4' in depth, it is a corridor and must meet all requirements for corridors, including direct view from a nurses' station, minimum width of the corridor, and provisions for handrails.

If resident rights are violated, what can a resident do?

If anyone hurts you, threatens to hurt you, neglects your care, takes your property, or violates your dignity, you have the right to file a complaint with the facility administrator or with the Texas Department of Human Services by calling 1-800-458-9858.

When should a facility Alzheimer's disclosure statement be amended?

If changes in the operation of the facility will affect the information in the disclosure statement. The changes must be submitted to DADs at least 30 days before changes are effected.

In facilities licensed before Sept. 11, 2003, in existing construction, what is permitted when it comes to the use of deodorants?

If deodorant is used for air-freshening purposes, the following procedures must apply: (A) deodorants or air fresheners are permitted provided the dispensing device is located where it is inaccessible to residents and patients; (B) these products are not used to cover odors resulting from poor housekeeping practices or unsanitary conditions; (C) these products are not used in excess; (D) there is no contra-indication on the label of the product indicating that the product should not be used in the presence of aged or ill persons; and (E) devices, such as ozone generators, ultra-violet generators, and smoke eliminators, must be approved by HHSC.

What is the procedure if the drugs are prescribed verbally?

If drug orders are verbal, they must be taken by a licensed nurse, pharmacist, physician assistant or a physician, and immediately recorded and signed by the person receiving the order. All drug orders must be counter-signed by the prescriber and returned to the chart in a timely manner.

What policy should be in place for emergency generators? How often should they be tested?

If emergency generators are required or provided, a facility must have a program to maintain, operate, and test all emergency generators, including all appurtenant components, and must execute the program at least once every week.

Can a paid feeding assistant transfer their skills to another facility?

If paid feeding assistants seek employment at a facility other than the facility at which they were trained, they will not be required to repeat the state-approved training course if documentation of successful course completion is given to the hiring facility.

When can an RN or PA pronounce a death?

If permitted by written policies of the nursing facility, an RN or a physician's assistant may determine and pronounce a resident dead unless a resident is being supported by artificial means that preclude a determination that the resident's spontaneous respiratory and circulatory functions have ceased. The facility's nursing staff and the medical staff or consultant must have jointly developed and approved the policies.

What is required if physical restraints are necessary?

If physical restraints are used because they are required to treat the resident's medical condition, the restraints must be released and the resident repositioned as needed to prevent deterioration in the resident's condition. Residents must be monitored hourly and, at a minimum, restraints must be released every two hours for a minimum of 10 minutes, and the resident repositioned.

What is the procedure if a restraint is required in a behavioral emergency?

If restraint is used in a behavioral emergency, the facility must use only an acceptable restraint hold. An acceptable restraint hold is a hold in which the resident's limbs are held close to the body to limit or prevent movement and that does not violate the provisions elsewhere stated.

When is a permanent license issued for a change of ownership?

If the applicant meets the requirements, and passes an initial inspection, desk review, or a subsequent inspection before the change of ownership license expires, a regular three-year license is issued. The effective date of the regular three-year license is the same date as the effective date of the change of ownership and cannot precede the date the application is received by DADS.

What if the recording must be transferred from the original format to a new format?

If the contents of the tape or recording are transferred from the original technological format, a qualified professional must do the transfer.

What if the director of food service is not a qualified dietitian?

If the director is not a qualified dietitian, he must receive consultation from a qualified dietitian.

In facilities licensed before Sept. 11, 2003, in existing construction, if the emergency power system supplies other systems that are considered critical, what are the requirements for switch over?

If the emergency electrical power system supplies other systems the facility considers critical to operation, the transfer to the emergency power source must be by delayed automatic connection.

If corrective actions are not completed by the specified date after the decision of the informal trust fund review has been handed down, what will happen?

If the facility does not complete the corrective actions by that date, DADS may impose a vendor hold. If DADS imposes a vendor hold, the facility may request a formal hearing. If the failure to correct is upheld, DADS continues the vendor hold until the facility completes the corrective action.

When can a Student Nurse provide care? Are they counted in the Licensed-care ratio?

If the facility has a contract or agreement with an accredited school of nursing to use their facility for a portion of the student nurses' clinical experience, those student nurses may provide care under the following conditions. (A) Student nurses may be used in nursing facilities, provided the instructor gives class supervision and assumes responsibility for all student nursing activities occurring within the facility. These students cannot be counted in the nurse-to-resident ratio required in the standards. (B) The student nurse may administer medications only when in the facility on assignment as a student of their school of nursing.

What should be done with interest in pooled accounts?

If the facility places any part of the resident's funds in savings accounts, certificates of deposit, or any other plan whereby interest or other benefits are accrued, the facility must distribute the interest or benefit to participating residents on an equitable basis. If pooled accounts are used, interest must be prorated on the basis of actual earnings or end-of-quarter balances.

When may the hospice arrange to have non-core hospice services provided by the NF?

If the hospice assumes professional management responsibility for the services and assures these services are performed in accordance with the policies of the hospice and the recipient's plan of care.

In facilities licensed before Sept. 11, 2003, what codes must be followed for existing construction?

If the municipality has a building code and a plumbing code, those codes govern.

In facilities licensed before Sept. 11, 2003, in existing construction, what plumbing codes should be followed?

If the municipality has a plumbing code, that code must be used as a basis for determining the correctness of plumbing installation. In the absence of a municipal code, a nationally recognized plumbing code must be used.

What happens if the original findings of the trust fund audit are reversed after the informal review?

If the original findings are reversed, DADS issues a corrected schedule of deficiencies with the written decision.

What happens if the original findings of the trust fund audit are revised after the informal review?

If the original findings are revised, DADS issues a revised schedule of deficiencies including any revised corrective action.

What additional action can a facility take if the original findings of a trust fund audit are upheld or revised after the informal review?

If the original findings are upheld or revised, the facility may request a formal hearing.

What happens if the original findings of the trust fund audit are upheld after the informal review?

If the original findings are upheld, DADS continues the schedule of deficiencies and requirement for corrective action.

In the event that a resident is comatose or otherwise incapacitated, what must be done?

If the resident is unable to receive information or articulate whether the resident has executed an advance directive, the facility must provide, review, and discuss written information regarding advance directives, including advance care planning educational material provided by DADS and facility policies regarding the implementation of advance directives, in the following order of preference, to: (A) the resident's legal guardian; (B) a person responsible for the resident's health care decisions; (C) the resident's spouse; (D) the resident's adult child; (E) the resident's parents; or (F) the person admitting the resident.

What if a member of the facility's staff is hired as a special nurse or sitter?

If the resident or family hires an individual to do the special duty nursing, who was already on the facility's staff and a replacement for this person was not hired, the facility will be determined to have received a monetary benefit. See §19.2606.

When is a 30-day discharge notice not required?

If the resident, responsible party, or family or legal representative requests the transfer or discharge.

For the purposes of psychoactive medication, when would the therapy be considered discontinued?

If therapy has been suspended for more than 70 days. If the suspended therapy is resumed within the 70-day period, an oral explanation of side effects should be documented in the clinical record.

What if the staffing levels return after a facility has requested a waiver?

If they are later able to meet the staffing requirements, HHSC Long-Term Care Regulatory Services Division staff must be notified, in writing, of the effective date that staffing meets requirements.

What are the rights of married residents if one is being discharged or transferred and the other is not?

If two residents in a facility are married and the facility proposes to discharge one spouse to another facility, the facility must give the other spouse notice of his right to be discharged to the same facility. If the spouse notifies a facility, in writing, that he wishes to be discharged to another facility, the facility must discharge both spouses on the same day, pending availability of accommodations.

When would a new construction not obtain a license after the survey?

If, during the survey of completed construction, the surveyor finds certain basic requirements not met, HHSC will not license the facility or approve it for occupancy.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what must be provided at all attic access panels? What should these panels be made of?

Illumination and a safe platform. Attic access must be provided for building maintenance. Access panels must be prime coated steel flush panels where required to maintain fire rating of ceiling-roof/ceiling-floor assemblies.

In facilities licensed before Sept. 11, 2003, in existing construction, where should general lighting be measured for proper illumination?

Illumination requirements apply to lighting throughout the space and should be measured at approximately 30 inches above the floor anywhere in the room.

In facilities licensed before Sept. 11, 2003, in existing construction, where should task lighting be measured for proper illumination?

Illumination requirements for these areas apply to the task performed and should be measured on the task.

How should a nursing facility be administered?

In a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the regulations for the design and installation of emergency motor generators?

In accordance with NFPA 37, NFPA 99, and NFPA 110.

How is the formal hearing on a trust fund audit conducted?

In accordance with Texas Administrative Code, Title 1, Chapter 357, Subchapter I.

How are investigations of abuse, neglect or exploitation conducted?

In accordance with Texas Health and Safety Code, §260A.007.

Who is in charge of investigating incidents and complaints in a Nursing Facility?

In accordance with a memorandum of understanding between DADS and the Texas Department of Family and Protective Services (DFPS), DADS will receive and investigate reports of abuse, neglect, and exploitation of elderly and disabled persons or other residents living in facilities licensed under this chapter.

What additional requirements are there for Medicaid-certified facilities in licensing? What happens if these are violated?

In addition to compliance with the regulations set forth in these Nursing Facility Requirements for Licensure and Certification, as Medicaid providers, facilities are obliged to meet the applicable provisions of other federal regulations, including but not limited to those pertaining to nondiscrimination on the basis of race, color, or national origin, nondiscrimination on the basis of handicap, nondiscrimination on the basis of age, protection of human subjects of research, and fraud and abuse. Although these regulations are not in themselves considered requirements under 42 Code of Federal Regulations 483, their violation may result in the termination or suspension of payment with federal funds, or the refusal to grant or continue payment with federal funds.

What are the fees for an Alzheimer's certification?

In addition to the basic license fee, a facility that applies for certification to provide specialized services to persons with Alzheimer's disease or related conditions must pay with each initial and renewal certification application a fee of $300 for the three-year certification.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, how many janitor's closet are needed in the facility?

In addition to the janitors' closet called for in certain departments, a sufficient number of janitors' closets must be provided throughout the facility to maintain a clean and sanitary environment. These must contain a floor receptor or service sink and storage space for housekeeping equipment and supplies.

In facilities licensed on or after April 2, 2018, what are the requirements for janitor's closets?

In addition to the janitors' closet called for in certain departments, a sufficient number of janitors' closets must be provided throughout the facility to maintain a clean and sanitary environment. These must contain a floor receptor or service sink and storage space for housekeeping equipment and supplies.

In facilities licensed before Sept. 11, 2003, in existing construction, what is required of janitor closets for facility use?

In addition to the janitors' closet called for in certain departments, other janitors' closets must be provided throughout the facility to maintain a clean and sanitary environment. All janitor closets must have a negative air pressure in relation to adjacent areas with air exhausted through ducts to the exterior.

In what area of the facility must the required information be posted?

In an area of the facility that is readily available to residents, employees, and visitors. The posting must be in a manner that each item of information is directly visible at a single time. In the case of a licensed section that is part of a larger building or complex, the posting must be in the licensed section or public way leading to it. Any exceptions must be approved by DADS.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what should the air flow direction be in the facility?

In areas requiring control of sanitation, the air flow must be from the clean area to the dirty area. Air supply to food preparation areas must not be from air which has circulated places such as resident bedrooms and baths.

In facilities licensed on or after April 2, 2018, where should duplex receptacles for general use be installed?

In corridors spaced not more than 50 feet apart and within 25 feet of ends of corridors.

In facilities licensed on or after April 2, 2018, where are exposed incandescent or fluorescent bulbs not permitted? Why?

In food service or other areas where glass fragments from breakage may get into food, medications, linens, or utensils. A facility must protect all fluorescent bulbs with a shield or catcher to prevent bulb drop-out.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what should be done in geographic areas that experience high humidity?

In geographic locations or interior room areas where extreme humidity levels are likely to occur for extended periods of time, apparatus for controlling humidity levels (preferably between 40-60%) are recommended to be installed as a part of central systems and with automatic humidistat controls.

In facilities licensed on or after April 2, 2018, what is required in high humidity areas of the facility?

In geographic locations or interior room areas where extreme humidity levels are likely to occur for extended periods of time, apparatus for controlling humidity levels with automatic humidistat controls, preferably at 40-60% relative humidity, are recommended as part of central systems.

When are surge-protectors not allowed in a room?

In no case may the facility use a surge-protection device to increase the number of existing electrical outlets in a room.

What would be the purpose of conducting after hours inspections of facilities?

In order to ensure continuous compliance, a sufficient number of inspections will be conducted between the hours of 5 p.m. and 8 a.m. in randomly selected institutions. This cursory after-hours inspection is conducted to verify staffing, assurance of emergency egress, resident care, medication security, food service or nourishments, sanitation, and other items as deemed appropriate. To the greatest extent feasible, any disruption of the residents is minimal.

In facilities licensed on or after April 2, 2018, in the absence of local plumbing codes? What if there are discrepancies?

In the absence of a locally-adopted plumbing code, a nationally recognized model plumbing code must be used. Any discrepancy between an applicable code and the requirements of this section must be called to the attention of HHSC for resolution.

If a resident is eligible for Medicaid, can the facility accept money in addition to the money paid by the state?

In the case of a person eligible for Medicaid, a nursing facility must not charge, solicit, accept, or receive, in addition to any amount otherwise required to be paid under the State Plan, any gift, money, donation, or other consideration as a precondition of admission, expedited admission, or continued stay in the facility.

When would fees be reimbursed for a license?

In the event the application is not processed in the time periods as stated, the applicant has a right to request of the program director full reimbursement of all filing fees paid in that particular application process. If the program director does not agree that the established periods have been violated or finds that good cause existed for exceeding the established periods, the request will be denied.

Where must a resident's refusal to consent to receive psychoactive medications be documented?

In the resident's clinical record.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the exit provisions for inactive leaves of double doors?

Inactive leaves of double doors may have easily accessible and easily operable bolts if the active leaf is 44 inches wide, where permitted by NFPA 101. Center mullions are prohibited.

What should be kept in the way of identifying information and consents on residents for the management of personal funds?

Include at least the following in these records: (A) resident's name; (B) identification of resident's legally authorized representative, representative payee, or responsible party, if any, and payor source; (C) valid letter of guardianship, if any; (D) valid power of attorney, if any; (E) resident's admission and discharge dates; (F) resident's trust fund ledger containing the following: (G) receipts for purchases and payments, including cash-register tapes or sales statements from a seller; (H) written requests for personal funds from the trust fund account; and (I) written requests for specific brands, items, or services.

Total health status

Includes functional status, medical care, nursing care, nutritional status, rehabilitation and restorative potential, activities potential, cognitive status, oral health status, psychosocial status, and sensory and physical impairments.

What permanent record must be kept on all residents admitted to the facility? What should it contain?

Index of admissions and discharges. The facility must maintain a permanent, master index of all residents admitted to and discharged from the facility. This index must contain at least the following information concerning each resident: (1) name of resident (first, middle, and last); (2) date of birth; (3) date of admission; (4) date of discharge; and (5) social security, Medicare, or Medicaid number.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what must be done to comply with the regulations for elevators?

Inspections and tests must be made and the owner must be furnished with a written certification that the installation meets the requirements set forth in this section and all applicable safety regulations and codes.

In facilities licensed on or after April 2, 2018, if an extinguisher has a gross weight greater than 40 pounds, where must it be installed?

Installed so the top of the extinguisher is located no more than 3-1/2 feet above the floor. In no case may the clearance between the bottom of an extinguisher and the floor be less than four inches.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, where should intakes from outside air be located?

Intakes for fresh outside air must be located sufficiently distant from exhaust outlets or other areas or conditions which may contaminate or otherwise pollute the incoming fresh air. Fresh air inlets must be appropriately screened to prevent entry of debris, rodents, and animals. Provision must be made for access to such screens for periodic inspection and cleaning to eliminate clogging or air stoppage.

When is the use of a master signature legend in lieu of the legend on each form for nursing staff signatures of medication, treatment, or flow sheet entries permitted? What must be documented?

It is acceptable under the following circumstances: (A) Each nursing employee documenting on medication, treatment, or flow sheets signs his full name, title, and initials on the legend. (B) The original master legend is kept in the clinical records office or director of nurses' office. (C) A current copy of the legend is filed at each nurses station. (D) When a nursing employee leaves employment with the facility, his name is deleted from the list by lining through it and writing the current date by the name. (E) The facility updates the master legend as needed for newly hired and terminated employees. (F) The master signature legend must be retained permanently as a reference to entries made in clinical records.

What is a rapid response team?

It is comprised of one or more quality-of-care monitors and visits a facility that: (A) is identified as high risk through the early warning system described in §19.910; or (B) has committed three violations that constitute an immediate threat to health and safety relating to abuse or neglect of a resident as described in §19.2107.

What must be ensured when it comes to the use of automated external defibrillators?

It is consistent with a resident's advance directive executed or issued under Texas Health and Safety Code, Chapter 166, Subchapter C.

Who should prepare the contract documents for new construction?

It is the facility's responsibility to employ qualified personnel to prepare the contract documents for construction of a new facility or rehabilitation of an existing facility. Contract documents for additions and rehabilitation other than that classified as repair or renovation in §19.350 and for the construction of an entirely new facility must be prepared by an architect licensed by the Texas State Board of Architectural Examiners. Drawings must bear the seal of the architect. Certain parts of contract documents, including final plans, designs, and specifications, must bear the seal of a licensed professional engineer approved by the Texas Board of Professional Engineers to operate in Texas, and signed by a Responsible Managing Employee or Alarm Planning Superintendent licensed by the State Fire Marshal's Office. These certain parts include sheets and sections covering structural, electrical, mechanical, sanitary, and civil engineering.

In facilities licensed on or after April 2, 2018, what are the requirements for a nurse call system that provides two-way voice communication?

It must be equipped with an indicating light at each call station which lights and remains lighted as long as the voice circuit is operating.

In facilities licensed on or after April 2, 2018, if resident-use laundry is provided, what are the requirements?

It must be limited to not more than one residential type washer and dryer per laundry room. This room must be classified as a hazardous area according to NFPA 101.

In facilities licensed on or after April 2, 2018, what is required for open or enclosed seating space?

It must be provided within view of the main nurses' station that will allow furniture or wheelchair parking that does not obstruct the corridor way of egress.

If DADs determines that more information is needed for the informal review of a disputed trust fund audit, when is that information due to DADs?

It must be received in writing by U.S. mail, hand delivery, special mail, or fax no later than 15 days after the date the facility receives the written request for additional information. If the 15th day is a Saturday, Sunday, national holiday, or state holiday, then the first day following the 15th day is the final day the additional information will be accepted.

When is the written request for a formal hearing due?

It must be received within 15 days after: (A) the date on the written notification of the report of findings; or (B) the facility receives the written decision sent.

In facilities licensed on or after April 2, 2018, if the laundry is located within the main building, what are the requirements?

It must be separated by minimum one-hour fire resistance-rated construction to structure above, and sprinklered, and must be located in a remote area away from resident sleeping areas. Access doors must be from the exterior or interior nonresident use area, such as a service corridor, that is separated from the resident area.

What if the facility does not provide laboratory services on site?

It must have an agreement to obtain these services only from a laboratory that meets the requirements of 42 Code of Federal Regulations, Part 493, or from a physician's office.

What is required if the facility provides blood bank and transfusion services?

It must meet the requirements for laboratories specified in 42 Code of Federal Regulations, Part 493.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what janitorial facilities must be provided for the kitchen?

Janitorial facilities must be provided exclusively for the kitchen and must be located in the kitchen area.

In facilities licensed on or after April 2, 2018, what janitorial facilities are required in the kitchen?

Janitorial facilities must be provided exclusively for the kitchen and must be located in the kitchen area.

In facilities licensed on or after April 2, 2018, what is the maximum temperature allowed in the kitchen? Where is this measured?

Kitchens must be designed so that room temperature at summertime peak load will not exceed a temperature of 85° F measured at the five-foot level.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is the maximum allowed temperature in the kitchen at summertime peak? At what level is it measured?

Kitchens must be designed so that room temperature at summertime peak load will not exceed a temperature of 85° F measured over the room at the five-foot level. The amount of supply air must take into account the large quantities of air that may be exhausted at the range hood and dishwashing area.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, how will kitchens be evaluated?

Kitchens will be evaluated on the basis of their performance in the sanitary and efficient preparation and serving of meals to residents. Consideration will be given to planning for the type of meals served, the overall building design, the food service equipment, arrangement, and the work flow involved in the preparation and delivery of food. Plans must include a large-scale detailed kitchen layout designed by a registered or licensed dietitian or architect having knowledge in the design of food service operations.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the regulations for laboratories?

Laboratories must be protected according to NFPA 99.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what type of ventilation system should be used for the comfort of laundry staff?

Laundry areas must have adequate air supply and ventilation for staff comfort without having to rely on opening a door that is part of the fire wall separation. Provisions must be made to exhaust heat from dryers and to separate dryer make-up air from the habitable work areas of the laundry.

In facilities licensed before Sept. 11, 2003, in existing construction, what type of ventilation is required for the laundry areas?

Laundry areas must have air supply and ventilation to minimize mildew and odors. Doors must not remain open, for sanitation and safety reasons.

In facilities licensed before Sept. 11, 2003, in existing construction, where must laundry facilities be located?

Laundry facilities must be located in areas separate from resident rooms. The laundry must be designed, constructed, and equipped and appropriate procedures must be utilized to assure that laundry is handled, cleaned, and stored in a sanitary manner.

In facilities licensed before Sept. 11, 2003, in existing construction, what is required for the laundering of soiled and clean linen and clothing?

Laundry for general linen and clothing must be arranged so as to separate soiled and clean operations as they relate to traffic, handling, and air currents. Suitable exhaust and ventilation must be provided to prevent air flow from soiled to clean areas.

What are the limitations of Licensed nurses?

Licensed nurses must practice within the constraints of applicable state laws and regulations governing their practice, including the Nurse Practice Act, and must follow the guidelines contained in the facility's written policies and procedures.

What if the deficiencies seen in the survey of new construction do not impact the health and safety of residents?

Licensure may be recommended based on an approved written plan of correction by the facility's administrator.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what code must building services pertaining to utilities; heating, ventilating, and air-conditioning systems; vertical conveyors; and chutes follow?

Life Safety Code.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what code must enclosures of vertical openings between floors meet?

Life Safety Code.

In facilities licensed on or after April 2, 2018, what are the required exit provisions for emergency egress lighting?

Lighting immediately outside of exit doors is required as a part of the building emergency lighting system. Photocell devices may be used to turn lights off during daylight hours. The requirements of an emergency lighting system must be in accordance with §19.361 (relating to New Facilities).

How should clean linens be handled and stored?

Linens must be handled, stored, and processed so as to control the spread of infection. Linen will be maintained in good repair. Linen must be washed, dried, stored, and transported in a manner which will produce hygienically clean linen. The washing process must have a mechanism for soil removal and bacteria kill. Clean linen must be stored in a clean linen area easily accessible to the personnel.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, where should receptacles be located?

Location of receptacles, horizontally and vertically, should be carefully planned and coordinated with the expected designed use of furnishings and equipment to maximize their accessibility and to minimize conditions such as beds or chests being jammed against plugs used in the outlets.

In facilities licensed on or after April 2, 2018, how should the location of receptacles be designed?

Location of receptacles, horizontally and vertically, should be carefully planned and coordinated with the expected designed use of furnishings and equipment to maximize their accessibility and to minimize conditions such as beds or furniture being jammed against plugs used in the outlets.

In facilities licensed before Sept. 11, 2003, in existing construction, when are locks on the resident doors permitted?

Locks on bedroom doors are permitted when they meet definite resident needs, including the following situations: (A) married couples whose rights of privacy could be infringed upon unless bedroom door locks are permitted; and (B) residents for whom the attending physician wants bedroom door locks to enhance their sense of security.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, when are locks on bedroom doors permitted?

Locks on bedroom doors are permitted when they meet definite resident needs.

In facilities licensed on or after April 2, 2018, when may locks be permitted on bedroom doors?

Locks on bedroom doors are permitted when they meet definite resident needs.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what lounge facilities are required?

Lounge and toilet room must be provided for nursing staff. Lockers or security compartments must be provided for the safekeeping of personal effects of staff. These must be located convenient to the duty station of personnel or in a central location.

What are the overall required measurements for resident rooms?

Measure at least 80 square feet per resident in multiple resident bedrooms and at least 100 square feet in single resident rooms;

What are considered medication errors?

Medication errors include, but are not limited to, administering the wrong medication, administering at the wrong time, administering the wrong dosage strength, administering by the wrong route, omitting a medication, and/or administering to the wrong resident.

What are Psychoactive medications?

Medications prescribed for the treatment of symptoms of psychosis or other severe mental or emotional disorders and used to exercise an effect on the central nervous system to influence and modify behavior, cognition, or affective state when treating the symptoms of mental illness.

In facilities licensed on or after April 2, 2018, the design of the freeze protection on sprinkler systems must?

Minimize the need for dependence on staff action or intervention to provide protection.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is the minimum size?

Minimum bedroom area, excluding toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules, must be 100 square feet in single occupancy rooms and 80 square feet per bed in multi-bed rooms. The minimum allowable room dimension is 10 feet. The room must be designed to provide at least 36 inches between beds and 24 inches between any bed and the adjacent wall.

In facilities licensed before Sept. 11, 2003, in existing construction, what is the minimum standard for task lighting?

Minimum illumination for over bed reading lamps, medication preparation or storage areas, kitchens, and nurse's station desks must be 50 foot candles.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the minimum lighting levels for task areas? Where should these levels be measured?

Minimum illumination for over-bed reading lamps, medication-preparation or storage area, kitchens, and nurse's station desks must be 50 foot candles. Illumination requirements for these areas apply to the task performed and are measured on the task.

In facilities licensed on or after April 2, 2018, what are the minimum task lighting levels? Where are these levels measured?

Minimum illumination for over-bed reading lamps, medication-preparation or storage area, kitchens, and nurses' station desks must be 50 foot candles. Illumination requirements for these areas apply to the task performed and are measured on the task.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the minimum lighting levels for general use areas? Where should these levels be measured?

Minimum illumination must be 20-foot candles in resident rooms, corridors, nurses' stations, dining rooms, lobbies, toilets, bathing facilities, laundries, stairways, and elevators. Illumination requirements for these areas apply to lighting throughout the space and should be measured at approximately 30 inches above the floor anywhere in the room.

In facilities licensed on or after April 2, 2018, where can the minimum lighting levels be found?

Minimum lighting levels can be found in the Illuminating Engineering Society Lighting Handbook, latest edition.

In facilities licensed on or after April 2, 2018, what is required for mirrors for resident use?

Mirrors must be arranged for convenient use by residents in wheelchairs as well as by residents in a standing position, and the minimum size must be 15"w x 30"h, or tilt type.

In facilities licensed on or after April 2, 2018, who writes the codes for exhaust hoods, ducts, and automatic extinguishers for kitchen cooking equipment?

Must be according to NFPA 96, when required by NFPA 101.

In facilities licensed on or after April 2, 2018, who must oversee the design of the mechanical systems?

Must be done by or under the direction of a licensed professional mechanical engineer approved by the Texas Board of Professional Engineers to operate in Texas, and the parts of the plans and specifications covering mechanical design must bear the legible seal of the engineer.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, if resident use laundry is provided, what are the regulations for the equipment?

Must be limited to not more than one residential type washer and dryer per laundry room. This room must be classified as a hazardous area according to NFPA 101.

In facilities licensed on or after April 2, 2018, what is required of remote annunciator panel?

Must be located at auxiliary or secondary nurses' stations on each floor Indicating location of alarm initiation and trouble indication, by zone or device, and must indicate the alarm condition of adjacent zones and the alarm conditions at all other nurses' stations.

In facilities licensed on or after April 2, 2018, what is the requirement for hot water for laundry and kitchen?

Must be normally 140° F. Hot water for dish sanitizing must be 180° F.

In facilities licensed on or after April 2, 2018, where are manual pull stations required to be located?

Must be provided at all exits, in living rooms and dining rooms, and at or near a nurses' station.

In facilities licensed on or after April 2, 2018, what is required of smoke dampers at a smoke barrier?

Must close automatically upon activation of the fire alarm system to prevent the flow of air or smoke in either direction, when required by NFPA 101.

In facilities licensed on or after April 2, 2018, what is required at nourishment stations? Where can this be located?

Must contain a sink equipped for hand-washing, equipment for serving nourishment between scheduled meals, refrigerator, and storage cabinets. Ice for residents' service and treatment must be provided only by icemaker units. This station may be furnished in a clean utility room.

In facilities licensed on or after April 2, 2018, what is required in soiled utility rooms?

Must contain a water closet or equivalent flushing rim fixture, a sink large enough to submerge a bedpan with spray hose and high-neck faucet with lever controls, work counter, waste receptacle, and linen receptacle. A soiled utility room must be part of a system for collection and cleaning or disposal of soiled utensils or materials. A separate hand-washing sink must be provided if the bedpan disinfecting sink cannot normally be used for hand-washing.

In facilities licensed on or after April 2, 2018, what is required in clean utility rooms?

Must contain a work counter, sink with high-neck faucet with lever controls, and storage facilities and must be part of a system for storage and distribution of clean and sterile supply materials.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the requirements for nursing unit corridors?

Must have general illumination with provisions for reduction of light levels at night.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, if the air ducts have smoke dampers, what must be done?

Must have maintenance panels for inspections. The maintenance panels must be removable without tools. Means of access must also be provided in the ceiling or side wall to facilitate smoke damper inspection readily and without obstruction. Location of dampers must be identified on the wall or ceiling of the occupied area below. Fusible links are not approved for smoke dampers.

In facilities licensed on or after April 2, 2018, if a motor generator is fueled by public utility natural gas, what must it be capable of doing?

Must have the capability to be switched to an alternate fuel source according to NFPA 70.

In facilities licensed on or after April 2, 2018, what are the requirements for auxiliary buildings located within 20 feet of the main building?

Must meet the applicable requirements in NFPA 101 for separation and construction.

In facilities licensed on or after April 2, 2018, what requirements must be met for receptacles in bedrooms?

Must meet the requirements in §19.354(a)(7) (relating to New Facilities).

In facilities licensed on or after April 2, 2018, what is not allowed in a door protecting a corridor or way of egress? What are the exceptions?

Must not include an air transfer grille or louver. A corridor must not be used to supply air to or exhaust air from any room except that air from a corridor may be used as make-up air to ventilate a small toilet room, a janitor's closet, or a small electrical or telephone closet opening directly on a corridor, provided the ventilation can be accomplished by door undercuts not exceeding 3/4 inches.

What must be in all facilities, regardless of whether AEM is being conducted?

Must post an 8" x 11" inch notice at the main facility entrance. The notice must be entitled "Electronic Monitoring" and must state, in large, easy-to-read type, "The rooms of some residents may be monitored electronically by or on behalf of the residents. Monitoring may not be open and obvious in all cases."

In facilities licensed on or after April 2, 2018, the requirement of these codes will apply unless otherwise noted?

NFPA 101 and other applicable NFPA codes and standards referenced in NFPA 101

In facilities licensed on or after April 2, 2018, required plumbing fixtures must be according to _____.

NFPA 101 and §19.354 (relating to New Facilities) in specific use areas.

In facilities licensed on or after April 2, 2018, where are the regulations stated for hazardous areas?

NFPA 101, except as required or modified in this section.

In facilities licensed on or after April 2, 2018, all interior walls, partitions, and roof structure in buildings of fire resistive and noncombustible construction must be according to _____?

NFPA 101.

In facilities licensed on or after April 2, 2018, building services pertaining to utilities; heating, ventilating, and air-conditioning systems; vertical conveyors; and chutes must be according to _____.

NFPA 101.

In facilities licensed on or after April 2, 2018, what code must enclosures of vertical openings between floors meet?

NFPA 101.

In facilities licensed on or after April 2, 2018, where are the regulations for the protection of cooking equipment?

NFPA 101.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, electrical systems must meet the requirements of _____?

NFPA 70.

In facilities licensed on or after April 2, 2018 what code requirements must be met for HVAC systems?

NFPA 90A and NFPA 99.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the regulations for the exhaust hoods, ducts, and automatic extinguishers for kitchen cooking equipment?

NFPA 96.

In facilities licensed on or after April 2, 2018, where are the regulations for protection of laboratories?

NFPA 99.

NFPA 70

National Electrical Code, 2011 edition.

NFPA 72

National Fire Alarm and Signaling Code, 2010 edition.

NFPA 54

National Fuel Gas Code, 2012 edition

In facilities licensed on or after April 2, 2018, buildings must comply with the ______ chapter of NFPA 101.

New Health Care Occupancies

Can attics, mechanical rooms, boiler rooms, and other similar areas be used for storage?

No

Does the in-service education qualify as continuing education units required for renewal of a medication aide permit?

No

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, can doors protecting corridors or ways of egress have air transfer grilles or louvers?

No

Is a physician, or a person designated by the physician, liable for civil damages or an administrative penalty and subject to disciplinary action for a breach of confidentiality of medical information for a disclosure of the information provided made by the resident, or the person authorized by law to consent on behalf of the resident, that occurs while the information is in the possession or control of the resident or the person authorized by law to consent on behalf of the resident?

No

Will DADS grant a request for an informal review that does not meet the requirements of this subsection?

No

What rules are in place for life safety features in construction?

No existing life safety feature shall be removed or reduced when the feature is a requirement for new construction. Life safety features and equipment that have been installed in existing buildings, if not required by NFPA 101, must continue to be maintained or may be completely removed if prior approval is obtained from HHSC.

In facilities licensed on or after April 2, 2018, what is the minimum number of receptacles which must be provided in each room?

No fewer than eight receptacles must be provided within the patient care vicinity, as defined in NFPA 99

In facilities licensed on or after April 2, 2018, if the failure of patient-care-related electrical equipment is likely to cause major injury or death to a resident, how many receptacles are required?

No fewer than fourteen receptacles must be provided within the patient care vicinity

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, where should food NOT be stored? What is the alternative?

No foods may be stored on the floor; dollies, racks, or pallets may be used to elevate foods not stored on shelving.

What happens if the initial phase of an incident or complaint investigation concludes that no abuse or neglect adversely affecting the physical or mental health or welfare of a resident has occurred?

No further investigation will be undertaken.

What if attempts to locate the child's LAR are unsuccessful?

No later than 30 days after the date the facility determines that it is unable to locate the LAR, notify DADS at 1-800-458-9858 of that determination and request that DADS initiate a search for the LAR.

After the final determination of a formal hearing, when is corrective action due?

No later than 60 days after a final determination is issued as a result of a formal hearing requested by a facility, the facility must complete any corrective action required by DADS or be subject to a vendor hold on payments due to the facility under the provider agreement until the facility completes corrective action.

In facilities licensed before Sept. 11, 2003, in existing construction, what activities are not permitted?

No occupancies or activities undesirable to the health, safety, or well-being of residents will be located in the facility.

Can the Texas or the Secretary of Health and Human Services require disclosure of the records of the Quality Assessment and Assurance Committee? When is there an exception?

No, except insofar as such disclosure is related to the compliance of the committee with the requirements.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, can corridors be used to supply air to or exhaust air from any room?

No, except that air from corridors may be used as make-up air to ventilate small toilet rooms, janitor's closets, and small electrical or telephone closets opening directly on corridors, provided that the ventilation can be accomplished by door undercuts not exceeding 3/4 inches.

Is a rural hospital participating in the Medicaid Swing Bed Program as specified in §19.2326 required to meet the requirements of in-service training? What are the conditions?

No, if the swing beds are used for no more than one 30-day length of stay per year, per resident.

Can several facilities combine to purchase a surety bond?

No, resident trust fund accounts are specific only to the single facility purchasing a resident trust fund surety bond.

Does the facility need to inventory resident clothing?

No; however, the operating policies and procedures must provide for the management of resident clothing and other personal property to prevent loss or damage.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what type of finishes are required in the kitchen?

Nonabsorbent smooth finishes or surfaces must be used on kitchen floors, walls, and ceilings. These surfaces must be capable of being routinely cleaned and sanitized to maintain a healthful environment. Counter and cabinet surfaces, inside and outside, must also have smooth, cleanable, relatively nonporous finishes.

In facilities licensed on or after April 2, 2018, what type of finishes are required in the kitchen?

Nonabsorbent smooth finishes or surfaces must be used on kitchen floors, walls, and ceilings. These surfaces must be capable of being routinely cleaned and sanitized to maintain a healthful environment. Counter and cabinet surfaces, inside and outside, must also have smooth, cleanable, relatively nonporous finishes.

In facilities licensed before Sept. 11, 2003, in existing construction, what kind of surfaces are required in a kitchen?

Nonabsorbent smooth finishes or surfaces must be used on kitchen floors, walls, and ceilings. These surfaces must be capable of being routinely sanitized to maintain a healthful environment.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, generators located on the exterior of the building must be provided with a _____?

Noncombustible protective cover or be protected as per manufacturer's recommendations.

Will HHSC disclose the identity of a resident or family member of a resident interviewed by a quality-of-care monitor?

Not unless required by law to do so.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, can a plan exceed minimum standards?

Nothing in this division may be construed as prohibiting a better type of building or construction, more space, services, features, or greater degree of safety than the minimum requirements.

If the resident's safety or that of others is in danger, when should the notice of discharge be made?

Notice may be made as soon as practicable before transfer or discharge when the safety of individuals in the facility would be endangered; the health of individuals in the facility would be endangered; the resident's health improves sufficiently to allow a more immediate transfer or discharge; the transfer and discharge is necessary for the resident's welfare because the resident's needs cannot be met in the facility, and the resident's urgent medical needs require an immediate transfer or discharge; or a resident has not resided in the facility for 30 days

In the event a facility ceases operation, temporarily or permanently, voluntarily or involuntarily, what must be provided to residents, relatives or responsible parties?

Notice of closure. See §19.2310 for additional notice requirements that apply to a Medicaid or Medicare certified facility.

What is considered loss or imminent loss of the right to possession of a facility?

Notice of eviction, foreclosure, termination of lease, or similar proposed action.

What must be provided to an employee if they are found on the EMR?

Notification about the EMR to an employee in accordance with §93.3.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required of the nourishment stations, if they are needed?

Nourishment stations are usually required in all but the smaller facilities and must contain a sink equipped for hand-washing, equipment for serving nourishment between scheduled meals, refrigerator, and storage cabinets. Ice for residents' service and treatment must be provided only by icemaker units. This station may be furnished in a clean utility room.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is the minimum size requirement for social-diversional spaces, such as living rooms, dayrooms, lounges, and sunrooms?

Number of Beds Area Per Bed Minimum 4-15 18 sf (Min. 144 sf) 16-20 17 sf 21-25 16 sf 26-30 15 sf 31-35 14 sf 36-40 13 sf 41-50 12 sf 51-60 11 sf 61 and over 10 sf (100 beds = 1,000 sf)

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required at the nurses' stations?

Nurses' stations must be provided with space for nurses' charting, doctors' charting, and storage for administrative supplies. Nurses' stations must be located to provide a direct view of resident corridors. A direct view of resident corridors is acceptable if a person can see down the corridors from a point within 24 inches of the outside of the nurses' station counter or wall. When a nurses' station does not provide a direct view of resident corridors, an auxiliary station complying with the following guidelines must be provided.

In facilities licensed on or after April 2, 2018, when can a nursing facility share generating equipment? What are the provisions?

Nursing facilities and contiguous or same-site facilities, such as hospitals and assisted living facilities, may be served by the same generating equipment so long as the integrity of the individual facilities' emergency or back-up power systems is not compromised. This permission applies only to the generating equipment and not to automatic or manual transfer switches or to distribution systems.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, are shared or combines services allowed?

Nursing facilities may be operated together with hospitals and may share administration, food service, recreation, janitor service, and physical therapy facilities, but must have clearly identifiable physical separations such as a separate wing or floor. Nursing facilities with different levels of care will require identifiable physical separations. Combined attendant or nurses' stations and medication room areas will require some separating construction features.

In facilities licensed before Sept. 11, 2003, in existing construction, how will facility kitchens be evaluated?

Nursing facility kitchens will be evaluated on the basis of their performance in the sanitary and efficient preparation and serving of meals. Consideration will be given to planning for the type of meals served, the overall building design, the food service equipment, arrangement, and the work flow involved in the preparation and delivery of food. Evaluation will be based on the number of meals served.

What type of financial records must be maintained by the facility?

Nursing facility staff must maintain current financial records in accordance with recognized fiscal and accounting procedures.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, are occupational therapy facilities required?

Occupational therapy facilities must be provided if required by the treatment program.

In facilities licensed on or after April 2, 2018, what are the requirements for occupational therapy?

Occupational therapy facilities must be provided if required by the treatment program. (1) An activities area with a sink or lavatory and facilities for collection of waste products prior to disposal must be provided. (2) Storage for supplies and equipment used in the therapy must be provided.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what is the temperature requirement for occupied areas with high heat? Where is this measured at?

Occupied areas generating high heat, such as kitchens, must be provided with a sufficient cool air supply to maintain a temperature not exceeding 85° F at the five-foot level. Supply air volume must be approximately equal to the air volume exhausted to the exterior for these areas.

How often should resident rooms be cleaned?

Occupied resident rooms must be cleaned and put in order at least daily.

What information must be conveyed to the resident, the resident's next of kin or guardian, both orally and in writing, in a language that the resident understands? When should this be done?

Of the resident's rights and all rules and regulations governing resident conduct and responsibilities during the stay in the facility. This notification must be made prior to or upon admission and during the resident's stay if changed.

What in-service training is required of Nursing staff, licensed nurses, and nurse aides annually which is appropriate to their job responsibilities?

One or more of the following categories: (A) communication techniques and skills useful when providing geriatric care, such as skills for communicating with the hearing impaired, visually impaired and cognitively impaired; therapeutic touch; and recognizing communication that indicates psychological abuse; (B) assessment and nursing interventions related to the common physical and psychological changes of aging for each body system; (C) geriatric pharmacology, including treatment for pain management and sleep disorders; (D) common emergencies of geriatric residents and how to prevent them, for example, falls, choking on food or medicines, injuries from restraint use; recognizing sudden changes in physical condition, such as stroke, heart attack, acute abdomen, and acute glaucoma; and obtaining emergency treatment; (E) common mental disorders with related nursing implications; and (F) ethical and legal issues regarding advance directives, abuse and neglect, guardianship, and confidentiality.

Substandard quality of care violation

One or more violations that constitute: (A) an immediate threat to resident health or safety; (B) a pattern of or actual harm that is not an immediate threat; or (C) a widespread potential for more than minimal harm, but less than an immediate threat, with no actual harm.

When can medications be released to a resident? What if the resident is going to another facility or home?

Only on the written or verbal authorization of the attending physician. When a resident is transferred directly to another nursing facility or discharged to home, the resident's medications must be released to the new facility or to the resident or his family, respectively.

If the resident does not have capacity to request AEM and has not been judicially declared to lack the required capacity, who can request the AEM?

Only the legal representative of the resident may request AEM.

When can a building, or portions of a building be occupied during construction, repair, alterations, or additions?

Only when required means of egress and required fire protection features are in place and continuously maintained for the portion occupied, or when alternative life safety measures acceptable to HHSC are in place.

In facilities licensed on or after April 2, 2018, if courtyards are at the facility, what are the requirements?

Open or enclosed courts with resident rooms or living areas opening upon them must not be less than 20' in the smallest dimension unless otherwise approved by HHSC. Nonparallel wings forming an acute angle may have a maximum of two windows in each wing that are separated by a distance less than 20', but not less than 10', when measured between the nearest edges of the opposing openings.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what type of equipment should be use in the kitchen?

Operational equipment must be provided as planned and scheduled by the facility consultants for preparing and serving meals and for refrigerating and freezing of perishable foods, as well as equipment in, or adjacent to, the kitchen or dining area for producing ice.

In facilities licensed on or after April 2, 2018, what equipment is required for the serving and storing of meals?

Operational equipment must be provided as planned and scheduled by the facility consultants for preparing and serving meals and for refrigerating and freezing of perishable foods, as well as equipment in, or adjacent to, the kitchen or dining area for producing ice.

For the building plan review, what other documents must be included?

Other layouts, plans, or details that are necessary to convey a clear understanding of the design and scope of the project, including plans covering private water or sewer systems, which must be reviewed by the local health or wastewater authority having jurisdiction.

Who should review the private water or sewer system plans for a new construction?

Other layouts, plans, or details that are necessary to convey a clear understanding of the design and scope of the project; including plans covering private water or sewer systems, which must be reviewed by the local health or wastewater authority having jurisdiction.

In facilities licensed before Sept. 11, 2003, in existing construction, what type of oxygen equipment should be used?

Oxygen cylinders and containers must be in compliance with NFPA 99. Liquid oxygen containers must be certified by UL or another approved testing laboratory for compliance with NFPA 55 requirements. The storage, handling, assembly, and testing must be in compliance with all applicable NFPA standards, including NFPA 99 and NFPA 50 requirements. The facility is responsible for defining all potential hazards both graphically and verbally to all persons involved in the use of liquid oxygen and ensuring that the liquid-oxygen provider does also.

Vendor payment

Payment made by HHSC on a daily-rate basis for services delivered to recipients in Medicaid-certified nursing facilities. Vendor payment is based on the nursing facility's approved-to-pay claim processed by the state Medicaid claims administrator. The Nursing Facility Billing Statement, subject to adjustments and corrections, is prepared from information submitted by the nursing facility, which is currently on file in the computer system as of the billing date. Vendor payment is made at periodic intervals, but not less than once per month for services rendered during the previous billing cycle.

How are payments for emergency dental services calculated?

Payments for emergency dental services are the lower of the: (A) dentist's usual fee; or (B) maximum fee as determined by the Texas Health and Human Services Commission (HHSC).

When making Accommodations for Children, what should be taken into consideration?

Pediatric residents should be matched with roommates of similar age and developmental levels.

When should the comprehensive care plan be reviewed?

Periodically and revised by a team of qualified persons after each assessment.

In facilities licensed before Sept. 11, 2003, in existing construction, what must be installed on exterior doors?

Permanently mounted hold-open devices to expedite emergency egress and prevent accidental lock-out must be provided for exterior doors.

What must be ensured when it comes to the content of personnel records?

Personnel records are correct and contain sufficient information to support placement in the assigned position (including a resume of training and experience). When appropriate, a current copy of the person's license or permit must be in the file.

Nursing personnel

Persons assigned to give direct personal and nursing services to residents, including registered nurses, licensed vocational nurses, nurse aides, and medication aides. Unlicensed personnel function under the authority of licensed personnel.

Non-nursing personnel

Persons not assigned to give direct personal care to residents; including administrators, secretaries, activities directors, bookkeepers, cooks, janitors, maids, laundry workers, and yard maintenance workers.

In facilities licensed on or after April 2, 2018, what are the requirements for physical therapy facilities?

Physical therapy facilities must be provided if required by the treatment program. (A) Provision for privacy at each individual treatment area; hand-washing facilities, one lavatory or sink may serve more than one cubicle; and facilities for the collection of soiled linen and other material that may be used in the therapy. (B) Residents' dressing areas with accessible benches, showers, lockers, and toilet rooms if the therapy is such that these would be needed at the area.

Which rehabilitative services are covered by Medicaid?

Physical therapy services, occupational therapy services, and speech therapy services.

In facilities licensed on or after April 2, 2018, where should portable fire extinguishers be located?

Portable fire extinguishers must be provided throughout the facility as required by NFPA 10 and as determined by the local fire department and HHSC.

In facilities licensed on or after April 2, 2018, site grades must provide for _____? Why? What does this not apply to?

Positive surface water drainage so that there will be no ponding or standing water on the designated site. This does not apply to local government requirements for engineered controlled run-off holding ponds.

What must be posted in the resident's room that is under AEM?

Post and maintain a conspicuous notice at the entrance to the resident's room. The notice must state that the room is being monitored by an electronic monitoring device.

In facilities licensed before Sept. 11, 2003, in existing construction, hot water heaters must be equipped with _____?

Pressure temperature relief valves

What must be done prior to the start of new construction of a facility?

Prior to the start of construction of a new facility or of building rehabilitation other than that classified as repair in §19.350, a facility must notify HHSC in Austin, Texas, in writing.

What may the quality-of-care monitor recommend?

Procedural and policy changes and staff training to improve the care or quality of life of residents.

What procedures must be included in the fire safety plan?

Procedures for: (A) conducting a fire drill on each work shift at least once per quarter with at least one fire drill conducted each month; and (B) completing the most current version of the required HHSC form titled, "Fire Drill Report" available on the HHSC website for each fire drill conducted.

What additional requirements are there for Medicaid-certified facilities in regard to how to apply for Medicaid?

Prominently display in the facility written information, and provide to residents and potential residents oral and written information about how to apply for and use Medicare and Medicaid benefits, and how to receive funds for previous payments covered by such benefits.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the regulations for hazardous areas?

Protection from hazardous areas must be as required in NFPA 101, except as required or modified.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, open or enclosed seating space must be ____?

Provided within view of the main nurse station that will allow furniture or wheelchair parking that does not obstruct the corridor way of egress.

In facilities licensed on or after April 2, 2018, what provisions should be made for medications?

Provision must be made for convenient and prompt 24-hour distribution of medication to residents.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required for medication rooms and medication distribution?

Provision must be made for convenient and prompt 24-hour distribution of medication to residents. The medication preparation room must be under the nursing staff's visual control and contain a work counter, refrigerator, sink with hot and cold water, and locked storage for biologicals and drugs and must have a minimum area of 50 sf. The minimum dimension allowed is 5'6". An appropriate air supply must be provided to maintain adequate temperature and ventilation for safe storage of medications. For purposes of storage of unrefrigerated medications, the room temperature must be maintained between 59° and 86° F.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the provisions for smoke barrier walls which have smoke dampers?

Provisions must be made for reasonable access must be to concealed smoke barrier walls for maintaining smoke dampers and so that walls and dampers can be visually checked periodically for conformance by facility staff, service persons, and inspectors. Access must provide for visual inspection of both sides of the wall, and of all parts (end-to-end and top-to-bottom). Ceiling access panels must be prefabricated metal panel, or its equivalent, and be at least 20" x 20" with no obstructions above (such as ducts) to hamper entrance, and it must be fire rated if required to maintain ceiling-roof or ceiling-floor fire rating. Access must be provided for both sides of the wall.

What provision must be complied with in regard to employees at the facility?

Provisions of the Texas Health and Safety Code, Chapter 250.

In facilities licensed on or after April 2, 2018, what are the required exit provisions for common areas?

Public assembly rooms, common living rooms, dining rooms, and other rooms with a capacity of 50 or more persons or greater than 1,000 square feet in area must have two means of egress remote from each other. Out-swinging doors with panic hardware must be provided for these egress doors.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the exit provisions for common areas?

Public assembly, common living rooms, dining rooms, and other rooms with a capacity of 50 or more persons or greater than 1,000 square feet must have two means of exit remote from each other. Out-swinging doors with panic hardware must be provided for these exits.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the public toilet requirements?

Public toilets with sanitary handwashing and drying provisions must be provided or designated.

What does TX DHS say about documenting information provided to the resident or resident's representative?

Receipt of information, and any amendments to it, must be acknowledged in writing by all parties receiving the information.

Before allowing an individual to serve as a nurse aide, a facility must?

Receive registry verification that the individual has met competency evaluation requirements and is not designated in the registry as having a finding concerning abuse, neglect or mistreatment of a resident, or misappropriation of a resident's property, unless: (A) the individual is a full-time employee in a training and competency evaluation program approved by the state; or (B) the individual can prove that he has recently successfully completed a training and competency evaluation program, or competency evaluation program approved by the state and has not yet been included in the registry. Facilities must follow up to ensure that such an individual actually becomes registered.

In facilities licensed on or after April 2, 2018, how are emergency receptacles and switches identified?

Receptacles and switches connected to emergency power must have red faceplates.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the regulations for bedroom receptacles?

Receptacles at bedrooms must be in accordance with §19.334(a)(7) of this division.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, how should emergency receptacles be identified?

Receptacles connected to emergency power must have red face plates.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, other than emergency receptacles, what type of receptacles should be installed in the remainder of the building?

Receptacles in the remainder of the building must be sufficient to serve the present and future needs of the residents and equipment.

In facilities licensed on or after April 2, 2018, where else are emergency receptacles required?

Receptacles must be provided with emergency electrical service for essential needs such as medication refrigerators and systems or equipment whose failure is likely to result in major injury or death to a resident. Receptacles in the remainder of the building must be sufficient to serve the present and future needs of residents and equipment.

NFPA 258

Recommended Practice for Determining Smoke Generation of Solid Materials. This document was withdrawn by NFPA in 2006 in lieu of ASTM E662.

What must be included in the documents provided to HHSC upon final survey for new construction in regard to the sprinkler system?

Record drawings of the fire sprinkler system as installed, signed by a Responsible Managing Employee licensed by the State Fire Marshal's Office, or sealed by a licensed professional engineer, including the hydraulic calculations, alarm configuration, Contractor's Material and Test Certificates for Aboveground and Underground Piping, and all literature and instructions provided by the manufacturer describing the proper operation and maintenance of all equipment and devices with NFPA 25;

If an existing licensed facility plans a building rehabilitation that includes a change in the facility capacity, HHSC must _____?

Reevaluate the ratio of bathing units to meet minimum standards and the square footage of dining and living areas to meet a minimum of 19sf per bed. Conversion of existing living, dining, or activity areas to resident bedrooms must not reduce these functions to a total area of less than 19sf per bed. The facility's registered or licensed dietitian or architect having knowledge in the design of food service operations must reevaluate the dietary department. This reevaluation must be provided to HHSC.

In regard to Disaster and Emergency Preparedness, what is a plan?

Refers to a facility's emergency preparedness and response plan.

What should be inspected on a regular basis as part of the maintenance program?

Regular inspections of all bed frames, mattresses, and bed rails, if any, as part of a regular maintenance program to identify areas of possible entrapment. When bed rails and mattresses are used and purchased separately from the bed frame, the facility must ensure that the bed rails, mattress, and bed frame are compatible.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the exit provisions for resident baths and toilets?

Resident baths or toilets having privacy locks will require that keys or devices for opening the doors are kept readily available to the staff.

In facilities licensed on or after April 2, 2018, what are the required exit provisions for resident baths and toilets with privacy locks?

Resident baths or toilets having privacy locks will require that keys or devices for opening the doors are kept readily available to the staff.

Who develops the resident care policies in the facility? How often should they be reviewed?

Resident care policies are developed by the medical director and by professional personnel, including one or more physicians, licensed or registered nurses, a registered pharmacist, and the licensed nursing home administrator. The advisory group must review the policies at least annually and update them as necessary.

What types of records and documents might be requested by HHSC during a visit?

Resident medical records, including nursing notes, pharmacy records, medication records, and physician's orders.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the general requirements for resident rooms?

Resident rooms must be designed and equipped for adequate nursing care, comfort, and privacy of residents.

How should resident's personal soiled clothing be handled and kept?

Resident's personal clothing that is not soiled with body wastes may be stored in a closed container in the resident's closet.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the regulations for resident-use hot water systems?

Resident-use hot water must be reliably controlled, such as by thermostatic or mixing valves, to not exceed 110° F and not less than 100° F at each fixture.

For the purposes of the rule about Respiratory care of children, what is considered compliant?

Respiratory therapy staff is defined as a registered respiratory therapist (RRT), a certified respiratory therapy technician (CRT), or a licensed nurse whose primary function is respiratory care.

What does the Statement of Resident rights say about admissions documents?

Right to A written statement or admission agreement describing the services provided by the facility and the related charges.

What does the Statement of Resident rights say about abuse?

Right to Be free from abuse and exploitation

What does the Statement of Resident rights say about discrimination?

Right to Be free from discrimination based on age, race, religion, sex, nationality, or disability and to practice your own religious beliefs.

What does the Statement of Resident rights say about treatment from others?

Right to Be treated with courtesy, consideration, and respect;

What does the Statement of Resident rights say about complaints?

Right to Complain about the facility and to organize or participate in any program that presents residents' concerns to the administrator of the facility.

What does the Statement of Resident rights say about confidentiality?

Right to Have facility information about you maintained as confidential.

What does the Statement of Resident rights say about personal property?

Right to Keep and use personal property, secure from theft or loss;

What does the Statement of Resident rights say about moving rooms?

Right to Not be relocated within the facility, except in accordance with nursing facility regulations;

What does the Statement of Resident rights say about care plans?

Right to Participate in developing a plan of care, to refuse treatment, and to refuse to participate in experimental research.

What does the Statement of Resident rights say about medical care by physicians?

Right to Retain the services of a physician of your choice, at your own expense or through a health care plan, and to have a physician explain to you, in language you understand, your complete medical condition, the recommended treatment, and the expected results of the treatment, including reasonably expected effects, side effects, and risks associated with psychoactive medications;

What does the Statement of Resident rights say about care?

Right to all care necessary for you to have the highest possible level of health;

ASME A17.1

Safety Code for Elevators and Escalators, published by ASME.

In facilities licensed before Sept. 11, 2003, in existing construction, what is required in the auxiliary serving areas of the kitchen?

Separate food service areas must have hand-washing facilities as a part of the food service area.

Involuntary seclusion

Separation of a resident from others or from the resident's room or confinement to the resident's room, against the resident's will or the will of a person who is legally authorized to act on behalf of the resident. Monitored separation from other residents is not involuntary seclusion if the separation is a therapeutic intervention that uses the least restrictive approach for the minimum amount of time, not exceed to 24 hours, until professional staff can develop a plan of care to meet the resident's needs.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the regulations when it comes to sewage?

Sewage must be discharged into a state-approved sewerage system or the sewage must be collected, treated, and disposed of in accordance with applicable Texas Natural Resource Conservation Commission rules and regulations.

When are signature stamps and faxed signed documents from the physician acceptable?

Signature stamps and faxed signed documents are acceptable if used as described in §19.1912(f)(2).

What are expedited the Life Safety Code and Physical Plant Inspection Fees for an addition or remodel?

Single story A. 3% of construction cost; B. minimum $1,500 plus $30 per bed; C. maximum $3000 plus $30 per bed Multiple story A. 3% of construction cost; B. minimum $1,500 plus $36 per bed; C. maximum $3000 plus $36 per bed

What are expedited the Life Safety Code and Physical Plant Inspection Fees for a new construction?

Single story--$30 per bed; minimum $3,600 Multiple story--$36 per bed; minimum $4,500

What are expedited the Life Safety Code and Physical Plant Inspection Fees for an Alzheimer's Certification?

Single story--$850 plus $36 per bed Multiply story--$850 plus $36 per bed

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, if it is possible that an outlet or attachment may be submerged, what is required on the water supply fixture?

Siphon breakers or back-flow preventers

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, how should drainage be addressed?

Site grades must provide for positive surface water drainage so that there will be no ponding or standing water on the designated site. This does not apply to local government requirements for engineered controlled run-off holding ponds.

What should be included in the site plan documents for new construction?

Site plan documents must include grade contours; streets with names; a north arrow; fire hydrant locations; fire lanes; utilities, public or private; fences; unusual site conditions, such as ditches, low water levels, and other buildings on-site; and indications of buildings located five feet or less beyond site property lines. Site plan documents for nursing facilities may include the developed landscaping plan for resident use.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what must be installed in the way of sound protection for residents?

Sound separation must be provided in corridor walls and resident room party walls; Minimum Sound Transmission Coefficient 30 per American Society for Testing Material E-90.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, how much space is needed for maintenance usage?

Space and facilities for adequate preventive maintenance and repair service must be provided.

In facilities licensed on or after April 2, 2018, what is required in the way of space for maintenance use? Where is it suggested they are located?

Space and facilities for adequate preventive maintenance and repair service must be provided. The following spaces are needed and it is suggested that these be part of a separate laundry building or area: (1) A storage area for building and equipment maintenance supplies, tools, and parts must be provided. (2) A space for storage of yard maintenance equipment and supplies, including flammable liquids bulk storage, must be provided separate from the resident-occupied facility. (3) A maintenance and repair workshop of at least 120 square feet and equipment to support usual functions is recommended. (4) A suitable office or desk space for the maintenance staff is recommended. This space may be located within the repair shop area with space for catalogs, files, and records.

In facilities licensed on or after April 2, 2018, what are required areas in the parking lot?

Space must be provided for emergency and delivery vehicles.

In facilities licensed on or after April 2, 2018, what are the size requirements for social-diversional rooms?

Spaces such as living rooms, dayrooms, lounges, and sunrooms, must be provided on a sliding scale as follows: Number of Beds Area Per Bed Minimum 4-8 A minimum of 144 sf 9-15 18 sf 16-20 17 sf 21-25 16 sf 26-30 15 sf 31-35 14 sf 36-40 13 sf 41-50 12 sf 51-60 11 sf 61 and over 10 sf (100 beds = 1,000 sf)

What must be included in the documents provided to HHSC upon final survey for new construction in regard to building materials with a fire rating?

Special wall finishes or floor coverings; flame retardant curtains, including cubicle curtains; and fire resistance-rated ceilings. This documentation must include a signed letter from the installer verifying the material installed, such as carpeting, is the same material named in the documented fire test;

In facilities licensed on or after April 2, 2018, who writes the codes for sprinkler systems?

Sprinkler systems must be according to NFPA 13 and this subchapter.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the requirements for sprinkler systems?

Sprinkler systems must be in accordance with NFPA 13, and this subchapter.

In facilities licensed on or after April 2, 2018, what is required for staff rest rooms in the kitchen?

Staff rest room facilities with lavatory must be directly accessible to kitchen staff without traversing resident use areas. A facility must provide a vestibule so the rest room door does not open directly into the kitchen.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the requirements for rest room facilities for kitchen staff use?

Staff rest room facilities with lavatory must be directly accessible to kitchen staff without traversing resident use areas. The rest room door must not open directly into the kitchen, that is, provide a vestibule.

When are stamped signatures acceptable on health care documents?

Stamped signatures are acceptable for all health care documents requiring a physician's signature, if the person using the stamp sends a letter of intent which specifies that he will be the only one using the stamp, and then signs the letter with the same signature as the stamp.

NFPA 255

Standard Method of Test of Surface Burning Characteristics of Building Materials. This document was withdrawn by NFPA in 2009 in lieu of ASTM E84 and UL 723.

ASTM E90

Standard Test Method for Laboratory Measurement of Airborne Sound Transmission Loss of Building Partitions and Elements, published by ASTM.

NFPA 25

Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems, 2011 edition.

NFPA 37

Standard for the Installation and Use of Stationary Combustion Engines and Gas Turbines, 2010 edition.

NFPA 90A

Standard for the Installation of Air-Conditioning and Ventilating Systems, 2012 edition.

NFPA 13

Standard for the Installation of Sprinkler Systems, 2010 edition.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, how much water must be supplied in the supply system for facility use?

Supply systems must assure an adequacy of hot and cold water. An average rule-of-thumb design for hot water for resident usage (at 110° F) is to provide 6-1/2 gallons per hour per resident in addition to kitchen and laundry use.

TCEQ

Texas Commission on Environmental Quality.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what happens if the municipality has a building code? What should be done if there is a conflict?

That code must govern the building requirements for the construction involved. The Life Safety Code must be used for fire safety requirements. Should discrepancies between the codes arise, they must be called to the attention of the Texas Department of Human Services for resolution.

In facilities licensed before Sept. 11, 2003, in existing construction, under what circumstance is the 150 foot limitation increased?

The 150-foot limitation may be increased to 165 feet in facilities or additions to facilities completed before August 10, 1983.

Who should be encouraged to participate in a child's comprehensive care plan meetings?

The LAR, and, if desired by the child or LAR, by family members, advocates and friends in the community

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what code must required plumbing fixtures follow?

The Life Safety Code and §19.334.

Who will monitor the infection control program?

The Quality Assessment and Assurance Committee as described in §19.1917 will monitor the infection control program.

Upon granting the Registered Nurse waiver, what will the SNF do?

The SNF that is granted a waiver by the state notifies residents of the facility (or, when appropriate, the guardians or legal representatives of the residents) and members of their immediate families of the waiver.

What must be documented about Authorized Electronic Monitoring in the resident's record?

The Texas Department of Human Services (DHS) Information Regarding Authorized Electronic Monitoring form must be signed by or on behalf of all new residents upon admission. The form must be completed and signed by or on behalf of all current residents by July 1, 2003. A copy of the form must be maintained in the active portion of the resident's clinical record.

What are plan review fees?

The Texas Department of Human Services (DHS) charges a fee to review plans for new buildings, additions, conversion of buildings not licensed by DHS, or remodeling of existing licensed facilities.

Who is required to provide a Model Drug Testing Policy to facilities? Is the facility required to drug test its employees?

The Texas Department of Human Services (DHS) is required to provide a model drug testing policy to nursing facilities under the Health and Safety Code, §242.050. A nursing facility is not required to perform drug testing on its employees or applicants for employment. Although this policy only covers drugs, coverage of alcohol may be added. Before implementing any drug testing policy, including the following model policy, DHS recommends that a facility discuss the policy with its attorney.

What must be included in a comprehensive care plan if the resident is between the ages of 18-22?

The activities, supports and services that, when provided or facilitated by the facility, will result in the resident having a consistent and nurturing environment in the least restrictive setting, as defined by the resident and LAR as defined in §19.805(a)(5).

Who is responsible for copying documents requested by HHSC?

The administrator or his designee.

How much must the surety bond be for?

The amount of a surety bond must equal the average monthly balance of all the facility's resident trust fund accounts for the 12-month period preceding the bond issuance or renewal date.

In facilities licensed on or after April 2, 2018, what must the ventilation in a kitchen take into consideration?

The amount of supply air must take into account the large quantities of air that may be exhausted at the range hood and dishwashing area.

If the facility provides its own diagnostic services, the services must meet _____.

The applicable conditions of participation for hospitals contained in 42 Code of Federal Regulations, §482.26.

If the request for full reimbursement is denied, what can the applicant do?

The applicant may appeal directly to the executive commissioner for resolution of the dispute. The applicant must send a written statement to the executive commissioner describing the request for reimbursement and the reasons for it. The program also may send a written statement to the executive commissioner describing the program's reasons for denying reimbursement. The executive commissioner makes a timely decision concerning the appeal and notifies the applicant and the program in writing of the decision.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, who must approve the sprinkler plans in Austin?

The approved sprinkler plans must be submitted to DHS, Architectural Section, Austin, Texas.

What are the fees for Background information?

The background information fee is $50.

In facilities licensed on or after April 2, 2018, what are the requirements on number of bathrooms to be provided? What must they contain?

The bathroom must serve no more than one resident room and must include, at least, a lavatory and toilet.

In facilities licensed on or after April 2, 2018, where should the bottoms of ventilation opening be located?

The bottoms of ventilation openings must be at least three inches above the floor of any room.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what is the required height of ventilation openings from the floor?

The bottoms of ventilation openings must be not less than three inches above the floor of any room.

In facilities licensed on or after April 2, 2018, in the case of a fire, what access is required for the fire department?

The building must have suitable all-weather fire lanes as required by local fire authorities or, if no local fire authority has jurisdiction, by HHSC. As a minimum, the fire department must be able to access two sides of the building.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required for fire lanes?

The building must have suitable all-weather fire lanes for access as required by local fire authorities and HHSC. As a minimum, there must be access to two sides of the building by an all-weather lane.

In facilities licensed on or after April 2, 2018, in the absence of a locally-adopted building code, what are the governing requirements for a building?

The building must meet the requirements of a nationally recognized model building code. NFPA 101 must be used for fire safety requirements.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, motor generators fueled by public utility natural gas must have _____?

The capability to be switched to an alternate fuel source in accordance with NFPA 70.

Who must sign off on the completed construction?

The completed construction must have the written approval of the local authorities having jurisdiction, including the fire marshal and building official.

What should be in the contract with the pharmacy that provides the emergency medication kits?

The contract must outline the services to be provided by the pharmacy and the responsibilities and accountabilities of each party in fulfilling the terms of the contract in compliance with federal and state laws and regulations.

If the board and/or governing body for a long-term care facility and a hospital are the same, what must be outlined in the transfer agreement?

The controlling entity must have written procedures outlining how transfers will occur.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the cooling requirements for the facility?

The cooling system must be capable of maintaining a temperature suitable for the comfort of the residents in resident-use areas.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what design specifications must be followed for the installation of sprinkler systems?

The design and installation of sprinkler systems must meet any applicable state laws pertaining to these systems and one of the following criteria: (i) The sprinkler system must be designed by a qualified registered professional engineer approved by the Texas State Board of Registration for Professional Engineers to operate in Texas. The engineer must supervise the installation and provide written approval of the completed installation. (ii) The sprinkler system must be planned and installed in accordance with NFPA 13 by firms with certificates of registration issued by the office of the state fire marshal that have at least one full-time licensed responsible managing employee (RME). The RME's license number and signature must be included on the prepared sprinkler drawings.

In facilities licensed on or after April 2, 2018, who must supervise the design of the electrical system?

The design of the electrical systems must be done by or under the direction of a licensed professional electrical engineer approved by the Texas Board of Professional Engineers to operate in Texas, and the parts of the plans and specifications covering electrical design must bear the legible seal of the engineer.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, who must oversee electric system designs?

The design of the electrical systems must be done by or under the direction of a licensed professional electrical engineer approved by the Texas State Board of Professional Engineers to operate in Texas, and the parts of the plans and specifications covering electrical design must bear the legible seal of the engineer. Utilities; heating, ventilating, and air-conditioning systems; vertical conveyors, and chutes must meet the requirements of NFPA 101, Chapter 9, Building Service and Fire Protection Equipment.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, who must direct the design of the mechanical system?

The design of the mechanical systems must be done by or under the direction of a registered professional (mechanical) engineer approved by the Texas State Board of Registration for Professional Engineers to operate in Texas, and the parts of the plans and specifications covering mechanical design must bear the legible seal of the engineer.

In facilities licensed on or after April 2, 2018, who is qualified to do the structural plan designs?

The design of the structural system must be done by or under the direction of a professional structural engineer who is currently licensed by the Texas Board of Professional Engineers according to state law.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, who must direct the design of the structural system?

The design of the structural system must be done by or under the direction of a professional structural engineer who is currently registered by the Texas State Board of Registration for Professional Engineers in accordance with state law.

In facilities licensed on or after April 2, 2018, what should be the direction of air flow for ventilation systems? What must be provided by the installer?

The design of ventilation systems must provide air movement that is from clean to less clean areas. The ventilation systems must be designed and balanced to provide the pressure relationships to adjacent spaces as required by NFPA 99. The installer must furnish and certify a final engineered system air balance report for the completed system. The report must demonstrate the pressure relationships required by NFPA 99.

What is the director of food service responsible for?

The designated director of food service is responsible for the overall operation of the dietary service.

Certification

The determination by HHSC that a nursing facility meets all the requirements of the Medicaid or Medicare programs.

For Small House and Household Facilities, what are the dietary facility requirements?

The dietary facility requirements in §19.354(g) must be met, except a kitchen serving 16 or fewer non-employees per meal: (A) may be open to the facility in compliance with NFPA 101; (B) must meet the general food service needs of the residents; (C) must provide for the storage, refrigeration, preparation, and serving of food; for dish and utensil cleaning; and for refuse storage and removal; (D) must contain a multi-compartment sink, vegetable sink, and hand washing sink; (E) must provide a supply of hot water that, if used for sanitizing purposes is 180° F or at the manufacturer's suggested temperature for chemical sanitizers; (F) must provide a supply of cold water; (G) must have janitorial facilities exclusively for the kitchen and located in close proximity to the kitchen; (H) must have kitchen floors, walls, and ceilings with nonabsorbent smooth finishes or surfaces that are capable of being routinely cleaned and sanitized to maintain a healthful environment; (I) must have counter and cabinet surfaces, inside and outside, with smooth, cleanable, relatively nonporous finishes; and (J) must have a toilet for the kitchen staff that is in close proximity to the kitchen and that may also be a toilet room for the public or the general bathing room.

What meetings must the director of food service participate in?

The director of food service must participate in regular conferences with the administrator and with the registered nurse who has responsibility for the resident and the resident's plan of care. In conferences concerning the resident's plan of care, the director of food service must provide information about approaches to identified nutritional problems.

What policies should the director of food service be involved with?

The director of food service should make recommendations and assist in developing personnel policies.

How many facilities can a Director of Nursing Services work at?

The director of nursing services must serve only one facility in this capacity.

If a facility that advertises, markets, or otherwise promotes that it provides services to residents with Alzheimer's disease and related disorders, what information must be given out?

The disclosure statement required by §19.204(b)(4) to: (A) an individual with Alzheimer's disease or a related disorder, who is seeking to become a resident of the facility; (B) an individual assisting an individual with Alzheimer's disease or a related disorder who is seeking to become a resident of the facility; and (C) an individual seeking information about the facility's care and treatment of residents with Alzheimer's disease or a related disorder.

How often must the drug regimen of each resident be reviewed, and by whom? What should be documented?

The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist. The consultant pharmacist's drug regimen review must be maintained in the resident's clinical record.

When is the change of ownership license effective?

The effective date of the license is the later of the date requested in the application or the 31st day after the date DADS receives the application, unless waived. The effective date of the change of ownership license cannot precede the date the application is received at DADs.

When is a license for relocation effective?

The effective date of the license will be the date all residents are relocated. The license holder must continue to maintain the license at the current location and must continue to meet all requirements for operation of the facility until the date of the relocation.

For Small House and Household Facilities, what are the electrical receptacle requirements?

The electrical receptacle requirements in §19.354(a)(6) must be met and additional receptacles must be provided to meet the requirements for Dwelling Unit Receptacle Outlets in NFPA 70.

In facilities licensed before Sept. 11, 2003, for existing construction, what should the emergency power system be able to run?

The emergency electrical power system must supply the following systems: (A) illumination for means of egress, nurses' stations, medication rooms, dining and living rooms, and areas immediately outside of exit doors; (B) exit signs and exit directional signs required by NFPA 101; (C) alarm systems, including fire alarms activated by manual stations, water flow alarm devices of sprinkler systems, fire and smoke detecting systems, and alarms required for nonflammable medical gas systems if installed; (D) task illumination and selected receptacles at any required or provided generator set location; (E) selected duplex receptacles, including receptacles in resident corridors, each resident-bed location where systems or equipment is used whose failure is likely to cause major injury or death to a resident, nurses' stations, medication rooms, including biological refrigerator, if a generator is required or provided; (F) nurse call systems; (G) resident room night lights when provided; (H) elevator cab lighting, control, and communication systems; (I) all facility telephone equipment; and (J) those paging or speaker systems that are necessary for the communication plan for an emergency. Radio transceivers that are necessary for emergency use must be capable of operating for at least one hour upon total failure of both normal and emergency power.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, facilities that were constructed or received design approval or building permits before July 5, 2016, may comply with _____?

The emergency electrical system requirements for existing health care facilities in NFPA 99.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, facilities that were constructed or received design approval or building permits after July 5, 2016, must comply with _____?

The emergency electrical system requirements for new health care facilities in NFPA 99.

In facilities licensed before Sept. 11, 2003, in existing construction, what is the maximum time allotted for emergency switch over?

The emergency lighting must be automatically in operation within 10 seconds after the interruption of normal electrical power supply. Emergency service to receptacles and equipment may be a delayed automatic connection. Receptacles connected to emergency power must be of a uniform and distinctive color. Stored fuel capacity must be sufficient for not less than four hours of required generator operation.

In facilities licensed on or after April 2, 2018, how soon must emergency lighting kick in? What must not be switched?

The emergency lighting must be automatically in operation within 10 seconds after the interruption of the normal power supply. Emergency egress lighting must not be switched.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what must be automatically in operation within ten seconds after a service interruption? What must not be switched?

The emergency lighting must be automatically in operation within ten seconds after the interruption of normal electric power supply. Emergency egress lighting must not be switched.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required at the entrance areas of the facility?

The entrance must be at grade level, sheltered from the weather, and able to accommodate wheelchairs. A drive-under canopy must be provided for the protection of residents or visitors entering or leaving a vehicle. The latter may be a secondary entrance.

For Small House and Household Facilities, what are the requirements for exits in the facility?

The exit requirements in §19.355(3) must be met except for fixed furniture and wheeled equipment as permitted by NFPA 101.

Who keeps the copies of the inventoried resident items?

The facility administrator or his or her designee must sign and retain the written inventory and must give a copy to the resident or the resident's responsible party or both.

Who must ensure that the social worker or other appropriate staff will contribute to the development of a permanency plan?

The facility administrator.

What does TX DHS say about notification of a change to a resident's rights?

The facility also must promptly notify the resident and, if known, the resident's legal representative or interested family member when there is: (A) a change in room or roommate assignment as described in §19.701(4)(B); or (B) a change in resident rights under federal or state law or regulations.

Who makes a respite plan of care for a resident?

The facility and the individual arranging respite care must agree on the plan of care.

If the original findings of a trust fund review are upheld or revised after the informal hearing, and the facility chooses not to request a formal hearing, when must the corrective action take place?

The facility has 60 days from the date of receipt of the written decision to complete the corrective actions.

What if the facility has in good faith tried to enter into an agreement with a hospital sufficiently close to the facility, but cannot? What must be documented?

The facility is considered to have a transfer agreement in effect if DHS determines that the facility attempted in good faith to enter into an agreement with a hospital sufficiently close to the facility to make transfer feasible but could not, and it is in the public interest not to enforce this requirement. The facility must document in writing its good faith effort to enter into an agreement.

In facilities licensed on or after April 2, 2018, who is responsible for the hiring the people who will do the structural plan designs?

The facility is responsible for employing qualified personnel in the preparation of plan designs and engineering and in the construction of the facility to ensure that all structural components are adequate, safe, and meet the applicable construction requirements.

Who is responsible for the accuracy of the building plans? What if they are found to not be accurate?

The facility is responsible for employing qualified personnel to prepare the contract documents for construction. If the contract documents contain errors or omissions to the extent that conformance with standards cannot be reasonably ensured or determined, HHSC may request a revised set of documents for review.

What is the role of the facility in the hiring and paying of special nurses or sitters?

The facility may assist in the hiring of a special nurse or sitter but may not in any way enter into the billing, collection, or fee-setting for the special duty nurse or sitter. If it is determined by the auditing staff that the facility received monetary benefits from an arrangement for special duty nurses or sitters, a financial exception will be made and the facility will be asked to reimburse the resident or the responsible party who paid the special duty nurses or sitters.

If a waiver of the 24-hour licensed nurse requirement is granted during review, what may be required of the facility?

The facility may be required by the state to use other qualified, licensed personnel.

What are some items that can be charged to a resident's personal funds?

The facility may charge a resident for requested services that are more expensive than or in excess of covered services in accordance with §19.2601. The following list contains general categories and examples of items and services that the facility may charge to a resident's personal funds if they are requested by a resident, if the facility informs the resident that there will be a charge, and if payment is not made by Medicare or Medicaid: telephone; television or radio for personal use; personal comfort items, including smoking materials, notions and novelties, and confections; cosmetics and grooming items and services in excess of those for which payment is made under Medicare or Medicaid; personal clothing; personal reading material; gifts purchased on behalf of a resident; flowers and plants; social events and entertainment offered outside the scope of the activities program, provided under §19.702; non-covered special care services, such as privately hired nurses and aides; private room, except when therapeutically required, such as isolation for infection control; specially-prepared or alternative food requested instead of the food generally prepared by the facility, as required in §19.1101; and incontinent briefs if the resident's legally authorized representative or responsible party submits a written request to the facility and the attending physician and director of nurses (DON) determine and document in the clinical record that there is no medical or psychosocial need for supplies.

What may the facility charge to non-Medicaid residents for services?

The facility may charge any amount for services furnished to non-Medicaid residents consistent with the notice requirement in §19.403(h) and (i).

When can the facility charge a bed-hold fee? How much can be charged?

The facility may enter into a written agreement with the recipient or responsible party to reserve a bed. (A) The facility may charge the recipient an amount not to exceed the DHS daily vendor rate according to the recipient's classification at the time the individual leaves the facility. (B) The facility must document all bed-hold charges in the recipient's financial record at the time the bed-hold reservation services were provided. (C) The facility may not charge a bed-hold fee if the Texas Department of Human Services (DHS) is paying for the same period of time, as in a three-day therapeutic home visit.

How long must a respite plan of care be kept at the facility? How many times can a resident be admitted under the original care plan?

The facility may keep a plan of care for an individual for six months from the date on which it is developed. During that period, the facility may admit the individual as frequently as needed.

If utilities are removed, when can an existing damper remain?

The facility may leave an existing damper that is no longer required by NFPA 101 in-place and inoperable, if the damper is in a duct penetration of a smoke barrier in a fully ducted HVAC system; the damper is permanently secured in the open position; and quick-response sprinklers have been provided for the smoke compartments on both sides of the smoke barrier.

What is the facility required to do if the resident's personal funds less than $50?

The facility may maintain a resident's personal funds that do not exceed $50 in a noninterest-bearing account, interest-bearing account, or petty cash fund.

What items and services may not be charged to a resident's personal funds?

The facility may not impose a charge against the personal funds of a resident for any item or service for which payment is made under Medicaid or Medicare.

Which unlicensed people can administer drugs, and under what circumstance?

The facility may permit unlicensed personnel to administer drugs, but only under the general supervision of a licensed nurse. The unlicensed individual must be a nursing student, a medication aide student, or a medication aide with a current permit issued by the Texas Department of Human Services.

What if the facility wants another formal hearing after the decision from the first one after a trust fund audit? What will this 2nd formal hearing be about?

The facility may request a formal hearing within 15 days after receiving notice of the correction failure and the vendor hold. The formal hearing is limited to the issue of whether the facility completed the corrective action.

How are claims paid to the facility for emergency dental services? What is the exception?

The facility must accept payment by DHS as payment in full for services. Neither the dentist nor the facility may charge an additional fee to the recipient, his family, or his trust fund, except that the dentist may charge the recipient for services that: (A) the recipient requests; and (B) are not reimbursable by the Texas Medical Assistance Program. (C) Nursing Facility Emergency Dental Services makes no payment for services that are available under any other Texas Medical Assistance Program.

What type of residents should be admitted to the facility?

The facility must admit and retain only residents whose needs can be met through service from the facility staff, or in cooperation with community resources or other providers under contract.

What does TX DHS say about religious beliefs?

The facility must allow the resident the right to observe his religious beliefs. The facility must respect the religious beliefs of the resident in accordance with 42 United States Code, §1396f.

Generally, what is required for Nurse call systems?

The facility must be adequately equipped to allow residents to call for staff assistance through a communication system which relays the call directly to a staff member or to a centralized staff work area: (A) before November 28, 2019, from each resident's room; (B) beginning November 28, 2019, from each resident's bedside; and (C) from toilet and bathing facilities.

What are the general requirements for a facility construction?

The facility must be designed, constructed, equipped, and maintained to protect the health and ensure the safety of residents, personnel, and the public.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the requirements for fire department service?

The facility must be served by a paid or volunteer fire department. The fire department must provide written assurance to HHSC that the fire department can respond to an emergency at the facility within an appropriately prompt time for the travel conditions involved.

In facilities licensed on or after April 2, 2018, who is required to serve the facility in the case of a fire? What must be provided to HHSC?

The facility must be served by a paid or volunteer fire department. The fire department must provide written assurance to HHSC that the fire department can respond to an emergency at the facility within an appropriately prompt time for the travel conditions involved.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the requirements for emergency water for use by the fire department?

The facility must be served by an adequate water supply that is satisfactory and accessible for fire department use as determined by the fire department serving the facility and by HHSC. There must be at least one readily accessible fire hydrant located within 300 feet of the building. The hydrant must be on a minimum six inch service line, or else there must be an approved equivalent, such as a storage tank. The hydrant, its location, and service line, or equivalent must be as approved by the local fire department and HHSC.

In facilities licensed on or after April 2, 2018, what must be made available to the fire department in case of a fire? Who approves this?

The facility must be served by an adequate water supply that is satisfactory and accessible for fire department use as determined by the fire department serving the facility and by HHSC. There must be at least one readily accessible fire hydrant located within 300 feet of the building. The hydrant must be on a minimum six inch service line. The hydrant, its location, and service line, or equivalent must be as approved by the local fire department and HHSC.

In facilities licensed before Sept. 11, 2003, in existing construction, how should proper ventilation be achieved?

The facility must be well ventilated through the use of windows, mechanical ventilation, or a combination of both. Rooms and areas which do not have outside windows and which are used by residents or personnel must be provided with functioning mechanical ventilation to change the air on a basis commensurate with the room usage. Air systems must provide for the induction and mixing of at least 10% outside fresh air into the facility unless otherwise approved by DHS; that is, 100% continuous recirculation of interior air in most areas is not acceptable. When certain rooms or areas are dependent on a central air system for proper ventilation, including exhaust, that central air system fan must run continuously.

What is required of the facility in regard to Nurse Aides?

The facility must complete a performance review of every nurse aide at least once every 12 months, and must provide regular in-service education based on the outcome of these reviews.

In facilities licensed before Sept. 11, 2003, what codes must be followed for existing construction for those with disabilities?

The facility must comply with accessibility requirements for individuals with disabilities in the revised regulations for Title II and III of the Americans with Disabilities Act at 28 CFR Part 35 and Part 36, also known as the 2010 ADA Standards for Accessible Design, and the TAS adopted by the Texas Department of Licensing and Regulation (TDLR) at 16 TAC Chapter 68. A facility must register plans for new construction, substantial renovations, modifications, and alterations with TDLR, Attn: Elimination of Architectural Barriers Program, and comply with TAS.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the accessibility requirements for persons with disabilities?

The facility must comply with accessibility requirements for individuals with disabilities in the revised regulations for Title II and III of the Americans with Disabilities Act at CFR Part 35 and Part 36, also known as the 2010 ADA Standards for Accessible Design and the TAS adopted by the Texas Department of Licensing and Regulation (TDLR) rules at 16 TAC Chapter 68. A facility must register plans for new construction, substantial renovations, modifications, and alterations with TDLR, Attn: Elimination of Architectural Barriers Program, and comply with TAS.

If the resident or a relative, surrogate, or other concerned or related person presents the facility with a copy of the resident's advance directive, what is the responsibility of the facility?

The facility must comply with the advance directive, including recognition of a Medical Power of Attorney, to the extent allowed under state law. If no one comes forward with a previously executed advance directive and the resident is incapacitated or otherwise unable to receive information or articulate whether he has executed an advance directive, the facility must document in the resident's clinical record that the resident was not able to receive information and was unable to communicate whether an advance directive existed.

What should be done annually about a Tuberculosis risk?

The facility must conduct and document an annual review that assesses the facility's current risk classification according to the current CDC Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health Care Settings.

Who is qualified to maintain the fire alarm system?

The facility must contract with a company that is registered by the State Fire Marshal's Office to execute the program.

What is the facility required to do if the resident's personal funds exceed $50?

The facility must deposit any residents' personal funds in excess of $50 in an interest-bearing account (or accounts) that is separate from any of the facility's operating accounts, and that credits all interest earned on the residents' funds to that account. In pooled accounts, there must be a separate accounting for each resident's share.

What are the responsibilities of a Clinical Record Supervisor?

The facility must designate in writing a clinical records supervisor who has the authority, responsibility, and accountability for the functions of the clinical records service.

Which employees must be offered the Hepatitis B vaccination? When should the vaccine be offered?

The facility must develop a method to identify employees at risk of directly contacting blood or potentially infectious materials. The facility must offer an employee identified as being at risk of directly contacting blood or potentially infectious materials a hepatitis B vaccine within 10 days of employment.

What policy must be developed and implemented about influenza vaccines? What must be provided to the resident when the vaccine is offered?

The facility must develop and implement policies and procedures that ensure that the resident or resident's legal representative receives education regarding the benefits and potential side effects of the influenza vaccination. When an influenza vaccination is offered, the facility must show in the resident medical record that this education was provided.

What policy must be developed and implemented about pneumococcal vaccines? What must be provided to the resident when the vaccine is offered?

The facility must develop and implement policies and procedures to ensure that the resident or resident's legal representative receives education regarding the benefits and potential side effects of the pneumococcal vaccination. When a pneumococcal vaccination is offered, the facility must show in the resident medical record that this was provided.

What policies should be made for the confidentiality of resident records?

The facility must develop and implement policies and procedures to safeguard the confidentiality of medical record information from unauthorized access.

What must the facility document in order to assure preservation of rights for an incapacitated resident?

The facility must document specific information concerning the incapability of the resident to understand and exercise his rights. The facility documentation must cover: (A) the relationship of the resident to the person assuming his rights and responsibilities; (B) the authority allowing the responsible person to act for the resident; (C) resident assessments, care plans, and progress notes that address the resident's inability to exercise his rights and responsibilities; and (D) assurance that the resident who is mentally capable of understanding and exercising his rights, but physically incapable of doing so, receives interventions which facilitate the exercise of his rights.

Who must serve as a pharmaceutical consultant? What are their responsibilities?

The facility must employ or obtain the services of a pharmacist, currently licensed by the Texas State Board of Pharmacy and in good standing, who: (A) provides consultation on all aspects of the provision of pharmacy services in the facility; (B) establishes a system of records of receipt and disposition of all controlled drugs in sufficient detail to enable an accurate reconciliation; (C) determines that drug records are in order and that an account of all controlled drugs is maintained and periodically reconciled; and (D) adheres to requirements in §19.1503.

What are the required hours for a qualified dietitian?

The facility must ensure a qualified dietitian is available as frequently and for such time as is necessary to assure each resident a diet that meets the daily nutritional and special dietary needs of each resident, based upon the acuity and clinical needs of the resident. The facility must ensure that monthly dietary consultant hours are provided, at a minimum, as follows: (A) facility population: 60 residents or under - eight hours; (B) facility population: each additional 30 residents or fraction thereof - four hours.

What should be done by the facility to maintain fire alarm system components?

The facility must ensure fire alarm system components that require maintenance are maintained in accordance with NFPA 72.

What should be done by the facility to test fire alarm system components?

The facility must ensure fire alarm system components that require testing are tested in accordance with NFPA 72.

What should be done by the facility to visually inspect fire alarm system components?

The facility must ensure fire alarm system components that require visual inspection are visually inspected in accordance with NFPA 72.

What are the regulations for emergency generator testing?

The facility must ensure generator components are inspected, tested, and maintained in accordance with NFPA 37, 70, 99, and 110. The facility must ensure all generators are operated, under load, for at least 30 minutes each week.

What should be done by the facility to maintain sprinkler alarm system components?

The facility must ensure sprinkler system components that require maintenance are maintained in accordance with NFPA 13 and 25. The facility must ensure that individual sprinkler heads are inspected and maintained in accordance with NFPA 13 and 25.

What should be done by the facility to test sprinkler alarm system components?

The facility must ensure sprinkler system components that require testing are tested in accordance with the NFPA 13 and 25.

What should be done by the facility to visually inspect sprinkler alarm system components?

The facility must ensure sprinkler system components that require visual inspection are visually inspected in accordance with NFPA 13 and 25.

What must be made available to the dietary service personnel and the supervisor of nursing service? How old must it be?

The facility must ensure that a current diet manual, approved by the facility dietitian or the consultant dietitian, is readily available. To be current, the diet manual must be no more than five years old.

What must be done in the way of resident assessments for Activities?

The facility must ensure that activities assessment and care planning are completed and reviewed or updated as provided in §19.801 and §19.802. If indicated by the Resident Assessment Instrument (RAI) and/or the resident's need, an in-depth activities assessment is required.

What is the responsibility of the facility when abuse allegations are suspected?

The facility must ensure that all alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source, and misappropriation of resident property, are reported immediately to the administrator of the facility and to other officials in accordance with Texas law through established procedures (see §19.602).

Where should the consulting pharmacists note be kept?

The facility must ensure that notes on the monthly visits by the consulting pharmacist are entered in the resident's clinical record.

What must the facility ensure when it comes to Nurse Aides?

The facility must ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents' needs, as identified through resident assessments, and described in the plan of care.

What should be identifiable on the financial records kept by the facility?

The facility must ensure that records clearly identify each charge and payment made on behalf of each resident residing in the facility. The facility must clearly state in its records to whom charges were made and for whom payment was received.

What is required for Special needs?

The facility must ensure that residents receive proper treatment and care for the following special services: (A) injections; (B) parenteral (vein) or enteral (digestive system) fluids; (C) colostomy, ureterostomy, or ileostomy care; (D) tracheostomy care; (E) tracheal suctioning; (F) respiratory care; (G) foot care; and (H) prostheses.

What is required for Hydration?

The facility must ensure that the resident is provided with sufficient fluid intake to maintain proper hydration and health.

What is required for the prevention of Medication errors?

The facility must ensure that: (A) it is free of medication error rates of five percent or greater, and (B) residents are free of significant medication errors.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the handrail requirements in the hallways?

The facility must equip corridors with firmly secured handrails on each side on all walls 18 inches or longer. These rails must be substantially anchored to withstand downward force and must be mounted 33 to 36 inches from the floor.

What kind of Infection Control Program must be developed by the facility? What is the purpose?

The facility must establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection, including influenza, pneumococcal pneumonia, and tuberculosis.

How should the accounting records be kept for resident personal funds?

The facility must establish and maintain current, written, individual records of all financial transactions involving a resident's personal funds that the facility is holding, safeguarding, and accounting; keep these records in accordance with the American Institute of Certified Public Accountants' Generally Accepted Accounting Principles; and the requirements of law for a fiduciary relationship; and include identifying information and consent from the resident or POA.

What must be furnished to the Resident about their rights?

The facility must give a copy of the Statement of Resident Rights to each resident, next of kin or guardian, and facility staff member. The facility must maintain a copy of the statement, signed by the resident or the resident's next of kin or guardian, in the facility records.

What are the duties of the governing body in a facility?

The facility must have a governing body, or designated persons functioning as a governing body that is legally responsible for establishing and implementing policies regarding the management and operation of the facility. The governing body must have periodically updated written policies and procedures that are formally adopted and dated, specifying and governing all services.

What is Restorative Nursing Care? What must be documented?

The facility must have a program of restorative nursing care that is an integral part of nursing service and is directed toward helping each resident to achieve and maintain an optimal level of self-care and independence, as defined by the Comprehensive Assessment and Comprehensive Care Plan. Nursing personnel must be trained in restorative nursing and must provide restorative services daily for residents who require them. Nursing personnel must routinely record these services in the resident's clinical record.

What policy should be in place for fire alarm systems? How often should it be maintained?

The facility must have a program to inspect, test, and maintain the fire alarm system and must execute the program at least once every three months.

In facilities licensed before Sept. 11, 2003, in existing construction, what type of ventilation is required?

The facility must have adequate outside ventilation by means of windows, mechanical ventilation, or a combination of the two

If a nursing facility, as a result of waivered status, employs a licensed vocational nurse to supervise and direct nursing services, what must be done?

The facility must have an agreement with a registered nurse who must provide the vocational nurse at least four hours of consultation in the facility per week. The registered nurse must not assume director of nursing duties, but must act as a consultant to solve problems involving resident care, conduct in-service training, and maintain proper clinical records.

What documentation is required to show compliance with the communicable disease policy?

The facility must have and implement written policies for the control of communicable diseases in employees and residents and must maintain evidence of compliance with local and state health codes and ordinances regarding employee and resident health status.

What rights do residents have for postmortem procedures?

The facility must have policies regarding postmortem procedures, including soliciting and meeting the resident's or families' requests regarding notification of a death, disposition of possessions or personal property, and choice of funeral homes.

What is meant by sufficient staff?

The facility must have sufficient staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care. Nursing services to children must be provided by staff who have been instructed and have demonstrated competence in the care of children. Care and services are to be provided as specified in §19.901.

How often should gas lines be tested at the facility, and by whom?

The facility must have the gas piping lines between from the meter and appliances tested for leaks annually by a person licensed with the State Board of Plumbing Examiners.

What policies and procedures are there for the stopping of the administration of drugs?

The facility must have written policies and procedures.

What policy about resident care must be written?

The facility must have written policies to govern the nursing care and related medical or other services provided.

What if a malfunction is suspected in the fire alarm, emergency electrical or sprinkler system?

The facility must immediately investigate and correct the condition. In addition, the facility must immediately report the failure of the fire alarm, emergency electrical, or sprinkler system to all facility staff and the local fire authority.

In facilities licensed before Sept. 11, 2003, in existing construction, what procedures should be followed for the use and storage of oxygen?

The facility must implement procedures that assure the safe and sanitary use and storage of oxygen. Such procedures must be in compliance with all applicable NFPA standards, including NFPA 99.

What does TX DHS say about information regarding physicians responsible for resident care?

The facility must inform a resident of the name, specialty, and way of contacting the physician responsible for the resident's care.

What additional requirements are there for Medicaid-certified facilities in regard to Medicaid eligibility?

The facility must inform a resident who is entitled to Medicaid benefits, in writing, at the time of admission to the nursing facility or, when the resident becomes eligible for Medicaid of: (A) the items and services that are included in nursing facility services provided under the State Plan and for which the resident may not be charged; (B) those other items and services that the facility offers and for which the resident may be charged, and the amount of charges for those services;

What does TX DHS say about changes in services provided by the facility and related charges?

The facility must inform each resident before, or at the time of admission, and periodically during the resident's stay (if there are any changes), of services available in the facility and of charges for those services, including any charges for services not covered under Medicare or by the facility's per diem rate. Notice must be in writing, at least 30 days before the effective date of any changes in rates for services not covered by the current charge, or in Medicaid-certified facilities, by Medicaid.

What additional requirements are there for Medicaid-certified facilities in regard to changes in Medicaid charges?

The facility must inform each resident when changes are made to the items and services.

What must be done if the facility determines in accordance with its infection control program, that a resident needs isolation to prevent the spread of infection?

The facility must isolate the resident. Residents with communicable disease must be provided acceptable accommodations according to current practices and policies for infection control. See §19.1(b)(4)(I) for information concerning the Centers for Disease Control and Prevention (CDC) guidelines.

What is the responsibility of the facility when it comes to confidentiality of resident's records?

The facility must keep confidential all information contained in the resident's records, regardless of the form or storage method of the records.

What additional requirements are there for Trust Funds in Medicaid-Certified Facilities?

The facility must keep funds received from a resident for holding, safeguarding, and accounting, separate from the facility's funds.

What are the minimum continuing in-service education requirements for each licensed person or nurse aide? Who keeps records of the in-service training?

The facility must keep in-service records for each employee listed. The minimum requirements are: (A) licensed personnel — two hours per quarter; and (B) nurse aides — 12 hours annually. For the purpose of this paragraph, a medication aide is considered a nurse aide and must receive the same continuing in-service education.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, in addition to the required normal and emergency illumination, what else must be at each nurses' station?

The facility must keep on hand and readily available to night staff no less than one working flashlight at each nurses' station.

In facilities licensed on or after April 2, 2018, in addition to the required normal and emergency illumination _____.

The facility must keep on hand and readily available to night staff no less than one working flashlight at each nurses' station.

How long must the financial records be kept in a Medicaid-certified facility?

The facility must keep the financial records in the facility for a minimum of three years and 90 days after the termination of the contract period or for three years after the end of the federal fiscal year in which services were provided if there was a provider agreement/contract with no specific termination date in effect. The facility must also keep for the same period of time supporting fiscal documents and other records necessary to ensure claims for federal matching funds.

What condition should the hoods, exhaust ducts and filters be in the kitchen?

The facility must keep the hood, exhaust ducts, and filters clean and free of accumulated grease.

What should be the Respiratory staffing level for a facility that cares for nine or more children with tracheostomies requiring daily care (including ventilator-dependent children with tracheostomies)?

The facility must maintain a ratio of no less than one respiratory therapy staff per nine tracheostomy residents twenty-four hours a day.

What should be documented on paid feeding assistants?

The facility must maintain a record of all individuals used by the facility as paid feeding assistants who have successfully completed the state-approved training course for paid feeding assistants. At a minimum, documentation must include the date and location of the course, the name of the trainer, and a statement that the course was successfully completed.

What must be retained for the use of stamped signatures?

The facility must maintain all letters of intent on file and make them available to representatives of the Texas Department of Human Services (DHS) upon request.

In facilities licensed before Sept. 11, 2003, in existing construction, what should the facility do about pest control?

The facility must maintain an effective pest control program so that the facility is free of pests and rodents

What documentation should be maintained on the battery operated emergency lighting?

The facility must maintain an onsite written record of all tests performed and make those records available to the authority having jurisdiction during an inspection.

What is the requirement for Resident Clinical Records?

The facility must maintain clinical records on each resident, in accordance with accepted professional health information management standards and practices, that are: (A) complete; (B) accurately documented; (C) readily accessible; (D) systematically organized; and (D) protected from unauthorized release.

What documentation is required for the testing, inspecting and maintaining of fire/smoke alarm components?

The facility must maintain onsite documentation of compliance with this subsection.

What documentation should be maintained for sprinkler alarm systems?

The facility must maintain onsite documentation of compliance.

What documentation should be maintained for the emergency lighting tests?

The facility must maintain onsite documentation of compliance.

How long must the posted daily nurse staffing data be retained?

The facility must maintain the posted daily nurse staffing data for the period of time specified by facility policy or for at least two years following the last day in the schedule, whichever is longer.

What policies and procedures must a facility maintain for implementing Advance Directives for adult residents?

The facility must maintain written policies regarding the implementation of advance directives; and include a clear and precise statement of any procedure the facility is unwilling or unable to provide or withhold in accordance with an advance directive.

What documentation should be maintained for the portable fire extinguishers?

The facility must maintain, onsite, a record of all fire extinguisher inspections and maintenance performed.

What documentation should be maintained on the emergency fire extinguishment system in the kitchen?

The facility must maintain, onsite, a written and signed report of the inspection and service performed.

What documentation should be maintained for the inspection of the gas lines?

The facility must maintain, onsite, a written and signed report of these tests. The facility must note and correct any unsatisfactory conditions immediately.

Who should have access to the incident and accident reports upon request?

The facility must make incident reports available for review, upon request and without prior notice, by representatives of HHSC, the U.S. Department of Health and Human Services, if applicable; and the Texas Department of Family and Protective Services. The facility must make reports related to specific incidents available to the Ombudsman and a certified ombudsman.

What if the employee initially declines the hepatitis B vaccination but at a later date, while still at risk of directly contacting blood or potentially infectious materials, decides to accept the vaccination?

The facility must make the vaccination available within 10 days after the employee decides to accept that vaccination.

What provisions must be met to comply with Life safety from Fire?

The facility must meet the applicable provisions of NFPA 101 as designated by the federal law and regulations.

In facilities licensed before Sept. 11, 2003, which version of the NFPA must be followed?

The facility must meet the provisions of the Existing Health Care Occupancies chapter of NFPA 101.

When must a facility not charge a resident for special services?

The facility must not charge a resident, nor his representative, for any item or service not requested by the resident; not require a resident, or his representative, to request any item or service as a condition of admission or continued stay; and inform the resident or his representative, when he requests an item or service for which a charge will be made, that there will be a charge for the item or service and the amount of the charge.

What must not be done by the facility regardless of whether the resident has or has not signed an Advance Directive?

The facility must not condition the provision of care or otherwise discriminate against a resident based on whether or not the resident has executed an advance directive.

When it comes to admission into a Medicaid/Medicare-certified facility, what is the facility not allowed to require from a third-party in regard to the resident?

The facility must not require a third-party guarantee of payment to the facility as a condition of admission or expedited admission, or continued stay in the facility. However, the facility may require an individual who has legal access to a resident's income or resources available to pay for facility care to sign a contract, without incurring personal financial liability, to provide facility payment from the resident's income or resources.

When it comes to admission into a Medicaid/Medicare-certified facility, what is the facility not allowed to require from the resident?

The facility must not require residents or potential residents to waive their rights to Medicare or Medicaid; and oral or written assurance that residents or potential residents are not eligible for, or will not apply for, Medicare or Medicaid benefits.

What abusive treatment is prohibited by the facility staff?

The facility must not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion.

Who should be notified when an AED is being used?

The facility must notify the local emergency medical services provider by calling 9-1-1, per standard CPR procedures, while using an automated external defibrillator on a resident.

What if the facility cannot obtain the signature of a resident as required?

The facility must obtain the signature of a witness. The witness may not be the person responsible for accounting for the resident's trust funds, that person's supervisor, or the person who accepts the withdrawn funds or who sells the item being purchased. The facility and DADS staff must be able to identify the witness's name, address, and relationship to the resident or facility.

Are facilities required to give residents and employees influenza vaccines? When would it not be given?

The facility must offer influenza vaccinations to residents and employees in contact with residents, unless the vaccination is medically contraindicated by a physician or the employee or resident has refused the vaccination.

When should the facility offer pneumococcal vaccinations? When should the vaccine not be given?

The facility must offer pneumococcal vaccination to a resident 65 years of age or older who has not received the vaccination and to a resident younger than 65 years of age, who has not received the vaccination but is a candidate for it because of chronic illness. A pneumococcal vaccination must be offered to a current resident of a facility and to a new resident at the time of admission. A vaccination must be completed unless a physician has indicated that the vaccination is medically contraindicated or the resident refuses the vaccination.

What are the requirements for a transfer or discharge in a Medicaid-Certified Facility?

The facility must permit each resident to remain in the facility and must not transfer or discharge the resident from the facility unless: (A) the transfer or discharge is necessary for the resident's welfare, and the resident's needs cannot be met in the facility; (B) the transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility; (C) the safety of individuals in the facility is endangered; (D) the health of other individuals in the facility would otherwise be endangered; (E) the resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges under Medicaid; (F) the resident, responsible party, or family or legal representative requests a voluntary transfer or discharge; or (G) the facility ceases to operate as a nursing facility and no longer provides resident care.

What does TX DHS say about posting of information provided to the resident?

The facility must post a copy of the documents specified in a conspicuous location.

Where should evacuation routes be posted?

The facility must post building evacuation routes at prominent locations throughout the facility.

What must be done within 72 hours after admission in regard to resident property?

The facility must prepare a written inventory of the personal property a resident brings to the facility, such as furnishings, jewelry, televisions, radios, sewing machines, and medical equipment.

Where should the food be obtained for the facility?

The facility must procure food from sources approved or considered satisfactory by federal, state, and local authorities

What should be done if an employee has a communicable disease or infected skin lesions?

The facility must prohibit the employees from direct contact with residents or their food, if direct contact will transmit the disease.

What is the Right to Dignity?

The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident's dignity and respect in full recognition of the resident's individuality.

If resident funds are held after a resident's death, what must the facility tell DADs?

The facility must provide DADS with a notarized affidavit that contains: (A) the resident's name; (B) the amount of funds being held; (C) a description of the facility's efforts to locate a responsible party or heir; (D) a statement acknowledging that the funds are not the property of the facility, but the property of the deceased resident's estate; and (E) a statement that the facility will hold the funds until they are conveyed to a responsible party or heir or submitted to DADS in accordance with paragraph (4) of this subsection;

What must happen no later than the fifth working day after the date a facility receives the final statement of violations?

The facility must provide a copy of the statement to a representative of the facility's family council.

In facilities licensed before Sept. 11, 2003, in existing construction, what type of environment must be maintained?

The facility must provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public.

Generally, what environmental conditions must be provided in the facility?

The facility must provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public. The facility must: (A) establish procedures to ensure that water is available to essential areas when there is a loss of normal water supply; (B) have adequate outside ventilation by means of windows, mechanical ventilation, or a combination of the two; (C) equip corridors with firmly secured handrails on each side; (D) maintain an effective pest control program so that the facility is free of pests and rodents; and (E) establish policies, according to applicable federal, state, and local laws and regulations, regarding smoking, smoking areas, and smoking safety that also take into account non-smoking residents.

What does TX DHS say about providing a written description of a resident's legal rights?

The facility must provide a written description of a resident's legal rights which includes: (1) a description of the manner of protecting personal funds, described in §19.404; (2) a posting of names, addresses, and telephone numbers of all pertinent state client advocacy groups such as HHSC, the Ombudsman Program, the protection and advocacy network, and, in Medicaid-certified facilities, the Medicaid fraud control unit; and (3) a statement that the resident may file a complaint with HHSC concerning resident abuse, neglect, and misappropriation of resident property in the facility.

In facilities licensed before Sept. 11, 2003, in existing construction, what must the facility comply with in the terms of ADA parking accommodations?

The facility must provide and mark at least one parking space for persons with disabilities.

What kind of diet must be provided to each resident?

The facility must provide each resident with a nourishing, palatable, well-balanced diet that meets daily nutritional and special dietary needs of each resident.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the bed requirements for each resident?

The facility must provide each resident with a separate bed of proper size and height for the convenience of the resident. The bed will be a minimum of 36 inches wide with a headboard of sturdy construction. The facility must provide each bed with suitable bedspreads and blankets to assure the comfort and warmth of each resident, and must not pass bedspreads and blanket from resident to resident without first being laundered. The bed of each resident with physician's orders for bedrails must have bedrails affixed to both sides of the bed;

What is required in the way of Activities in the facility?

The facility must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interest and the physical, mental, and psychosocial well-being of each resident.

What is required in the way of Social Services in a facility?

The facility must provide medically-related social services to attain the highest practicable physical, mental, or psychosocial well-being of each resident. See also §19.901 for information concerning psychosocial functioning.

Generally, what is required for Dining and resident activity areas?

The facility must provide one or more rooms designated for resident dining and activities. These rooms must be: (A) well-lighted; (B) well ventilated, with nonsmoking areas identified; (C) adequately furnished; and (D) sufficiently spacious to accommodate all activities.

Who should be available should an emergency occur with a resident?

The facility must provide or arrange for the provision of physician services 24 hours a day, in case of an emergency.

What is the responsibility of the facility when it comes to Laboratory Services?

The facility must provide or obtain clinical laboratory services to meet the needs of its residents. The facility is responsible for the quality and timeliness of the services.

What is considered sufficient licensed nursing staff?

The facility must provide services by sufficient numbers of each of the following types of personnel on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans: (A) licensed nurses, except when waived under paragraph (3) of this subsection; and (B) other nursing personnel. (C) The facility must designate a licensed nurse to serve as a charge nurse on each shift, except when waived.

In regard to staffing requirements, how many housekeeping and maintenance staff should be employed?

The facility must provide sufficient housekeeping and maintenance personnel, equipment, and supplies to maintain the interior, exterior, and grounds of the facility in a safe, clean, orderly, and attractive manner. In a nursing facility, an employee must be designated as responsible for housekeeping services.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the general space requirements of the building?

The facility must provide sufficient space and equipment in dining, health services, recreation, and program areas to enable staff to provide residents with needed services as required by these standards and as identified in each resident's plan of care; and maintain all essential mechanical, electrical, and patient care equipment in safe operating condition.

What additional requirements are there for Medicaid-certified facilities in regard to resident rights?

The facility must provide the resident with the state-developed notice of rights under §1919 (e)(6) of the Social Security Act (see also §19.402).

How are resident funds assured?

The facility must purchase a surety bond, or otherwise provide assurance satisfactory to the Secretary of Health and Human Services to ensure the security of all personal funds of residents deposited with the facility.

What does TX DHS say about updating a resident's family information?

The facility must record and periodically update the address and phone number of the resident's family or legal representative, or a responsible party.

When should the administrator request a waiver concerning staffing levels? When is this done?

The facility must request a waiver through the local HHSC Regulatory Services Division, in writing, at any time the administrator determines that staffing will fall, or has fallen, below that required for a period of 30 days or more out of any 45 days.

What safety precautions must be taken so there is a reduced chance of the spread of a communicable disease?

The facility must require staff to wash their hands after each direct resident contact for which handwashing is indicated by accepted professional practice.

What if the facility determines or suspects that a resident has been exposed to a communicable disease or has a positive screening?

The facility must respond according to the current CDC guidelines and attending physician's recommendations, and keep documentation of the response.

What if it is determined or suspected that an employee or person providing services under an outside resource contract has been exposed to or has a positive screening for a communicable disease?

The facility must respond according to the current CDC guidelines and keep documentation of the action taken. The facility must then conduct and document a reassessment of the risk classification. The facility must conduct and document subsequent screening based upon the reassessed risk classification.

How long must documentation for the kitchen be retained?

The facility must retain records of menus served and food purchased for 30 days. A list of residents receiving special diets and a record of their diets must be kept in the dietary area for at least 30 days.

When should the inventory of resident property be revised?

The facility must revise the written inventory to show if property is lost, destroyed, damaged, replaced, or supplemented.

What is required before an employee or outside vendor can provide services in a facility in regard to Tb?

The facility must screen all employees before providing services in the facility, according to CDC guidelines. The facility must require all persons providing services under an outside resource contract to provide evidence of a current tuberculosis screening prior to providing services in the facility. The facility must document or keep a copy of the evidence provided.

Before a facility hires an unlicensed employee, what must be done? Where is this done?

The facility must search the employee misconduct registry (EMR) established under §253.007, Texas Health and Safety Code, and the DADS nurse aide registry (NAR) to determine whether the individual is designated in either registry as unemployable. Both registries can be accessed on the DADS Internet website.

After an investigation of abuse has been conducted, when is the written report of the findings due to DADS?

The facility must send a written report of the investigation to DADS no later than the fifth working day after the oral report.

Under what environmental conditions should medications be stored?

The facility must store medications under appropriate conditions of sanitation, temperature, light, moisture, ventilation, segregation, and security.

If a formal hearing on a trust fund audit is requested, what is the process?

The facility must submit a written request for a formal hearing under this section to: HHSC Appeals Division, Mail Code W-613, P.O. Box 149030, Austin, Texas 78714-9030.

What must happen within 10 working days after receipt of the final statement of violations?

The facility must submit an acceptable plan of correction to the regional director, except plans of correction under §19.2112(i).

Who should oversee the emergency generator?

The facility must use a properly instructed person to oversee and execute the program.

Can the public have access to the postings about the Nursing Staff?

The facility must, upon oral or written request, make copies of nurse staffing data available to the public for review at a cost not to exceed the community standard rate.

What must be done by the facility in regard to radiology or other diagnostic services?

The facility must: (A) provide or obtain radiology and other diagnostic services only when ordered by the attending physician; (B) promptly notify the attending physician of the findings; (C) assist the resident in making transportation arrangements to and from the source of service, if the resident needs assistance; and (D) file in the resident's clinical record signed and dated reports of x-ray and other diagnostic services.

Who will receive the findings of a quality-of-care monitor?

The findings of a monitoring visit, both positive and negative, orally and in writing to the facility administrator or, in the absence of the facility administrator, to the administrator on duty or the director of nursing.

Under what conditions can a graduate nurse with a temporary work permit work in a facility?

The graduate nurse who has a temporary work permit must work under the direction of a registered nurse until registration has been achieved.

In facilities licensed before Sept. 11, 2003, in existing construction, what heating requirements are there for the facility?

The heating system must be capable of maintaining a temperature of not less than 71° F at the resident level in all resident-use areas.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what temperature must the heating system be designed to maintain?

The heating system must be designed, installed, and functioning to be able to maintain a temperature of at least 75° F for all areas occupied by residents. For all other occupied areas, the indoor design temperature must be at least 72° F. The cooling system must be designed, installed, and functioning to be able to maintain a temperature of not more than 78° F.

When a resident is in a facility under hospice care, who retains overall professional management responsibility for directing the implementation of the plan of care related to the terminal illness and related conditions?

The hospice

What must the notice of change of ownership include?

The identity of each new individual or company.

Exploitation

The illegal or improper act or process of a caregiver, family member, or other individual who has an ongoing relationship with a resident using the resources of the resident for monetary or personal benefit, profit, or gain without the informed consent of the resident.

The qualified dietitian must be a part of _____.

The interdisciplinary team conducting assessment and care planning where indicated by the individual resident's needs.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the cold water supply system regulations?

The interior cold water supply system and piping must be so placed or so insulated as to prevent condensation drip in habitable areas and in storage areas.

In facilities licensed before Sept. 11, 2003, in existing construction, what is the water requirements for a kitchen?

The kitchen must have an adequate supply of hot and cold water. Hot water for sanitizing purposes must be 180° F or the manufacturer's suggested temperature for chemical sanitizers, as specified for the system in use. For mechanical dishwashers, the temperature measurement is at the manifold. Hot water for general kitchen use must be 140° F.

In facilities licensed before Sept. 11, 2003, in existing construction, what dishwashing facilities are required?

The kitchen must have facilities for washing and sanitizing dishes and cooking utensils. These facilities must be adequate for the number of meals served and the method of serving, such as use of permanent or disposable dishes. The kitchen must contain a multi-compartment sink large enough to immerse pots and pans. In all facilities, a mechanical dishwasher is required for sanitizing dishes. The facility must maintain separation of soiled and clean dish areas including air flow and traffic flow.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the exit provisions for the landing outside each exit door?

The landing outside of each exit door must be essentially the same elevation as the interior floor and level for a distance equal to the door width plus at least 4'. Generally, the difference in floor elevation at an exterior door must not be over 1/2" with the outside slope not to exceed 1/4" per foot sloping away from the door for drainage on the exterior. In locations north of the +20 Fahrenheit Isothermal Line as defined in the ASHRAE Handbook of Fundamentals, the landing outside of all exit doors must be protected from ice build-up which would prohibit the door from opening and be a slip hazard.

If a license holder changes its name, but does not undergo a change of ownership, what must be done?

The license holder must notify DADS and submit a copy of a certificate of amendment from the Secretary of State's office. On receipt of the certificate of amendment, the current license will be re-issued in the license holder's new name.

When should DADS be notified of a significant adverse change in its financial condition?

The license holder must notify DADS in writing of a significant adverse change in its financial condition within 72 hours after the license holder becomes aware of or should have become aware of change.

When must the license holder notify DADS after the license holder becomes aware of or should have become aware of the loss and imminent loss of the right to possession of the facility? How is this done?

The license holder must notify DADS in writing within 72 hours.

If requested, what must be provided to DADS about financial condition compliance?

The license holder must provide any other information DADS requests to substantiate continued compliance with the requirements of this section within 30 days after the request.

In facilities licensed on or after April 2, 2018, what are the requirements for general lighting in the bedrooms?

The light providing general illumination must be switchable at the door of the resident room for use of staff and residents.

For Small House and Household Facilities, what are the living area requirements?

The living area requirements in §19.354(e) of this subchapter and dining room requirements in §19.354(f) of this subchapter must be met, except the distance between the floor and the window sill of a window in the living or dining room must not exceed 36 inches, to allow a view to the outside from a seated position.

In facilities licensed on or after April 2, 2018, what is required in the lobby area? Is this counted as resident living space?

The lobby, which may also be designed to satisfy a portion of the minimum area required for resident living room space, must include: (i) storage space for wheelchairs if more than one is kept available; (ii) a reception or information area, which may be adjacent to the lobby if the location is obvious; (iii) waiting space; (iv) public toilet facilities for individuals with disabilities, which may be adjacent to the lobby; (v) at least one public access telephone, installed to meet standards under the Americans with Disabilities Act; and (vi) a drinking fountain, which may be provided in a common public area and at least one of which must be installed to meet standards under the Americans with Disabilities Act.

In facilities licensed on or after April 2, 2018, what are the requirements for air diffusers, registers and return air grilles?

The location and design of air diffusers, registers, and return air grilles must ensure that residents are not in harmful or excessive drafts in their normal usage of the room.

In facilities licensed on or after April 2, 2018, what is the maximum capacity of a bedroom?

The maximum room capacity must be two residents.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is the maximum temperature for food storage areas? Where is this measurement taken?

The maximum room temperature for food storage must not exceed 85° F at any time. The measurement must be taken at the highest food storage level but not less than five feet from the floor.

In facilities licensed on or after April 2, 2018, what is the maximum room temperature for the food storage area? Where is this measured?

The maximum room temperature for food storage must not exceed 85° F at any time. The measurement must be taken at the highest food storage level but not less than five feet from the floor.

In facilities licensed before Sept. 11, 2003, in existing construction, what is the maximum allowed temperature for the food storage area?

The maximum room temperature for food storage must not exceed 85° F. The measurement must be taken at the five-foot level.

What are the responsibilities of a medical director?

The medical director is responsible for: (A) implementation of resident care policies (see §19.1922); and (B) the coordination of medical care in the facility.

What should be done if the directions for administration of a resident's medication have changed, but the existing supply of medication can still be administered accurately?

The medication must not be destroyed. The facility must affix a change-of-direction ancillary sticker or similar system and use the remaining medication. The medication label must be updated at the time of next dispensing.

In facilities licensed on or after April 2, 2018, what is required in the medication preparation room?

The medication preparation room must be under the nursing staff's visual control and contain a work counter, refrigerator, sink with hot and cold water, and locked storage for biologicals and drugs.

In facilities licensed on or after April 2, 2018, what are the vision panels in smoke barrier doors to be made of? What else is in the requirements?

The metal frame for a vision panel in a smoke barrier door must be steel, unless otherwise approved by HHSC. The bottom of a vision panel must be located no more than 43" above the floor. A facility must provide push or pull hardware on pairs of opposite swinging, double egress smoke barrier doors in corridors. Door leaves must align in the closed position.

In facilities licensed before Sept. 11, 2003, in existing construction, what must the resident monitoring systems NOT do?

The monitoring systems must not be used to deny privacy to staff or residents.

What and where should a communicable disease be reported? What happens then?

The name of any resident with a reportable disease as specified in Title 25, Chapter 97, Subchapter A must be reported immediately to the city health officer, county health officer, or health unit director having jurisdiction, and appropriate infection control procedures must be implemented as directed by the local health authority.

In facilities licensed on or after April 2, 2018, what are the requirements on night lighting in the bedrooms?

The night light must be switched just inside the entrance to each resident room with a silent type switch, must be a recessed wall mounted fixture just inside the entry door to the room and must not be obstructed by the door or furniture, unless otherwise approved by HHSC.

For Small House and Household Facilities, what are the night lighting requirements?

The night lighting requirement in §19.354(a)(5) must be met, except it must be a recessed wall mounted fixture just inside the entry door to the room and must not be obstructed by the door or furniture

How many hours are required for a consulting pharmacist?

The number of hours per month the consultant pharmacist devotes to the pharmaceutical services for ordering, storage, administration, disposal, recordkeeping (documentation) of drugs and medications, and drug regimen review must be sufficient to meet the needs of the residents

When special nurses or sitters are used, who is responsible for resident care?

The nursing facility is responsible for meeting the needs of the residents regardless of the presence of special nurses or sitters.

In facilities licensed before Sept. 11, 2003, in existing construction, what mechanical means may be used for resident observation?

The nursing facility may use closed-circuit television or mirrors to observe residents in the facility.

How much linen should be available for use?

The nursing facility must have available at all times a quantity of linen essential for the proper care and comfort of residents.

When a facility is required to refund private funds paid to a facility for periods covered by Medicaid, including retroactive periods of Medicaid coverage, when is this refund due?

The nursing facility must make the refund within 30 days of: (A) notification of eligibility for nursing home coverage; (B) notification of correction of applied income (see also §19.2316(f) which specifies procedures concerning applied income refunds at the time of discharge); or (C) receipt of any vendor payment from DHS for any covered period.

What is the responsibility of the facility in regard to Radiology or other Diagnostic Services?

The nursing facility must provide or obtain radiology and other diagnostic services to meet the needs of its residents. The facility is responsible for the quality and timeliness of the services.

What must be provided to the resident or legal representative upon transfer to a hospital or for therapeutic leave?

The nursing facility must provide to the resident and a family member or legal representative, written notice which specifies the duration of the bed-hold policy.

After a waiver is granted for the 24-hour licensed nurse requirement, what does the facility do?

The nursing facility that is granted a waiver by the state notifies residents of the facility (or, when appropriate, the guardians or legal representatives of the residents) and members of their immediate families of the waiver.

For Small House and Household Facilities, what are the nursing service area requirements?

The nursing service area requirements in §19.354(b) must be met, except: (A) a nursing staff lounge is not required in a small house facility; (B) the nursing staff toilet room may also be a toilet room for kitchen staff; the public; or a general bathing room, if the toilet room opens into the general bathing room and common areas; and (C) the nourishment station may be part of the residential kitchen area.

The NF and hospice must ensure that the coordinated plan of care reflects _____.

The participation of the hospice, the NF, the recipient, and the recipient's legal representative to the extent possible.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what must be on the structural design plans?

The parts of the plans, details, and specifications covering the structural design must bear the legible seal of the engineer on the original drawings from which the prints are made.

In facilities licensed on or after April 2, 2018, what must be on the structural plan designs?

The parts of the plans, details, and specifications covering the structural design must bear the legible seal of the engineer on the original drawings from which the prints are made.

In facilities licensed on or after April 2, 2018, what performance requirements must be met for electrical systems?

The performance requirements of NFPA 99.

When must the allegation of abuse be reported?

The person reporting must make the telephone report immediately on learning of the alleged abuse, neglect, exploitation, conduct, or conditions. The person must send a written report to DADS Consumer Rights and Services within five days after the telephone report.

What documentation should be maintained for generator maintenance?

The person who executes the program must maintain a signed and dated record or log of inspections, tests and maintenance performed.

Who licenses the people who work on sprinkler alarm systems?

The person who performs a service under the contract must be licensed by the State Fire Marshal's Office to perform the service and must complete, sign and date an inspection form similar to the inspection and testing form in NFPA 25 for a service provided under the contract.

Who licenses the people who work on fire alarm systems?

The person who performs a service under the contract must be licensed by the State Fire Marshal's Office to perform the service and must complete, sign and date an inspection form similar to the inspection and testing form in NFPA 72 for a service provided under the contract.

If abuse or neglect of the resident is reported to the facility and the facility requests a copy of any relevant tape or recording made by an electronic monitoring device, what is the responsibility of the person in possession of the recording? Who responsibility is it to pay for the requested recording?

The person who possesses the tape or recording must provide the facility with a copy at the facility's expense. The cost of the copy must not exceed the community standard.

What should happen if the consulting pharmacist finds irregularities in the drug regimen review?

The pharmacist must report any irregularities to the attending physician and the director of nursing, and these reports must be acted upon.

What special qualifications does a physician's delegate need when dealing with children in a nursing facility?

The physician extender providing care to a pediatric resident must have training and expertise in the care of children with complex medical needs.

When should communicable disease be reported, and by whom?

The physician must report all reportable communicable diseases immediately according to the requirements specified in §19.1601(2)(D).

Covert electronic monitoring

The placement and use of an electronic monitoring device that is not open and obvious, and the facility and HHSC have not been informed about the device by the resident, by a person who placed the device in the room, or by a person who uses the device.

Authorized electronic monitoring

The placement of an electronic monitoring device in a resident's room and using the device to make tapes or recordings after making a request to the facility to allow electronic monitoring.

When does a respite plan of care need to be filed out with the facility?

The plan must be filed at the facility before the facility admits the individual.

Who should have access to the policy and procedures of the facility?

The policies and procedures must be available to all of the facility's governing body's members, staff, residents, family or legal representatives of residents, and the public.

What should be contained in the administrative policy and procedure manual?

The policies and procedures related to admission and admission agreements, resident care services, refunds, transfers and discharges, termination from Medicaid or Medicare participation in accordance with §19.2121, receiving and responding to complaints and recommendations, and protection of residents' personal property and civil rights.

What is the primary purpose of an investigation into complaints of abuse, neglect or exploitation?

The protection of the resident. If, before the completion of an investigation, DADS determines that the immediate removal of the resident is necessary to protect the resident from further abuse or neglect, DADS will petition a court to allow the immediate removal of the resident from the facility.

What if the provider desires to provide and administer the provider's own educational program(s)?

The provider must secure and maintain certification as a nonpublic school from the Texas Education Agency.

What is Respite care?

The provision by a facility to an individual, for not more than two weeks for each stay in the facility, of room, board, and care at the level ordinarily provided for permanent residents.

A facility fire safety plan must be implemented that includes:

The provisions described in the Operating Features section of the NFPA 101, Chapter 18, New Health Care Occupancies, and Chapter 19, Existing Health Care Occupancies, and concerning: (A) use of alarms; (B) transmission of alarm to fire department; (C) emergency phone call to fire department; (D) response to alarms; (E) isolation of fire; (F) evacuation of immediate area; (G) evacuation of smoke compartment; (H) preparation of floors and building for evacuation; and extinguishment of fire

If the Social Security Administration has determined that a Title II and Title XVI Supplemental Security Income (SSI) benefit to which the resident is entitled should be paid through a representative payee, what should happen?

The provisions in 20 Code of Federal Regulations (CFR), §§404.2001 - 404.2065, for Old Age, Survivors, and Disability Insurance benefits and 20 CFR, §§416.601 - 416.665, for SSI benefits apply.

What right do residents have in regard to choice of provider for Medicaid-certified facilities?

The recipient must be allowed complete freedom of choice to obtain any Medicaid services from any institution, agency, pharmacy, person, or organization that is qualified to perform the services, unless the provider causes the facility to be out of compliance with the requirements specified in this chapter. (A) A facility must not require recipients to purchase supplies or services, including pharmaceutical supplies or services, from the facility itself or from any particular vendor. The recipient has the right to be informed of prices before purchasing any item or services from the facility, except in an emergency (see §19.1502(b)(3)). (B) The facility must furnish Medicaid recipients with complete information about available Medicaid services, how to obtain these services, their rights to freely choose service providers and the right to request a hearing before the Texas Department of Human Services (DHS) if the right to freely choose providers has been abridged without due process.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, where should remote annunciator panels be located?

The remote panel, indicating location of alarm initiation, by zone or device, and trouble indication, must be located at auxiliary or secondary nurse stations on each floor, and will indicate the alarm condition of adjacent zones and the alarm conditions at all other nurse stations.

What if a complaint or incident report does not include the required identifying information on the resident or person reporting the incident?

The report may be considered a complaint or an incident report not meeting the reporting criteria and may be investigated using other procedures. In receiving an oral report, DADS will take all reasonable steps to elicit from the reporter all the information.

What must each incident or complaint report reflect?

The reporting person's belief that a resident has been or will be abused or neglected.

In facilities licensed on or after April 2, 2018, branch circuits serving resident bedrooms must meet _____.

The requirements of NFPA 99.

In facilities licensed on or after April 2, 2018, what requirements must be met for lighting and outlets at resident bedrooms?

The requirements of §19.354 (relating to New Facilities).

In facilities licensed on or after April 2, 2018, what requirements must be met for fire protection systems, including fire alarms?

The requirements of §19.357 (relating to New Facilities).

For Small House and Household Facilities, what resident bedroom requirements must be met?

The resident bedroom requirements in §19.354(a) must be met, except a bedroom must be occupied by only one resident; or by two residents, if they are members of the same family and the bedroom size, furniture, and headboard wall requirements for double occupancy are met;

What are the basic resident rights?

The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility. A facility must protect and promote the rights of each resident.

What does the right to be free of restraints mean?

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

What is meant by the freedom from abuse?

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

What does TX DHS say about notification of a resident's health status?

The resident has the right to be fully informed in language the resident understands of the resident's total health status, including the resident's medical condition.

What is meant by the right "Free Choice"?

The resident has the right to choose and retain a personal attending physician, subject to that physician's compliance with the facility's standard operating procedures for physician practices in the facility; be fully informed in advance about care and treatment and of any changes in that care or treatment that may affect the resident's well-being; and unless adjudged incompetent or otherwise found to be incapacitated under the laws of the State of Texas, participate in planning care and treatment or changes in care and treatment. See §19.419.

What are a resident's rights regarding managing financial affairs?

The resident has the right to manage his financial affairs and the facility may not require residents to deposit their personal funds with the facility. The resident may designate another person to manage his financial affairs.

What is meant by a resident's right to privacy and confidentiality?

The resident has the right to personal privacy and confidentiality of his personal and clinical records. (See also §19.1910(e) and §19.403(e)).

What does TX DHS say about refusing treatment?

The resident has the right to refuse treatment. If the resident refuses treatment, the resident must be informed of the possible consequences.

What is meant by the right to Personal Property?

The resident has the right to retain and use personal possessions, including some furnishings, and appropriate clothing as space permits, unless to do so would infringe upon the rights or health and safety of other residents. Reasons for any limitations are documented in the resident's clinical record. See §19.1921(i).

What is meant by the Right to Examine Survey Results?

The resident has the right to: (A) examine the results of the most recent survey of the facility conducted by federal or state surveyors and any plan of correction in effect with respect to the facility. The facility must make the results available for examination in a place readily accessible to residents, and must post a notice of their availability; and (B) receive information from agencies acting as client advocates, and be afforded the opportunity to contact these agencies.

What is meant by the Right to Work?

The resident has the right to: (A) refuse to perform services for the facility; and (B) perform services for the facility, if he chooses, when the facility has documented the need or desire for work in the plan of care; the plan specifies the nature of the services performed and whether the services are voluntary or paid; compensation for paid services is at or above prevailing rates; and the resident agrees to the work arrangement described in the plan of care.

What is meant by the right to privacy in written communications?

The resident has the right to: (A) send and receive mail promptly that is unopened; (B) request facility staff to help open and read incoming mail and help address and post outgoing mail; (C) have access to stationery, postage, and writing implements at the resident's own expense.

Who chooses the pharmacy provider for residents if the facility does not pay for the drugs? Where is this documented?

The resident's choice of pharmacy provider and any changes in his choice must be recorded on appropriate forms maintained by the facility. The resident's choice of pharmacy provider must be in accordance with §19.406(c).

In facilities licensed before Sept. 11, 2003, in existing construction, if a resident's bedroom is more than 150 feet from a nurse's or auxiliary station, what are the requirements for line of site?

The resident's room must be observable by direct line of sight from the designated nurses' station or auxiliary station. Corridors located in the service area of an auxiliary station must be observable at the auxiliary station.

Who is responsible for the AEM?

The resident, or the resident's guardian or legal representative, must pay for all costs associated with conducting AEM, including installation in compliance with life safety and electrical codes, maintenance, removal of the equipment, posting and removal of the notice, or repair following removal of the equipment and notice, other than the cost of electricity.

What if a facility employee is responsible for the loss of funds in a resident's trust fund account?

The resident, the resident's family, and the resident's legal representative are not obligated to make any payments to the facility that would have been made out of the trust fund had the loss not occurred.

What is the review of building plans based on?

The review of plans and specifications by HHSC is based on general utility, the minimum licensing standards, and conformance with NFPA 101.

What is meant by the Right to Voice Grievances?

The right to voice grievances without discrimination or reprisal. These grievances include those with respect to treatment which has been furnished as well as that which has not been furnished; prompt efforts by the facility to resolve grievances the resident may have, including those with respect to the behavior of other residents; and notify state agencies of complaints against a facility. Complaints will be acknowledged by the staff of the agency that receives the complaint. All complaints will be investigated, whether oral or written.

Are HIPAA rules violated by releasing resident information to an Ombudsman?

The rules adopted under the Health Insurance Portability and Accountability Act of 1996, 45 CFR Part 164, Subparts A and E, do not preclude a facility from releasing protected health information or other identifying information regarding a resident to the State Ombudsman or a certified ombudsman if the requirements are met. The State Ombudsman and a certified ombudsman are each a "health oversight agency" as that phrase is defined in 45 CFR §164.501.

What rules must the facility comply with in regard to nurse aide training and registry rules?

The rules found in Title 40, Texas Administrative Code, Chapter 94.

When would a waiver of the requirement to provide services of a registered nurse for more than 40 hours a week in a Medicare skilled nursing facility (SNF) be granted?

The secretary of the U.S. Department of Health and Human Services (secretary) may waive the requirement that a Medicare SNF provide the services of a registered nurse for more than 40 hours a week, including a director of nursing, if the secretary finds that: (A) the facility is located in a rural area and the supply of Medicare SNF services in the area is not sufficient to meet the needs of individuals residing in the area; (B) the facility has one full-time registered nurse who is regularly on duty at the facility 40 hours a week; and (C) the facility either has only residents whose physicians have indicated (through physician's orders or admission notes) that they do not require the services of a registered nurse or a physician for a 48-hour period; or made arrangements for a registered nurse or a physician to spend time at the facility, as determined necessary by the physician, to provide necessary skilled nursing services on days when the regular full-time registered nurse is not on duty.

In facilities licensed before Sept. 11, 2003, in existing construction, if residents are allowed to do their own laundry, what must be provided?

The service must be limited to not more than one residential type washer and dryer per laundry room. This room must be classified as a hazardous area according to the NFPA 101.

In facilities licensed on or after April 2, 2018, where must the sewage system be connected?

The sewage system must connect to a system permitted by the Water Quality Division of TCEQ, or to a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Quality Division of TCEQ.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, who must approve the sewage system?

The sewage system must connect to a system permitted by the Watershed Management Division, Texas Natural Resources Conservation Commission, or to a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Utility Division, Texas Natural Resources Conservation Commission.

In facilities licensed on or after April 2, 2018, what are the size requirements for nursing service areas?

The size and disposition of each service area will depend upon the number and types of beds to be served.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the requirements for nursing area sizes?

The size and disposition of each service area will depend upon the number and types of beds to be served. Each service area may be arranged and located to serve more than one nursing unit, but at least one service area must be provided on each nursing floor. The maximum allowable distance from a resident room door to a nurses' station is 150 feet.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the size requirements for various departments?

The sizes of the various departments will depend upon program requirements and organization of services within the facility. Some functions requiring separate spaces or rooms in these minimum requirements may be combined provided that the resulting plan will not compromise the best standards of safety and of medical and nursing practices.

In facilities licensed on or after April 2, 2018, what is the required size of the various departments?

The sizes of the various departments will depend upon program requirements and the organization of services within the facility. Some functions requiring separate spaces or rooms in these minimum requirements may be combined, provided that the resulting plan will not compromise the best standards of safety and of medical and nursing practices.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the regulations for the storage and use of oxygen?

The storage and use of oxygen and equipment must meet applicable NFPA standards for oxygen, including NFPA 99.

In facilities licensed on or after April 2, 2018, what is required for oxygen storage?

The storage and use of oxygen and oxygen equipment must meet applicable NFPA standards for gas equipment, including NFPA 99. Piped medical gas and vacuum systems must comply with §19.360(e) (relating to New Facilities).

In facilities licensed before Sept. 11, 2003, in existing construction, what is the requirement when it comes to hot water supply?

The supply quantity of hot water must be adequate for normal peak load usage. Facilities which continue to experience a shortage of hot water must remedy the situation by such means as adding storage tanks, adding or increasing the size of water heaters, or other approved means.

Misappropriation of funds

The taking, secretion, misapplication, deprivation, transfer, or attempted transfer to any person not entitled to receive any property, real or personal, or anything of value belonging to or under the legal control of a resident without the effective consent of the resident or other appropriate legal authority, or the taking of any action contrary to any duty imposed by federal or state law prescribing conduct relating to the custody or disposition of property of a resident.

What should be provided to the immediate family member of a resident upon their admission in regard to neglect and abuse?

The telephone number for reporting cases of suspected abuse, neglect, or exploitation.

If the facility uses licensed temporary nursing personnel, what are the required qualifications of the temporary personnel?

The temporary personnel must have the same qualifications that permanent facility employees do. If temporary personnel are used for afternoon or night shifts, a full-time, licensed nurse must be on call and immediately available by telephone. The on-call nurse must be a registered nurse unless the facility has a current waiver from DHS and is not required to provide daily RN coverage.

What term may not be used as a part of the name of a nursing facility? What are the exceptions?

The term "hospital", unless it has been classified and duly licensed as a hospital by the appropriate state agency.

For Small House and Household Facilities, what are the toilet facility requirements?

The toilet requirements in §19.354(a)(7) must be met, except a bathroom must serve no more than one resident room and must include a lavatory, toilet, and a shower or bathing unit;

In facilities licensed before Sept. 11, 2003, in existing construction, what is the total number of rooms in the facility that can accommodate more than 3 residents?

The total number of beds in ward rooms with three or more beds must not exceed 50% of the total facility capacity in existing facilities unless approved by the HHSC.

What data must be posted at the beginning of each shift about the Nursing staff?

The total number of hours and actual time of day to be worked by the following licensed and unlicensed nursing staff, including relief personnel directly responsible for resident care: (A) RNs; (B) LVNs; and (C) CNAs.

In facilities licensed on or after April 2, 2018, what are the requirements for the components of a nurse call system?

The units must be compatible and laboratory listed by a nationally recognized testing laboratory for the system and use intended.

What are the requirements for documents that are sent through electronic means?

The use of electronic data transmission of facsimiles (faxing) is acceptable for sending and receiving health care documents, including the transmission of physicians' orders. Long term care facilities may utilize electronic transmission if they adhere to the following requirements: (A) The facility must implement safeguards to assure that faxed documents are directed to the correct location to protect confidential health information. (B) All faxed documents must be signed by the author before transmission.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what is required in regard to pressure relationships for ventilation systems?

The ventilation systems must be designed and balanced to provide the pressure relationship as shown in the table. A final engineered system air balance report will be required for the completed system to be furnished and certified by the installer.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the requirements when it comes to wastewater?

The wastewater drainage and sewage system must assure that sanitation is maintained for residents. Wastewater or sewage must not be discharged on the surface of the ground. Traps must not be allowed to lose their seal. Appliances must have air gaps as required for connections to the sewerage system. Venting must assure a rapid flow of wastewater in the sewage system.

In facilities licensed before Sept. 11, 2003, in existing construction, what are the regulations for water supply?

The water supply must be of safe, sanitary quality, suitable for use, and adequate in quantity and pressure. The water must be obtained from a water supply system, the location, construction, and operation of which are approved by the Texas Natural Resource Conservation Commission.

In facilities licensed on or after April 2, 2018, what are the requirements on the wiring for the EES?

The wiring circuits for the EES must be kept entirely independent of all other wiring and must not enter the same race-ways, boxes, or cabinets according to NFPA 70.

What must be contained in the written policy about resident care?

The written policies must include plans for promoting self-care and independence. If children are admitted to the facility, written policies must address the care of children, consistent with currently acceptable pediatric practice and should address the ongoing assessment of the potential for community reintegration.

In facilities licensed on or after April 2, 2018, what provision should be made for hand drying and toothbrush storage at lavatories?

There must be paper towel dispensers or separate towel racks and separate toothbrush holders.

In facilities licensed on or after April 2, 2018, what regulations must be followed for fire protection systems?

These systems must meet the requirements of NFPA 101, and of this section. Components must be compatible and listed by a nationally recognized testing laboratory for the intended use. Fire protection systems must meet the requirements of all applicable NFPA standards, such as NFPA 72 for alarm systems, as referenced in NFPA 101. Wiring and circuitry for alarm systems must meet the applicable requirements of NFPA standards, including NFPA 70.

What is the TX DHS's policy on services that are offered to residents?

They are not required to offer additional services on behalf of a recipient other than services provided in the State Plan.

What are the roles of Quality-of-care monitors in the detection of conditions that may be detrimental to the health, safety and welfare of residents?

They conduct visits that may be announced or unannounced and may occur on any day and at any time, including nights, weekends, and holidays.

Who may be counted in the licensed-care ratio?

They include, but are not limited to, director of nursing, assistant directors of nursing, staff development coordinators, charge nurses, and medication/treatment nurses.

What will happen to the amounts paid to Medicaid-certified facilities in the per diem payment to meet the staffing requirements?

They may be adjusted if staffing requirements are not met.

Without DADS prior written approval, what is a facility not allowed to do about alternate forms of documentation and resident personal funds?

They may not submit alternate forms of documentation, including affidavits, to verify a resident's personal fund expenditures or as proof of compliance with any requirements specified in these requirements for the resident's personal funds.

What type of policy must be adopted by the Quality Assessment and Assurance Committee?

They must adopt and ensure implementation of a policy to identify, assess, and develop strategies to control risk of injury to residents and nurses associated with the lifting, transferring, repositioning, or moving of a resident.

In facilities licensed on or after April 2, 2018, what are the requirements for smoke compartments?

They must be as described in NFPA 101 and in this section.

In facilities licensed on or after April 2, 2018, if HVAC systems serving spaces or providing health functions covered by NFPA 99, then _____.

They must be commissioned as required by NFPA 99.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the requirements for sprinkler systems?

They must be in accordance with §19.340(4). The sprinkler system must be monitored for flow and tamper conditions by the fire alarm system.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the requirements for the emergency electrical systems?

They must be in accordance with §19.341.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the requirements for partial sprinkler systems (those provided only for hazardous areas)?

They must be interconnected with the fire alarm and comply with the Life Safety Code. Each partial system must have a valve with a supervisory switch to sound a trouble signal, water flow switch to activate the fire alarm, and an end-of-line test drain.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, where should fire alarm bells or horns be located?

They must be located throughout the building for audible coverage. Flashing alarm lights (visual alarms) must be installed to be visible in corridors and public areas including dining rooms and living rooms in a manner that will identify exit routes.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, where should manual pull stations be located?

They must be provided at all exits, living rooms, dining rooms, and at or near the nurse stations.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what are the requirements for portable fire extinguishers?

They must be provided throughout the facility as required by NFPA Standard 10 and as determined by the local fire department and the Texas Department of Human Services. Extinguishers in resident corridors must be spaced so that travel distance is not more than 75 feet. The minimum size of extinguishers must be either 2 1/2 gallon for water type or 5 pound for ABC type.

What should be done with the medications of deceased residents, expired medications and discontinued ones?

They must be securely stored and reconciled. These medications must be disposed of according to federal and state laws or rules on a quarterly basis. Discontinued drugs may be reinstated if reordered prior to destruction. These medications cannot be given to a family member or representative.

In facilities licensed on or after April 2, 2018, how many elevators are required if the facility has more than 350 resident beds?

They must determine the number of elevators required from a study of the facility plan and the estimated vertical transportation requirements.

What provisions are made in regard to Advance Directives when it comes to children?

They must ensure that prior to admission to the facility, the primary physician, who has been providing care to the child, has discussed advance directives with the family or guardian and has provided documentation of this discussion to the facility; and the decision made by the family or guardian regarding advance directives is addressed in the comprehensive care plan (see §19.802).

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the provisions for smoke barrier walls in concealed spaces such as attics?

They must have prominent signs on each side that read: "Warning: Smoke/fire barrier. Properly seal all openings."

What is required of Medicaid-certified facilities when it comes to pharmacy providers?

They must have written agreements with its provider pharmacies that define required services. These agreements will not be considered to abridge the resident's freedom of choice of pharmacy services when they require labeling, packaging, and a drug-distribution system according to facility policy. The drug-distribution system must be accessible to all pharmacies willing to meet the distribution system requirements.

What educational requirements are there for a nursing facility that accepts school-age residents, ages 3 through 21?

They must provide assurances to the Texas Department of Human Services (DHS) that it has: (A) established a written cooperative agreement with the local independent school district that includes: (B) developed written policies and procedures to ensure that all eligible school-age residents, ages 3 through 21, who have neither successfully graduated from nor completed an approved school program are enrolled in a Texas Education Agency-approved educational program.

What is required of Medicaid-certified facilities when it comes to dental care?

They must provide or obtain from an outside resource, in accordance with §19.1906, the following dental services to meet the needs of each resident: (A) Emergency dental services, which are limited to procedures necessary to control bleeding, relieve pain, and eliminate acute infection; operative procedures which are required to prevent the imminent loss of teeth; treatment of injuries to the teeth or supporting structures. (B) assistance to the resident, if necessary: in making appointments, and by arranging for transportation to and from the dentist's office. (C) prompt referral of residents with lost or damaged dentures to a dentist. (D) coordination of dental services for pediatric residents age 12 months to 21 years, in accordance with Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) guidelines.

What is the responsibility of Medicaid-certified facilities when it comes to obtaining drugs for residents?

They must provide routine and emergency drugs and biologicals to its residents, or obtain them under an agreement described in §19.1906. See also §19.901(12) and (13) for information concerning drug therapy and medication errors.

How will the violations of regulations be presented?

They will be listed on forms designed for the purpose of the inspection or will be listed in letter form when administrative penalties are being proposed.

What if the quality-of-care monitor observes conditions that may constitute an immediate threat to the health or safety of a resident?

They will immediately report the conditions to the facility administrator, the monitor's regional office supervisor for appropriate action and, as appropriate, to law enforcement, adult protective services, other divisions of HHSC, and other agencies.

If a palliative plan of care is needed in the comprehensive assessment, who should make the request? What should be included?

This plan may be developed only at the request of the resident, surrogate decision maker or legal representative for residents with terminal conditions, end stage diseases or other conditions for which curative medical interventions are not appropriate. The plan of care must have goals that focus on maintaining a safe, comfortable and supportive environment in providing care to a resident at the end of life.

What is the review of building plans not?

This review must not be construed as all-inclusive approval of the structural, electrical, or mechanical components, nor does it constitute the review of required building plans for compliance with the TAS as administered and enforced by the Texas Department of Licensing and Regulation.

What facilities must abide by the Small House and Household Facility requirements?

This section applies to a small house or household facility that is designed to provide a non-institutional environment to promote resident-centered care. New construction of a small house or household facility, including a conversion to an existing facility, an addition to an existing facility, or rehabilitation of an existing facility, must meet the requirements of this section.

How should the separate Trust Fund account be identified?

This separate account must be identified "(Name of Facility), Resident's Trust Fund Account," or by a similar title that shows a fiduciary relationship exists between a resident and the facility.

DHS

This term referred to the Texas Department of Human Services; it now refers to HHSC, unless the context concerns an administrative hearing. Administrative hearings were formerly the responsibility of DHS; they now are the responsibility of the HHSC.

If children are to be admitted to the facility, what accommodations, furnishings, and equipment must be provided?

Those appropriate to children. These include: (1) The facility must provide indoor and outdoor recreation areas designed to encourage exploration within the children's capabilities. (2) The facility must provide pediatric equipment and supplies in appropriate sizes for the age and development level of the children. Pediatric emergency supplies and equipment must be readily available for use. (3) The environment must be the least restrictive allowable while remaining within the parameters of safety. All areas of the facility accessible to children must be "child proof" for safety hazards. This type of safety proofing is above the normal level of hazard control maintained for adult residents and includes the addition of safety covers on electrical outlets not in use that are accessible to children. (4) Pediatric resident's rooms must be decorated and furnished in accordance with the age and developmental level of the children and as an expression of their individual preferences.

What procedures must be established for the storing and disposing of drugs and biologicals?

Those that are in accordance with federal, state, and local laws.

How long is a facility license good for?

Three years

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what type of general safety hazard precautions must be observed to aid in the use of wheelchairs and carts?

Thresholds and expansion joint covers must be made essentially flush with the floor surface to facilitate use of wheelchairs and carts. See §19.340(a)(8) for requirements for such items as shower curbs, surfaces, and doors.

How long are the approved staffing waivers valid?

Throughout the facility licensure or certification period, unless approval is withdrawn. During the re-licensure or recertification survey, the determination is made for approval or denial for the next facility licensure or certification period if a waiver continues to be necessary.

Willfully interfere

To act or not act to intentionally prevent, interfere with, or impede or to attempt to intentially prevent, interfere with, or impede.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, can buzzers be located on exterior doors?

To aid in control of wandering residents, buzzers or other sounding devices may be used to announce the unauthorized use of an exit door. Other methods include approved emergency exit door locks or fencing with a gate outside of exit doors which enclose a space large enough to allow the space to be an exterior area of egress and refuge away from the building.

What is the purpose of a volunteer program at the facility?

To assist in meeting the social and emotional needs of the residents.

What are the requirements for staffing waiver approval?

To be approved for a waiver, the nursing facility must meet all of the requirements stated.

Why should financial records be made available to DADs upon request?

To demonstrate the facility's compliance with applicable state laws and standards relating to licensing.

Why would an inspection be conducted after regular working hours?

To determine standard compliance which cannot be verified during regular working hours, night or weekend inspections may be conducted to cover specific segments of operation and will be completed with the least possible interference to staff and residents.

What is required for Vision and hearing?

To ensure that residents receive proper treatment and assistive devices to maintain vision and hearing abilities, the facility must, if necessary, assist the resident: (A) in making appointments; and (B) by arranging for transportation to and from the office of a practitioner specializing in the treatment of vision or hearing impairment or the office of a professional specializing in the provision of vision or hearing assistive devices.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what is the requirement for seat height in water closets?

To provide a seat height 17 inches to 19 inches from the floor is required for persons with disabilities.

In facilities licensed on or after April 2, 2018, what is required for essential electrical systems?

To provide electricity during an interruption of the normal electric supply, an emergency source of electricity must be provided and connected to certain circuits for lighting and power. All facilities covered by this section must comply with the EES requirements for new health care facilities in NFPA 99, based on the risk category determined by the assessment required by §19.300(i).

What is the purpose of a volunteer program for pediatric residents?

To provide social, emotional, educational, and sensory opportunities for its pediatric residents.

What is the purpose of a volunteer council?

To solicit community involvement in the volunteer program.

Under what circumstances would a waiver of requirement to provide licensed nurses on a 24-hour basis be granted?

To the extent that a facility is unable to meet the requirements, the state may waive these requirements with respect to the facility, if: (A) the facility demonstrates to the satisfaction of the HHSC that the facility has been unable, despite diligent efforts (including offering wages at the community prevailing rate for nursing facilities), to recruit appropriate personnel; (B) HHSC determines that a waiver of the requirement will not endanger the health or safety of individuals staying in the facility; (C) the state finds that, for any periods in which licensed nursing services are not available, a registered nurse or a physician is obligated to respond immediately to telephone calls from the facility; and (D) the waivered facility has a full-time registered or licensed vocational nurse on the day shift seven days a week. For purposes of this requirement, the starting time for the day shift must be between 6 a.m. and 9 a.m. The facility must specify in writing the schedule that it follows.

Why must a Medicaid-certified facility coordinate assessments with the PASSR process?

To the maximum extent practicable to avoid duplicative testing and effort.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what type of toilet facilities should be made available in the facility?

Toilet facilities for the disabled must be available in the building.

In facilities licensed on or after April 2, 2018, what toilet facilities are required in the public space of the facility?

Toilet facilities for the disabled must be available in the building.

In facilities licensed before Sept. 11, 2003, in existing construction, what toilet facilities should be provided to comply with ADA?

Toilet facilities must be available and of sufficient size to accommodate wheelchairs. There must be at least one public wheelchair-accessible restroom. Water closet seat height in toilet facilities for persons with disabilities must be 17 to 19 inches from floor.

What is considered a transfer or discharge in a Medicaid-Certified Facility?

Transfer and discharge includes movement of a resident to a bed outside the certified facility, whether that bed is in the same physical plant or not. Transfer and discharge does not refer to movement within the same certified facility.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what receptacles are required in each room?

Two duplex or a fourplex grounding type receptacles must be provided beside the head of each bed. Other walls must have duplex receptacles as needed for TV, radio, razors, hairdryers, clocks, and as required by NFPA 70.

What types of trends might be identified from incident/accidents and complaints?

Type of accident, type of injury, time of day, staff involved, staffing level, and relationship to past complaints.

In facilities licensed on or after April 2, 2018, what regulations must be met for the core system of the power units, annunciator control units, corridor dome lights, emergency call stations, bedside call stations, and activating devices?

UL 1069

In building constructed or licensed on or after September 11, 2003, but before April 2, 2018, in addition to NFPA 101 and the standards referenced therein, a facility covered by this division is subject to the codes, standards, and requirements established by the following:

UL; ASHRAE; and ASTM

In facilities licensed on or after April 2, 2018, in addition to NFPA 101 and the standards referenced therein, a facility covered by this division is subject to the codes, standards, and requirements established by _____.

UL; ASHRAE; and ASTM

How should the food be stored, prepared, and served?

Under sanitary conditions, as required by the Texas Department of Health food service sanitation requirements

What type of precautions must be used in the care of all residents? What policies must be followed?

Universal precautions must be used in the care of all residents. Facilities are responsible for complying with Occupational Safety Hazards Administration (OSHA) regulations found at 29 Code of Federal Regulations, §1910.1030.

In facilities licensed on or after April 2, 2018, what exterior finishes are required?

Unless otherwise approved by HHSC, the exterior finish material of a building classified as fire resistive or protected noncombustible construction, per NFPA 220, must have a flame spread index no greater than 25 and a smoke developed index no greater than 450, when tested according to ASTM E84 or UL 723. All other exterior materials must have a flame spread index no greater than 75 and a smoke developed index no greater than 450. Items of trim may be of combustible material subject to approval by HHSC. Roof covering assemblies must have a Class A or Class B rating, when tested according to ASTM E108 or UL 790.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is required for exterior finishes on the building?

Unless otherwise approved by HHSC, the exterior finish material of buildings classified as fire resistive or protected noncombustible construction, per NFPA 220, must have a flame spread index no greater than 25 and a smoke developed index no greater than 450, when tested in accordance with ASTM E84 or UL 723. All other exterior materials must have a flame spread index no greater than 75 and a smoke developed index no greater than 450. Items of trim may be of combustible material subject to approval by HHSC. Roof covering assemblies must have a Class A or Class B rating, when tested in accordance with ASTM E108 or UL 790.

What if a family council member wishes another person to attend?

Unless the resident objects, a family council member may authorize, in writing, another member to visit and observe a resident represented by the authorizing member.

In facilities licensed before Sept. 11, 2003, in existing construction, are unvented or portable heaters allowed?

Unvented heating units and portable heaters are prohibited.

In facilities licensed on or after April 2, 2018, what are not allowed to be used for heating?

Unvented space heaters and portable heating units must not be used. Heating devices or appliances must not be a burn hazard to residents.

Who must inspect the new construction prior to building occupation?

Upon completion of construction of a new facility, or building rehabilitation other than that classified as repair or renovation in §19.350, a final construction inspection of the facility, including grounds, basic equipment and furnishings, must be performed by HHSC prior to occupancy.

What should be done with the inventoried property upon discharge from the facility?

Upon discharge of the resident, the facility must document the disposition of personal effects by a dated receipt bearing the signature of the resident or the resident's responsible party or both. See §19.416.

When is a change of ownership license issued?

Upon receipt of a complete application, fee, and signed, written notice from the facility's existing license holder of the intent to transfer the operation of the facility to the applicant beginning on a date specified by the applicant, DADS issues a change of ownership license to the prospective new owner if DADS finds that the prospective new owner and any other persons listed meet these requirements: (A) the proper application filled out in accordance with DADS instructions, signed, and notarized, and must contain all forms required by DADS. (B) DADS approves or denies an application for a change of ownership license not later than the 31st day after the date of receipt of the complete application and a signed, written notice from the facility's existing license holder of his intent to transfer the operation of the facility to the applicant beginning on a date specified by the applicant.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what is not allowed in vacant bedrooms?

Vacant bedrooms must not be used for hazardous activities or hazardous storage, unless specifically approved by HHSC in writing.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what type of ventilation system is required for the cooking area?

Vapor removal from cooking equipment must be designed and installed in accordance with NFPA 96.

Electronic monitoring device

Video surveillance cameras and audio devices installed in a resident's room, designed to acquire communications or other sounds that occur in the room. An electronic, mechanical, or other device used specifically for the nonconsensual interception of wire or electronic communication is excluded from this definition.

In facilities licensed on or after April 2, 2018, what must be provided to residents to assure privacy?

Visual privacy, such as cubicle curtains, must be available for each resident in multi-bed bedrooms.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what material must plumbing fixtures for residents be made of?

Vitreous china or porcelain finished cast iron or steel unless otherwise approved by DHS. Bathing units constructed of class B fire rated fiberglass are acceptable for use.

Who approves the staffing waivers for Medicare SNFs?

Waivers for a Medicare SNF receive final approval from the Centers for Medicare and Medicaid Services.

In facilities licensed on or after April 2, 2018, what are the regulations on walk ways?

Walks must be provided as required from all exits and must be of non-slip surfaces free of hazards. Walks must be at least 48 inches wide except as otherwise approved. Ramps must be used in lieu of steps where possible for the individuals with a disability and to facilitate bed or wheelchair removal in an emergency.

In buildings constructed or licensed on or after September 11, 2003, but before April 2, 2018, what are the requirements for walkways?

Walks must be provided as required from all exits and must be of non-slip surfaces free of hazards. Walks must be at least 48" wide except as otherwise approved. Ramps should be used in lieu of steps where possible for individuals with a disability and to facilitate bed or wheelchair removal in an emergency.

In facilities licensed on or after April 2, 2018, where must the water supply come from?

Water must be supplied from a system approved by the Water Supply Division of TCEQ, or from a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Supply Division of TCEQ.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, who must approve the water supply?

Water supply must be from a system approved by the Water Utility Division, Texas Natural Resources Conservation Commission, or from a system regulated by an entity responsible for water quality in that jurisdiction as approved by the Water Utility Division, Texas Natural Resources Conservation Commission.

When should the discharge summary be made available?

When a resident is being discharged home; to another nursing facility; a Medicare skilled nursing facility; or another residential facility, such as a board and care home, an intermediate care facility for individuals with an intellectual disability or related conditions, or an assisted living facility.

When could a facility use a constructed or rehabilitated portion of a facility without the final inspection?

When construction or building rehabilitation does not alter the licensed capacity of a facility, based on submitted documentation and the scope of the performed building rehabilitation, HHSC may permit a facility to use the rehabilitated portion of a facility pending a final construction inspection or may determine a final construction inspection is not required.

When the facility becomes aware of the need for a refund, when must the facility staff write to the resident or his responsible party, notifying him about his right to a refund and amount due?

When it happens.

When is a facility required to refund private funds paid to a facility for periods covered by Medicaid, including retroactive periods of Medicaid coverage?

When the Medicaid vendor payment has been accepted by the nursing facility; or the nursing facility has been notified by the Texas Department of Human Services (DHS) about an individual's eligibility for Medicaid.

When will DADS investigate complaints of abuse, neglect, or exploitation?

When the act occurs in the facility, when such licensed facility is responsible for the supervision of the resident at the time the act occurs, or when the alleged perpetrator is affiliated with the facility. Complaints of abuse, neglect, or exploitation not meeting this criteria will be referred to DFPS.

When may HHSC permit variations in requirements specified under Life and Safety from Fire?

When the facility demonstrates in writing that the variations are required by the special needs of the residents; and will not adversely affect residents' health and safety.

If a facility transfers or discharges a resident, what documentation is required?

When the facility transfers or discharges a resident under any of the allowed circumstances, the resident's clinical record must be documented. The documentation must be made by: (A) the resident's physician when transfer or discharge is necessary for their health and safety; and (B) a physician when transfer or discharge is necessary for the health and safety of others.

In facilities licensed before Sept. 11, 2003, in existing construction, if the emergency generator is to power life-sustaining equipment, what are the requirements?

When the failure of systems or equipment is likely to cause major injury or death to a resident, such as the failure of a mechanical ventilator used to support or completely control breathing, the facility must provide emergency electrical power with an emergency generator as, defined in NFPA 99, located on the premises.

What happens if the hearing officer determines that the resident discharge was appropriate?

When the hearing officer determines that the discharge is appropriate, the resident is notified in writing of this decision. Any payments made on behalf of the recipient past the date of discharge or decision, whichever is later, must be recouped.

What happens if the hearing officer determines that the resident discharge was inappropriate?

When the hearing officer determines that the discharge was inappropriate, the facility, upon written notification by the hearing officer, must readmit the resident immediately, or to the next available bed. If the discharge has not yet taken place, and the hearing officer finds that the discharge will be inappropriate, the facility, upon written notification by the hearing officer, must allow the resident to remain in the facility. The hearing officer will also report the findings to HHSC Long-Term Care Regulatory Services Division for investigation of possible noncompliance.

In facilities licensed before Sept. 11, 2003, in existing construction, when an auxiliary serving area is used, what are the requirements?

Where service areas other than the kitchen are used to dispense foods, the facility must designate these service areas as food service areas and must have equipment for maintaining required food temperatures while serving.

What should the facility refrain from providing the child's LAR?

With inaccurate or misleading information regarding the risks of moving the child to another facility or community setting.

In buildings constructed or license on or after September 11, 2003, but before April 2, 2018, what type of pressure must be introduced into clean rooms?

With relationship to adjacent areas, a positive air pressure must be provided for clean utility rooms, clean linen rooms, and medication rooms. Conditioned supply air must be introduced into these rooms.

What is the timeline for "significant change" assessments?

Within 14 calendar days after the facility determines, or should have determined, that there has been a significant change in the resident's physical or mental condition. For purposes of this section, a "significant change" means a major decline or improvement in the resident's status that will not normally resolve itself without further intervention by staff or by implementing standard disease-related clinical interventions, that has an impact on more than one area of the resident's health status, and requires interdisciplinary review or revision of the care plan, or both.

If anything is incomplete on an application, when will the facility be notified?

Within 30 days of receipt of the application if any of the following applications are incomplete: (1) initial application; (2) change of ownership; (3) renewal; and (4) increase in capacity.

After an applicant asks for a plan review of a new or rehabilitation of a building, how long until the applicant receives the results of the review?

Within 30 days the applicant will be informed in writing.

When should residents, relatives or responsible parties be notified of the closure of the facility if the closure is voluntary? What must be sent?

Within one week after the date on which the decision to close is made. The facility must send written notice to residents' relatives or responsible parties stating that the closure will occur no earlier than 60 days after receipt of the notice.

What in general must be provided for Building approval to Texas DHS?

Written approval of the local fire authority that the facility and its operation meet local fire ordinances.

What policies should be explained to new employees during orientation?

Written personnel policies and procedures, and they should be readily available to them after that time.

Can the facility adopt policies that allow less use of restraints than allowed by the rules of this chapter?

Yes

Can a facility commingle Trust Funds of Medicaid residents and private-pay residents? If they are commingled what is required of the facility?

Yes, If the funds are commingled, the facility must provide, upon request, the following records to the Department of Aging and Disability Services, the Texas attorney general's Medicaid Fraud Control Unit, and the U.S. Department of Health and Human Services--copies of release forms signed and dated by each private-pay resident or responsible party whose funds are commingled; and legible copies of the trust fund records of private-pay residents whose funds are commingled.

Can additional violations be added after the exit conference?

Yes; any additional violation that may be determined during review of field notes or preparation of the official final list will be communicated to the facility in writing within 10 working days after the exit conference.

What does the Statement of Resident rights say about when rights might be restricted?

Your rights may be restricted only to the extent necessary to protect you or another person from danger or harm or to protect a right of another resident, particularly those relating to privacy and confidentiality.

In facilities licensed on or after April 2, 2018, enclosed exterior spaces that are in a means of egress to a public way must meet the requirements of _____?