26 Tex. Admin. Code § 506.32 - Resident Care and Services
(a) Physician
services.
(1) Each resident shall have an
attending physician who is charge of the resident's medical care.
(2) The facility shall make a reasonable
effort to contact the resident's physician within 72 hours after admission to
obtain any information relating to the care of the resident. Any relevant
information obtained from the physician will be recorded in the resident's care
document.
(3) In the event of an
acute illness, condition, or accident requiring medical and/or nursing care
beyond the capabilities of the facility, the resident shall be transferred, in
a medically appropriate manner, to a hospital or other health care facility as
appropriate where needed services and facilities are available.
(b) Nursing services.
(1) Licensed nurses shall function consistent
with the nursing practices recognized and authorized by Texas Board of Nurse
Examiners.
(2) When nursing
services are provided, nursing personnel are responsible for ensuring that
residents receive treatments, medications, and diets as prescribed; receive
preventive care to prevent and minimize the incidence of skin breakdown; are
kept comfortable with personal hygiene needs met; are protected from accident
and injury through the initiation of appropriate safety measures; and are
treated with kindness and respect.
(3) Nursing or attendant personnel on duty
shall be responsible for obtaining emergency medical care when a resident's
condition so requires and shall be responsible for notifying the attending
physician.
(c)
Medications.
(1) Medications shall be
provided as required for those residents on a physician or practitioner-ordered
medication therapy regimen.
(2)
Upon admission, and as part of the plan of care, the admitting physician shall
determine whether a resident can self-administer his or her medications or will
require administration by qualified personnel in accordance with paragraph (7)
of this subsection.
(3) Each
resident's health status shall be reviewed at least quarterly, or more often if
indicated, to determine if any changes are necessary in the medication
administration procedures.
(A) The
appropriateness for a resident to self-administer medications shall be reviewed
by facility staff and the attending physician or an advanced practice nurse
working in collaboration with the attending physician.
(B) A resident's drug regimen review shall be
incorporated into the individual's plan of care.
(4) Medications must be kept secured at all
times. Only the resident and authorized facility staff shall have access to the
secured medications. Residents self-administering their medications may:
(A) keep medications in their possession at
all times;
(B) secure their
medications within their locked room if the room is not shared with others, or
in a locked cabinet in their room; or
(C) allow the facility to keep residents'
medications in a central medication storage area under control of facility
staff.
(5) The central
medication storage shall be kept locked when facility staff is not actually in
or at the storage area.
(6)
Residents may be permitted entrance or access to the storage area for the
purpose of self-administering their medications or treatments or receiving
assistance with their medication or treatment regimen. A facility staff member
shall remain in or at the storage area the entire time any resident is in the
storage area.
(7) Medications that
are administered to a resident shall be administered only by a registered
professional nurse, licensed vocational nurse, or an individual under direct
delegation orders by a physician and in conformance with all laws, rules, and
recognized professional standards of practice. A home health agency who is
providing services within a special care facility may use a home health
medication aide in accordance with 40 Texas Administrative Code, §
95.128(relating to Home Health Medication Aides).
(A) The person administering medications
shall properly record the medications administered. This record will be
retained in the resident file.
(B)
Medications classified as dangerous drugs or controlled substances may not be
taken by or administered to residents unless the medication was obtained
directly from or under a valid prescription or order of a physician or
practitioner. If facility staff administer the medications, they shall only be
administered under written orders, or verbal orders which are subsequently
verified in writing by the treating physician or practitioner.
(C) All injectable medication, intravenous
solutions, or medications administered by way of a tube inserted in a cavity of
the body shall be administered under physician's or practitioner's orders by a
physician, registered professional nurse, licensed vocational nurse, or other
individual qualified under state law.
(D) If administration of medications to
residents is performed by a registered professional nurse or licensed
vocational nurse the following shall apply.
(i) There shall be a specific area designated
for medication that is:
(I) sufficient in
size and/or space for the storage of all medications that are being
administered to residents and for the preparation of medications for
administration to residents;
(II)
lockable and shall be maintained locked at all times when not
occupied;
(III) accessible only to
persons authorized to administer medications to residents;
(IV) equipped with a sink having hot and cold
water available at all times; and
(V) adequately ventilated and temperature
controlled.
(ii) A
medication storage cart may be used in addition to the medication room for the
storage of residents' medications. When not in use, the medication storage cart
must be kept locked in the locked medication room or in the designated locked
storage room that shall be used only for the storage of the cart.
(8) When a resident
needs assistance with taking oral medication, only those individuals approved
in writing by the director of the facility may provide that assistance.
(A) A mechanism will be developed,
implemented and monitored by the facility director to insure that the resident
is given only those medications that have been prescribed by the resident's
physician or practitioner at the intervals detailed on the resident's
medication container.
(B) When
assistance with taking oral medication is provided, the facility will maintain
a medication record which documents the medication, date, and time taken. The
name of the individual who assisted the resident taking the oral medication
shall also be documented.
(C) The
facility director or designee will monitor the medication records daily to
insure accuracy.
(9)
Medication requiring refrigeration shall be stored in a separate refrigerator
designated for medications which is kept in the secured medication storage
area. Medications may be stored in an area within the common refrigerator if
they are stored in a manner that prevents contamination of the medications, and
allows for the security of the medication to be maintained.
(10) Medication under storage control of the
facility shall be returned to the resident upon dismissal from the facility, or
as directed by the physician.
(11)
Medications of a resident shall not be used for another resident. When a
resident is dismissed from or otherwise leaves the facility for a period of
time greater than 48 hours, medications which had been under the control of the
resident and left in the facility shall be secured under locked storage control
of the facility until reclaimed by the resident and no longer than 90 days.
Medications of deceased residents shall not remain in the facility for more
than 7 days after the resident's death. Medications of deceased residents and
medications which have been left unclaimed in the facility for more than 90
days shall be handled in one of the following manners.
(A) Medications may be returned to any
licensed pharmacy for destruction in accordance with regulations of the Texas
Board of Pharmacy governing the destruction of dangerous drugs or controlled
substances. A record shall be maintained by the facility which itemizes the
quantity and strength of each medication returned to a pharmacy for
destruction. Such record shall be signed by the director of the facility and
the pharmacist accepting the drugs for destruction and shall be retained in the
resident's file.
(B) Medications
may be destroyed beyond reclamation on site by the facility director. Drugs
should be destroyed by incineration, if possible. Small amounts of drugs may be
flushed into the sewer system unless prohibited by local ordinance. Large
quantities of drugs may be destroyed by removing the drugs from the
prescription containers, placing them in a strong plastic container, and
adulterating the drugs with water or bleach.
(i) A record of the destruction shall be
maintained by the facility and include:
(I)
the name, strength, and quantity of the drug;
(II) the method of destruction; and
(III) the signature of the facility director
who destroyed the drugs and signatures of two other individuals who witnessed
the destruction.
(ii)
This record shall be retained in the resident's file.
(12) Controlled substances and
drugs under storage control of the facility shall be kept separately locked in
a permanently affixed compartment within the medicine room or medication
storage cart.
(A) A separate record must be
maintained for each controlled substance and drug.
(B) The record shall include, but not be
limited to, prescription number, name and strength of drug, date received by
the facility, date and time each dose is provided, signature of person
providing the dose, name of resident, and the original amount received with the
balance verifiable by drug inventory at least daily.
(13) All residents' medications shall be
properly labeled in accordance with applicable laws and regulations.
(d) Dietary services.
(1) A dining room, rooms, or space with
appropriate furnishings shall be provided. The dining space and furnishings
should allow the residents who can come to the dining room to dine at one
sitting. Where alternate or second meal services are employed, quantity and
quality shall be maintained.
(2)
The facility shall have a kitchen or dietary area to meet the food service
needs of the residents. It shall include provisions for the storage,
refrigeration, preparation, and serving of food; for dish and utensil cleaning;
and for refuse storage and removal.
(3) Meal service at intervals of at least
three meals per day, seven days per week, shall be provided or arranged to be
commensurate with the needs of the residents. Meals shall be palatable and meet
the nutritional needs of the residents.
(4) Procedures to prevent cross contamination
shall be observed in the storage, preparation, and distribution of food; in the
cleaning of dishes, equipment, and work area; and in the storage and disposal
of waste. The facility shall provide storage of food for emergency use for a
minimum of four calendar days.
(5)
All dishes and utensils shall be washed in an automatic dishwasher or by the
use of manual dishwashing procedures.
(A) A
three-compartment sink shall be used if washing, rinsing and sanitizing of
utensils and equipment is done manually; or a two-compartment sink may be
utilized if single service tableware is provided, or when an approved detergent
sanitizer is used.
(B) Cleaning and
sanitizing may be done by spray-type or immersion dishwashing machines or by
any other type of machine or device if it is demonstrated that it thoroughly
cleans and sanitizes equipment and utensils either by chemical or mechanical
sanitization.
(6)
Sanitary hand washing and drying provisions shall be provided in the kitchen
area and shall include soap, water and individual disposable towels.
(e) Social services/pastoral care.
Services to meet identified social, spiritual, and emotional needs shall be
offered to the resident. Services may also be available to the resident's
family, responsible party, and significant other persons. Acceptance of these
services will be at the option of the resident.
(f) Personal care services.
(1) The facility shall provide personal care
services in accordance with the individualized needs of each
resident.
(2) Personal care
services shall include normal activities of daily, and may include:
(A) assistance with their
medications;
(B) assistance with
hygiene;
(C) assistance with
dressing;
(D) assistance with
ambulation; and
(E) emotional
support.
(g)
Laboratory services.
(1) A facility that
provides laboratory services shall comply with the Clinical Laboratory
Improvement Amendments of 1988 (CLIA 1988), in accordance with the requirements
specified in 42 Code of Federal Regulations (CFR), Chapter IV, Part 493,
§§ 493.1-493.1780. CLIA 1988 applies to all facilities with
laboratories that examine human specimens for the diagnosis, prevention, or
treatment of any disease or impairment of, or the assessment of the health of,
human beings.
(2) The facility
shall ensure that all laboratory services provided to its residents through a
contractual agreement are performed in a facility certified in the appropriate
specialties and subspecialties of service in accordance with the requirements
specified in 42 CFR, Chapter IV, Part 493 to comply with CLIA 1988.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.