Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 553 - LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
Subchapter E - STANDARDS FOR LICENSURE
Section 553.253 - Employee Qualifications and Training
Universal Citation: 26 TX Admin Code ยง 553.253
Current through Reg. 49, No. 38; September 20, 2024
(a) Manager qualifications. Each facility must designate, in writing, a manager to have authority over the operation.
(1) Qualifications. In small facilities, the
manager must have proof of graduation from an accredited high school or
certification of equivalency of graduation. In large facilities, a manager
musthave:
(A) an associate's degree in
nursing, health care management, or a related field;
(B) a bachelor's degree; or
(C) proof of graduation from an accredited
high school or certification of equivalency of graduation and at least one year
of experience working in management or in health care industry
management.
(2) Training
in management of assisted living facilities. A manager must complete at least
one educational course on the management of assisted living facilities, which
must include information on the assisted living standards; resident
characteristics (including dementia), resident assessment and skills working
with residents; basic principles of management; food and nutrition services;
federal laws, with an emphasis on accessibility requirements under the
Americans with Disabilities Act; community resources; ethics, and financial
management.
(A) The course must be at least 24
hours in length.
(i) A manager must complete
eight hours of training on the assisted living standards within the first three
months of employment.
(ii) The
24-hour training requirement may not be met through in-services at the
facility, but may be met through structured, formalized classes, correspondence
courses, training videos, distance learning programs, or off-site training
courses. All training must be provided or produced by academic institutions,
assisted living corporations, or recognized state or national organizations or
associations. Subject matter that deals with the internal affairs of an
organization will not qualify for credit.
(iii) Evidence of training must be on file at
the facility and must contain documentation of content, hours, dates, and
provider.
(B) A manager
who can show documentation of a previously completed comparable course of study
are exempt from the training requirements.
(C) A manager must complete the training
required by subparagraph (A) or (B) of this paragraph, as applicable, by the
first anniversary of employment as manager.
(D) An assisted living manager who was
employed by a licensed assisted living facility as the manager and changes
employment to another licensed assisted living facility as the manager, with a
break in employment of no longer than 30 days, is exempt from the 24-hour
training requirement.
(3)
Continuing education. All managers must show evidence of 12 hours of annual
continuing education. This requirement will be met during the first year of
employment by the 24-hour assisted living management course. The annual
continuing education requirement must include at least two of the following
areas:
(A) resident and provider rights and
responsibilities, abuse and neglect, and confidentiality;
(B) basic principles of management;
(C) skills for working with residents,
families, and other professional service providers;
(D) resident characteristics and
needs;
(E) community
resources;
(F) accounting and
budgeting;
(G) basic emergency
first aid; or
(H) federal laws,
such as the Americans with Disabilities Act of 1990, as amended; the Civil
Rights Act of 1991; the Rehabilitation Act of 1973, as amended; the Family and
Medical Leave Act of 1993; and the Fair Housing Act, as amended.
(4) Manager's responsibilities.
The manager must be on duty 40 hours per week and may manage only one facility,
except for managers of small Type A facilities, who may have responsibility for
no more than 16 residents in no more than four facilities. The managers of
small Type A facilities must be available by telephone or pager when conducting
facility business off-site.
(5)
Manager's absence. An employee competent and authorized to act in the absence
of the manager must be designated in writing.
(b) Attendants. Full-time facility attendants must be at least 18 years old or a high-school graduate.
(1) An attendant must be in the facility at
all times when residents are in the facility.
(2) Attendants are not precluded from
performing other functions as required by the facility.
(c) Staffing.
(1) A facility must develop and implement
staffing policies, which require staffing ratios based upon the needs of the
residents, as identified in their service plans.
(2) Prior to admission, a facility must
disclose, to prospective residents and their families, the facility's normal
24-hour staffing pattern and post it monthly in accordance with § 553.271
of this subchapter (relating to Postings).
(3) A facility must have sufficient staff to:
(A) maintain order, safety, and
cleanliness;
(B) assist with
medication regimens;
(C) prepare
and serve meals that meet the daily nutritional and special dietary needs of
each resident, in accordance with each resident's service plan;
(D) assist with laundry;
(E) assure that each resident receives the
kind and amount of supervision and care required to meet his basic needs;
and
(F) ensure safe evacuation of
the facility in the event of an emergency.
(4) A facility must meet the staffing
requirements described in this subparagraph.
(A) Type A facility: Night shift staff in a
small facility must be immediately available. In a large facility, the staff
must be immediately available and awake.
(B) Type B facility: Night shift staff must
be immediately available and awake, regardless of the number of licensed
beds.
(d) Staff training. The facility must document that staff members are competent to provide personal care before assuming responsibilities and have received the following training.
(1) All staff members must
complete four hours of orientation before assuming any job responsibilities.
Training must cover, at a minimum, the following topics:
(A) reporting of abuse and neglect;
(B) confidentiality of resident
information;
(C) universal
precautions;
(D) conditions about
which they should notify the facility manager;
(E) residents' rights; and
(F) emergency and evacuation
procedures.
(2)
Attendants must complete 16 hours of on-the-job supervision and training within
the first 16 hours of employment following orientation. Training must include:
(A) providing assistance with the activities
of daily living;
(B) resident's
health conditions and how they may affect provision of tasks;
(C) safety measures to prevent accidents and
injuries;
(D) emergency first aid
procedures, such as the Heimlich maneuver and actions to take when a resident
falls, suffers a laceration, or experiences a sudden change in physical or
mental status;
(E) managing
disruptive behavior;
(F) behavior
management, for example, prevention of aggressive behavior and de-escalation
techniques, practices to decrease the frequency of the use of restraint, and
alternatives to restraints; and
(G)
fall prevention.
(3)
Direct care staff must complete six documented hours of education annually,
based on each employee's hire date. Staff must complete one hour of annual
training in fall prevention and one hour of training in behavior management,
for example, prevention of aggressive behavior and de-escalation techniques,
practices to decrease the frequency of the use of restraint, and alternatives
to restraints. Training for these subjects must be competency-based. Subject
matter must address the unique needs of the facility. Suggested topics include:
(A) promoting resident dignity, independence,
individuality, privacy, and choice;
(B) resident rights and principles of
self-determination;
(C)
communication techniques for working with residents with hearing, visual, or
cognitive impairment;
(D)
communicating with families and other persons interested in the
resident;
(E) common physical,
psychological, social, and emotional conditions and how these conditions affect
residents' care;
(F) essential
facts about common physical and mental disorders, for example, arthritis,
cancer, dementia, depression, heart and lung diseases, sensory problems, or
stroke;
(G) cardiopulmonary
resuscitation;
(H) common
medications and side effects, including psychotropic medications, when
appropriate;
(I) understanding
mental illness;
(J) conflict
resolution and de-escalation techniques; and
(K) information regarding community
resources.
(4) Facilities
that employ licensed nurses, certified nurse aides, or certified medication
aides must provide annual in-service training, appropriate to their job
responsibilities, from one or more of the following areas:
(A) communication techniques and skills
useful when providing geriatric care (skills for communicating with the hearing
impaired, visually impaired and cognitively impaired; therapeutic touch;
recognizing communication that indicates psychological abuse);
(B) assessment and interventions related to
the common physical and psychological changes of aging for each body
system;
(C) geriatric pharmacology,
including treatment for pain management, food and drug interactions, 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, 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.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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