Current through Reg. 49, No. 52; December 27, 2024
(a) General. The resident has the right to be
free from abuse, neglect, misappropriation of resident property, and
exploitation as defined in §
554.101 of this chapter (relating
to Definitions). This includes freedom from any physical or chemical restraint
not required to treat the resident's medical symptoms.
(b) Abuse. The resident has the right to be
free from verbal, sexual, physical, and mental abuse, corporal punishment, and
involuntary seclusion.
(c) Policies
and procedures. The facility must develop and implement written policies and
procedures that prohibit and prevent mistreatment, abuse, neglect, and
exploitation of a resident, and misappropriation of a resident's property.
(1) The facility must:
(A) not use verbal, mental, sexual, or
physical abuse, corporal punishment, or involuntary seclusion;
(B) not employ or otherwise engage an
individual who has:
(i) been found guilty of
abuse, neglect, exploitation, misappropriation of property, or mistreatment of
a resident by a court of law;
(ii)
had a finding entered into the state nurse aide registry concerning abuse,
neglect, exploitation or mistreatment of a resident, or misappropriation of a
resident's property;
(iii) been
convicted of any crime contained in §250.006, Texas Health and Safety
Code; or
(iv) a disciplinary action
in effect against the individual's professional license by a state licensure
body as a result of a finding of abuse, neglect, exploitation, mistreatment of
a resident or misappropriation of a resident's property;
(C) report any knowledge it has of actions by
a court of law against an employee that would indicate unfitness for service as
a nurse aide or other staff to the state nurse aide registry or licensing
authority; and
(D) suspend the
employment of an employee who HHSC finds has engaged in reportable conduct, as
defined in section §
554.101 of this chapter, while the
employee exhausts any applicable appeals process, including informal and formal
appeals and any hearing or judicial review, pending a final decision by an
administrative law judge. A facility must not reinstate the employee's
employment or contract during any applicable appeals
process.
(2) The written
policies and procedures must:
(A) establish
protocols to investigate any such allegations; and
(B) include training as required by §
554.1929 of this chapter (relating
to Staff Development).
(d) Restraints. The facility must ensure that
the resident is free from physical or chemical restraints imposed for purposes
of discipline or convenience and that are not required to treat the resident's
medical symptoms. If the use of restraints is indicated, the facility must use
the least restrictive alternative for the least amount of time and document
ongoing re-evaluation of the need for restraints.
(1) 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
ten minutes, and the resident repositioned.
(2) A facility must not administer to a
resident a restraint that:
(A) 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.
(3) A behavioral
emergency is a situation in which severely aggressive, destructive, violent, or
self-injurious behavior 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.
(4) 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 of paragraph (2) of this subsection.
(5) 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.
(6) A facility may adopt policies that allow
less use of restraint than allowed by the rules of this chapter.
(7) A resident, or the resident's legally
authorized representative, must agree to the use of a physical restraint in
accordance with §
554.402 of this chapter (relating
to Exercise of Rights) and §
554.406 of this chapter (relating
to Free Choice).
(8) A physical
restraint must be ordered by a physician. The order must include why the
restraint is necessary to treat the resident's medical condition and the
specified timeframe for re-evaluation of the order.
(9) Use of restraints and their release must
be documented in the resident's clinical record and in the resident's care plan
in accordance with §
554.802 of this chapter (relating
to Comprehensive Person-Centered Care Planning).
