Current through Reg. 49, No. 38; September 20, 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).
