Header:
TEXAS ADMINISTRATIVE CODE
TITLE 40. SOCIAL SERVICES AND ASSISTANCE
PART 1. DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 92. LICENSING STANDARDS FOR ASSISTED LIVING FACILITIES
SUBCHAPTER C. STANDARDS FOR LICENSURE
Date:
08/31/2009
Document:
40 TAC § 92.53 (2011)
§ 92.53. Standards for Certified Alzheimer's Assisted Living Facilities
(a) Manager qualifications and training.
(1) The manager of the certified Alzheimer facility or the supervisor of the certified Alzheimer unit must be 21 years of age, and have:
(A) an associate's degree in nursing, health care management;
(B) a bachelor's degree in psychology, gerontology, nursing, or a related field; or
(C) proof of graduation from an accredited high school or certification of equivalency of graduation and at least one year of experience working with persons with dementia.
(2) The manager or supervisor must complete six hours of annual continuing education regarding dementia care.
(b) Staff training.
(1) All staff members must receive four hours of dementia-specific orientation prior to assuming any job responsibilities. Training must cover, at a minimum, the following topics:
(A) basic information about the causes, progression, and management of Alzheimer's disease;
(B) managing dysfunctional behavior; and
(C) identifying and alleviating safety risks to residents with Alzheimer's disease.
(2) Direct care staff must receive 16 hours of on-the-job supervision and training within the first 16 hours of employment following orientation. Training must cover:
(A) providing assistance with the activities of daily living;
(B) emergency and evacuation procedures specific to the dementia population;
(C) managing dysfunctional behavior; and
(D) behavior management, including prevention of aggressive behavior and de-escalation techniques, or fall prevention, or alternatives to restraints.
(3) Direct care staff must annually complete 12 hours of in-service education regarding Alzheimer's disease. One hour of annual training must address behavior management, including prevention of aggressive behavior and de-escalation techniques, or fall prevention, or alternatives to restraints. Training for these subjects must be competency-based. Subject matter must address the unique needs of the facility. Additional suggested topics include:
(A) assessing resident capabilities and developing and implementing service plans;
(B) promoting resident dignity, independence, individuality, privacy and choice;
(C) planning and facilitating activities appropriate for the dementia resident;
(D) communicating with families and other persons interested in the resident;
(E) resident rights and principles of self-determination;
(F) care of elderly persons with physical, cognitive, behavioral and social disabilities;
(G) medical and social needs of the resident;
(H) common psychotropics and side effects; and
(I) local community resources.
(c) Staffing. A facility must employ sufficient staff to provide services for and meet the needs of its Alzheimer's residents. In large facilities or units with 17 or more residents, two staff members must be immediately available when residents are present.
(d) Pre-admission. The facility must establish procedures, such as an application process, interviews, and home visits, to ensure that prospective residents are appropriate and their needs can be met.
(1) Prior to admitting a resident, facility staff must discuss and explain the disclosure statement with the family or responsible party.
(2) The facility must give the required DADS disclosure statement to any individual seeking information about the facility's care or treatment of residents with Alzheimer's disease or a related disorder.
(e) Assessment. The facility must make a comprehensive assessment of each resident within 14 days of admission and annually. The assessment must include the items listed in § 92.41(c)(1)(A) - (T) of this chapter (relating to Standards for Type A and Type B Assisted Living Facilities).
(f) Service plan. Facility staff, with input from the family, if available, must develop an individualized service plan for each resident, based upon the resident assessment, within 14 days of admission. The service plan must address the individual needs, preferences, and strengths of the resident. The service plan must be designed to help the resident maintain the highest possible level of physical, cognitive, and social functioning. The service plan must be updated annually and upon a significant change in condition, based upon an assessment of the resident.
(g) Activities. A facility must encourage socialization, cognitive awareness, self-expression, and physical activity in a planned and structured activities program. Activities must be individualized, based upon the resident assessment, and appropriate for each resident's abilities.
(1) The activity program must contain a balanced mixture of activities addressing cognitive, recreational, and activity of daily living (ADL) needs.
(A) Cognitive activities include, but are not limited to, arts, crafts, story telling, poetry readings, writing, music, reading, discussion, reminiscences, and reviews of current events.
(B) Recreational activities include all socially interactive activities, such as board games and cards, and physical exercise. Care of pets is encouraged.
(C) Self-care ADLs include grooming, bathing, dressing, oral care, and eating. Occupational ADLs include cleaning, dusting, cooking, gardening, and yard work. Residents must be allowed to perform self-care ADLs as long as they are able to promote independence and self worth.
(2) Residents must be encouraged, but never forced, to participate in activities. Residents who choose not to participate in a large group activity must be offered at least one small group or one-on-one activity per day.
(3) Facilities must have an employee responsible for leading activities.
(A) Facilities with 16 or fewer residents must designate an employee to plan, supply, implement, and record activities.
(B) Facilities with 17 or more residents must employ, at a minimum, an activity director for 20 hours weekly. The activity director must be a qualified professional who: (i) is a qualified therapeutic recreation specialist or an activities professional who is 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, the National Certification Council for Activity Professionals, or the Consortium for Therapeutic Recreation/Activities Certification, Inc.; or (ii) has two years of experience in a social or recreational program within the last five years, one year of which was full-time in an activities program in a health care setting; or (iii) has completed an activity director training course approved by the National Association for Activity Professionals or the National Therapeutic Recreation Society.
(4) The activity director or designee must review each resident's medical and social history, preferences, and dislikes, in determining appropriate activities for the resident. Activities must be tailored to the residents' unique requirements and skills.
(5) The activities program must provide opportunities for group and individual settings. On weekdays, each resident must be offered at least one cognitive activity, two recreational activities and three ADL activities each day. The cognitive and recreational activities (structured activities) must be at least 30 minutes in duration, with a minimum of six and a half hours of structured activity for the entire week. At least an hour and a half of structured activities must be provided during the weekend and must include at least one cognitive activity and one physical activity.
(6) The activity director or designee must create a monthly activities schedule. Structured activities should occur at the same time and place each week to ensure a consistent routine within the facility.
(7) The activity director or designee must annually attend at least six hours of continuing education regarding Alzheimer's disease or related disorders.
(8) Special equipment and supplies necessary to accommodate persons with a physical disability or other persons with special needs must be provided as appropriate.
(h) Physical plant. Alzheimer's units, if segregated from other parts of the Type B facility with approved security devices, must meet the following requirements within the Alzheimer's unit:
(1) Resident living area(s) must be in compliance with § 92.62(m)(3) of this chapter (relating to General Requirements).
(2) Resident dining area(s) must be in compliance with § 92.62(m)(4) of this chapter.
(3) Resident toilet and bathing facilities must be in compliance with § 92.62(m)(2) of this chapter.
(4) A monitoring station must be provided within the Alzheimer's unit with a writing surface such as a desk or counter, chair, task illumination, telephone or intercom, and lockable storage for resident records.
(5) Access to at least two approved exits remote from each other must be provided in order to meet the Life Safety Code requirements.
(6) In large facilities, cross corridor control doors, if used for the security of the residents, must be similar to smoke doors, which are each 34 inches in width and swing in opposite directions. A latch or other fastening device on a door must be provided with a knob, handle, panic bar, or other simple type of releasing device.
(7) An outdoor area of at least 800 square feet must be provided in at least one contiguous space. This area must be connected to, be a part of, be controlled by, and be directly accessible from the facility.
(A) Such areas must have walls or fencing that do not allow climbing or present a hazard and meet the following requirements. These minimum dimensions do not apply to additional fencing erected along property lines or building setback lines for privacy or to meet requirements of local building authorities. (i) Minimum distance of the enclosure fence from the building is 8 feet if the fence is parallel to the building and there are no window openings; (ii) Minimum distance of the enclosure fence (parallel with building walls) from bedroom windows is 20 feet if the fencing is solid and 15 feet from bedroom windows if the fencing is open; or (iii) For unusual or unique site conditions, areas of enclosure may have alternate configurations with DADS approval.
(B) Access to at least two approved exits remote from each other must be provided from the enclosed area in order to meet the Life Safety Code requirements.
(C) If the enclosed area involves a required exit from the building, the following additional requirements must be met: (i) A minimum of two gates must be remotely located from each other if only one exit is enclosed. If two or more exits are enclosed by the fencing and entry access can be made at each door, a minimum of one gate is required. (ii) The gate(s) must be located to provide a continuous path of travel from the building exit to a public way, including walkways of concrete, asphalt, or other approved materials. (iii) If gate(s) are locked, the gate nearest the exit from the building must be locked with an electronic lock that operates the same as electronic locks on control doors and/or exit doors and is in compliance with the National Electrical Code for exterior exposure. Additional gates may also have electronic locks or may have keyed locks provided staff carry the keys. All gates may have keyed locks, provided all staff carry the keys, and the outdoor area has an area of refuge which:
(I) extends beyond a minimum of 30 feet from the building; and
(II) the area of refuge allows at least 15 square feet per person (resident, staff, visitor) potentially present at the time of a fire.
(8) Locking devices may be used on the control doors provided the following criteria are met:
(A) The building must have an approved sprinkler system and an approved fire alarm system to meet the licensing standards.
(B) The locking device must be electronic and must be released when any one of the following occurs: (i) activation of the fire alarm or sprinkler system; (ii) power failure to the facility; or (iii) activation of a switch or button located at the monitoring station and at the main staff station.
(C) A key pad or buttons may be located at the control doors for routine use by staff.
(9) Locking devices may be used on the exit doors provided:
(A) the locking arrangements meet § 5-2.1.6 of the Life Safety Code; or
(B) the following criteria are met: (i) The building must have an approved sprinkler system and an approved fire alarm system to meet the licensing standards. (ii) The locking device must be electro-magnetic; that is, no type of throw-bolt is to be used. (iii) The device must release when any one of the following occurs:
(I) activation of the fire alarm or sprinkler system;
(II) power failure to the facility; or
(III) activation of a switch or button located at the monitoring station and at the main staff station. (iv) A key pad or buttons may be located at the control doors for routine use by staff. (v) A manual fire alarm pull must be located within five feet of each exit door with a sign stating, "Pull to release door in an emergency." (vi) Staff must be trained in the methods of releasing the door device.
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