SECTION 559.227. Program Requirements

(a) Staff qualifications.

(1) An individualized skills and socialization provider must:

(A) employ an administrator;

(B) ensure the administrator meets the requirements outlined in paragraph (2) of this subsection; and

(C) have a policy regarding the delegation of responsibility in the administrator's absence.

(2) A service provider of individualized skills and socialization must be at least 18 years of age and:

(A) have a high school diploma or a certificate recognized by a state as the equivalent of a high school diploma; or

(B) have documentation of a proficiency evaluation of experience and competence to perform the job tasks that includes:

(i) a written competency-based assessment of the ability to document service delivery and observations of the individuals receiving services; and

(ii) at least three written personal references from persons not related by blood that indicate the ability to provide a safe, healthy environment for the individuals receiving services.

(3) A service provider of individualized skills and socialization who provides transportation must:

(A) have a valid driver's license; and

(B) transport individuals in a vehicle insured in accordance with state law.

(b) Staffing. An individualized skills and socialization provider must ensure that:

(1) an individual whose needs cannot be met by the individualized skills and socialization provider is not admitted or retained;

(2) the ratio of service providers to individuals is maintained in accordance with §260.507 of this title (relating to Staffing Ratios), §262.917 of this title (relating to Staffing Ratios for Off-Site Individualized Skills and Socialization), and §263.2017 of this title (relating to Staffing Ratios for Off-Site Individualized Skills and Socialization), during the provision of off-site individualized skills and socialization, including during transportation; and

(3) sufficient staff are on duty at all times during the provision of on-site individualized skills and socialization to ensure:

(A) the health and safety of the individuals;

(B) supervision is provided in accordance with the needs of an individual; and

(C) individualized skills and socialization are provided in accordance with an individual's individual plan of care (IPC), individual program plan (IPP), person-directed plan (PDP), and implementation plan, as applicable.

(c) Staff responsibilities.

(1) The administrator:

(A) manages the individualized skills and socialization services and the on-site individualized skills and socialization location;

(B) ensures staff are trained;

(C) supervises staff; and

(D) maintains all records.

(2) A service provider:

(A) delivers individualized skills and socialization services;

(B) assists with recreational activities; and

(C) provides protective supervision through observation and monitoring.

(d) An individualized skills and socialization provider must make both on-site and off-site individualized skills and socialization available to an individual, unless the individualized skills and socialization provider provides off-site individualized skills and socialization only.

(e) An individualized skills and socialization provider must ensure that on-site individualized skills and socialization:

(1) is provided in a building or a portion of a building that is owned or leased by an individualized skills and socialization provider; and

(2) is not provided in a prohibited setting for an individual, as set forth in the rules governing the HCS Program.

(f) An individualized skills and socialization provider must ensure that off-site individualized skills and socialization:

(1) are provided in a community setting chosen by the individual from among available community setting options;

(2) includes transportation necessary for the individual's participation in off-site individualized skills and socialization; and

(3) is not provided in:

(A) a building in which on-site individualized skills and socialization are provided;

(B) a prohibited setting for an individual, as set forth in the rules governing the HCS Program, unless:

(i) provided in an event open to the public; or

(ii) the activity is a volunteer activity performed by an individual in such a setting; or

(C) the residence of an individual or another person, unless the activity is a volunteer activity performed by an individual in the residence.

(g) An individualized skills and socialization provider must provide individualized skills and socialization:

(1) in the Deaf Blind with Multiple Disabilities (DBMD) program, in accordance with an individual's individual plan of care (IPC) and individual program plan (IPP); and

(2) in the Texas Home Living (TxHmL) program and Home and Community-based Services (HCS) program, in accordance with an individual's person-directed plan (PDP), IPC, and implementation plan.

(h) An individualized skills and socialization provider must not require an individual to take a skills test or meet other requirements to receive off-site individualized skills and socialization.

(i) If an individual does not want to participate in an activity the individual scheduled for on-site individualized skills and socialization or off-site individualized skills and socialization, or the legally authorized representative (LAR) does not want the individual to participate in such activity, the individualized skills and socialization provider must document the decision not to participate in the individual's record.

(j) An individualized skills and socialization provider must provide on-site and off-site individualized skills and socialization in-person.

(k) Training.

(1) Initial training.

(A) An individualized skills and socialization provider must:

(i) provide service providers with training on fire, disaster, and their responsibilities under the emergency response plan developed in accordance with §559.229 of this subchapter (relating to Environment and Emergency Response Plan) within three workdays after the start of employment and document the training in the individualized skills and socialization provider's records; and

(ii) provide service providers a minimum of eight hours of training during the first three months after the start of employment and document the training in the records of the individualized skills and socialization provider.

(B) The training provided in accordance with subparagraph (A)(ii) of this paragraph must include:

(i) any nationally or locally recognized adult CPR course or certification;

(ii) first aid;

(iii) infection control;

(iv) overview of the population served by the individualized skills and socialization provider; and

(v) identification and reporting of abuse, neglect, or exploitation.

(2) Ongoing training.

(A) An individualized skills and socialization provider must:

(i) ensure that service providers maintain current certification in CPR;

(ii) train on responsibilities under the emergency response plan developed in accordance with §559.229;

(iii) train on infection control policies and procedures developed in accordance with subsection (n) of this section; and

(iv) train on the identification and reporting of abuse, neglect, or exploitation.

(l) Medications.

(1) Administration.

(A) If an individual cannot or chooses not to self-administer his or her medications, an individualized skills and socialization provider must provide assistance with such medications and the performance of related tasks if:

(i) a registered nurse has assessed the assistance and related tasks and delegated such to the individualized skills and socialization provider in accordance with state law and rules; or

(ii) a physician has delegated the assistance and related tasks as a medical act to the individualized skills and socialization provider under Texas Occupations Code Chapter 157, as documented by the physician.

(B) An individualized skills and socialization provider must record an individual's medications, including over-the-counter medications, on the individual's medication profile record. The recorded information must be obtained from the prescription label and must include the medication name, strength, dosage, doses received, directions for use, route of administration, prescription number, pharmacy name, and the date each medication was issued by the pharmacy.

(2) General.

(A) An individualized skills and socialization provider must immediately report to an individual's program provider any unusual reactions to a medication or treatment.

(B) When an individualized skills and socialization provider supervises or administers medications, the individualized skills and socialization provider must document in writing if an individual does not receive or take the medication and treatment as prescribed. The documentation must include the date and time the dose should have been taken, and the name and strength of medication missed.

(3) Storage.

(A) An individualized skills and socialization provider must provide a locked area for all medications, which may include:

(i) a central storage area; or

(ii) a medication cart.

(B) An individualized skills and socialization provider must store an individual's medication separately from other individuals' medications within the storage area.

(C) An individualized skills and socialization provider must store medication requiring refrigeration in a locked refrigerator that is used only for medication storage or in a separate, permanently attached, locked medication storage box in a refrigerator.

(D) An individualized skills and socialization provider must store poisonous substances and medications labeled for "external use only" separately within the locked area.

(E) An individualized skills and socialization provider must store drugs covered by Schedule II of the Controlled Substances Act of 1970 in a locked, permanently attached cabinet, box, or drawer that is separate from the locked storage area for other medications.

(m) Accident, injury, or acute illness.

(1) An individualized skills and socialization provider must stock and maintain in a single location in the on-site individualized skills and socialization location first aid supplies to treat burns, cuts, and poisoning.

(2) An individualized skills and socialization provider delivering off-site individualized skills and socialization must ensure first aid supplies to treat burns, cuts, and poisoning are immediately available at all times during service provision.

(3) In the event of accident or injury to an individual requiring emergency care, or in the event of death of an individual, an individualized skills and socialization provider must:

(A) arrange for emergency care or transfer to an appropriate place for treatment, including:

(i) a physician's office;

(ii) a clinic; or

(iii) a hospital;

(B) immediately notify an individual's program provider with which the individualized skills and socialization provider contracts to provide services to the individual; and

(C) describe and document the accident, injury, or illness on a separate report containing a statement of final disposition and maintain the report on file.

(n) An individualized skills and socialization provider must create and enforce written policies and procedures for infection control, including spread of disease to ensure staff compliance with state law, the Occupational Safety and Health Administration, and the Centers for Disease Control and Prevention.

Source Note: The provisions of this §559.227 adopted to be effective January 1, 2023, 47 TexReg 8709