The DAHS facility must provide services that include the following:
  (1) Nursing services. Nursing services must include:
    (A) assessing, observing, evaluation, and documenting an individual's health condition, and instituting appropriate nursing intervention to stabilize or improve an individual's condition or prevent complications;
    (B) ensuring that the individual plan of care appropriately reflects the physician's orders;
    (C) assisting the individual to order, maintain, or administer prescribed medications or treatments, as indicated by physician's orders;
    (D) counseling the individual on his health need and illness and involving significant others in the discussions of his immediate and long-term health goals; and
    (E) providing or supervising personal care services to enable the individual to restore, maintain, or improve his ability to perform personal care tasks. For purposes of this requirement, personal care is defined as assistance with dressing, feeding, grooming, bathing, toileting, transferring/ambulation, or assistance with self-administering medication.
  (2) Physical rehabilitative services. Physical rehabilitative services must include:
    (A) restorative nursing; and
    (B) group and individual exercises, including range of motion exercises.
  (3) Nutrition/food service. Nutrition/food service in DAHS facilities is provided under 4 TAC Chapter 25, Subchapter A, concerning the Child and Adult Care Food Program (CACFP) and must include:
    (A) one hot noon meal served between the hours of 11:00 a.m. and 1:00 p.m. The meal must:
      (i) be suitable in quantity and adequacy to attain and maintain nutritional requirements, including those of an individual with special needs. The CACFP staff monitor the adequacy of a meal by totaling the amount of food produced and cooked by the number of adults fed to determine if the average amount of food meet the following food components: two ounces of meat, 1/2 cup of fruit/vegetables, one cup of milk, and two servings of bread; and
      (ii) supply 1/3 of the recommended daily allowance for adults as recommended by the United States Department of Agriculture;
    (B) special diets as required by the individual's plan of care;
    (C) a supplementary mid-morning and mid-afternoon snack;
    (D) dietary counseling and nutrition education for the individual and family; and
    (E) assisting the individual with his meals if necessary. This includes:
      (i) food texture modification, including grinding meats and mashing vegetables for an individual having trouble chewing; and
      (ii) food management, including spoon feeding, bread buttering, and milk opening for an individual with hand deformities, paralysis, or hand tremors.
  (4) Other supportive services. Other supportive services must include:
    (A) community interaction, cultural enrichment, educational or recreational activities, and other social activities on site or in the community in a planned program to meet an individual's social needs and interests;
    (B) providing at least three social activities per day; and
    (C) posting a monthly activity calendar at least one week in advance.
  (5) Transportation services.
    (A) Transportation services must include:
      (i) transportation to and from the DAHS facility; and
      (ii) transportation to and from a DAHS facility approved to provide therapies, if an individual requires specialized services on days of attendance at the day activity and health services DAHS facility.
    (B) If the DAHS facility provides transportation for an individual to a non-therapy medical DAHS facility, the DAHS facility can claim the time spent in transport as part of the unit of services.
    (C) If the DAHS facility does not provide transportation, the DAHS facility must coordinate transportation with other resources.
    (D) Vehicles used for transportation services must:
      (i) be properly operated and maintained in accordance with state law;
      (ii) have current inspection and registration;
      (iii) have proper heating and cooling systems to maintain reasonable temperature levels inside the vehicle;
      (iv) have working seatbelts for each individual unless the vehicle was manufactured without seatbelts;
      (v) have a method to secure a wheelchair to ensure an individual's safety during transit; and
      (vi) if equipped with a wheelchair lift, have a properly operated and maintained lift.

Source Note: The provisions of this §211.206 adopted to be effective May 1, 1999, 24 TexReg 3100; amended to be effective April 1, 2007, 32 TexReg 1749; amended to be effective November 20, 2012, 37 TexReg 9117; transferred effective July 31, 2024, as published in the July 5, 2024, issue of the Texas Register, 49 TexReg 4935