(a) Resident care and services. The adult foster care provider must:
  (1) provide services to residents according to the individual service plan and the resident/provider agreement;
  (2) meet all requirements and conditions stated on the resident/provider agreement, approval of foster care, and resident service plan;
  (3) ensure that an approved substitute provider is present in the home if at least one resident remains in the home when the provider plans to be absent from the home for more than three hours in a 24-hour period. Residents whose care plans specify the need for 24-hour supervision may not be left without the supervision of an approved substitute provider for any period of time;
  (4) receive prior approval from the adult foster care caseworker or supervisor if he plans to be absent for more than 24 hours. The proposed substitute provider must have prior Department of Aging and Disability Services (DADS) approval. The provider must ensure that the substitute provider is aware of and takes responsibility for meeting resident needs and providing services according to the residents service plans and the requirements of these standards. If two adults in the home have been approved as dual providers, this notification is not necessary when one provider leaves for more than 24 hours;
  (5) ensure that residents are not abused, neglected, or exploited while in foster care. Validated reports of the provider, the provider's family, or employees willfully inflicting injury, physical suffering, intimidation, or mental anguish on any resident in the home shall constitute grounds for immediate removal of the home from enrollment;
  (6) respond to, investigate, and document resident complaints and report unresolved complaints to the adult foster care caseworker within five days of receipt of the complaint;
  (7) have clearly defined house rules, including smoking policies. House rules must be shared with the resident before moving to the foster home;
  (8) take appropriate action if he finds that a resident threatens the health or safety of others or himself; and
  (9) provide the resident with a final accounting of the resident's funds and refund any monies owed to the resident within five days of discharge. Any unused room and board money must be reimbursed within 30 days.
(b) The foster care provider providing services to three or less residents must comply with Title 42 United States Code §1396a(w) regarding advance directives.
(c) Recordkeeping. The adult foster care provider must:
  (1) maintain for each resident a record with the following information:
    (A) the names, addresses, and telephone numbers of:
      (i) person(s) other than DADS staff to be notified in case of emergency, (if any);
      (ii) the resident's physician, (if any); and
      (iii) the resident's adult foster care caseworker;
    (B) current and past copies of the client and provider agreement, signed by the resident and/or responsible party, provider, and the adult foster care caseworker;
    (C) current and past copies of the approval of adult foster care;
    (D) current and past copies of the client service plan;
    (E) any DADS communications regarding the resident;
    (F) personal papers of the resident, such as life insurance policies, burial arrangements, savings accounts, etc., if requested by the resident; and
    (G) records related to assistance provided the resident with money management, payments, distribution of personal allowance, expenditures, etc.;
  (2) file claims for services according to DADS rules using the appropriate DADS forms and agree to accept the claimed amount as full payment from DADS for services provided. Nursing facility waiver residents are required to pay a co-payment.
(d) Reporting and notification. The adult foster care provider must:
  (1) report to the adult foster care caseworker, within 24 hours or the next work day after awareness of the change, all significant changes in the resident's physical health, mental and/or behavior status;
  (2) report to the adult foster care caseworker pending resident hospitalizations before the hospitalization, and unplanned hospitalizations within 24 hours of the hospitalization or the next work day;
  (3) report pending hospital discharges of approved residents to the adult foster care caseworker before the actual discharge, or on the day the resident returns to the foster care setting, to ensure continued resident appropriateness;
  (4) notify the adult foster care caseworker, at a minimum, within 24 hours or the next work day after a resident is away from or vacates the adult foster home;
  (5) notify the adult foster care caseworker immediately by telephone upon becoming aware of the following: death of a resident, serious physical injury or distress of a resident, offense against the resident, or public indecency of a resident. The provider must submit a written report within 48 hours of the verbal report. The provider must also notify the police in the following situations: the death of a resident in the foster home, serious physical injury resulting from assault or battery, offenses against the resident, and public indecency;
  (6) notify the adult foster care caseworker about serious occurrences involving the provider, the home, or the residents. These may include, but are not limited to, fire, accidents, altercations among residents, break-ins, or illness of the provider or residents. The provider must notify the caseworker by telephone no later than the next calendar day after awareness of the occurrence;
  (7) notify the adult foster care caseworker before any resident receives home health services;
  (8) notify the adult foster care caseworker when the provider, substitute provider, or a family member is the subject of an adult protective services investigation. The provider must notify the adult foster care caseworker within 24 hours of the beginning of the investigation or the next work day; and
  (9) report to the adult foster care caseworker's supervisor or another adult foster care staff person any of the required notifications if the caseworker is not available to speak with the provider.
(e) Responding/acting. The adult foster care provider must:
  (1) upon awareness, obtain medical attention for a resident exhibiting signs of physical injury, pain, or discomfort;
  (2) seek medical attention/care on the same day of awareness for a resident exhibiting acute changes in physical health, mental or behavior status; and
  (3) follow DADS adult foster care directives related to resident care within the specified time frames.
(f) Nutrition. The adult foster care provider must:
  (1) provide a resident with at least three meals daily which meet each resident's dietary and nutritional needs;
  (2) consider a resident's food preferences and make reasonable accommodations within his dietary needs;
  (3) serve a variety of foods, within the resident's dietary needs; and
  (4) follow special diets as prescribed in writing by the resident's physician.
(g) Medications. The adult foster care provider must comply with the following rules regarding the storage and management of medications:
  (1) prescription medications must be in the original container labeled with the resident's name, date, instructions, name of medication and dosage, and the physician's name;
  (2) medications requiring refrigeration must be separated from food in a clearly labeled, designated locked container;
  (3) medications must be transferred with the resident when the resident leaves the home. Medications must be disposed of when resident medication regimen changes, or when the medication is out of date;
  (4) medications prescribed for one resident must not be taken by or given to any other resident;
  (5) the adult foster care provider must ensure that a resident takes over-the-counter medications according to the package directions. Excessive use of these medications must be reported to the adult foster care caseworker;
  (6) the adult foster care provider must ensure that all medications are taken as prescribed and in a timely manner according to the instructions on the medication label or instructions from the resident's physician;
  (7) the adult foster care provider may administer medications only as allowed by state law or regulation; and
  (8) prescription medications must be kept in a locked container.
(h) Resident rights and responsibilities. The adult foster care provider must:
Cont'd...
(1) inform the resident verbally and in writing, before or at the time of admission, of his rights and responsibilities. The rights and responsibilities include rules governing resident conduct, complaints, bedhold policies for hospital and personal leave, and eviction procedures. The policies must not violate the rules specified in this subchapter nor adversely affect the resident's health or safety. All policies must have an effective date. If the provider amends any policy, each resident must be informed before the change becomes effective. A written copy of these policies must be given to the resident to initial and date. This copy must be filed in the resident's casefolder. A copy of the policies must also be given to the resident. If the resident is unable to read or understand the policies, a copy must be given to the person responsible for him;
  (2) allow the resident to manage his finances or trust funds. The provider must assist the resident in managing his finances only if the resident requests assistance in writing. The resident may rescind this authorization at any time by doing so in writing;
  (3) investigate all problems, deficiencies, and non-compliance with policies, procedures, and standards which are reported by the resident or DADS staff within five workdays from receipt of the report. A copy of the documented complaint must be submitted to the adult protective services caseworker within 30 days of the receipt of the report;
  (4) provide each resident with a general orientation about his needs and the tasks to be provided before or at the time the service begins;
  (5) not require a resident to perform services for the provider or other residents; and
  (6) treat each resident with dignity and respect. The provider must guarantee certain basic rights to each resident living in his home. Such rights include the right to privacy, humane care and environment, safety of personal possessions and funds, receipt of visitors, confidentiality of personal records, freedom of religion, freedom from physical or mental abuse, neglect and exploitation, freedom from physical or chemical restraints, freedom from financial exploitation, and the right to voice grievances without retribution or intimidation.
(i) Transportation. Adult foster care providers must provide or make arrangements to meet the transportation needs of a resident for medical appointments/care, shopping for personal needs, and church activities as identified by the adult foster care caseworker. An escort must also be provided if specified in the individual service plan for a resident.
(j) Provider rights. Each provider must post a providers' bill of rights in a prominent place in the foster home. The bill of rights must state that the adult foster care provider has the right to:
  (1) be shown consideration and respect that recognizes the dignity and individuality of the provider;
  (2) terminate the client/provider agreement after a written 30-day notice;
  (3) terminate the client/provider agreement immediately, after notice to DADS, if the provider finds that a resident creates a serious or immediate threat to the health, safety, or welfare of the provider or the other residents of the foster home;
  (4) refuse to perform services for the resident or the resident's family other than those specified in the client/provider agreement;
  (5) refuse to accept a person referred to the foster home if the referral is inappropriate;
  (6) refuse to allow the presence of illegal drugs and weapons in the home; and
  (7) be made aware of a resident's problems, including aggressive or violent behavior, disease, alcoholism, or drug abuse.
(k) Termination of services. Adult foster care providers cannot terminate services to a resident without the prior approval of the adult foster care caseworker or supervisor, unless the resident creates a serious or immediate threat to the health, safety, or welfare of the provider or the other residents of the foster home.

Source Note: The provisions of this §278.113 adopted to be effective January 1, 1994, 18 TexReg 8232; amended to be effective November 1, 1994, 19 TexReg 8132; amended to be effective September 1, 2014, 39 TexReg 6637; transferred effective June 28, 2024, as published in the June 7, 2024, issue of the Texas Register, 49 TexReg 4061