Each facility must develop, implement and maintain effective training programs of orientation, training, and continuing in-service education to develop the skills of its staff, including all new and existing staff; individuals providing services under a contractual arrangement; and volunteers, consistent with their expected roles. Effective November 28, 2019, a facility must determine the amount and types of training necessary based on a facility assessment as specified at §19.1931 of this subchapter (relating to Facility Assessment) and as described in §19.1001 of this chapter (relating to Nursing Services).
  (1) As part of orientation and annually, each employee must receive instruction regarding:
    (A) Human Immunodeficiency Virus (HIV), as outlined in the educational information provided by the Texas Department of State Health Services Model Workplace Guidelines. At a minimum the HIV curriculum must include:
      (i) modes of transmission;
      (ii) methods of prevention;
      (iii) behaviors related to substance abuse;
      (iv) occupational precautions;
      (v) current laws and regulations concerning the rights of an acquired immune deficiency syndrome/HIV-infected individual; and
      (vi) behaviors associated with HIV transmission which are in violation of Texas law;
    (B) restraint reduction and the prevention of falls through competency-based training. Facilities also may choose to train on behavior management, including prevention of aggressive behavior and de-escalation techniques;
    (C) activities that constitute abuse, neglect, exploitation, or misappropriation of resident property as set forth at §19.601 of this chapter (relating to Freedom from Abuse, Neglect and Exploitation);
    (D) procedures for reporting incidents of abuse, neglect, exploitation, or misappropriation of resident property; and
    (E) dementia management and resident abuse prevention.
  (2) Each registered nurse, licensed vocational nurse, and nurse aide (nurse assistant) who provides nursing services must receive at least one hour of training each year in caring for people who have dementia.
  (3) Nursing staff, licensed nurses, and nurse aides must receive annual in-service training which includes components, appropriate to their job responsibilities, from one or more of the following categories:
    (A) communication techniques and skills useful when providing geriatric care, such as skills for communicating with the hearing impaired, visually impaired and cognitively impaired; therapeutic touch; and recognizing communication that indicates psychological abuse;
    (B) assessment and nursing interventions related to the common physical and psychological changes of aging for each body system;
    (C) geriatric pharmacology, including treatment for pain management and sleep disorders;
    (D) common emergencies of geriatric residents and how to prevent them, for example, falls, choking on food or medicines, injuries from restraint use; recognizing sudden changes in physical condition, such as stroke, heart attack, acute abdomen, and acute glaucoma; and obtaining emergency treatment;
    (E) common mental disorders with related nursing implications; and
    (F) ethical and legal issues regarding advance directives, abuse and neglect, guardianship, and confidentiality.
  (4) Facilities with pediatric residents must comply with the following:
    (A) Facility staff must be trained in the use of pediatric equipment and supplies, including emergency equipment and supplies.
    (B) Facility staff must receive annual continuing education dealing with pediatric issues, including child growth and development and pediatric assessment.
  (5) Minimum continuing in-service education requirements are listed in subparagraphs (A) - (B) of this paragraph. Attendance at relevant outside training may be used to satisfy the in-service education requirement. The facility must keep in-service records for each employee listed. The minimum requirements are:
    (A) licensed personnel--two hours per quarter; and
    (B) nurse aides--12 hours annually. For the purpose of this paragraph, a medication aide is considered a nurse aide and must receive the same continuing in-service education. This in-service education does not qualify as continuing education units required for renewal of a medication aide permit.
  (6) A rural hospital participating in the Medicaid Swing Bed Program as specified in §19.2326 of this chapter (relating to Medicaid Swing Bed Program for Rural Hospitals) is not required to meet the requirements of this section, if the swing beds are used for no more than one 30-day length of stay per year, per resident.
  (7) Effective November 28, 2019, the facility must also include as part of its mandatory training the following topics:
    (A) effective communications for direct care staff;
    (B) rights of the resident and the responsibilities of a facility to properly care for its residents as set forth in Subchapter E of this chapter (relating to Resident Rights);
    (C) standards, policies, and procedures for the facility's infection prevention and control program, as set forth in §19.1601 of this chapter (relating to Infection Control); and
    (D) behavioral health training, as set forth in §19.904 of this chapter (relating to Behavioral Health Services).

Source Note: The provisions of this §554.1929 adopted to be effective September 1, 1996, 21 TexReg 7859; amended to be effective June 1, 2003, 28 TexReg 3828; amended to be effective May 1, 2004, 29 TexReg 3235; amended to be effective March 24, 2020, 45 TexReg 2025; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871