(a) General. The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in §19.101 of this chapter (relating to Definitions). This includes freedom from any physical or chemical restraint not required to treat the resident's medical symptoms.     
      (b) Abuse. The resident has the right to be free from verbal, sexual, physical and mental abuse, corporal punishment, and involuntary seclusion.     
      (c) Policies and procedures. The facility must develop and implement written policies and procedures that prohibit and prevent mistreatment, abuse, neglect, and exploitation of a resident, and misappropriation of a resident's property.      
        (1) The facility must:                  (A) not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion;                   (B) not employ or otherwise engage an individual who has:                      (i) been found guilty of abuse, neglect, exploitation, misappropriation of property, or mistreatment of a resident by a court of law;                       (ii) had a finding entered into the state nurse aide registry concerning abuse, neglect, exploitation or mistreatment of a resident, or misappropriation of a resident's property;                       (iii) been convicted of any crime contained in §250.006, Texas Health and Safety Code; or                       (iv) a disciplinary action in effect against the  individual's professional license by a state licensure body as a result of a finding of abuse, neglect, exploitation, mistreatment of a resident or misappropriation of a resident's property.                     (C) report any knowledge it has of actions by a court of law against an employee, which would indicate unfitness for service as a nurse aide or other staff to the state nurse aide registry or licensing authority.         
        (2) The written policies and procedures must:                  (A) establish protocols to investigate any such allegations; and                   (B) include training as required by §19.1929 of this chapter (relating to Staff Development).         
      (d) Restraints. The facility must ensure  that the resident is free from physical or chemical restraints imposed for purposes of discipline or convenience and that are not required to treat the resident's medical symptoms. If the use of restraints is indicated, the facility must use the least restrictive alternative for the least amount of time and document ongoing re-evaluation of the need for restraints.      
        (1) If physical restraints are used because they are required to treat the resident's medical condition, the restraints must be released and the resident repositioned as needed to prevent deterioration in the resident's condition. Residents must be monitored hourly and, at a minimum, restraints must be released every two hours for a minimum of ten minutes, and the resident repositioned.       
        (2) A facility must not administer to a resident a restraint that:                  (A) obstructs the resident's airway, including a procedure that places anything in, on, or over the resident's mouth or nose;                   (B) impairs the resident's breathing by putting pressure on the resident's torso;                   (C) interferes with the resident's ability to communicate; or                   (D) places the resident in a prone or supine hold.         
        (3) A behavioral emergency is a situation in which severely aggressive, destructive, violent, or self-injurious behavior exhibited by a resident:                  (A) poses a substantial risk of imminent probable death of, or substantial bodily harm  to, the resident or others;                   (B) has not abated in response to attempted preventive de-escalatory or redirection techniques;                   (C) could not reasonably have been anticipated; and                   (D) is not addressed in the resident's comprehensive care plan.         
        (4) If restraint is used in a behavioral emergency, the facility must use only an acceptable restraint hold. An acceptable restraint hold is a hold in which the resident's limbs are held close to the body to limit or prevent movement and that does not violate the provisions of paragraph (2) of this subsection.       
        (5) A staff person may use a restraint hold only for the shortest period of time necessary to ensure  the protection of the resident or others in a behavioral emergency.       
        (6) A facility may adopt policies that allow less use of restraint than allowed by the rules of this chapter.       
        (7) Use of restraints and their release must be documented in the clinical record.       
     Source Note:        The provisions of this §554.601 adopted to be effective May 1, 1995, 20 TexReg 2393; amended to be effective March 1, 1998, 23 TexReg 1314; amended to be effective June 1, 2006, 31 TexReg 4449; 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