(a) Staff qualifications.      
        (1) Director. A facility must employ a director.                  (A) The director must:                      (i) have graduated from an accredited four-year college or university and have no less than one year of experience in working with people in a human service or medically related program, or have an associate degree or 60 semester hours from an accredited college or university with three years of experience working with people in a human service or medically related program;                       (ii) be an RN with one year of experience in a human service or medically related program;                       (iii) meet the training and experience requirements for a license as a nursing facility  administrator under Texas Administrative Code (TAC), Title 40, Chapter 18, Nursing Facility Administrators; or                       (iv) have met, on July 16, 1989, the qualifications for a director required at that time and have served continuously in the capacity of director since that date.                     (B) The director must show evidence of 12 hours of annual continuing education in at least two of the following areas:                      (i) individual and provider rights and responsibilities, abuse, neglect, exploitation and confidentiality;                       (ii) basic principles of supervision;                       (iii) skills for working with individuals, families, and other professional service providers;                       (iv) individual characteristics and needs;                       (v) community resources;                       (vi) basic emergency first aid, such as cardiopulmonary resuscitation (CPR) or choking; or                       (vii) federal laws, such as Americans with Disabilities Act, Civil Rights Act of 1991, the Rehabilitation Act of 1993, and the Family and Medical Leave Act of 1993.                     (C) The activities director may fulfill the function of director if the activities director meets the qualifications for facility director.                   (D) One person may not serve as facility nurse, activities director, and director, regardless of qualifications.                   (E) The facility must have a policy  regarding the delegation of responsibility in the director's absence from the facility.                   (F) The facility must notify the HHSC regional office in which the facility is located if the director is absent from the facility for more than 10 working days.         
        (2) Nurse. A facility must employ a nurse.                  (A) An RN must have a license from the Texas Board of Nursing and practice in compliance with the Nurse Practice Act and rules and regulations of the Texas Board of Nursing.                   (B) An LVN must have a license from the Texas Board of Nursing and practice in compliance with the Nurse Practice Act and rules and regulations of the Texas Board of Nursing.                   (C) If a nurse  serving as director leaves the facility to perform other duties related to the DAHS program, an LVN or another RN must fulfill the duties of the facility nurse.                   (D) A facility that does not have a DAHS contract, but has a Special Services to Persons with Disabilities contract, is not required to have an RN on duty, if the individual receiving services has no medical needs and is able to self-administer medication.         
        (3) Activities director. A facility must employ an activities director.                  (A) Except as provided in subparagraph (B) of this paragraph, an activities director must have graduated from a high school or have a certificate recognized by a state of the United States as the equivalent of a  high-school diploma and have:                      (i) a bachelor's degree from an accredited college or university, and one year of full-time experience working with elderly people or people with disabilities in a human service or medically related program;                       (ii) 60 semester hours from an accredited college or university, and two years of full-time experience working with elderly people or people with disabilities in a human service or medically related program; or                       (iii) completed an activities director's course, and two years of full-time experience working with elderly people or people with disabilities in a human service or medically related program.                     (B) An activities director hired before May 1,  1999, with four years of full-time experience working with elderly people or people with disabilities in a human service or medically related program is not subject to the requirements of subparagraph (A) of this paragraph.         
        (4) Attendants. An attendant must be at least 18 years of age and may be employed as a driver, aide, cook, janitor, porter, housekeeper, or laundry worker.                  (A) If a facility employs a driver, the driver must have a current operator's license, issued by the Texas Department of Public Safety, which is appropriate for the class of vehicle used to transport individuals.                   (B) If an attendant handles food in the facility, the attendant must meet requirements of the Department of State  Health Services rules on food service sanitation as described in 25 TAC, Chapter 228, Subchapters A - J (relating to Retail Food).         
        (5) Food service personnel. If a facility prepares meals on site, the facility must have sufficient food service personnel to prepare meals and snacks. Food service personnel must meet the requirements of the Department of State Health Services rules on food service sanitation as described in 25 TAC, Chapter 228, Subchapters A - J (relating to Retail Food).       
        (6) Additional requirements for a facility that contracts with HHSC.                  (A) Housekeeper. A facility that contracts with HHSC may employ a part-time or full-time housekeeper.                   (B) Driver. If a  facility that contracts with HHSC employs a driver, the driver must:                      (i) operate the facility's vehicles in a safe manner; and                       (ii) maintain adult cardiopulmonary resuscitation (CPR) certification.           
      (b) Staffing. A facility must ensure that:      
        (1) the ratio of direct service staff to individuals is at least one to eight, which must be maintained during provision of all DAHS except during facility-provided transportation;       
        (2) at least one RN or LVN is working at the facility for at least eight hours per day and sufficient nurses are at the facility to meet the nursing needs of the individuals at all times;       
        (3) the facility director routinely works at least 40 hours per week performing duties relating to the provision of the DAHS program;       
        (4) the activities director routinely works at least 40 hours a week;       
        (5) individuals whose needs cannot be met by the facility are not admitted or retained; and       
        (6) sufficient staff are on duty at all times to meet the needs of the individuals who are served by the facility.       
      (c) Staff health. All direct service staff must be free of communicable diseases.      
        (1) A facility must screen all employees for tuberculosis within two weeks of employment and annually, according to Center for Disease Control and Prevention (CDC)  screening guidelines. All persons providing services under an outside resource contract must also screen all employees for tuberculosis within two weeks of employment and annually according to CDC screening guidelines.       
        (2) If an employee contracts a communicable disease that is transmissible to individuals through food handling or direct individual care, the facility must exclude the employee from providing these services while the employee is infectious.       
      (d) Staff responsibilities.      
        (1) The facility director:                  (A) manages the DAHS program and the facility;                   (B) trains and supervises facility staff;                   (C) monitors the facility  building and grounds to ensure compliance;                   (D) maintains all financial and individual records;                   (E) develops relationships with community groups and agencies for identification and referral of individuals;                   (F) maintains communication with an individual's family members or responsible parties;                   (G) assures the development and maintenance of the individual's plan of care; and                   (H) ensures that, if the facility director serves as the RN consultant, the facility director fulfills the responsibility as director.         
        (2) The facility nurse:                  (A) assesses an individual's nursing and medical needs;                   (B) develops an individual's plan of care;                   (C) obtains physician's orders for medication and treatments to be administered;                   (D) determines whether self-administered medications have been appropriately taken, applied, or used;                   (E) enters, dates, and signs monthly progress notes on medical care provided;                   (F) administers medication and treatments;                   (G) provides health education; and                   (H) maintains medical records.         
        (3) The activities director:                  (A) plans and directs the daily program of activities, including physical fitness exercises or other recreational  activities;                   (B) records the individual's social history;                   (C) assists the individual's related support needs;                   (D) assures that the identified related support services are included in the individual's plan of care; and                   (E) signs and dates monthly progress notes about social and related support services activities provided.         
        (4) An attendant:                  (A) provides personal care services to assist with activities of daily living;                   (B) assists the activities director with recreational activities; and                   (C) provides protective supervision through observation and monitoring.         
        (5) Food service personnel:                  (A) prepare meals and snacks; and                   (B) maintain the kitchen area and utensils in a safe and sanitary condition.         
        (6) A facility must obtain consultation at least four hours per month from a dietitian consultant.                  (A) The dietitian consultant plans and reviews menus and must:                      (i) approve and sign snack and luncheon menus;                       (ii) review menus monthly to ensure that substitutions were appropriate; and                       (iii) develop a special diet for an individual, if ordered by a physician.                     (B) A facility must obtain consultation from a dietitian consultant,  even if the facility has meals delivered from another facility with a dietitian consultant or the facility contracts for the preparation and delivery of meals with a contractor that employs a registered dietician. A consultant who provides consultation to several facilities must provide at least four hours of consultation per month to each facility.         
        (7) If a facility employs an LVN as the facility nurse, the facility must ensure that an RN consultant provides consultation at the facility at least four hours per week. The RN consultant must document the consultation provided. The RN consultant must provide the consultation when individuals are present in the facility. The RN consultant may provide the following types of assistance:                  (A) review plans of care and suggest changes, if appropriate;                   (B) assess individuals' health conditions;                   (C) consult with the LVN in solving problems involving care and service planning;                   (D) counsel individuals on health needs;                   (E) train, consult, and assist the LVN to maintain proper medical records; and                   (F) provide in-service training for direct service staff.         
      (e) Training.      
        (1) Initial training.                  (A) A facility must:                      (i) provide direct service staff with training in the fire, disaster, and evacuation procedures within three workdays after  the start of employment and document the training in the facility records; and                       (ii) provide direct service staff a minimum of 18 hours of training during the first three months after the start of employment and document the training in the facility records.                     (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; or                       (iii) orientation to health care delivery, including the following topics:                          (I) safe body function and mechanics;                           (II) personal care techniques and procedures; and                           (III) overview of the population served at the facility; and                        Cont'd...