(a) This applies to all three-person and four-person residences and host home/companion care settings, unless otherwise specified.     
      (b) A program provider must ensure that:      
        (1) the residence, neighborhood, and community meet the needs of the individual and provide an environment that ensures the health, safety, and welfare of the individual;       
        (2) the home is modified to meet the specific adaptive needs of the individual;       
        (3) adaptive equipment is functional for the individual or, if the equipment is not functional, the provider has documented:                  (A) the broken equipment;                   (B) the order date of new or replacement equipment;                   (C) the date of the new or replacement equipment installment; and                   (D) alternative strategies used during the interim;         
        (4) mattresses are off the floor and a mattress cover is utilized unless contraindicated and documented by the service planning team;       
        (5) home furnishings are safe and fit for use;       
        (6) the home is clean and sanitary;       
        (7) the home is free of infestations including bugs, rodents, and other pests;       
        (8) the walls, ceilings, floors, and windows are in good condition and not hazardous to the individual;       
        (9) the bathrooms are functional and safe to use;       
        (10) there is hot water available at sinks and in bathing facilities;       
        (11) the temperature of the hot water at sinks and bathing facilities does not exceed 120 degrees Fahrenheit unless the program provider, in accordance with subsection (c) of this section, conducts a competency-based skills assessment showing that all individuals in the residence can independently regulate the temperature of the hot water from the sinks and bathing facilities;       
        (12) the major home appliances are in working order, including kitchen appliances and heating and cooling systems;       
        (13) the individual's bedroom door has a lock that:                  (A) is operable by the individual;                   (B) only the individual, a roommate of the individual if applicable, and staff designated by the program provider have keys to the individual's bedroom door; and                   (C) is not purchased and installed at the individual's or LAR's expense;         
        (14) the individual does not require a lock if:                  (A) the individual lives in a host home/companion care setting and the service provider is the LAR; or                   (B) there is a documented modification in the individual's person-directed plan;         
        (15) household cleaners and chemicals are stored securely;       
        (16) perishable foods are refrigerated or stored safely;       
        (17) animals and pets are kept free of disease and vaccinated as required by Texas Health and Safety Code, Chapter 826; and       
        (18) the interior and exterior of the home:                  (A) is free of accumulation of waste and trash;                   (B) is accessible and free of hazards to an individual; and                   (C) does not compromise the health or safety of an individual.         
      (c) If the program provider conducts the competency-based skills assessment described in subsection (b)(11) of this section:      
        (1) the assessment must:                  (A) be conducted by a staff member who is not a service provider of residential support, supervised living, or host home/companion care who works or lives in the residence;                   (B) be conducted for each individual;                   (C) evaluate the individual's cognitive and physical ability to independently mix or regulate the hot water temperature without assistance or guidance from each sink and bathing facility in the residence; and                   (D) be based on a face-to-face demonstration by the individual; and         
        (2) the program provider must:                  (A) complete the assessment at least annually;                   (B) document the results of the assessment; and                   (C) keep a copy of the results in the residence.         
      (d) The program provider must ensure that each residence has:      
        (1) exterior doors that are unobstructed and accessible to all individuals living in the residence;       
        (2) two means of escape from the residence;       
        (3) two means of escape from an individual's bedroom, unless the program provider has a fire sprinkler system that is checked and maintained according to Texas Insurance Code, Chapter 6003, at which point there can be one means of escape from an individual's bedroom;       
        (4) working smoke alarms in each bedroom and immediately outside the bedrooms; and       
        (5) fire extinguishers that are:                  (A) accessible and unobstructed to the service provider;                   (B) on each level of the home;                   (C) serviced or replaced after each use; and                   (D) if unused, serviced according to the manufacturer's instructions, or as required by the state or local fire marshal.         
      (e) The program provider, as it relates to fire drills, must:      
        (1) conduct at each residence at least:                  (A) one fire drill every 90 days;                   (B) four fire drills every 365 days; and                   (C) two of the fire drills listed in subparagraph (B) of this paragraph must be conducted during sleeping hours;         
        (2) ensure that each staff member participates in a fire drill within 90 days of hire and at least annually thereafter;       
        (3) ensure that the staff member can explain the emergency plans for the residence;       
        (4) provide training for a staff member who does not follow the emergency plan during the fire drill; and       
        (5) revise the emergency plan to ensure the individual can exit the residence safely if the individual is unable to exit the home according to the emergency plan.       
      (f) The program provider, as it relates to emergency plans, must:      
        (1) ensure that a staff member reviews the emergency plans for each individual at a residence before providing services;       
        (2) instruct staff members on where to locate the emergency plans at the residence; and       
        (3) maintain documentation related to emergency preparedness accessible to staff members at the residence, including:                  (A) emergency plans that address:                      (i) the relevant emergencies given the geographic location;                       (ii) the needs of the individuals living in the residence; and                       (iii) fire drill responses; and                     (B) emergency numbers publicly posted in an area of the residence that is easily accessible to staff members.         
      (g) A program provider must implement and maintain personnel practices that safeguard individuals against infectious and communicable diseases, which includes:      
        (1) using standard precautions in the care of all individuals, including hand hygiene and maintaining a sanitary environment to avoid sources and transmission of infections;       
        (2) creating written policies for the prevention and control of communicable diseases among employees and individuals, including the appropriate use of transmission-based precautions and protective measures the program provider must take if an employee contracts a communicable disease; and       
        (3) revising a policy or practice if a shortcoming is identified.       
      (h) A program provider must implement and maintain medication administration and storage practices that safeguard an individual's medication, which includes:      
        (1) creating written policies for preventing unauthorized access to medications;       
        (2) using a procedure that ensures safe medication administration to the individual;       
        (3) ensuring staff are trained and knowledgeable about the individuals' medications;       
        (4) ensuring staff who are administering medications have been trained and delegated by a registered nurse (RN);       
        (5) maintaining accurate, current, and accessible documentation of medication administration; and       
        (6) revising a policy or practice if a shortcoming is identified.       
      (i) A program provider must comply with the requirements in this subsection regarding a four-person residence.      
        (1) Before providing residential support in a four-person residence, the program provider must:                  (A) obtain an inspection by the local fire marshal, or the Texas State Fire Marshal's office in locations where there is no local fire marshal, and correct any items cited by the local fire marshal or Texas State Fire Marshal's Office to the satisfaction of those authorities; and                   (B) obtain Texas Health and Human Services Commission (HHSC)approval of the residence in accordance with §565.43 of this chapter(relating to HHSC Approval of Four Person Residences).         
        (2) HHSC inspects for certification, as described in paragraph(1)(A) of this subsection, only if the program provider submits to the HHSC Architectural Unit:                  (A) one of the following:                      (i) if the four-person residence is located in a jurisdiction with a local fire safety authority:                          (I) a completed HHSC Form 5606,                             Life Safety Code Certification,                            available on the HHSC website, documenting that the local fire safety authority having jurisdiction refused to inspect for certification using the code (i.e., the Life Safety Code or International Fire Code) for that jurisdiction; and                           (II) written documentation from the Texas State Fire Marshal's Office that it refused to inspect for certification using the Life Safety Code; or                         (ii) if the four-person residence is located in a jurisdiction without a local fire safety authority, written documentation from the Texas State Fire Marshal's Office that it refused to inspect for certification using the Life Safety Code; and                     (B) a completed HHSC Form 5604,                     HCS Program Provider Request for Life Safety Inspection,                    available on the HHSC website.         
        (3) The program provider must:                  (A) obtain the certification required by this subsection annually; and                   (B) ensure that a four-person residence:                      (i) contains a copy of the most recent inspection of the residence by the local fire safety authority, Texas State Fire Marshal's Office, or HHSC; and                       (ii) is in continuous compliance with all applicable local building codes and ordinances and state and federal laws, rules, and regulations.           
     Source Note:        The provisions of this §565.23 adopted to be effective June 21, 2023, 48 TexReg 3246