Annual Mandatory Training for Assisted Living Facilities
Welcome. You have launched the Annual Mandatory Training for Assisted Living Facilities computer-based training (CBT)!
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The Texas Health and Safety Code requires the following individuals to take annual training on aging in place and retaliation:
To document your compliance with this requirement, you must print and maintain a copy of the course certificate available at the end of the training.
If you are a state employee, your employee transcript will be automatically updated within 24 hours only if you have launched this course through the Blackboard Learning Tree learning management system (LMS).
For policy/course content questions contact an ALF policy specialist at LTCRPolicy@hhs.texas.gov.
This course is based on the ALF regulations, laws, and official communications listed below. To access these materials, click the titles.
This training is divided into two sections. After finishing both sections, a knowledge check must be completed.
In this course, you will review the:
This section of the training covers aging in place and the state rules and enforcement actions associated with aging in place.
Assisted living facilities are regulated under Health and Safety Code, Chapter 247 and Texas Administrative Code (TAC), Title 26, Part I, Chapter 553.
There are two types of ALFs in which aging in place may occur:
Aging in place does not apply to Type C facilities.
The aging in place process allows for continuity in living arrangements while securing the necessary support services in response to the resident's changing needs. The intent is to allow residents to remain in the ALF if the resident or the resident's representative, the resident's physician, and the facility have provided the documentation needed to support the resident's aging in place.
Over time, the appropriateness of placement of a resident in a particular facility often changes due to the resident's change in condition, needed services or ability to evacuate.
According to the process of aging in place, a resident may be allowed to remain in his or her environment if the facility agrees and if certain procedures are followed and if their health and safety needs can be met.
All residents must be appropriate for the facility's licensure type when admitted to an ALF, but residents often become inappropriately placed over time due to a change in condition.
The resident or his or her representative may prefer to remain in the facility if the resident's condition changes. The aging in place process applies only to residents who are already residents of a facility and were originally appropriately placed at admission into that facility.
The ALF is not required to keep a resident who is no longer appropriately placed.
Inappropriate placement looks different in each ALF type.
The resident of a Type A facility is incapable of following directions in an emergency.
NOTE: According to 26 TAC §553.62(b), residents in Type A facilities must be able to travel from their rooms to a centralized space, such as a lobby, living, or dining room, on the level of discharge within 13 minutes without continuous staff assistance. Elevators cannot be used as an evacuation route.
As outlined in Provider Letter 22-22, the ALF may proactively identify an inappropriately placed resident instead of waiting for a inspector to make this determination.
The ALF must comply with certain requirements, procedures and documentation:
If a resident has been identified as inappropriately placed, it is always a facility's right to decide to discharge the resident. The facility is not required to keep a resident who is no longer appropriate for the facility's license.
If the facility wants the resident to remain, but fails to obtain and submit all required documentation within the 10-day timeframe, then the resident must be discharged. The resident is allowed 30 days after the date of the discharge notice to move from the facility.
Source: HSC §247.066(d)
When a resident can meet the evacuation criteria of the facility's license (the resident can evacuate in case of emergencies without extra help), the focus of aging in place is to find ways to provide needed services in the resident's preferred facility.
When a resident cannot meet the evacuation criteria of the facility's license (the resident cannot evacuate in case of emergencies without extra help or is bedfast), the focus of aging in place must include finding ways to provide needed services. The facility must also create and document special evacuation plans for the resident.
We will review the required documentation required for each of these two scenarios beginning on the next slide.
When the resident is inappropriately placed and the evacuation criteria are met (the resident can evacuate in case of emergencies without extra help), the facility must complete and submit the following three documents:
The facility obtains a written statement from the resident declaring that the resident wants to remain in the facility. If the resident lacks capacity to give a statement, a family member of the resident may complete the written statement requesting that the resident remain in the facility.
The facility obtains a written assessment from a physician that the resident is appropriately placed. Form 1126 must be completed and signed by the physician. The assessment must address the resident's medical conditions, related nursing needs, ambulatory and transfer abilities, and mental status.
All required documents must be submitted to the regional office no later than the 10th working day after the date the facility determines a resident is inappropriately placed or the 10th working day after the ALF is officially informed of the inspector's determination. The 10-working day time frame begins the day the facility receives the "Statement of Licensing Violations and Plan of Correction" (Form 3724) and the report of contact (Form 3614-A).
Regulatory Services reviews the documentation submitted by the ALF, and, as long as the ALF submitted all required documentation within the time frames, the resident may remain in the ALF. Regulatory Services regional office will send a letter to the ALF verifying that required documentation was timely received.
When an inappropriately placed resident's evacuation criteria cannot be met, the facility must complete and submit the following documents to the regional office, in addition to Forms 1124, 1125, and 1126, to obtain an evacuation waiver from Regulatory Services.
Forms 1127 and 1129 are discussed in greater detail on the following slides.
Form 1127 Fire Marshall/State Fire Marshal Notification
This form notifies the fire marshal, or state fire marshal, that the specific resident is inappropriately placed and no longer meets all requirements for evacuation. The form acknowledges that the fire marshal, or state fire marshal, has been notified of the change in evacuation capability of the specified resident.
This form is signed by the fire marshal, or state fire marshal, who is the fire authority having jurisdiction (the entity that inspects and signs the facility's license application). Although the fire authority may make comments, the notification form does not require that the fire authority approve or disapprove the resident's decision to remain in the facility.
Form 1129 Fire Suppression authority Notification
This form notifies the fire suppression authority that the specific resident is inappropriately placed and no longer meets all requirements for evacuation. The form acknowledges that the fire suppression authority has been notified of the change in evacuation capability of the specified resident.
Although the fire suppression authority may make comments and must sign the form, the notification form does not require that the fire suppression authority to approve or disapprove the resident's decision to remain in the facility.
For an inappropriately placed resident who does not meet the facility's evacuation criteria, Regulatory Services will determine if a waiver of evacuation capability will be granted or denied. Regulatory Services notifies the facility in writing of its determination within 10 working days from the date the request is received in the regional office.
Upon notification that Regulatory Services has approved a waiver of evacuation capability, the facility must immediately initiate all provisions of the plan of action proposed to Regulatory Services. If the plan of action is not followed and there are health or safety concerns for the resident, Regulatory Services may cite the facility for immediate threat to the health or safety of a resident(s).
Regulatory Services will review the waiver of evacuation during the facility's renewal licensing inspection every two years.
Source: 26 TAC §553.259(e)
When a waiver of evacuation capability for an inappropriately placed resident is denied, Regulatory Services notifies the facility in writing. The facility must then discharge the resident. The resident has 30 days from the notice of discharge date to move from the facility.
Source: 26 TAC §553.259(a); 26 TAC §553.259(e)
If during a survey, a Regulatory Services inspector identifies an inappropriately placed resident who has not received an evacuation waiver, but is inappropriately placed based on the resident's inability to evacuate, then the inspector may identify the resident as inappropriately placed as part of the survey. Inspectors should never request multiple fire drills to see whether residents can evacuate the facility.
Source: 26 TAC §553.259(e)
Regulatory Services may assess an administrative penalty if:
Regulatory Services may also assess an administrative penalty if their final finding, after exhausting any appeals or other due process, determines the process has been followed, but the placement is determined to be inappropriate and the facility still refuses to discharge the resident.
Source: HSC §247.066(d-1)(1)
Regulatory Services can exercise the following remedies if a facility fails to obtain the required statements and waiver, or if Regulatory Services denies a waiver but the facility does not discharge the resident:
This section of the training covers the policy that prohibits inspectors from retaliating against an ALF.
Regulatory Services staff must adhere to a code of professionalism based on integrity, honesty and ethical behavior in all internal and external communications and daily operations.
Regulatory Services is committed to maintaining an ethical environment including high standards, sound judgment and discretion in the decision making process. Regulatory Services staff are responsible to the people of Texas in the performance of their official duties.
The State of Texas sets out laws that govern the conduct of state employees. Regulatory staff must bear in mind that ethical conduct involves more than merely following the state laws. As public servants, it is expected that state employees act fairly, honestly and avoid creating even the appearance of impropriety.
Retaliation is defined as harmful action against a person or group in response to a grievance, be it real or perceived. It may also be referred to as payback, retribution, or vengeance.
By statute, Regulatory Services employees may not retaliate against an assisted living facility, an employee of an assisted living facility, or a person in control of an assisted living facility for:
Source: HSC §247.068(c) and 26 TAC §553.337
The inspector cannot retaliate against the facility because the facility disagrees with his or her findings. A Regulatory Services employee is strictly prohibited from retaliating against a facility. There is zero tolerance for this behavior.
Retaliation is a violation of the state employment law that may result in a disciplinary actions including a fine and termination of employment.
The facility should make a report to Regulatory Services central office if the facility feels the inspector has retaliated against them. This should be done using the Survey Comment Card that is accessed online at:
https://www.surveymonkey.com/r/2GV6F2K?sm=Ygu5f0mWHFQUdaPXO2%2bfzw%3d%3d
Regulatory Services central office staff will investigate all reports made by facilities regarding inspectors' alleged inappropriate behaviors, including retaliation.
An ALF may request an Informal Dispute Resolution (IDR) regarding a violation of regulations that resulted in an adverse action. The facility must make the request to the Health and Human Services Commission using the form found at the link below:
https://hhs.texas.gov/doing-business-hhs/vendor-contractor-information/informal-dispute-resolution-process
Source: 26 TAC §553.333
Congratulations! You have completed the Annual Mandatory Training for Assisted Living Facilities CBT.
Please return to the main dashboard and click "ALF Mandatory Training Knowledge Check". After completing the knowledge check, please print your certificate of completion.
You must complete and maintain the certificate in your files as proof of compliance with HSC §247.066(h).