Minimum Standards for General Residential Operations

1 1 Minimum Standards for General Residential Operations Child Care Regulation Texas Health and Human Services Commission October 2021 Revised 4/4/20222 Table of Contents Table of Contents .. 2 Introduction .. 6 Minimum Standards .. 6 Deficiencies .. 6 Weights .. 6 Maintaining Compliance .. 7 The Inspection .. 7 Technical Assistance .. 7 Investigations .. 8 Your Rights and Entitlements .. 8 For Further Information .. 8 Subchapter A, Purpose and Scope .. 9 Subchapter B, Definitions and Services .. 12 Division 1, Definitions .. 12 Division 2, Services .. 23 Subchapter C, Organization and Administration .. 30 Division 1, Plans and Policies Required For the Application Process .. 30 Division 2, Operational Responsibilities and Notifications .. 45 Division 3, General Fiscal Requirements .. 50 Division 4, Required Postings .. 50 Subchapter D, Reports and Record Keeping.

2 51 Division 1, Reporting Serious Incidents and Other Occurrences .. 51 Division 2, Operation Records .. 67 Division 3, Personnel Records .. 69 Division 4, Child Records .. 71 Division 5, Record Retention .. 73 Division 6, Unauthorized Absences .. 73 Subchapter E, Personnel .. 79 Division 1, General Requirements .. 79 Division 2, Child-Care Administrator .. 81 Division 3, Professional Level Service Providers .. 84 Division 4, Treatment Director .. 91 Division 5, Caregivers .. 93 Division 6, Normalcy .. 96 Division 7, Contract Staff and Volunteers .. 99 Subchapter F, Training and Professional Development .. 102 Division 1, Definitions .. 102 Division 2, Orientation .. 103 Revised 4/4/20223 Division 3, Pre-Service Experience and Training .. 104 Division 4, General Pre-Service Training and Pre-Service Training Regarding Normalcy .. 109 Division 5, Pre-Service Training Regarding Emergency Behavior Intervention.

3 112 Division 6, Annual Training .. 114 Division 7, First-Aid and CPR Certification .. 126 Subchapter G, Child/Caregiver Ratios .. 129 Subchapter H, Child Rights .. 128 Subchapter I, Admission, Service Planning, and Discharge .. 137 Division 1, Admission .. 125 Division 2, Emergency Admission .. 141 Division 3, Educational Services .. 144 Division 4, Service Plans .. 146 Division 5, Service Plan Reviews and Updates .. 158 Division 6, Discharge and Transfer Planning .. 161 Division 7, Release of Child .. 165 Subchapter J, Child Care .. 166 Division 1, Dental Care .. 166 Division 2, Medical Care .. 168 Division 3, Communicable Diseases .. 175 Division 4, Protective Devices .. 177 Division 5, Supportive Devices .. 180 Division 6, Tobacco and E-Cigarette Use .. 182 Division 7, Nutrition and Hydration .. 182 Division 8, Additional Requirements for Infant Care.

4 196 Division 9, Additional Requirements for Toddler Care .. 206 Division 10, Additional Requirements for Pregnant and Parenting Children 208 Subchapter K, Operations That Provide Care for Children and Adults . 211 Division 1, Scope .. 211 Division 2, General Requirements .. 211 Subchapter L, Medication .. 215 Division 1, Administration of Medication .. 215 Division 2, Self-Administration of Medication .. 218 Division 3, Medication Storage and Destruction .. 219 Division 4, Medication Records .. 221 Division 5, Medication and Label Errors .. 223 Division 6, Side Effects and Adverse Reactions to Medication .. 225 Division 7, Use of Psychotropic Medication .. 227 Division 8, Unassigned Epinephrine Auto-Injectors .. 231 Subchapter M, Discipline and Punishment .. 232 Revised 4/4/20224 Subchapter N, Emergency Behavior Intervention .. 236 Division 1, Definitions.

5 236 Division 2, Types of Emergency Behavior Intervention That May Be Administered .. 236 Division 3, Orders .. 240 Division 4, Responsibilities During Administration of Any Type of Emergency Behavior Intervention .. 244 Division 5, Additional Responsibilities During Administration of a Personal Restraint .. 247 Division 6, Additional Responsibilities During Administration of Seclusion .. 249 Division 7, Additional Responsibilities During Administration of a Mechanical Restraint .. 250 Division 8, Successive Use and Combinations of Emergency Behavior Intervention .. 252 Division 9, Time Restrictions for Emergency Behavior Intervention .. 255 Division 10, General Caregiver Responsibilities, Including Documentation, After the Administration of Emergency Behavior Intervention .. 259 Division 11, Triggered Reviews .. 263 Division 12, Overall Operation Evaluation.

6 266 Subchapter O, Safety and Emergency Practices .. 268 Division 1, Sanitation and Health Practices .. 268 Division 2, Natural Gas and Liquefied Petroleum .. 273 Division 3, Fire Safety Practices .. 275 Division 4, Heating Devices .. 279 Division 5, Carbon Monoxide Safety Practices .. 280 Division 6, Emergency Evacuation and Relocation .. 281 Division 7, First-Aid Kits .. 284 Subchapter P, Physical Site .. 286 Division 1, Grounds and General 286 Division 2, Interior Space .. 290 Division 3, Toilet and Bath Facilities .. 297 Division 4, Poisons .. 300 Division 5, Food Preparation, Storage, and Equipment .. 300 Division 6, Play Equipment and Safety Requirements .. 304 Division 7, Playground Use Zones .. 308 Division 8, Protective Surfacing .. 311 Division 9, Swimming Pools, Wading/Splashing Pools, and Hot Tubs .. 313 Subchapter Q, Recreation Activities.

7 316 Division 1, General Requirements .. 316 Division 2, Swimming Activities .. 322 Division 3, Watercraft Activities .. 326 Division 4, Wilderness Hiking and Camping Excursions .. 328 Division 5, Trampoline Use .. 339 Division 6, Weapons, Firearms, Explosive Materials, and Projectiles .. 341 Revised 4/4/20225 Subchapter R, Transportation .. 343 Division 1, General Requirements .. 343 Division 2, Safety Restraints .. 347 Division 3, Vehicle and Vehicle Maintenance .. 350 Division 4, Transportation 350 Subchapter S, Additional Requirements for Operations That Provide Emergency Care 351 Division 1, Service Management .. 352 Division 2, Admission Assessment .. 355 Division 3, Respite Child-Care Services .. 357 Subchapter T, Additional Requirements for Operations That Provide an Assessment Services Program .. 361 Division 1, Regulation .. 361 Division 2, Admission.

8 361 Division 3, Assessment Plan .. 362 Division 4, Assessment Report .. 364 Subchapter U, Additional Requirements for Operations That Provide Therapeutic Camp Services .. 368 Division 1, Definitions .. 368 Division 2, Activities Requiring Spotting or Belaying .. 370 Division 3, Primitive Camping Excursions .. 371 Subchapter V, Additional Requirements for Operations that Provide Trafficking Victim Services .. 375 Division 1, Definitions and Scope .. 375 Division 2, Policies and Procedures .. 377 Division 3, Personnel .. 379 Division 4, Training .. 380 Division 5, Child/Caregiver Ratios .. 386 Division 6, Admission and Service Planning .. 387 Appendix A: Definitions .. 393 Appendix B, Vaccine-Preventable Diseases .. 398 Revised 4/4/20226 Introduction Minimum Standards These Minimum Standards tell you (the child care operation permit holder) what requirements you, your employees, and your caregivers must follow.

9 These Minimum Standards : were developed by the Texas Health and Human Services Commission (HHSC) with the assistance of child-care Operations , parents, stakeholders, and other experts in a variety of fields; reflect what the citizens of Texas consider to be reasonable and Minimum ; and meet the guidelines set forth in Chapter 42 of the Texas Human Resources Code (law) for what must be included in the Minimum Standards . The Administrative Procedure and Texas Register Act requires that proposed Standards be published for public comment before they are adopted as rules . All members of the public, including providers, are encouraged to provide input when proposed Minimum Standards are published for comment. The commission considers recommendations from interested persons or groups in formulating the final draft, which is filed as rules with the Secretary of State.

10 Deficiencies A deficiency is any failure to comply with a Minimum standard, rule in Texas Administrative Code Chapter 745, law, specific term of the permit, or specific condition of probation or suspension. Weights The Minimum Standards are weighted based on a common understanding of the risk to children presented if the standard or rule is violated. The weights are: high, medium-high, medium, medium-low, and low. The assigned weights do not change based on the scope or severity of an actual deficiency. Scope and severity are assessed by Child Care Regulation (CCR) staff, documented, and considered in conjunction with the weight when making CCR decisions. You will see the weight is noted at the end of each standard or subsection in green. Only those Minimum Standards which can be cited as a deficiency are weighted. For example, the Minimum standard prohibiting physical discipline is weighted but Minimum Standards that are definitions are not weighted.