Texas Administrative Code Title 40

Social Services and Assistance: As effective August 6, 2010

Chapter 727

Subchapter A

§727.101: Legal Basis for Operation

The maternity home must

(1) be legally established to operate within Texas and comply with all applicable statutes;

(2) along with the application for a license, submit documentation of the legal basis for operation to the Texas Department of Protective and Regulatory Services (TDPRS);

(3) notify TDPRS of any planned change in the facility's legal basis for operation at least five working days before that change is made;

(4) report any planned change impacting the conditions of the license to TDPRS at least five working days before that change is made; and

(5) be licensed as a child-placing agency before engaging in any child-placing activity.

Comments

Source Note: The provisions of this §727.101 adopted to be effective July 1, 1996, 21 TexReg 5596.

§727.103: Governing Body of the Maternity Home

(a) The maternity home must

(1) have a governing body that is responsible for, and has authority over the maternity home's policies and activities;

(2) submit a written copy of the names, addresses, and titles of the officers or executive committee of the governing body with the application for a license;

(3) submit written notice of any change in the composition of the governing body to the Texas Department of Protective and Regulatory Services (TDPRS) within ten working days of such change; and

(4) inform TDPRS of any change in the information about governing body officers or executive committee members within ten working days of learning about such change.

(b) The maternity home's policies must clearly state the responsibilities assigned to the governing body.

(c) The governing body of the maternity home must carry out the responsibilities assigned in the maternity home's policies.

Comments

Source Note: The provisions of this §727.103 adopted to be effective July 1, 1996, 21 TexReg 5596.

§727.105: General Administration

The maternity home must

(1) allow the Texas Department of Protective and Regulatory Services (TDPRS) to visit and inspect the facility at all times;

(2) make its records available to and open for TDPRS to review;

(3) display the license at the facility;

(4) observe the conditions of the license;

(5) not offer other types of care in the facility; and

(6) obtain the written informed consent of a client and the parents or managing conservator of a minor client before involving a client in any fund raising or publicity for the facility.

Comments

Source Note: The provisions of this §727.105 adopted to be effective July 1, 1996, 21 TexReg 5596.

§727.107: Fiscal Accountability

(a) General fiscal requirements. The maternity home must

(1) be established and maintained on a sound fiscal basis;

(2) maintain complete financial records;

(3) have a fee policy that clearly describes what fees are charged and what services are covered by the fees; and

(4) not accept any payment for adoption referrals.

(b) Fiscal requirements for new maternity homes. New maternity homes must

(1) submit a 12-month budget to the Texas Department of Protective and Regulatory Services when the signed application is submitted;

(2) have reserve funds or documentation of available credit at least equal to operating costs for the first three months of operation; and

(3) have predictable funds sufficient for the first year of operation.

Comments

Source Note: The provisions of this §727.107 adopted to be effective July 1, 1996, 21 TexReg 5596.

§727.109: Maternity Home Policies

The maternity home must

(1) have clearly stated, governing body approved policies that at least meet minimum standards and are fully implemented.

(2) have policies that include a statement that describes the facility's services. The statement must describe who the maternity home will serve and what services the maternity home will provide.

(3) maintain copies of the most recent version of all policies. Policies must indicate governing body approval and effective date.

(4) have policies available for review upon request by the Texas Department of Protective and Regulatory Services (TDPRS) and maternity home clients.

(5) operate according to its written policies.

(6) report any changes in the written policies to TDPRS at least five working days before implementing the change.

Comments

Source Note: The provisions of this §727.109 adopted to be effective July 1, 1996, 21 TexReg 5596.

§727.111: Serious Incident Reports

The maternity home must:

(1) complete written reports for serious incidents involving facility staff members or clients within 24 hours of learning about the occurrence. Each report must include the date and time of the occurrence, the staff members or clients involved, the nature of the incident, and the surrounding circumstances.

(2) report the following types of serious incidents to the Licensing Division and to a minor client's parent or managing conservator within 24 hours:

(A) a suicide attempt by a client;

(B) abusive treatment, including alleged abuse, and abusive activity among clients;

(C) incidents that critically injure or permanently disable a client;

(D) serious illness of a client; and

(E) death of a client.

(3) have written policies and procedures to follow when a client is absent without permission. These policies and procedures must include:

(A) time frames for determining when a client is absent without permission;

(B) actions that maternity home staff members must take to locate the client; and

(C) procedures, including time frames, that maternity home staff members must follow to notify the parents or managing conservator of a minor client and the appropriate law enforcement agency.

(4) report when a minor client is not located. Absence without permission must be reported to the client's parents or managing conservator and to the appropriate law enforcement agency.

(5) document if a minor client is absent without permission, the circumstances surrounding the absence, efforts to locate the client, and notification of the client's parents or managing conservator and the appropriate law enforcement agency. If the parent or managing conservator cannot be located, attempts to report the client's absence must be documented.

(6) report to the Licensing Division within 24 hours, disasters or emergencies, such as fires or severe weather, that requires any part of the facility in which clients reside to close.

(7) report to the Licensing Division within 24 hours after learning of an allegation that a person who directly cares for or has access to a child in care has abused drugs within the past seven days.

Comments

Source Note: The provisions of this §727.111 adopted to be effective July 1, 1996, 21 TexReg 5596; amended to be effective December 1, 2005, 30 TexReg 7490

Subchapter B

§727.201: Personnel Policies

The maternity home must

(1) have an organization chart showing the administrative structure and staffing, including lines of authority;

(2) have a written job description for each employee;

(3) have volunteer policies describing the way volunteers will be used, if the home uses volunteers; and

(4) have written policies covering volunteer qualifications and orientation and training programs if volunteers have contact with clients.

Comments

Source Note: The provisions of this §727.201 adopted to be effective July 1, 1996, 21 TexReg 5596.

§727.203: General Personnel Requirements

(a) All staff and volunteers having contact with clients must meet the requirements in §725.1801 of this title (relating to Criminal History and Central Registry Background Checks).

(b) Until charges are dropped, a person who is indicted for any felony offense under Title 5, Title 6, or Chapter 43 of Title 9 of the Penal Code or who is the subject of an official criminal complaint (related to those offenses) that has been accepted by a county or district attorney must not be at the facility or have contact with the children while the children are in care. Until charges are dropped, a person who is indicted for any other criminal offense or who is the subject of an official criminal complaint (related to these other offenses) that has been accepted by a county or district attorney must not be at the facility or have contact with the children while the children are in care, unless it is determined by the Licensing Division that the person does not pose a risk to the children in care.

(c) The maternity home must report any occurrences as stated in subsections (a)-(d) of this section to the Texas Department of Protective and Regulatory Services (TDPRS) by the end of the first workday after learning of the occurrence.

(d) A person who is under investigation by TDPRS for the abuse or neglect of a child must not have contact with children in care unless the Licensing Division determines that the person does not pose a risk to the children in care or until the investigation is closed without a finding of abuse or neglect. The facility must notify the Licensing Division of any investigation of abuse or neglect within 24 hours of awareness or by the next workday.

(e) Persons whose behavior or health status present a danger to clients must not be allowed at the maternity home.

(f) Before having contact with clients, all staff, volunteers and family members or other persons residing at the maternity home must be tested for tuberculosis according to the recommendations of the Texas Department of Health or local health authorities.

(g) The maternity home must have a personnel file for each employee and volunteer whose work relates to maternity home services. Each file must contain:

(1) the date of employment;

(2) documentation that the person meets the qualifications for the position;

(3) tuberculosis test reports, if required, for persons having contact with clients;

(4) criminal background check reports;

(5) documentation that the person meets training requirements; and

(6) the date and the reason for separation, if applicable.

Comments

Source Note: The provisions of this §727.203 adopted to be effective July 1, 1996, 21 TexReg 5596; amended to be effective May 1, 2000, 25 TexReg 3306

§727.205: Personnel Qualifications and Responsibilities

(a) Administrative responsibilities.

(1) The maternity home must have an administrator who is responsible for

(A) the overall administrative responsibility for the facility;

(B) managing the maternity home according to the policies adopted by the governing body; and

(C) ensuring that the maternity home's operation complies with minimum standards specified in this chapter.

(2) The maternity home administrator must meet one of the following qualifications:

(A) a master's or higher degree and at least one year of experience in human services' management, supervision, or administration;

(B) a bachelor's degree and at least two years of experience in management, supervision, or administration, one year of which must have been in human services;

(C) an associate's degree and at least four years of experience in management, supervision, or administration, one year of which must have been in human services; or

(D) a high school diploma or general educational development (GED) certificate and at least six years of experience in management, supervision, or administration, one year of which must have been in human services.

(b) Service program responsibilities.

(1) The maternity home must employ a person who is responsible for the overall services provided by the facility. This person must

(A) approve maternity home admissions;

(B) develop and update service plans for maternity home clients or approve service plans developed or updated by less qualified staff; and

(C) provide general program oversight.

(2) The person responsible for maternity home services must have at least a bachelor's degree in a human services field and two years of experience in human services or a bachelor's degree in any field and at least four years of supervised maternity home experience.

(c) Other maternity home staff.

(1) The maternity home must employ sufficient qualified staff to protect the health, safety, and well-being of clients and provide maternity home services.

(2) Staff who provide casework services, including admissions assessment, counseling, placement planning, and discharge planning, must have at least a bachelor's degree and direct supervision from a person who meets the requirements specified in subsection (b)(2) of this section.

(3) Other staff working with clients must have at least a high school diploma or GED certificate.

(4) At least one staff must be immediately accessible at the maternity home at all times when clients are present. At least one other staff must be immediately available in case of emergency.

(5) The maternity home must ensure that staff and volunteers are supervised

(A) to protect clients' health, safety and well-being; and

(B) to ensure that assigned duties are performed adequately.

Comments

Source Note: The provisions of this §727.205 adopted to be effective July 1, 1996, 21 TexReg 5596.

§727.207: Training Requirements

(a) The maternity home must have a written training plan or program for all staff. The plan must include stated time frames for assessment of each staff's training needs, training content, and number of training hours required.

(b) New staff who will work with clients must receive an orientation to the facility's policies and services.

(c) Client care staff must successfully complete training from a certified instructor in cardiopulmonary resuscitation (CPR) and first aid before assuming their responsibilities. CPR and first aid training must be updated as required to maintain certification. CPR and first aid training must meet criteria established by the Texas Department of Protective and Regulatory Services (TDPRS).

(d) The maternity home administrator, the person responsible for the service program, and any staff who provide casework services, including admissions assessment, counseling, placement planning, and discharge planning, must obtain at least 20 clock hours of job-related training annually.

(e) Maternity home staff working with clients must receive at least 15 hours of training each year related to maternity home services. Annual training hour requirements are in addition to initial first aid and CPR training. First aid and CPR updates may be included in the annual training requirements.

(f) Persons who hold related professional licenses or credentials that require continuing education will be considered as meeting the training requirements by meeting the requirements to maintain their professional license or credential.

(g) At least 75% of the required annual training must consist of course work from an accredited educational institution, workshops, seminars, or other direct training provided by qualified agencies, organizations and individuals. In-service training and self-instruction programs may be counted in the formal training component if the training includes stated learning objectives, curriculum and learning activities, and an evaluation program. Training must be documented, including date, subject, number of hours, and training provider.

(h) When maternity home staff complete training in excess of the minimum requirements, up to one-half of the following year's annual training requirement may be carried over from the previous year.

Comments

Source Note: The provisions of this §727.207 adopted to be effective July 1, 1996, 21 TexReg 5596.

Subchapter C

§727.301: Admission

(a) Admission Policies.

(1) The maternity home must have written admission policies and criteria describing the age and type of client served.

(2) The maternity home may only admit clients who meet the admission policies and criteria and for whom the maternity home has an operational program.

(3) A maternity home whose policies permit the admission of a client whose behavior or history indicates that she may be a danger to herself or others must arrange for the client to be evaluated by a qualified professional. The evaluation may be done by

(A) a psychiatrist;

(B) a psychologist;

(C) a licensed Master Social Worker, Advanced Clinical Practitioner;

(D) an obstetrician/gynecologist; or

(E) a licensed professional counselor.

(4) The evaluation of a client who may be a danger to self or others must be done within 72 hours following admission. The evaluation must be documented in the client's record and include:

(A) an assessment of the potential danger to self or others;

(B) an assessment of the client's need for care, treatment, and supervision; and

(C) recommendations for care, treatment, supervision, and further evaluation, if any, if the client is admitted to the maternity home.

(5) A maternity home that admits a client who may be a danger to self or others must document precautions including level of supervision taken until the professional evaluation is performed and implemented.

(6) A maternity home that admits a client who may be a danger to self or others must

(A) evaluate the client's needs, as identified in the professional assessment, in relation to the maternity home's admission policy and criteria;

(B) evaluate the potential danger to the client or others, as identified in the professional assessment, in relation to the safeguards and services the maternity home can provide; and

(C) arrange for the client's discharge as soon as possible if the evaluation indicates that the maternity home's program cannot meet her needs or that the maternity home cannot provide necessary safeguards.

(7) If the maternity home decides to provide care for a client who may be a danger to self or others, the maternity home must include the professional assessment and recommendations in the client's service plan and ensure that recommendations are followed.

(8) Maternity homes that have admission policies, rules for group living, or other requirements that may make the maternity home an inappropriate choice for a prospective client must provide the prospective client with a list of licensed maternity homes so that she can locate a facility that better meets her needs.

(b) Admission procedures.

(1) The maternity home must complete an admission assessment, including pregnancy testing, for each client within five working days of admission to determine that the program will be able to meet the client's needs.

(2) The admission assessment must be in writing and must include information on each of the following:

(A) the circumstances that led to the client's referral;

(B) the client's plan for her baby;

(C) the client's history including

(i) health history information and information about the pregnancy;

(ii) educational background and records that may be needed to enroll the client in school or a general educational development program;

(iii) social history with a description of the family situation and relationships, previous placements, and work history; and

(iv) psychological history (if applicable and available) including any results of testing, evaluation, or assessment;

(D) a description of any special needs (physical, emotional, or intellectual) the client might have;

(E) the client's expectations of maternity home placement; and

(F) the level of parent or family involvement with the client during her stay at the maternity home.

(3) Clients must have a health examination by a health care provider within 30 days before admission or an examination must be arranged or scheduled within two work days after admission. The arrangement or scheduling must include an assessment by a health care provider to ensure that the client is not in immediate need of medical treatment.

(4) Clients must be tested for tuberculosis according to the recommendations of their health care provider.

(5) A written placement agreement between the maternity home and the parents or managing conservator of a minor client must be completed at or before placement. A copy of the placement agreement must be in the client's record. The placement agreement must include:

(A) authorization for the minor client to reside at the maternity home; and

(B) a medical consent form signed by a person authorized to give consent by the Texas Family Code.

(6) If a minor client has been living independent of her parents or her parents refuse to sign the placement agreement, the minor client may admit herself to the maternity home. This must be documented in the client's record.

(7) Maternity homes must inform clients and the parents or managing conservators of minor clients, in writing, at or before admission of:

(A) rules and guidelines for group living that maternity home clients will be expected to follow, including visits, gifts, mail, and telephone calls;

(B) the type and frequency of reports the maternity home will make to parents or managing conservators of minor clients;

(C) the maternity home's religious policy or program, if any; and

(D) the maternity home's fee policy.

Comments

Source Note: The provisions of this §727.301 adopted to be effective July 1, 1996, 21 TexReg 5596.

§727.303: Service Plan

(a) Within 15 working days of admission, the maternity home must develop a service plan with the client.

(b) The service plan must include:

(1) the client's individual needs in addition to basic needs for food, clothing, shelter, and routine health care related to the pregnancy, delivery, and postpartum period;

(2) a specific description of how the maternity home will address any needs of the client in addition to basic needs; and

(3) a specific description of what the maternity home expects of the client in terms of meeting the service plan.

(c) The service plans for minor clients must address the level of supervision the maternity home will provide for the client.

(d) The maternity home must give a copy or summary of the service plan to the client and the parents or managing conservator of a minor client.

(e) The maternity home must carry out the service plan.

(f) The maternity home must develop a policy for reviewing plans of service. The policy must state how frequently plans will be reviewed.

(g) The maternity home must review the service plan at least as frequently as stated in the home's policy with the client. The review must be in writing and show what has been accomplished in meeting the client's needs, any change in the client's needs, and any change in how the client's needs will be met. The maternity home must give a copy or summary of the service plan review to the client and to the parents or managing conservator of a minor clients.

Comments

Source Note: The provisions of this §727.303 adopted to be effective July 1, 1996, 21 TexReg 5596.

§727.305: Discharge

(a) The maternity home must involve the client and the parents or the managing conservator of a minor client in discharge planning.

(b) The date and circumstances of the client's discharge must be documented in the client's record.

(c) Upon discharge, the maternity home must inform clients of how long and where client records will be maintained.

Comments

Source Note: The provisions of this §727.305 adopted to be effective July 1, 1996, 21 TexReg 5596.

Subchapter D

§727.401: Nutrition

The maternity home must:

(1) provide food that meets clients' individual nutritional requirements.

(2) make provision for three regularly scheduled meals daily and provide for additional nutrition between meals, mid-morning, afternoon, and evening, as needed and desired by clients.

(3) provide any special diet prescribed by a client's physician.

(4) offer nutritional counseling and guidance to all clients. Content of the counseling and guidance program must meet generally accepted standards in regard to nutrition during pregnancy and lactation.

(5) maintain food preparation, storage, and serving facilities and implement procedures that meet local health department requirements and recommendations.

Comments

Source Note: The provisions of this §727.401 adopted to be effective July 1, 1996, 21 TexReg 5596.

§727.403: Housing

(a) Health and safety. The maternity home must

(1) construct, maintain, clean, and repair buildings so that there are no hazards to the health and safety of clients.

(2) establish and maintain grounds so that there are no hazards to the health and safety of clients.

(3) have approved fire, health, and safety inspections. The maternity home must submit approved inspection reports with the application for the license. The maternity home must obtain approved inspections annually. Inspection reports must be kept on file at the maternity home. The maternity home must

(A) have an annual fire inspection with a written report by a local or state fire marshal. The maternity home must be in compliance with corrections, conditions, or restrictions specified in the report.

(B) have an annual sanitation inspection with a written report by a local or state sanitation official. The maternity home must be in compliance with any corrections, restrictions, or conditions stated in the report.

(C) have an annual gas-pipe inspection, if gas is used. The inspection must be documented.

(D) have an inspection by an inspector certified by the Liquefied Petroleum Gas Division of the Railroad Commission, if the maternity home has a liquid petroleum gas system.

(4) have written plans and procedures for assuring the health and safety of clients in case of a disaster or emergency, such as fire or severe weather. Maternity home staff must know these procedures and a copy must be available at the maternity home for Texas Department of Protective and Regulatory Services to review.

(5) have first aid supplies readily available to maternity home staff, including a sterile emergency delivery pack, in designated locations.

(b) Living space. Maternity homes must

(1) provide adequate living space, appropriate furnishings, and bathroom facilities for clients.

(2) have bedrooms with at least 75 square feet of floor space per occupant with a maximum of four clients per bedroom. Bedrooms must have at least one window with outside exposure.

(3) provide each client with her own bed and provisions for personal storage space.

(4) have at least 40 square feet per client of indoor activity space exclusive of halls, kitchen, bathrooms, and any other space not regularly available to clients. Where bedrooms exceed the minimum square footage requirements, the difference may be counted towards indoor activity space.

(5) have bathrooms located convenient to client bedrooms.

(6) have at least one lavatory and commode for each six clients and one tub or shower for each 10 clients.

(7) have food preparation and dining areas appropriate to the food service program.

Comments

Source Note: The provisions of this §727.403 adopted to be effective July 1, 1996, 21 TexReg 5596.

§727.405: Health Care

The maternity home must

(1) have written policies and procedures for providing routine health care relating to pregnancy and delivery and for emergency diagnosis and treatment of other health and dental problems.

(2) ensure that clients have access to prenatal health care, delivery and immediate postpartum health care, and postpartum convalescent health care for the period post delivery and prior to discharge from the maternity home.

(3) ensure that each client is informed of the need for a postpartum examination, unless the examination is provided before her discharge from the facility.

(4) provide for other emergency health care diagnosis and treatment as needed, when such is ordered by the client's primary health care provider.

(5) ensure that maternity home staff do not provide any medication or treatment to a client except on written orders of a licensed health care provider. If, in an emergency, instructions are given verbally, the health care provider must write and sign orders within 24 hours.

(6) ensure that a minor client's health care provider has authorized, in writing, a self-medication program or that maternity home staff administer the minor client's medication.

Comments

Source Note: The provisions of this §727.405 adopted to be effective July 1, 1996, 21 TexReg 5596.

§727.407: Other Services

The maternity home must:

(1) ensure that counseling about the different options regarding pregnancy is available to clients.

(2) ensure that clients have information, training, and counseling available regarding health aspects of pregnancy, preparation for child birth, and recovery from child birth.

(3) make provisions for minor clients who have not completed high school or received a general educational development program certificate (GED) to continue their education while in the maternity home.

(4) provide a recreational program planned according to the individual needs of the clients.

(5) provide transportation for clients' medical and counseling appointments.

(6) ensure that clients have adequate and appropriate clothing.

Comments

Source Note: The provisions of this §727.407 adopted to be effective July 1, 1996, 21 TexReg 5596.

§727.409: Client Rights

The maternity home must ensure that:

(1) clients have the right to initiate their discharge from the maternity home at any time.

(2) clients have the right to communicate freely by telephone and mail. The rules and guidelines for group living may establish reasonable rules for long distance calls and telephone hours.

(3) maternity home policies and practices do not infringe upon the client's right to self-determination, privacy, and personal dignity.

(4) clients are not subjected to any form of abuse, punishment, humiliation, coercion, or intimidation. A client must not be subjected to any pressure to relinquish her child for adoption or to parent her child.

(5) each client has the right to manage her own money.

(6) clients have the right to receive and send uncensored mail. Any exceptions must be part of the client's individual service plan.

(7) clients have the right to receive visitors. The rules and guidelines for group living may establish reasonable rules for visits. Any exceptions must be part of the client's individual service plan.

Comments

Source Note: The provisions of this §727.409 adopted to be effective July 1, 1996, 21 TexReg 5596.

§727.411: Client Records

The maternity home must ensure that

(1) records for each client are kept accurate and current.

(2) client records are locked and kept in a safe location.

(3) client records are not released to any agency, organization, or individual without the written consent of the client.

(4) client records and information are kept confidential. All maternity home staff and consulting, contracting, and volunteer professionals and others with access to information about the client must be informed, in writing, of their responsibility to maintain client confidentiality.

(5) client records are retained permanently when the client chooses to relinquish her child for adoption. The maternity home has the option of transferring the record to the licensed child-placing agency that handled the adoption. Records for other clients must be retained for a minimum of two years from the date of discharge.

Comments

Source Note: The provisions of this §727.411 adopted to be effective July 1, 1996, 21 TexReg 5596.