Regulatory Policies & Procedures Manual

Applicant Organization: Advisory Engineering & Analytics, LLC. d/b/a Taylor’s Gift ISS
Service Type: Day Activity and Health Services (DAHS) — Individualized Skills and Socialization (ISS) Only — OFF-SITE Only
Effective Date: Planned for Initial Licensure Survey 

Policy 1: Emergency Preparedness and Off-Site Crisis Response Policy

1.1 Purpose

This policy establishes the operational frameworks and safety protocols required to ensure individual safety, continuous monitoring, and structured emergency response during off-site service delivery in rural Northeast Texas (Bowie, Red River, Titus, and Morris counties). Because the Organization operates an OFF-SITE Only model under 26 TAC Chapter 559, Subchapter H, all services occur in community-based settings. This policy guarantees absolute emergency preparedness in the absence of a centralized physical facility.

1.2 Scope

This policy applies to all employed service providers, host home caregivers operating as caregiver-employees, program supervisors, and the Program Director.

1.3 Pre-Outing Safety and Risk Assessment Checklist

Prior to departing for any scheduled off-site activity, the officiating Service Provider must complete and submit the Pre-Outing Safety Checklist via the mobile application (or written log in the event of cell outage):

1. Destination Integrity Audit:

• Verify the physical address and GPS coordinates of the destination.
  • Confirm the venue is ADA-compliant and fully accessible for the specific physical needs of all individuals in the cohort.
  • Locate the nearest public restroom that is private, clean, and caregiver-friendly (to accommodate toileting routines).
  • Identify a pre-established safe brick-and-mortar shelter zone (interior rooms, designated storm shelter area) within or immediately adjacent to the venue.

2. Emergency Route Mapping:

• Map the exact route from the starting location/host home to the destination.
  • Identify the address, route, and contact number for the closest:
    • Emergency Medical Services (EMS) dispatch zone.
    • Acute care hospital or emergency clinic.
    • First responder/police precinct.

3. Individual Dossier Review:

• Confirm that current laminated emergency cards are on the facilitator’s person.
  • Review specific medical plans (e.g., active seizure protocols, diabetic schedules).
  • Review the active Behavior Support Plans (BSP) and specific de-escalation triggers for all participants.

1.4 Mandatory On-Person Safety Pack

Service Providers must carry a secure, water-resistant Safety Pack at all times during direct off-site service hours. The Program Director will audit safety packs monthly. Each pack must contain:

1.5 Emergency Action Protocols (EAPs)

1.5.1 Medical Emergencies (e.g., Seizures, Severe Injury, Cardiac Distress)

1. Secure the Venue: The Service Provider must immediately ensure the physical safety of the affected individual and the other members of the cohort (e.g., removing physical obstructions, moving peers away to protect client dignity).

2. First Aid & CPR Administration:

• For seizures: Gently lower the individual to the ground, turn them onto their side, clear the immediate area of hard objects, cushion their head, and strictly time the seizure duration. Never insert anything into the individual’s mouth.
  • For cardiac or breathing arrest: Immediately initiate Cardiopulmonary Resuscitation (CPR) and deploy a pocket mask.

3. 911 Activation: Dial 911 immediately. In rural settings, provide the dispatcher with precise GPS coordinates (available on the mobile app) and clear visual landmark descriptors.

4. Administrative Notification: Immediately contact the licensed ISS Program Director and the individual’s Legally Authorized Representative (LAR).

5. EMS Hand-Off: Remain with the individual. Present the laminated emergency card, medication list, and documented event timeline directly to arriving EMS personnel.

1.5.2 Behavioral Crises and Crisis Intervention

1. Proactive Redirection: At the first linguistic or physical sign of agitative escalations (e.g., pacing, verbalizations, self-soothing gestures), staff must immediately implement the individual’s Behavior Support Plan (BSP) utilizing:

• Sensory reduction (moving the individual to a quiet space).
  • Choice prompts and calming verbal scripts.

2. Safe Positioning: Position staff at a safe physical distance that protects the public, peer participants, and the individual while maintaining full line-of-sight supervision.

3. Approved Physical Intervention: Physical restraints are strictly prohibited. In cases of immediate, life-threatening danger to the individual or others, staff may apply only non-violent, approved hold techniques in which they are certified:

• SAMA (Satori Alternatives to Managing Aggression)
  • PMAB (Prevention and Management of Aggressive Behavior)

4. Immediate Outing Suspension: The outing must be immediately suspended. Staff will transport the individual safely back to their primary residence or coordinate an immediate pickup with the Program Director/LAR.

5. Documentation: Staff must file a formal Incident Report within 24 hours of the physical intervention.

1.5.3 Severe Weather and Environmental Hazards (NWS Watch or Warning)

1. Weather Ingestion: The Program Director will monitor National Weather Service (NWS) APIs. If an active Tornado, Severe Thunderstorm, or Flash Flood Watch/Warning is issued for Bowie, Red River, Titus, or Morris counties, the Program Director will immediately notify all active off-site staff via the app to suspend outdoor activities.

2. Shelter Ingress: In the event of a sudden, active Warning:

• If in a public indoor space: Immediately move the cohort to the designated interior safe room or storm shelter.
  • If outdoors or in transit: Immediately seek shelter in the nearest pre-identified solid brick-and-mortar building. Never remain in vehicles or under highway underpasses during severe wind/tornado events.

3. Texas Heat Mitigation Protocol: During summer months (June–September) or when the heat index exceeds 95°F:

• Limit outdoor exposure to a maximum of 45 continuous minutes.
  • Enforce mandatory hydration breaks every 20 minutes (clean water supplied by the agency at no cost).
  • Restrict physical outings to climate-controlled indoor settings (e.g., public libraries, shopping centers).

1.5.4 Vehicle Breakdown in Rural Areas

1. Roadside Positioning: Pull the transport vehicle completely off the roadway, engage emergency hazard lights, and set the parking brake.

2. Passenger Security: Keep all passengers securely buckled inside the climate-controlled vehicle with doors locked unless a structural threat (fire, odor of gas, rising floodwaters) necessitates immediate evacuation.

3. Evacuation (If Required): Move the cohort to a safe, shaded area well away from the roadway, maintaining strict, continuous line-of-sight supervision.

4. Backup Dispatch: Contact the Program Director immediately. The administrative office will dispatch a pre-arranged backup transport vehicle to the GPS coordinates to transfer passengers and return them safely to their host homes.

Policy 2: Inter-Agency Intake & Person-Directed Plan Integration Protocol

2.1 Purpose

To establish a rigorous, legally compliant collaborative intake and program-planning process. Under 26 TAC §263.2017 and Rule §565.11, the Organization must systematically align all off-site socialization activities with the authorized Person-Directed Plans (PDP), Individual Plans of Care (IPC), and specific clinical needs of the individuals, working in direct coordination with HCS/CLASS Program Providers and Local Intellectual and Developmental Disability Authorities (LIDDAs).

2.2 Intake & Document Acquisition Workflow

Prior to the commencement of any direct off-site service hours, the licensed ISS Program Director must execute the following document acquisition and compliance workflow:

Mandatory Documentation Requirements:

The Organization will never begin services without securing and analyzing the following active files from the primary provider:

• Person-Directed Plan (PDP): Outlining the individual’s personal preferences, outcomes, and chosen day activities.
• Individual Plan of Care (IPC): Confirming the authorized hours and allocation of the ISS service component.
• Individual Comprehensive Assessment Plan (ICAP): Detailing the service need score and adaptive behavior levels.
• Behavior Support Plan (BSP): Outlining targeted behaviors, specific de-escalation protocols, and authorized physical interventions (if applicable).
• Specialized Medical Orders: Including physician-ordered diet specifications, seizure management plans, and physical therapy constraints.

2.3 Translating Outcomes into Off-Site Habilitation Plans

The Program Director will utilize the acquired PDP outcomes to author a customized Off-Site Habilitation Lesson Plan for the individual. The template below demonstrates this translation process:

        
    INDIVIDUAL HABILITATION PLAN (IHP) TEMPLATE   
    ———————————————————————————   
    Client Name: [Jane Doe]                    Medicaid ID: [XXXXXXXXX]   
    Authorized ISS Hours: [15 hrs/week]            Level of Need (LON): [LON 6]   
    Primary HCS Provider: [Partner Agency]          LIDDA Coordinator: [Bowie County SC]   
    ———————————————————————————   
    PDP Outcome Statement:   
    “Jane Doe wants to learn how to manage her personal finances and purchase items independently.”   
        
    Habilitative Focus Area:   
    Functional Academics, Money Management, and Community Socialization.   
        
    Scheduled Community Settings:   
    De Kalb local market, Mount Pleasant post office, and Texarkana public library.   
        
    Staff Intervention Methodology:   
    1. Provide visual currency sorting board during outing transit.   
    2. At the checkout counter, apply a least-to-most prompting hierarchy (Visual -> Verbal -> Physical nudge) to encourage Taylor to select the correct cash denomination and hand it directly to the cashier.   
    3. Verbally reinforce successful transaction completion within 3 seconds.   
        
    Data Tracking Metric:   
    Percentage of independent steps completed during the transaction sequence (Scale: 0% – 100%).   
        

2.4 Staffing Ratios & Cohort Management

1. Ratio Rigor: The Program Director will assign service facilitators based strictly on the individuals’ Level of Need (LON) in compliance with 26 TAC §263.2017:

• Standard LON (1, 5, 8): Maximum ratio of 1:8 or 1:4.
  • Enhanced LON (6, 9): Configured up to 1:1 or 2:1 to guarantee safety, continuous line-of-sight monitoring, and immediate behavioral redirection.

2. Dedicated Service Providers: Facilitators assigned to a cohort are strictly prohibited from performing non-service tasks during billable hours. 100% of their focus must remain on the direct facilitation, safety, and habilitation of the individuals in their care.

Policy 3: Abuse, Neglect, and Exploitation (ANE) Reporting & Registry Compliance Policy

3.1 Purpose

To enforce zero-tolerance standards for any act of Abuse, Neglect, or Exploitation (ANE) in compliance with Texas Human Resource Code Chapter 103, Texas Family Code Chapter 261, and 26 TAC Chapter 559, Subchapter F. This policy establishes clear, mandated reporting protocols and continuous employee registry tracking to ensure the absolute protection of vulnerable individuals receiving off-site ISS services.

3.2 Definition of Terms

[!WARNING]
ABUSE: Any act or failure to act performed by an employee or service provider that causes or results in physical injury, pain, mental anguish, or death to an individual receiving services, including physical, sexual, or verbal assault.

[!WARNING]
NEGLECT: The failure of an employee or service provider to provide the necessary food, shelter, supervision, medical care, or physical/mental health support required to maintain the individual’s safety and well-being.

[!WARNING]
EXPLOITATION: The illegal, unauthorized, or improper act of using an individual’s resources, funds, property, or assets for personal gain, benefit, or profit without the consent of the individual or their LAR.

3.3 Mandated Reporting Protocols

1. Immediate Duty to Report: Every employee, contractor, or caregiver-employee of the Organization who has reason to believe that an individual receiving services has been, is, or will be subjected to ANE is legally mandated to report the suspicion immediately.

2. Regulatory Channels: Reports must be filed directly with:

• Texas Department of Family and Protective Services (DFPS) Abuse Hotline:
  • Phone: 1-800-252-5400 
  • Secure Web Portal: txabusehotline.org
  • HHSC Long-Term Care Regulation (LTCR) Complaint Line: 1-800-458-9858

3. Mandated Timeline: The report to DFPS must be completed immediately, and no later than 24 hours after the employee first suspects or witnesses the occurrence. Failing to report is a Class A misdemeanor under Texas law.

4. Internal reporting Sequence:

• Immediately after calling DFPS, the employee must notify the licensed ISS Program Director.
  • The Program Director will complete and submit the HHSC-compliant incident notification through the TULIP portal within 24 hours of the report.

3.4 Immediate Protective Interventions

If an allegation of ANE involves an active employee or service provider of the Organization:

1. Immediate Suspension: The Program Director will instantly suspend the accused employee from all direct service delivery and contact hours, pending a full investigation by DFPS and HHSC.

2. Administrative Lockout: The Program Director will revoke the suspended employee’s access to the dispatch routing and billing systems.

3. LAR Notification: The Program Director will notify the individual’s LAR immediately (and no later than 24 hours) after the filing of the report, detailing the protective actions taken.

4. Investigation Cooperation: The Organization will provide unrestricted access to records, digital telemetry, and supervisor interviews to facilitate investigations conducted by DFPS, HHSC, and local law enforcement.

3.5 Registry Compliance & Employment Clearances

Prior to the first hour of employment or service delivery, and on a strict, bi-annual or annual recurrence cycle, all service facilitators must complete the following background checks:

• Daily Misconduct Registry Sweeps: The Organization’s planned AI compliance system will run automated nightly sweeps of the following state databases:

1. HHSC Employee Misconduct Registry (EMR)

2. Texas Nurse Aide Registry (NAR)

3. Texas DPS Criminal History Records (Fact Clearinghouse)

• Absolute Employment Prohibitions: Under Texas law, the Organization is strictly prohibited from employing, contracting with, or retaining any individual who:
  • Has an active, confirmed finding of ANE on the EMR.
  • Is listed as “revoked” or “suspended” on the NAR.
  • Has been convicted of a disqualifying criminal offense listed in Texas Health and Safety Code §250.006 (including assault, sexual offense, theft, or exploitation of a child or elderly/disabled individual).
• Documentation Retention: All registry search results, background clearances, and TULIP portal confirmations will be permanently stored within the employee’s secure digital HR file for a minimum of five (5) years post-termination.

Authorized by:
Henry A. Thomas, PE
Principal Owner & Director, Advisory Engineering & Analytics, LLC. dba Taylor’s Gift ISS