11100, Overview of Heightened Monitoring

October 2021

Heightened Monitoring (HM) is an increase in oversight and tracking of residential child care operations that:

  • have a current contract with the Texas Department of Family and Protective Services (DFPS) or a Single Source Continuum Contractor (SSCC) to provide care to children in DFPS conservatorship; and
  • have demonstrated a pattern of contract or minimum standard violations during at least three of the last five years compared to other operations of the same care-type and size.

HM is a multi-agency, multi-division program delivered by both HHSC and DFPS. There are three primary features to HM:

  • HM Inspections/Visits;
  • HM Plan; and
  • HM FITS Meetings.

When an operation is on HM, it is referred to as an HM episode. There are three phases of an HM episode:

  • Pre-Plan Development;
  • Plan in Effect; and
  • Post-Plan Monitoring.

Heightened Monitoring is not an enforcement action. An HM plan complements, not replaces, any enforcement actions that CCR recommends or imposes on an operation.

 

11110 Identifying and Notifying an Operation for Heightened Monitoring

October 2021

To be eligible for Heightened Monitoring (HM), the operation must:

  • be a licensed residential child care operation; and
  • have a current contract with DFPS or a Single Source Continuum Contractor (SSCC) to provide care to children in DFPS conservatorship.

Operations are placed on HM only after the DFPS Data and Systems Improvement (DSI) team completes data analysis of all residential child care operations caring for children in DFPS conservatorship and identifies that the operation has a pattern of violations that meets the criteria for HM that is outlined in the federal court order for M.D. v Abbott litigation.

Heightened Monitoring is not an enforcement action; therefore, CCR staff may not recommend that an operation be placed on Heightened Monitoring.

 

11111 Heightened Monitoring Start Date

October 2021

Heightened Monitoring starts on the date HHSC or DFPS notifies the operation that it has been placed on heightened monitoring.

 

11112 Notifying the Operation and CCR Staff of Heightened Monitoring

October 2021

Procedure

No later than the business day after the initial FITS coordination meeting, the HM development team notifies the operation and inspector assigned to the operation that the operation is on HM and documents the notification as follows:

  1. The HHSC or DFPS HM director contacts the operation’s licensed administrator or chief executive officer to notify him or her that the operation is being placed on Heightened Monitoring;
  2. After contacting the operation, the HHSC or DFPS HM director sends a written notification to the operation;
  3. The lead HM program specialist emails notification that the operation is being placed on Heightened Monitoring to the:
    1. CCR inspector assigned to the operation;
    2. CCR supervisor;
    3. CCR program administrator; and
    4. CCR regional director;
  4. The lead HM program specialist saves a copy of the written notification in the operation’s file on the DFPS HM SharePoint site; and
  5. The lead HM program specialist documents a summary of the notification in a Chronology in CLASS (type Heightened Monitoring).

 

11120 Heightened Monitoring Team Roles and Responsibilities

October 2021

Health and Human Services Commission (HHSC) and Department of Family and Protective Services (DFPS) work jointly to coordinate activities for Heightened Monitoring (HM). The HM team for each operation will consist of members from the following HHSC and DFPS divisions:

  • HHSC Child Care Regulation Heightened Monitoring (CCR);
  • DFPS Child Protective Services (CPS);
  • DFPS Residential Child Care Contracts (RCC);
  • DFPS Child Care Investigations (CCI); and
  • DFPS Data and Systems Improvement (DSI).

The table below outlines the roles that comprise each HM development team and the duties that each role completes. Each agency/division determines which staff will be assigned to fill the roles on the operation’s HM development team.

Role Duties
CCR HM Inspector
  1. Conducts weekly unannounced inspections at the operation in coordination with the DFPS HM visit team
  2. Monitors for compliance with the Heightened Monitoring (HM) Plan tasks
  3. Escalates concerns to the supervisor and the assigned RCCR inspector
CCR HM Supervisor
  1. Supervises the HM inspectors
  2. Manages assignments of HM operations to appropriate HM inspector
  3. Manages assignments of weekly unannounced visits
  4. Ensures weekly visits are completed timely and accurately
  5. Escalates concerns to the CCR HM program specialist and CCR HM director
  6. Provides support to the HM managers and director
CCR HM Program Specialist
  1. Completes data analysis for each operation placed on HM
  2. Participates in all Facility Intervention Team Staffings (FITS) meetings
  3. Tracks compliance with the HM plan tasks
  4. Reports on progress during future staffing meetings
  5. Recommends HHSC HM visit location for each operation assigned
  6. Uploads documents from CCR (Risk Analysis/QA report/CCR FITS analysis document)
  7. Communicates with CCR regarding plan compliance
CCR HM Manager
  1. Supervisors the HM program specialist staff
  2. Manages assignments of HM operations to the HM program specialist
CCR HM Director
  1. Participates in the HM FITS meetings
  2. Assists in the development of an operation’s HM plan
  3. Serves as the HHSC CCR approver for all HM plans
DFPS HM Visit Team Conducts weekly unannounced visits in coordination with the CCR HM inspector as follows:
  1. CPS HM safety specialists conduct unannounced visits at GROs and foster homes
  2. DFPS HM residential contract managers conduct weekly unannounced visits at GROs, CPAs and foster homes
DFPS Program Specialist
  1. Participates in all FITS meetings
  2. Uploads documents submitted from the operation to the operation folder on the DFPS HM SharePoint site under the HM development team link
  3. Uploads documents from their respective areas (Risk Analysis/QA report/CCR FITS analysis document)
  4. Communicates with their respective divisions regarding plan compliance
Lead HM Program Specialist
This can be an HHSC or DFPS program specialist.

 

  1. Schedules the initial coordination meeting
  2. Schedules ongoing FITS meetings
  3. Schedules plan development meeting
  4. Schedules the quarterly evaluation meeting
  5. Facilitates meetings
  6. Takes notes and/or identifies someone to take the notes
  7. Uploads meeting minutes to the operation’s folder on the DFPS HM SharePoint site under HM Development Teams link
  8. Uploads documents submitted from the operation to the operation folder on the DFPS HM SharePoint site under the HM development team link
  9. Drafts the HM plan and HM quarterly evaluation
  10. Serves as primary point of contact for the operation while it is on HM

Lead HM Director
This can be an HHSC or DFPS director.

  1. Notifies the operation that it is on HM
  2. Is the primary point of contact for providers to contact with questions and concerns
  3. Participates in ongoing FITS meetings for operations when the director’s division is the lead division
  4. Reviews and approves quarterly reviews
  5. Participates in quarterly reviews with operations, as necessary

11121 HM Inspector Responsibilities After Being Assigned an Operation

October 2021

Procedure

Upon assignment, the assigned HM inspector reviews and becomes familiar with:

  1. the conditions, restrictions, services and capacity on the operation’s license;
  2. the operation’s treatment model;
  3. the operation’s license;
  4. the operation’s treatment modalities; and
  5. the characteristics of children accepted by the operation.

This information may be obtained by reviewing one or more of the following:

  1. CLASS;
  2. IMPACT;
  3. Youth for Tomorrow’s website (www.yft.org); and
  4. Operation’s website, if applicable.

The assigned HM Inspector may also contact the operation and speak with the provider.

 

11121.1 Steps When the HM Inspector Identifies Health or Safety Concerns

October 2021

If the HM inspector identifies a health or safety concern when assessing the operation’s compliance history or when conducting a Heightened Monitoring inspection, the HM inspector:

  • discusses these concerns with the operation; and
  • consults with his or her supervisor for further guidance.

 

11130 Lead Heightened Monitoring Division Assignment

October 2021

Procedure

When an operation is placed on Heightened Monitoring (HM), the HM directors select a lead division. The lead HM director, lead HM manager, and lead HM program specialist are staff from the lead HM division.

 

11131 Lead Heightened Monitoring Division Responsibilities

October 2021

The lead Heightened Monitoring (HM) division is responsible for:

  • coordinating and documenting subsequent Facility Intervention Team Staffings (FITS) meetings;
  • gathering all required documents and filing them in the appropriate locations; and
  • documenting the Heightened Monitoring plan and any subsequent updates/evaluations to the plan.

The lead HM division and lead HM program specialist will be identified prior to the initial FITS coordination meeting.

11200, Heightened Monitoring and Facility Intervention Team Staffings

October 2021

Facility Intervention Team Staffings (FITS) are multidisciplinary meetings between CCR and DFPS to discuss licensed operations that serve children and youth in DFPS conservatorship.

The following are the FITS meeting subtypes for operations on HM:

  1. Initial FITS Coordination Meeting;
  2. HM Plan Development Meeting;
  3. HM Plan Approval Meeting;
  4. Ongoing FITS Meetings;
  5. Quarterly Plan Evaluation Meetings;
  6. Annual HM Plan Evaluation Meeting; and
  7. Final HM Review Meeting.

 

11210 Initial FITS Coordination Meeting

October 2021

Procedure

Within five days of identifying an operation for Heightened Monitoring (HM), the lead HM program specialist schedules an initial FITS coordination meeting with the HM directors and applicable HM staff made up of staff from, at least, CCR, DFPS CCI, DFPS Contracts, and CPS to discuss the operation. During the initial FITS coordination meeting, the attendees:

  • review for the most recent five-year period all:
    • trends identified as a result of the retrospective analysis conducted by Data and Systems Improvement (DSI);
    • monitoring plans or corrective actions imposed by DFPS;
    • enforcement actions imposed by HHSC; and
    • risk analyses conducted by HHSC or DFPS.
  • assign the members of the HM development team; and
  • establish due dates for HM plan materials.

No later than the business day after the initial FITS coordination meeting, CCR HM staff notify, develop, send and document the notification that the operation is on HM according to 11112 Notifying the Operation and CCR Staff of Heightened Monitoring.

 

11211 Tasks of Initial FITS Coordination Meeting

October 2021

Procedure

Tasks associated with the initial FITS coordination meeting are as follows:

  1. Review of requirements for operation analysis;
  2. Establish HM plan due date;
  3. Begin weekly unannounced visits/inspections; and
  4. Send notifications to agency/commission staff as follows:
    1. CCR state office staff notify CCR inspectors and supervisors of HM status;
    2. DFPS CPS state office staff notify caseworkers, placement staff, regional leadership and the SSCC, if applicable, of HM status and placement approval requirements;
    3. DFPS HM CCI state office staff notify the CCI director and program administrators; and
    4. DFPS HM Contracts notifies the director for DFPS RCC.

 

11212 Heightened Monitoring Safety Plan

October 2021

Procedure

If the HM team identifies events that implicate an ongoing concern for the health and safety of children, the HM development team will develop a safety plan and DFPS will temporarily suspend placements until all concerns for children’s health and safety have been addressed.

The lead HM program specialist documents the safety plan by:

  • documenting the safety plan in a HM Plan Update that is provided to the operation; and
  • entering a Chronology in CLASS (type Heightened Monitoring).

 

11230 Quarterly Heightened Monitoring Plan Review Meetings

October 2021

Each quarter, the HM development team holds Quarterly HM Plan Review meetings to evaluate each operation on Heightened Monitoring. During each meeting, the HM team:

  • Reviews overall compliance with the HM plan tasks;
  • Assesses compliance data, including any new deficiencies; and
  • Evaluates if tasks have been completed, need to be modified or if additional tasks need to be added.

After the meeting, the lead HM director or manager meets with the operation as outlined in 11232 Presenting the HM Quarterly Review Report with the Operation.

By the end of the next business day, each program specialist assigned to the operation enters its program’s information from the quarterly meeting into the Quarterly HM Plan review FITS meeting in the operation’s HM episode in CLASS.  

 

11231 HM Plan Quarterly Review Report

October 2021

Procedure

Prior to the Quarterly HM Plan Review meeting, the HM development team drafts an HM Plan Quarterly Review report.

The HM development team presents for review and approval the draft HM Plan Quarterly Review report to the HM directors at the Quarterly HM Plan Evaluation meeting.

During the meeting, the HM directors and HM development team review and discuss the compliance status report and any modifications that need to be made to the plan.

Within seven days of the quarterly HM plan meeting:

  • the HM directors approve the HM quarterly review report; and
  • the lead HM program specialist finalizes the HM Quarterly Review report.

 

11232 Presenting the HM Quarterly Review Report with the Operation

October 2021

After the HM directors approve the HM Plan Quarterly Review report, the lead HM director or manager meets with the operation within seven days after approval to:

  • Review the operation’s status on HM; and
  • Present the HM Plan Quarterly Review report.

The lead HM program specialist files a copy of the report on the DFPS HM SharePoint site.

 

11240 Annual Heightened Monitoring Plan Review

October 2021

Procedure

After an operation has been on Heightened Monitoring for at least one year, the HM development team holds a review meeting to:

  • Assess the operation’s overall progress; and
  • Determine if the operation has met the criteria to move to HM Post Plan-Monitoring.

The criteria for moving from an HM Plan in Effect to HM Post-Plan Monitoring is successful completion the requirements of their HM plan.

 

11250 Final Heightened Monitoring Review Meeting

October 2021

Procedure

During the final HM review meeting, the HM development team completes a comprehensive review of the operation’s performance while on HM and during Post Plan Monitoring to determine if the operation:

  • has reduced risk to children; and

11300, Heightened Monitoring Plan

October 2021

Every operation on Heightened Monitoring (HM) receives an HM plan that is customized to address the individual operation’s patterns and trends identified through the HM plan development meetings and pre-plan inspections.

All HM plans contain:

  1. The operation’s HM start date and anticipated end date;
  2. A listing of the trends and patterns identified through a five-year retrospective analysis of the operations’ CCR licensing and residential contract history with a summary of those areas;
  3. Technical assistance that HHSC, DFPS or a third party will offer to the operation;
  4. Plan tasks and due dates; and
  5. A listing of the HM team members.

The HM development team has four weeks from the Initial FITS coordination meeting to develop and approve the HM plan.  

The approved HM plan is located in the DFPS HM SharePoint site in the operation’s folder.

The HM phase from the date the operation is placed on HM until the date the HM plan is presented to the operation is called the Pre-Plan Development Phase.

 

11310 Point of Contact for Initiating the Heightened Monitoring Plan Meetings

October 2021

The lead HM program specialist initiates the plan development meetings.

 

11320 Heightened Monitoring Development Plan Meeting Preparation

October 2021

After the HM development team is established, the team members complete their respective assigned activities to gather the information necessary to assess the operation’s performance history and identify areas of improvement.

Procedure

In preparation for the HM Development Plan meetings, the HM development team conducts an in-depth review by compiling and analyzing information obtained by:

  1. Reviewing data to identify trends and patterns in the operation’s history;
  2. Reviewing interviews with operation staff and/or children completed during HM inspections/visits;
  3. Contacting the operation’s leadership for their input on areas of improvement or activities that are already in place to address issues identified as part of HM; and
  4. Reviewing current or prior CCR enforcement action documentation, CCR risk analysis documentation or RCC corrective action plan documentation.

The date the operation is placed on Heightened Monitoring is the start date for the HM Pre-Plan Development Phase of the HM episode.

 

11330 Five-Year Review and Assessment of an Operation

October 2021

Procedure

At the HM Plan Development meetings, the team reviews and assesses an operation’s last five years for the following:

  1. Any trends and patterns identified as a result of the analysis conducted by the DSI;
  2. Any trends and patterns identified as a result of the five-year retrospective analysis conducted by the CCR HM program specialist;
  3. The operation’s contract performance both with DFPS and the Single Source Continuum Contractors (SSCC), if applicable;
  4. Any monitoring plans or corrective actions imposed by DFPS Residential Contracts or SSCC contracts;
  5. Any enforcement actions imposed by HHSC; and
  6. Any risk analyses conducted by HHSC or DFPS.

 

11340 Developing the Heightened Monitoring Plan

October 2021

The HM Plan is developed by the HM team and approved by all HM directors. The HM plan must be approved and finalized four weeks after the operation is notified of its placement on Heightened Monitoring.

Procedure

Using the information obtained from the in-depth review and the information reviewed and assessed at the HM Plan Development meetings, the HM team develops a plan that describes:

  1. The pattern of CCR deficiencies and RCC contract violations that led to heightened monitoring;
  2. Any barriers to compliance identified during a review of previous CCR enforcement actions, CCR risk analyses, DFPS RCC corrective action plans or DFPS risk analyses;
  3. Any technical assistance the operation needs from CCR or DFPS (including additional information and guidance for improving program operations that the operation needs to obtain from a third party);
  4. Any ongoing concerns for the health and safety of children; and
  5. The specific steps the operation must take to satisfy the plan.

The due dates for the tasks in the HM plan are staggered to allow time for the operation to implement the required changes.

 

11350 Heightened Monitoring Plan Approval

October 2021

After the HM plan is developed, the HM development team schedules a meeting to present the plan to the HM directors for review and approval.

 

11360 Heightened Monitoring Plan Implementation Plan Meeting

October 2021

Procedure

After the HM directors approve the HM plan, the CCR HM program specialist is responsible for:

  • developing an inspection schedule throughout the period of the HM plan;
  • identifying the location for inspections (for CPAs); and
  • describing the intent behind each task in the HM plan.

The CCR HM program specialist presents the HM plan to the HM inspector and HM supervisor during an implementation plan meeting.

The internal HM implementation plan will include a review of:

  1. The operation’s trends and patterns;
  2. The plan tasks;
  3. What tasks the HM inspectors will review during the HM inspections; and
  4. What deliverables the HM program specialists will review.

The CCR HM program specialist will provide the recommended inspection schedule to the assigned CCR HM supervisor quarterly.

 

11370 Heightened Monitoring Plan Presentation Meeting with the Operation

October 2021

Procedure

Within one business day of the HM plan’s approval, the HM director or HM manager contacts the operation’s leadership and schedules a meeting with the operation’s:

  • licensed administrator;
  • executive director, if applicable;
  • CEO; or
  • any of the above.

During the meeting, HM staff provides a copy of the HM Plan to the operation and presents the five-year retrospective data analysis completed by the DFPS Division of System Improvement. If the operation requests any changes to the HM plan, those changes are discussed and agreed upon during the meeting and within one business day, the final plan is emailed to the operation.

The date the plan is provided to the operation is the start date for the HM Plan in Effect phase of the HM episode.

 

11371 Documenting the Heightened Monitoring Plan Presentation Meeting

October 2021

Procedure

No later than the next business day after the plan presentation meeting, the lead HM program specialist documents the following in a Chronology in CLASS (type Heightened Monitoring):

  • HM presentation meeting date;
  • HM plan start date; and
  • HM plan tasks.

 

11380 Heightened Monitoring Plan Revisions

October 2021

Procedure

When the HM plan is revised to reflect changes in the operation’s performance or to adjust a plan task, all HM directors must approve the changes, and the HM lead director and/or HM lead manager meets with the operation to present the changes.

The lead HM program specialist documents a summary of the HM plan revisions in a Chronology in CLASS (type Heightened Monitoring).

 

11381 Revisions When an Operation Requests an Extension on a Plan Task

October 2021

Procedure

If an operation requests an extension on a plan task due date, the lead HM program specialist consults with the HM development team. If the team agrees to extending the due date, the lead HM program specialist modifies the task due date and documents the modified due date in:

  • a Chronology in CLASS (type Heightened Monitoring); and
  • written correspondence to the operation.

Updating a due date is not considered a plan update and does not require HM director approval.

11400, Heightened Monitoring Inspections and Visits

October 2021

Weekly Heightened Monitoring (HM) inspections and visits begin the week the operation is notified that it is on HM.

For child-placing agencies (CPAs) on heightened monitoring, inspections/visits are conducted at the CPA’s main location, branch location and foster homes verified by the CPA.

The location of each weekly HM inspection will alternate between CPA offices and foster homes, with a maximum of one foster home inspection per month (unless an exception is granted by the CCR HM director).

 

11410 How CCR and DFPS Split Heightened Monitoring Inspection/Visit Workload

October 2021

CCR and DFPS share responsibility for conducting weekly unannounced inspections/visits to each operation on Heightened Monitoring (CCR conducts inspections and DFPS conducts visits).  

CCR and DFPS Residential Contracts rotate inspections/visits every other week.  This rotation continues throughout the operation’s time on HM.

Each HM division determines which methods are appropriate to use during each unannounced, weekly visit to properly assess and evaluate the divisions’ assigned tasks.

 

11420 Types of Heightened Monitoring Inspections/Visits

October 2021

There are three categories of Heightened Monitoring (HM) inspections conducted during HM episodes:

  • Pre-Plan HM Inspections – inspections completed during the four-week period between HM notification and HM plan finalization
  • Recurring HM Inspections – weekly inspections completed after HM plan approval that are focused on HM plan tasks and the areas that led to HM
  • Post-Plan HM Inspections – inspections completed during the first three months release from the HM plan

 

11421 Pre-Plan Heightened Monitoring Inspections

October 2021

There is approximately a four-week period between HM notification and HM plan finalization. During this time, referred to as the Pre-Plan Development Phase of the HM episode, HM inspectors complete one to two inspections at the operation. These are referred to as pre-plan inspections.

The purpose of the pre-plan inspections is to:

  • introduce the operation to HM;
  • support the HM team’s development of the HM plan; and
  • identify areas in need of improvement.

CCR HM staff consider the following questions when conducting the pre-plan inspections:

  1. What is working well?
  2. What is not working well?
  3. What changes would the operation like to see and what ideas have they considered for making those changes?

Procedure

Preparing for the Pre-Plan Inspection

CCR HM staff prepare for a pre-plan inspection as outlined in 11440 Preparing for Heightened Monitoring Inspections.

Conducting the Pre-Plan Inspection

When conducting a pre-plan inspection, CCR HM staff meet with the licensed administrator or person in charge to introduce the operation to HM. The discussion includes:

  • overview of HM and what to expect (only completed during the first pre-plan inspection);
  • review of trends, patterns or areas of concern; and
  • discussion of the operation’s plan to address the trends, patterns or concerns.

In addition, during each pre-plan inspection, the HM inspector will:

  • conduct interviews with direct delivery staff;
  • engage the operation’s leadership in plan development; and
  • conduct walk-throughs of the operation to assess physical plant/environment.

If there are notable changes in compliance, the HM inspector discusses with the licensed administrator or person in charge:

  • strategies the operation has implemented since being placed on HM;
  • what changes the operation has made since being placed on HM and when those changes were made; and
  • if the operation is considering implementing any other changes and, if so, what changes and when.

Documenting the Pre-Plan Inspection

The HM inspector documents the results of the inspection as outlined in 11470 Documenting the Results of All Heightened Monitoring Inspections.

See:
4150  Conducting Inspections
4151  Operation Walk-Throughs

 

11422 Recurring Heightened Monitoring Inspections

October 2021

Once the HM plan is finalized and presented to the operation, recurring HM inspections begin. These weekly unannounced inspections focus on the HM plan tasks and the areas that led to HM.

See:
11450  Conducting Recurring Heightened Monitoring Inspections
11460  Citing Deficiencies During All Heightened Monitoring Inspections
11470  Documenting the Results of All Heightened Monitoring Inspections

 

11430 Selecting and Scheduling Heightened Monitoring Inspections at Foster Homes

October 2021

The HM inspector conducts unannounced inspections at foster homes that have active DFPS placements.

Procedure

Selecting Foster Homes for HM Inspections

The HM Agency Home report is generated monthly on the 1st of the month and located on the DFPS HM SharePoint site. The HM inspector uses the report to prioritize visits to homes verified by an operation on HM based on the following information for each home for the past two years:

  1. number of total investigations;
  2. number of RTBs;
  3. deficiencies for standards weighted Medium, Medium-High, and High (excluding overturned); and
  4. identifying if the home has not been inspected.

Prior to conducting an inspection at an agency home, the CCR HM supervisor reviews the HM Agency Home report, CLASS and IMPACT to select an agency home for inspection. The CCR HM supervisor selects the home based on priority and that meets the following criteria:

  • CCR has not conducted a random-sampling inspection or HM inspection at that agency home in the current quarter;
  • DFPS has not conducted an HM inspection at that agency home in the current quarter; and
  • Children in DFPS conservatorship are placed at that agency home.

There may be some circumstances when CCR needs to inspect a foster home on the list with a lower priority before inspecting a foster home with a higher priority. In these circumstances, the HM supervisor requests an exception through the CCR HM director or designee.

Conducting HM Inspections at Foster Homes

The HM inspector conducts the unannounced inspection at a time when the children in DFPS conservatorship are expected to be at the residence.

 

11440 Preparing for Heightened Monitoring Inspections

October 2021

After an HM inspector is assigned to the operation and prior to inspecting the operation, the HM inspector:

  • reviews the operation’s record in CLASS;
  • reviews the HM plan, if applicable; and
  • may contact the assigned HM program specialist prior to the inspection and ask if there are any specific areas that should be explored during the inspection.

See:
11441  Reviewing an Operation’s Record in CLASS When Preparing for Heightened Monitoring Inspections
11442  Reviewing the HM Plan When Preparing for Heightened Monitoring Inspections

 

11441 Reviewing an Operation’s Record in CLASS When Preparing for Heightened Monitoring Inspections

October 2021

Procedure

When preparing for a Heightened Monitoring inspection, the HM inspector reviews the following in CLASS:

  1. the operation’s compliance history that the HM inspector has not previously reviewed;
  2. all Chronologies with the type of Heightened Monitoring since the date the operation was placed on HM that the HM inspector has not previously reviewed;
  3. current waivers or variances, if applicable;
  4. HM safety plans, if applicable;
  5. CCR and CCI safety plans, if applicable;
  6. the operation's background check records, as documented in CLASS;
  7. new investigations since the last HM inspection, if applicable;
  8. results of following-up on deficiencies that the HM inspector has not previously reviewed;
  9. results of monitoring inspections that the HM inspector has not previously reviewed; and
  10. notes and documentation from all unannounced HM inspections and visits the HM inspector has not previously reviewed.

 

11442 Reviewing the HM Plan When Preparing for Heightened Monitoring Inspections

October 2021

Procedure

Prior to the weekly inspection, the HM inspector reviews each HM plan task to determine if it needs to be evaluated during the next inspection. The table below outlines when tasks are evaluated:

Type of Task Evaluation Frequency
Reoccurring task Weekly or monthly
Point in time task Quarterly

If there is a task that requires the operation to maintain a log, the HM inspector reviews the log and documents what information was present and any feedback the HM inspector has.

If a task requires approval by the HM team, the HM inspector reviews CLASS for a task approval date. If an approval date is not listed in CLASS, the HM inspector contacts the CCR HM program specialist for an update. If a task is not approved by the date of the HM inspection, the HM Inspector does not evaluate that task for compliance.

 

11443 Additional Requirements for Preparing for Heightened Monitoring Inspections at Foster Homes

October 2021

Procedure

When preparing for a HM inspection at a foster home, the HM inspector:

  • Reviews the current home screening for the foster home; and
  • Reviews the full compliance history of the home in CLASS (this includes history associated with all CPAs that have verified the home).

To obtain a copy of the home screening, the HM inspector first:

  • Searches the CCR Digital Storage SharePoint site for a copy of the home screening;
  • asks the monitoring inspector assigned to the operation if he or she has a copy; or
  • both.

If CCR does not have a copy of the home screening, the HM inspector requests a copy of the home screening from the operation after the inspection, when CLASS Form 2936 Child-Care Facility Inspection is sent to the operation.

 

11443.1 Creating a Draft CLASS Form 2936 for Heightened Monitoring Inspections at Foster Homes

October 2021

To draft CLASS Form 2936 Child-Care Facility Inspection for a Heightened Monitoring inspection at a foster home, the HM inspector follows the procedures in 4161.1 Creating a Draft CLASS Form 2936, with the following modifications:

  1. Selects the inspection type of “Other”;
  2. Does not select any subchapters in the Standards Evaluated section; and
  3. Adds the following text to the Narrative box: “Heightened Monitoring Inspection conducted at the operation.”

 

11450 Conducting Recurring Heightened Monitoring Inspections

October 2021

 

11451 Conducting Recurring Heightened Monitoring Inspections at General Residential Operations

October 2021

Procedure

During each recurring HM inspection at a General Residential Operation (GRO), the HM inspector:

  1. Reviews targeted staff and child files to inspect for compliance with the minimum standards listed on the HM plan.
  2. Monitors the operation for compliance with the HM plan.
  3. Evaluates the operation for compliance with background check rules.
  4. Reviews compliance with the HM safety plan, if applicable, and collects documentation to support compliance with the HM safety plan.
  5. Reviews Serious Incident Reports as outlined in 11454 Determining the Type and Number of Records to Review at a Heightened Monitoring Inspection of a GRO or CPA Office.
  6. Conducts a walk-through.
  7. Interviews a minimum of one staff member and asks the following questions:
    1. Is the person aware the operation is on HM?
    2. Is the person aware of the HM plan and plan tasks?
    3. What changes has he or she noticed since HM started?
  8. Interviews children, if necessary.
  9. Follows up on any previous HM deficiencies, if applicable.
  10. Follows up on any previous action items, if applicable.
  11. Discusses the progress of the HM plan with the operation’s licensed administrator or person in charge.
  12. Asks the licensed administrator or designee if they need clarification or guidance for any upcoming HM plan tasks.
  13. Documents the inspection.
  14. Conducts an exit interview.

The HM inspector notifies the HM supervisor or HM manager if concerns are observed.

If the operation is on a CCR enforcement action, the CCR monitoring inspector (not the HM inspector) monitors the operation for compliance with any POA action items or CA conditions.

See:
4140  Preparing for Inspections
4151  Operation Walk-Throughs
4160  Documenting the Results of an Inspection
4170  Conducting the Exit Conference
10700  Monitoring Operations for Compliance with Background Check Requirements
11454  Determining the Type and Number of Records to Review at a Heightened Monitoring Inspection of a GRO or CPA Office

 

11452 Conducting Recurring Heightened Monitoring Inspections at Child-Placing Agency Offices

October 2021

Procedure

During each recurring HM inspection at a CPA office, the HM inspector:

  1. Reviews targeted staff, child and home files to inspect for compliance with the minimum standards listed on the HM plan.
  2. Monitors the operation for compliance with the HM plan.
  3. Evaluates the operation for compliance with background check rules.
  4. Reviews compliance with the HM safety plan, if applicable, and collects documentation to support compliance with the HM safety plan.
  5. Reviews Serious Incident Reports, as outlined in 11454 Determining the Type and Number of Records to Review at a Heightened Monitoring Inspection of a GRO or CPA Office.
  6. Interviews a minimum of one staff member and asks the following questions:
    1. Is the staff member aware the operation is on HM?
    2. Is the staff member aware of the HM plan and plan tasks?
    3. What changes has the staff member noticed since HM started?
  7. Follows up on any previous HM deficiencies, if applicable.
  8. Follows up on any previous action items, if applicable.
  9. Discusses the progress of the HM plan with the operation’s licensed administrator or person in charge.
  10. Asks the licensed administrator or designee if they need clarification or guidance for any upcoming HM plan tasks.
  11. Documents the inspection.
  12. Conducts an exit interview.

The HM inspector notifies the HM supervisor or HM manager if concerns are observed.

If the operation is on a CCR enforcement action, the CCR monitoring inspector (not the HM inspector) monitors the operation for compliance with any plan of action (POA) items or corrective action (CA) conditions.

See:
4140  Preparing for Inspections
4151  Operation Walk-Throughs
4160  Documenting the Results of an Inspection
4170  Conducting the Exit Conference
10700  Monitoring Operations for Compliance with Background Check Requirements
11454  Determining the Type and Number of Records to Review at a Heightened Monitoring Inspection of a GRO or CPA Office

 

11453 Conducting Recurring Heightened Monitoring Inspections at Foster Homes

October 2021

Procedure

Before conducting a recurring HM inspection at a foster home, the HM inspector prepares for the inspection following procedures in 11443 Additional Requirements for Preparing for HM Inspections at Foster Homes.

During the HM inspection at a foster home, the HM inspector:

  1. Presents, on arrival, a valid HHSC identification card to the person in charge and explain the purpose of the HM inspection;
  2. Completes the HM inspection using the HM Agency Home Inspection Guide located on the DFPS HM SharePoint site;
  3. Reviews the service plans for children on file at the home;
  4. Evaluates the operation for compliance with background check rules;
  5. Interviews at least one foster parent/caregiver;
  6. Interviews all children in foster care who are present during the inspection who are able and willing to talk;
  7. Observes all non-verbal children in foster care who are present during the inspection;
  8. Completes a walk-through of the home;
  9. Points out immediate safety and health hazards to the foster parent or adult who is in charge during the inspection;
  10. Documents the inspection on CLASS Form 2936 Child-Care Facility Inspection; and
  11. Conducts an exit interview with the foster parent and has the foster parent sign CLASS Form 2936 Child-Care Facility Inspection.

The HM inspector notifies the HM supervisor or HM manager if concerns are observed.

CCR HM staff do not interview a foster parent's biological or adopted children during an HM inspection.

See:
4151  Operation Walk-Throughs
4160  Documenting the Results of an Inspection
4170  Conducting the Exit Conference
10700  Monitoring Operations for Compliance with Background Check Requirements

 

11454 Determining the Type and Number of Records to Review at a Recurring Heightened Monitoring Inspection of a GRO or CPA Office

October 2021

Procedure

HM inspectors review child, employee and foster home records only when there is a task on the HM plan that addresses improvement for the applicable type of record.  For example, if the HM plan has a task for improvement of service plan records but does not have tasks associated with employee or foster home records, the HM inspector only reviews child service plan records during HM inspections.

HM inspectors also review serious incident report records at each inspection.

When reviewing records during a routine HM inspection, HM inspectors do not select records that were previously evaluated.  

HM inspectors may review records previously selected for the purposes of following-up on a deficiency as outlined in 4300 Conducting a Follow-Up with an Operation.

Number of Child, Employee and Foster Home Records to Review

The number of child, employee and foster home records the HM inspector reviews is based upon:

  • the operation’s capacity, if the operation is a general residential operation; or
  • the total number of verified foster homes and approved adoptive homes, if the operation is a child-placing agency.

The type(s) of records the HM inspector reviews at each inspection may rotate throughout each month. For example, if the HM plan has tasks for improvement of child and employee records, an inspector may review child records during the first inspection of the month and then employee records at the next inspection that month.

The table below outlines the minimum number of child records and employee records the HM inspector reviews each month:

Capacity or Number of Homes Minimum Number of Each Type of Record to Review Per Month (Child and Employee Records)
20 or less

1

21-50

2

51 or more 3

The number of foster and adoptive home records the HM inspector reviews is based on the number of homes. The table below outlines the minimum number of foster and adoptive home records the HM inspector reviews each month:

Number of Homes Minimum Number of Foster and Adoptive Home Records to Review Each Month
50 or fewer 1
51 or more 2

Number of Serious Incident Reports to Review

HM inspectors review up to 10 serious incident reports at each HM inspection that is conducted at a GRO or CPA. When selecting records, the HM inspector selects for review only serious incident reports created since the last inspection.

 

11460 Citing Deficiencies During All Heightened Monitoring Inspections

October 2021

HM staff cite deficiencies for all violations of high-weighted standards observed during an HM inspection.

When HM staff observe a violation associated with an HM plan task during a Heightened Monitoring inspection conducted before the task due date, the inspector:

  • cites the operation if the violation is of a high-weighted standard; and
  • considers if technical assistance (TA) is appropriate in lieu of a deficiency if the violation is for a standard that is not weighted high.

When HM staff observe a violation associated with an HM plan task during a Heightened Monitoring inspection conducted after the task due date, the inspector cites the operation.

In addition, HM staff always provide TA if:

  • the violation is related to records;
  • a deficiency for the same standard was cited previously; and
  • the compliance date for the deficiency is in the future.

See:
4160 Documenting the Results of an Inspection
4161 Completing CLASS Form 2936 Child-Care Facility Inspection
4162 Finalizing Form 2936 and Synchronizing CLASSMate with CLASS

 

11470 Documenting the Results of All Heightened Monitoring Inspections

October 2021

The HM inspector documents the results of all HM inspections:

  • on CLASS Form 2936 Child-Care Facility Inspection;
  • in a CLASS Chronology (type Heightened Monitoring); and
  • in the DFPS HM SharePoint site.

 

11471 Documenting the Results of All Heightened Monitoring Inspections on CLASS Form 2936

October 2021

Procedure

In addition to following the policies and procedures in 4161 Completing CLASS Form 2836 Child-Care Facility Inspection to document the results of the inspection on the Inspection Details page in CLASS, the HM inspector:

  • Selects Other for the inspection type;
  • Completes the Heightened Monitoring section; and
  • Documents “HM” in the narrative box.

See:
4160 Documenting the Results of an Inspection
4161 Completing CLASS Form 2936 Child-Care Facility Inspection
4162 Finalizing Form 2936 and Synchronizing CLASSMate with CLASS

Additional Requirements for HM Inspections at Foster Homes

Within three days of conducting the HM inspection, the HM inspector contacts the licensed administrator or person in charge at the CPA that verified the home to conduct an exit interview and send the CLASS Form 2936 Child-Care Facility Inspection to the CPA.

 

11472 Documenting All Heightened Monitoring Inspections in a CLASS Chronology

October 2021

All HM inspections must have a chronology entered in the CLASS system no later than the close of the business day after the HM inspection.

Documentation related to HM tasks must be specific so the HM team can determine if the operation is on the right track or if additional communication or clarification to the operation is needed.

Procedure

Documentation of HM Inspection at GRO or CPA Office

No later than close of business the business day after the HM inspection at a GRO or CPA office, the HM inspector documents the following information in a Chronology in CLASS (type Heightened Monitoring):

  1. Staff’s name, date and purpose of visit;
  2. Each task reviewed;
  3. Status of compliance for each task (If the task was not reviewed, then an entry explaining why the task was not reviewed must be included in the chronology.);
  4. Type and name of each file reviewed;
  5. Documentation regarding any technical assistance (TA) or deficiencies issued;
  6. Description of walk-through, including observations made;
  7. Exit interview, including the name of the person(s) who attended the exit interview; and
  8. Next steps.

Documentation of HM Inspection at Foster Home

No later than close of business the business day after the HM inspection at a foster home, the HM inspector documents in the CLASS record of the CPA office that verified the foster home the following information in a Chronology in CLASS (type Heightened Monitoring):

  • A summary of the HM inspection, including an overview of any discussion that occurred with the operation;
  • Observations made during the HM inspection; and
  • A detailed description of any HM tasks assessed and information gathered during the HM inspection.

 

11473 Documenting the Results of All Heightened Monitoring Inspections in SharePoint

October 2021

Procedure

In addition to documenting the results of the HM inspection in CLASS, staff document the following to the DFPS HM SharePoint site:

  • Update the Weekly Visit Tracker; and
  • Upload photos and other documentation from the weekly visit into the Operation’s Development Team Folder.

 

11480 Following Up to HM Inspection to a Heightened Monitoring Citation

October 2021

Procedure

When possible, the HM inspector completes any needed follow-up during a routine HM inspection.

See:
4310 How and When to Conduct a Follow-Up with an Operation When There are Deficiencies
4311.11 Documenting Heightened Monitoring Follow-Up Inspections (HM Staff Only)
4312.1 Documenting Follow-Ups When an Inspection is Not Required

11500, Heightened Monitoring Post-Plan Monitoring

11510 Post-Plan Monitoring When Heightened Monitoring Has Been Successful

October 2021

An operation is released from the HM plan and progresses to HM Post-Plan Monitoring once the operation:

  • Has been on an HM plan for one year;
  • Satisfies the conditions of the HM plan;
  • Has at least six months’ successive HM inspections and visits indicating the operation is in compliance with the CCR statute, rules and/or minimum standards and DFPS contract requirements that led to Heightened Monitoring; and
  • Has corrected deficiencies on any CCR statute, rule or minimum standard that is weighted medium-high or high.

Procedure

During the first three months following release from the HM plan, HHSC and DFPS coordinate to:

  • Track any new intakes received by CCR and DFPS Child Care Investigations; and
  • Complete a minimum of three unannounced inspections/visits.

If the HM development team determines that the operation continues to show progress during the first three months of Post-Plan Monitoring, CCR and DFPS will continue to track new intakes for an additional three months while discontinuing the unannounced inspections/visits.

If no serious concerns are identified during the three-month period, a final HM review meeting is held.

11600, Steps if Risk Identified During Heightened Monitoring

October 2021

Procedure

If risk is identified at the operation at any time during HM, the HM team determines the next steps to take. Next steps could include:

  1. The HM team conducting additional inspections/visits;
  2. The HM team having further discussions with the operation;
  3. The HM team imposing a Heightened Monitoring Safety Plan;
  4. DFPS suspending placements;
  5. DFPS imposing fines;
  6. HHSC suspending or revoking the operation’s license; and
  7. DFPS terminating the DFPS RCC contact.

11700, When Heightened Monitoring Has Not Been Successful

October 2021

Procedure

If the HM development team determines that an operation has not successfully met the conditions of the HM plan, CCR HM and DFPS HM staff continue to reduce risk and improve quality of care by:

  • Continuing to complete weekly inspections/visits;
  • Continuing to assess the operation’s compliance with the HM plan; and
  • Holding regular FITS staffings to determine if alternative actions should be taken.