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