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Revision 22-1; Effective February 4, 2022
Effective Sept. 1, 2009, the 81st Texas Legislature, Regular Session, required HHSC to conduct annual unannounced inspections of HCS three- and four-person residences. In accordance with 40 TAC, Chapter 9, Subchapter D, §9.171(k), HHSC LTCR conducts annual unannounced visits to each residence in which Residential Support Services or Supervised Living is provided and may conduct unannounced visits to each residence in which Host Home/Companion Care services are provided. These visits are completed to verify that these residences offer environments that comply with Form 3609, Waiver Survey and Certification Residential Checklist.
14410 Residential Visit Policy and Procedures
Revision 22-1; Effective February 4, 2022
Upon arrival at the residence, LTCR staff will present their HHSC identification to the Host Home/Companion Care provider or the staff at the three-person or four-person residence and explain the reason for the visit. If the LTCR staff arrives at a residence in which no one speaks English and the LTCR staff is unable to speak the language of the people living in the residence, the LTCR staff member will secure interpreting services through HHSC to assist with interpreting for the Host Home/Companion Care provider or staff at the three- or four-person residence.
See Information Letter 2009-99 at: https://www.hhs.texas.gov/sites/default/files/documents/providers/communications/2009/letters/IL2009-99.pdf.
LTCR staff use Form 3609, Waiver Survey and Certification Residential Checklist, to conduct each residential visit. Each item on the checklist will be marked pass, fail or not applicable (N/A). Some of the checklist items require interviewing the supervised living staff, residential support staff or the Host Home/Companion Care service provider to assess knowledge of the specific needs of the individual(s) in the residence and to confirm training on areas such as abuse, neglect and exploitation (ANE), emergency plans, medications, behavior support plans and other required service provision areas.
LTCR staff may take photographs to substantiate identified concerns, when appropriate.
Provider Letter 2020-01 provides information for how the Host Home/Companion Care provider or HCS provider can give feedback about a residential visit.
If the Address in the HHSC Data System is Invalid
If LTCR staff arrive at a residence that is no longer associated with the HCS program, or cannot find the address provided for a location code in the HHSC data system, LTCR staff will fill out Form 3609 noting the incorrect address. A letter notifying the program provider of the inaccuracy in the HHSC data system will be sent to the program provider.
If No One is Home
If LTCR staff finds no one at the residence after two attempts to visit, LTCR staff contacts the program provider to find out when the residential service provider is most likely to be home. LTCR staff may call Host Home/Companion Care service providers to verify times of the week that they will be available for a residential visit.
If LTCR Staff are Not Allowed to Access the Residence
If LTCR staff are not allowed access to a three-person or a four-person residence or a Host Home/Companion Care residence, LTCR staff will notify the program provider for a resolution. It is the program provider's responsibility to ensure that regular or contracted employees cooperate with the residential visit process.
14411 Residential Visit Results
Revision 22-1; Effective February 4, 2022
Calculating the Score from a Residential Visit
A program provider receives a score as a result of a residential visit.
- A program provider’s score for a visit is calculated by deducting the following from 100 points (the total points on the Residential Review Checklist):
- the total points for items on the checklist that are marked “fail” during the visit; and
- ten points for each significant risk identified during the visit.
- The value of each item on a checklist is calculated by dividing 100 points by the number of items on the checklist that are applicable to the visit.
Example: A residential visit of a program provider is conducted, and there are 30 items on the checklist that are applicable to the visit. During the visit, three items on the checklist are marked “fail,” and two significant risks are identified.
- The value of each item on the checklist is calculated as follows:
- 100 points ÷ 30 applicable items = 3.33 points/item
- The program provider’s score is calculated as follows:
- 100 points – [(3 items marked fail x 3.33) + (2 significant risks x 10)] =
- 100 – [9.99 + 20] =
- 100 – 29.99 =
- 70.01 (Score)
No Evidence of Correction Required and No Follow-Up Action Taken
If a program provider has no items marked “fail” on the Residential Review Checklist, LTCR does not require evidence of correction (EoC) to be submitted and does not conduct follow-up activities.
No Evidence of Correction Required but Follow-Up Action Taken
If a program provider receives a score of 90 or above and there is no significant risk identified during the residential visit, LTCR does not require an EoC to be submitted. At the next residential visit, LTCR examines the items marked “fail” at the previous visit and requires an EoC for any of those items that have not been corrected. If the program provider does not submit an EoC as required, or LTCR does not approve the EoC, LTCR may conduct an intermittent survey in accordance with 40 TAC §9.171(l).
Evidence of Correction Required
If a program provider receives a score below 90 or there is an identified significant risk, LTCR requires an EoC for all items marked “significant risk” or “fail.” LTCR also requires the program provider to take action for an identified significant risk, as described below. If the program provider does not submit an EoC as required, or LTCR does not approve the EoC, LTCR may conduct an intermittent survey in accordance with 40 TAC §9.171(l)(4).
A program provider must submit an EoC to LTCR using the WSC Portal or by submitting Form 1573, Residential Review Evidence of Correction. If using Form 1573, the Residential Review ID must be listed on the form with accompanying evidence. The time frame to submit the EoC is included in the documentation received by the program provider. LTCR will not accept an EoC without the correct Residential Review ID.
Significant Risk Identified
A significant risk is an act or failure to act by the program provider that could have a major adverse effect on the health, safety or welfare of one or more individuals, including emotional or physical harm, or death. If LTCR determines that an item marked “fail” on the Residential Review Checklist results in a significant risk, LTCR requires the program provider to take action.
- If LTCR concludes that the significant risk requires immediate corrective or mitigating action, such as locking up hazardous chemicals or securing a copy of the residence’s emergency plan, LTCR staff will not leave the residence until the program provider has taken immediate action and the significant risk is removed.
- LTCR will also contact the persons identified in the HHSC data system as the “program provider contract contacts” (the HCS provider or a representative of the HCS provider) and informs such persons of the date, as determined by LTCR, by which the program provider must submit evidence of correction showing that action has been taken and the significant risk removed.